David Thomas: Why Torbay cannot afford to lose its integrated care model

Last Wednesday, I attended a special meeting of Torbay’s Health Overview and Scrutiny Board, convened specifically to question Torbay and South Devon NHS Foundation Trust about the future of adult social care and health arrangements in Torbay.

What makes this moment so important is that Torbay has something genuinely special: an integrated care organisation that has been in place for around 20 years. Long before ‘integration’ became fashionable in Whitehall, health, social care and the voluntary sector in Torbay were already working as one. For residents, that integration is almost invisible: they don’t need to know whether help comes from the voluntary sector, the NHS or the council, because one trained person can step in and deal with what would usually be passed between several different organisations.

Only a few months ago, the Care Quality Commission inspected our local system and rated it as ‘GOOD’. Yet now, barely months later, the Trust is considering ending this deeply integrated model. That would be a profoundly sad day for Torbay, and a baffling one, given that integrated health and social care is repeatedly described by government as the future for the whole country.

At the meeting, the Trust told councillors it is seeking savings of between £20 and £25 million. More concerning was the assertion that these changes would not represent a ‘substantial change’ to residents’ experience. Those words matter, because ‘substantial change’ is the exact test set out in legislation. If changes are deemed to be substantial, a full public consultation is required.

The Trust does not believe consultation is necessary. Yet after 20 years as an elected councillor, I simply cannot understand that logic. These proposals could fundamentally alter how health and social care work together and certainly the experience our residents could receive when accessing health services, yet residents are being told they will be no formal voice in any change.

Time is also against us. We were informed that the Trust intends to make a final decision on 5th March. With no consultation planned and the clock ticking, the Overview and Scrutiny Board took the rare but important step of formally referring the matter to the Secretary of State for Health and Social Care – Wes Streeting MP.

So now we wait, either for the Trust’s decision on 5th March, or for national intervention. What I want residents to know is, conversations between myself, the Trust and the Devon Integrated Care Board are continuing. We must find a way forward that protects what works. Torbay’s integrated care system is not a problem to be fixed; it is a success to be safeguarded.

These events are not happening in isolation. They form part of a much wider question about who makes decisions for Torbay, and whose voices are truly being heard. At the same time as we are challenging proposals that could weaken our successful integrated health and care system, Torbay is also in the middle of a national process of Local Government Reorganisation. In both cases, the same concern arises: that changes driven from outside the Bay risk overriding local evidence, local experience and local success, without residents being properly consulted.

The Local Government Reorganisation (LGR) process has been under way for some time, beginning on 16th December ‘24 when the Government published its White Paper setting out the case for reform. Since then, councils across Devon have been working through what this could mean locally, including extensive engagement with residents and partners.

Here in Torbay, the Council has carried out its own consultation and engagement to inform the proposal we submitted. More than 1,430 residents took part in our survey, and the feedback was clear: 64% of respondents supported Torbay Council continuing as a unitary authority on its existing boundaries. That local evidence formed an important part of the submission made to Government earlier this year.

The Government has now launched the next national phase of the LGR consultation. This is no longer a council-led process; it is a formal Government consultation on the proposals submitted by councils across Devon. There are five different proposals being consulted on. Some of these proposals align with each other in key areas, while others present different options. 

A dedicated webpage has been set up by Government to bring all the proposals together in one place, and residents can also access the proposals and the consultation survey in libraries across Torbay. This ensures that everyone can read the detail and have their say.

No decisions have yet been made, and none will be made locally. The final decision rests entirely with national government. We have been told to expect a decision around July this year, with ministers having committed to providing clarity before the summer recess. Subject to what is decided, elections to any shadow authorities could take place in May 2027, with new unitary councils potentially going live in April 2028.

Until next week.