About the Cornwall and Isles of Scilly ICB
NHS Cornwall and Isles of Scilly Integrated Care Board plans and funds most NHS services for its local population, including planned care, urgent care, primary care, community care, maternity, mental health and children and young people’s services. It unites system partners (NHS organisations, local government, voluntary, community and social enterprise sector (VCSE) and others) to develop and deliver our integrated care strategy.
The ICB and its partners prioritise out of hospital care, with investment directed to the development of integrated neighbourhood teams. Other key priorities for 2025/26 include the development of community-based alternatives to admission for our frail elderly, 24/7 end of life community services, strengthened discharge to assess arrangements, improving our urgent and emergency care response, and enhancing mental health services and neurodiversity support for adults and children.
Our budget for 2025/26 is £1.5 billion. We have achieved a balanced budget for three consecutive years, resulting in historic debt of £114 million being written off by NHS England (NHSE)
About Cornwall and the Isles of Scilly
Cornwall Council is England’s largest unitary authority, with a population of 578,324, whilst the Council of the Isles of Scilly is the smallest with a population of 2,229 (2023 MYE, ONS). For the purposes of ICB configuration and related resources, NHSE is are using our weighted population of 676, 091. Weighted populations are a population count that has been adjusted to reflect varying healthcare needs, and unavoidable geographical differences in the cost of providing services.
Cornwall covers an area of 3.559 sq. km, and has the longest coastline of all English counties (697 km). It is an area of many contrasts, including remote rural, coastal and environmentally sensitive areas, interspersed with villages and market towns, where affluence sits alongside some of England’s most disadvantaged areas. Approximately 32% of residents live in settlements with fewer than 3,000 people. Population density is one of the lowest in England at 1.6 people per hectare – presenting unique service delivery challenges compared to more densely populated regions.
Our Integrated Care System
The Royal Cornwall Hospitals NHS Trust provides most acute care. University Hospitals Plymouth NHS Trust serves 20% of patients for their acute care and delivers most tertiary care for our population. Some patients also use Royal Devon University Healthcare NHS Foundation Trust services.
Cornwall Partnership NHS Foundation Trust provides mental health, community services, community hospitals, and minor injury units. South Western Ambulance Services NHS Foundation Trust delivers ambulance services.
Primary care consists of 55 general practices, nearly 100 community pharmacies, 65 dental practices, and 47 ophthalmic providers. Kernow Health community interest company provides NHS 111, out of hours, school immunisations and some primary care services.
To address inequalities and deliver social value, we have invested significantly in care delivered through a wealth of voluntary and community sector organisations, including nationally recognised community health and wellbeing workers, community hubs and reablement at home services.
Population
Cornwall and the Isles of Scilly face a growing aging population, with projections showing 56% more people aged 75 to 85 and 87% more people aged 85+ between 2019 and 2038. While longer life expectancy is positive, time spent living with long-term illness or disability is increasing, meaning pressures on the care system will only increase.
Natural population change is negative (more deaths than births), contrary to England’s overall continuing trend of positive natural change (more births than deaths). However, migration into Cornwall continues to drive population growth. In addition, an additional 1,714 dwellings per annum are required by government per annum across Cornwall and the Isles of Scilly. There is currently a projected increase in population of 12% by 2034 (due to be refreshed in June 2025).
The region has a disproportionately older demographic profile compared to the national average, creating additional pressures on health and care services. Dementia cases are expected to increase significantly in the next decade, with prevalence rising with age.
Deprivation
Deprivation is a persistent problem. Approximately 74,200 people (35,900 households) live in England’s 20% most deprived communities. Child poverty affects 22% of children, while fuel poverty and damp housing remain persistent problems. National measures often miss hidden rural deprivation due to dispersed populations – a particular issue for Cornwall and the Isles of Scilly compared to urban areas where deprivation is more easily identified through standard metrics.
People in deprived communities experience shorter lives with earlier chronic illness than those in affluent areas. More preventable illnesses occur, with respiratory, cancer, and circulatory conditions contributing most to lost years of healthy life. The inequality gap between the most affluent and most deprived areas is widening in Cornwall, mirroring national trends but with additional challenges due to rural isolation. Key risk factors contributing to premature death include smoking, poor diet, physical inactivity, and excessive alcohol consumption.
Geography
Cornwall’s shape and position create infrastructure challenges affecting service provision. Dispersed population patterns and the extensive coastline present accessibility and equity issues that are more pronounced than in most English counties.
These challenges are magnified on the Isles of Scilly, England’s most remote island community, located 45 km off Cornwall’s southwestern tip. Of approximately 140 islands, only five are inhabited: St Mary’s (the largest at 6 square miles with 1,700 residents), Tresco, St Martin’s, Bryher, and St Agnes (England’s southernmost inhabited settlement). This extreme remoteness creates healthcare delivery challenges requiring specialised solutions and additional resources compared to mainland services.
Place
Developing a better understanding of ‘place’ is key to driving effective integration of health and social care, and in doing so improving outcomes for local residents. In Cornwall and the Isles of Scilly, 55 GP practices are organised into 15 primary care networks (PCN) within 3 integrated care areas (ICA). Integrated Neighbourhood Teams bring together staff from the NHS, social care and the voluntary sector to improve community health and wellbeing – delivering holistic, person-centred care that is flexible, joined-up, proactive and preventative.
- The West ICA: includes St Ives, Marazion, Redruth, Pool, Camborne, Praze-an-Beeble, St Keverne, Mullion, Helston and the Isles of Scilly. It comprises 4 PCNs serving approximately 172,000 patients (2024/25 registered patients). It includes 3 of Cornwall’s most deprived areas, which are among England’s top 15 most deprived.
- Central ICA: spans from Constantine to Lostwithiel, including Falmouth, Penryn, Truro, Newquay, Padstow and St Austell. It contains 6 PCNs serving around 237,000 patients.
- North and East ICA: extends from the Devon border to Lostwithiel, including Bude, Launceston, Callington, Camelford, Bodmin, Lostwithiel and Wadebridge. It features 5 PCNs serving around 197,000 patients. Around 20% of this area’s population look to Devon for their acute care.
Summary
Cornwall and the Isles of Scilly’s geography creates significant access challenges, with sea boundaries limiting cross-boundary interfaces for service resilience and mutual aid – a situation unique in comparison to most English counties that have multiple land borders facilitating service integration with neighbouring areas.
The region has developed resourcefulness and innovation to address these distinct challenges, exemplified by mobile x-ray and falls vehicles that bring services to local people, reducing avoidable admissions. These innovations are now gaining recognition nationally as potential solutions for other remote areas.
Recent years have seen substantial developments in place-based care, addressing the access challenges, particularly for those experiencing poverty. The ICB’s continued focus on preserving its new model of care while protecting financial health will be essential in any future NHS configuration changes, as well as ensuring the benefits of a wider footprint are fully optimised.