Agenda and minutes

Apologies were received from Councillor William Huntington-Thresher and Councillor Charles Rideout, Councillor Simon Fawthrop attended as Councillor Rideout’s alternate.  Apologies were also received from Mr Keith Marshall.

Councillor Roger Charsley declared he was a Member of Bromley Autistic Trust and SLAM.

Councillor Reg Adams declared that his wife was an employee of Bromley Community Counselling Service.

In respect of Item 11, Mr Richard Lane declared that he was a Member of Bromley LINk.

To hear questions to the Committee received in writing by the Legal, Democratic and Customer Services Department by 5pm on Wednesday 15^th September 2010 and to respond.

One written question and four oral questions were received from Members of the Public and these are attached at Appendix A to the minutes.

Mr Richard Lane reported that he felt strongly that Mrs Sulis’ questions should be read out and a public response provided.  The Chairman responded that in the past Mrs Sulis had asked a Member of the Committee to read out her questions but that no arrangements had been made for this meeting.  The Chairman reported that all the questions received would be appended to the minutes and that arrangements could be made for Mrs Sulis’s questions to be read out in the future.

A Member highlighted a typing error on page 10 of the minutes Special awareness should be spatial awareness.

RESOLVED that the minutes from the meeting held on 27^th July 2010 be agreed, subject to the amendment outlined above.

Report LDCS10147

The Committee considered recommendations from previous meetings which continued to be outstanding.

A Member highlighted that the dates for the Blue Badge Update should be 25^th January 2011.

RESOLVED that progress on recommendations made at previous meetings be noted.

To hear questions to the Adult and Community Portfolio Holder received in writing by the Legal, Democratic and Customer Services Department by 5pm on Wednesday 15^th September 2010 and to respond.

Three oral questions were received from Members of the Public and these are attached at Appendix A.

The Portfolio Holder reported that the Thyme Out had attracted further publicity over the summer, winning a Bromley Star award and attracting a Green Flag.  The Portfolio Holder reported that all the participants in the scheme would be gaining a City and Guilds qualification.  A further intake of 20 participants would start the scheme next month.

The Portfolio Holder also reported that he had attended the Champions Evening in the Great Hall and had been invited to take part in the opening of Stafford House.

The Portfolio Holder commented on the publishing of the Health White Paper and the far reaching implications that it would have for the Borough.

The Committee noted decisions taken by the Portfolio Holder since the last meeting held on 27^th July 2010.

The Adult and Community Portfolio Holder to present scheduled reports for pre-decision scrutiny on matters where he is minded to make decisions.

Report ACS10055

The Portfolio Holder introduced a report outlining the future changes to the care management arrangements arising from the revised business operating model for the delivery of adult social care assessment and care management services in the light of the Supporting Independence Programme.

The Assistant Director (Care Services) and the Programme Manager, Supporting Independence in Bromley introduced the report and highlighted the diagram of the Business Operation Model outlined on the last page of the report.

A Co-opted Member asked Officers to clarify what would happen to the programme when the Transforming Social Care Grant ceased.  Officers confirmed that the grant had been used to set up new services such as re-ablement and that future efficiencies from these services would make them sustainable.

Another Co-opted Member asked if there was any interaction with health services at the bottom tier of the Business Operation Model.  The Programme Manager, Supporting Independence in Bromley reported there had been  discussions with the PCT about the development of an integrated service in the future.

The Committee considered issues surrounding delays in assessments and the uncertainty this could cause for services users regarding their eligibility for services.  Officers provided assurances that work was being undertaken to develop information, advice and guidance and that individuals would be supported in accessing the available information.

The Director ACS highlighted that as part of these proposals Care Management Teams would be reorganised.  This would involve staff moving into different areas and undertaking different roles. He pointed out that formal consultation with staff would be undertaken and whilst there would be changes in the numbers and grades of staff, it was not anticipated that this would result in significant job losses or redundancies.

The Portfolio holder reported that he had received positive feedback regarding the services under consideration.  He went on to highlight the importance of rapid assessments and targeted, rapid intervention.

RESOLVED that the Portfolio Holder be recommended to endorse the revised care management arrangements arising from the revised business operating model.

Report ACS10053

The Portfolio Holder introduced a report providing information about the direction of travel of the in-house home care service and proposals about the future of the service contained within the Direct Care Services annual business plan.

The Portfolio Holder provided an overview of the report.  Following this summary, the Unison Staff Side Secretary read a statement to the Committee.  The Staff Side Secretary made a number of points:

·  Clients had the right to choice;

·  130 workers were facing redundancy as a result of this decision;

·  The notion that the in-house service was no longer viable was ‘a fantasy’;

·  Levels of care would be lost;

·  It did matter to clients who provided their care;

·  Agencies did not provide the same level of care as the in-house service;

·  Clients would lose the carers that they knew;

·  In the past, when a service had been privatised the Council had been undertaking the process openly and honestly but that this was not the case with this decision;

·  There had been no consultation regarding the decision;

·  The duty of the elected Councillors was to the residents.

The Staff Side Secretary questioned why the decision had to be taken before the outcome of the comprehensive spending review had been announced and suggested that a portion of the Council’s reserves could be utilised to protect the service.  In concluding, the staff Side Secretary urged Councillors to reject the proposal.

The Director ACS responded to the statement and highlighted the need to ensure that suitable care arrangements were in place for  the residents of Bromley in order to meet increasing demand for services and  also to be able to respond to the challenges of the future 

The Assistant Director (Care Services) provided an overview of the report and explained to the Committee that in Bromley approximately 13,000 hours per week of care were provided by the independent sector, compared to the  3,000 hours of care provided by the in-house service.  The personalisation agenda had a significant impact on the service due to the increasing number of people receiving personal budgets.  The resources available were increasingly limited and the available resources had to be used wisely.  The Assistant Director (Care Services) stressed that the proposed changes would not affect the pattern of care provided to service users.

A Member questioned whether the 30% higher costs of the in house home care service solely related to staff salaries or other issues.  The Interim Head of ACS Finance reported that the difference in  costs were influenced  in part by competition within the market place but noted that Council services also carried a higher degree of  overheads. 

The issue of client choice was also raised and the Director ACS reported that there had not traditionally been a large degree of choice as the logistics of the service meant that carers were allocated on the basis of availability, but as the use of personal budgets increased service users would expect to exercise choice and that this would also involve them needing  ...  view the full minutes text for item 40b

Oliver Lake, Director at the SE London Sector of the NHS and Dr Andrew Parson, Chislehurst GP and the Clinical Commissioning lead for Bromley attended the meeting to provide Members with an update on the ‘A Picture of Health’ Programme.  The presentation provided to the Committee is attached at Appendix C to these minutes.

Members requested an update on the Birthing Unit.  Mr Lake explained that the co-located Birthing unit on the PRUH site would go ahead.  There had been concerns about the viability of the Queen Mary Sidcup proposals. 

With regards A Picture of Health, Mr Lake stressed that the uncertainty that had been created was not good for the staff, service or service users.  It was hoped that the evidence of compliance with the tests would be submitted by the end of the month and a decision would be taken shortly after the beginning of October 2010.

Mr Lake reported that the views expressed by Members of the public during previous consultations had been forwarded to the Stakeholder Reference Group.  The Chairman urged Members of the Committee and the public to forward their views to the web address that had been set up for the consultation.

The Portfolio Holder introduced a report providing the budget monitoring position for the first two months of 2010/2011 for the Adult and Community Portfolio, based on expenditure and activity levels up to 31^st July 2010.  The Portfolio Holder highlighted the projected overspend reported and suggested that in the short term the situation was likely to worsen before it improved.  The Portfolio Holder also outlined service areas that were currently causing pressure on the budget.

The Interim Head of ACS Finance reported that the Department was taking action in order to minimise the impact of the pressure on the budget.

A Member congratulated Officers on the reduction that had been achieved in the deficit and asked what controls were being used to bring the current overspend back in line.  The Interim Head of ACS Finance reported that all departmental expenditure was being reviewed and drew the Committee’s attention to the Chief Officer comments outlined in the report.

The Portfolio Holder reminded the Committee that in recent years the Department had recorded an underspend in the budget.  This year there were a number of additional budget pressures, not least in housing.  The Portfolio Holder reported to the Committee that the budget pressures were constantly under review with action being taken to minimise the impact of the pressures.

RESOLVED that the Portfolio Holder be recommended to note that a projected overspend of £451,000 is forecast for the Adult and Community Services Portfolio as at 31^st July 2010.

On 21^st July 2010, the Executive received a report summarising the current position on capital expenditure and receipts following the 1^st quarter of 2010/11 and agreed a revised Capital Programme for the four year period 2010/11 to 2013/14.  The Portfolio Holder considered a report which highlighted changes agreed by the Executive in respect of the Capital Programme for the Adult and Community Services (ACS) Portfolio.

RESOLVED that the Portfolio Holder be recommended to confirm the report.

Ms Jennie Hall and Dr Moray from South London Healthcare NHS Trust attended the meeting to provide Members with an update on progress by South London NHS Trust. 

Ms Hall reported that there had been no cases of MRSA since April 2010 and that levels of CDif were well ahead of target for the year.  A&E performance was over 96% and the Trust was aiming to achieve 98%.  In terms of safeguarding, the Trust would be declaring full compliance by the end of the month.  Building work was also underway for the co-located birthing unit.

In terms of the challenges faced by the Trust, pressure points had been identified in A&E and Midwifery services.  The Trust was still experiencing problems with the recruitment and retention of midwives and had implemented a targeted recruitment programme to address this.

Turning to the questions raised by the public in July 2010, Ms Hall reported that all the issues raised by clinicians had been fully investigated.  The Trust was continuing to work with clinicians and their concerns would continue to be investigated.  In response to a question from the Committee, Ms Hall reported that around 77 clinicians had expressed concerns in July 2010 but that it was difficult to give an accurate number as one of the elements of the complaint had been a letter placed in the media.  The Chairman asked for the Committee to be provided with feedback as to how the issues raised by the clinicians as the complaint had been made public and therefore the resolution should also be public.

Referring to the issue of pressure ulcers, Ms Hall reported that the Trust had undertaken a programme of work to address those issues identified.  Changes were being implemented against a national framework which would encourage best practice to be imported into the Trust.  Bromley LINk had asked to be involved in this work and this had been agreed.  The Chairman asked if the Trust had been investing in additional equipment to help resolve the issue of pressure ulcers.  Ms Hall reported that equipment was in place and that early assessment and staff training were important in minimising the instances of pressure ulcers.

A Co-opted Member suggested that it might be helpful to have some written information from South London Healthcare Trust presented to members of the Committee prior to each meeting.  The Chairman agreed that this may be helpful in the future.

Mark Hindmarsh, Senior Project Officer, Commissioning Support for London attended the meeting to provide Members with an overview of the recently published case for change and proposed model of care for future cardiovascular service provision in London.  The presentation provided to the Committee is attached at Appendix D to these minutes.

A Member asked if high risk cardiovascular cases could be taken directly to specialist centres and Mr Hindmarsh reported that this was the aim.

Another Member asked about weekend cover for cardiovascular services and Mr Hindmarsh reported that the service specification was clear that cover would have to be provided on a 7 day a week basis.

Tom Pharaoh, Senior Project Officer, Commissioning Support for London, provided an overview of the recently published case for change and proposed model of care for future cancer service provision in London.

The Chairman stressed that transport was an important issue for Bromley residents.  Mr Pharaoh reported that the consultation was emphasising localism.  Dr Angela Bhan reported that the possibility of bringing services back to local hospitals had been investigated and that the PCT had been looking at developing a satellite service for radiotherapy in South East London.

A Co-opted Member asked about the timeframe for responses to the consultation.  Mr Pharaoh reported that the questionnaire would be open until 31^st October 2010 and the questionnaire could be accessed at www.csl.nhs.uk. 

Report ACS10057

The Committee considered a report seeking Members’ endorsement of revised terms of reference for the Care Home Reference Group to encompass all issues relating to accommodation with care for older people.

RESOLVED that the proposal to expand the focus of the Care Home Reference Group to encompass all accommodation with care issues for older people (including a change of name to Accommodation with Care for Older People Reference Group) and the revised terms of reference be endorsed.

Report LDCS10148

The Committee reviewed its Work Programme for 2010/2011.  The Chairman reported that the Committee would continue to monitor domiciliary home care.  The Committee also requested an update on the Health White Paper at the next meeting.

RESOLVED that the Committee’s Work Programme for 2010/2011 be noted.

The Chairman to move that the Press and public be excluded during consideration of the items of business listed below as it is likely in view of the nature of the business to be transacted or the nature of the proceedings that if members of the Press and public were present there would be disclosure to them of exempt information.

RESOLVED that the Press and public be excluded during consideration of the items of business listed below as it is likely in view of the nature of the business to be transacted or the nature of the proceedings that if members of the Press and public were present there would be disclosure to them of exempt information.

The exempt minutes of the meeting held on 27^th July 2010 were agreed.

Report ACS10054

The Portfolio Holder introduced a report requesting that the Portfolio Holder agree a waiver of financial regulations to enable an extension of the current contract until 31^st December 2010 to allow for further consideration of the most advantageous procurement route. 

A Member expressed concerns about waiving financial regulations.  The Director ACS explained why the Portfolio Holder was being asked to waive financial regulations.

The Chairman reported that she endorsed the proposals in the report and the Portfolio Holder reported that he was satisfied with the case that was being made.

RESOLVED that the Portfolio Holder be recommended to agree under Rule 13 of the Council’s Financial Regulations that a contract for support services to women’s refuges be entered into with Bromley Women’s Aid for a period of 3 months from 1^st October 2010 until 21^st December 2010.