Agenda and minutes

Apologies were received from Mr Keith Marshall.

In respect of Item 13, Councillor Judi Ellis declared that her father was a resident of a care home in the Borough.  Councillor William Huntington-Thresher declared that he was a board member of Broomleigh.  In relation to item 9f, Councillor Peter Fookes declared that he was a Trustee of Age Concern Bromley.  In respect of item 10, Mr Richard Lane declared that his wife was an employee of South London Healthcare Trust. 

To hear questions to the Committee received in writing by the Legal, Democratic and Customer Services Department by 5pm on Wednesday 19^th January 2011.

Three questions were received from Mrs Jean Stout, Chairman of Community Care Protection Group and these are attached at Appendix A.

RESOLVED that the minutes of the meeting held on 2^nd November 2010 be agreed.

Report LDCS11008

The Committee considered a report providing an update on the progress made on recommendations from previous meetings.

Referring to Minute 60A, the Chairman reported that Bromley Council had staff based in hospitals in other boroughs, such as Lewisham Hospital.

In reference to Minute 65, the Chairman reported that the way the Committee considered health scrutiny was under review.  Health scrutiny had become an increasingly big issue for the Committee.  The Chairman reported that she was looking to have a meeting with Bromley LINk and representatives from the Health Trusts.  The proposal was to have two daytime meetings a year with the Health Trusts attending.  The Chairman hoped that the first meeting could take place in May/June 2011 in order for South London Healthcare Trust to report back on the CQC inspection.

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

Representatives, David Barnett and Matthew Froude, from Bromley and Bexley Advocacy Project gave a presentation to the Committee focusing on the Self Advocacy work that was being undertaken across the Borough.  The presentation is attached at Appendix B.

The Chairman asked about the number of people who were actively involved in the meetings held across the Borough, and the Committee was told that there were 20 people who regularly attended the meetings.  The Committee heard that there was no charge for participants to attend the ‘Speaking Up Together’ groups.

In response to a question regarding whether Bromley Sparks had an active role on the various boards, representatives confirmed that members of Bromley Sparks felt supported in influencing the decisions that had been made.

A Co-opted Member highlighted the growth of Bromley Sparks since it was established nearly ten years ago, and underlined the positive support that it had provided to its Members.

The Chairman thanked David and Matthew for their presentation to the Committee.

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 19^th January 2011 and to respond.

No questions were received.

The Committee noted decsions that had been taken by the Portfolio Holder since the last meeting.

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

The Portfolio Holder provided the Committee with an update of Portfolio events:

• The Third Sector Compact had been signed;
• The Council had held four public meetings which had been well attended;
• The Portfolio Planning Day had been held at the end of November 2010 and the Portfolio Holder thanked all those who had attended the conference.

Over the coming weeks the Portfolio Holder was intending to undertake the following engagements:

• Attending the Later Life Conference in London; and
• The Thyme Out Celebrations on Friday 28^th January 2011.

The Portfolio Holder reported that the Extra Care Housing Schemes were progressing ahead of schedule and Members of the Committee had visited the Crown Meadow Court scheme to see the services available.

The Shadow Health and Wellbeing Board had been operating since last year and was now expanding to incorporate representatives from both Community Links Bromley and the Bromley Local Involvement Network (LINk).  The Portfolio Holder stressed that it was important that the newly established Health and Wellbeing Board did not duplicate the work of existing Boards and Forums.

Turning to the Local Government Finance Settlement,  the Portfolio Holder stressed that there were going to be many challenges ahead, but Members and Officers would do all they could to maintain frontline services.  The Portfolio Holder also highlighted that the Adult and Community Portfolio currently accounted for 50% of the Council’s overall budget, and this proportion was likely to increase in the coming years.

Report ACS11002

The Portfolio Holder introduced a report which provided an update on the progress made toward achieving a web-based information, advice and guidance system, as part of the Supporting Independence Programme.  The report outlined the joint work undertaken with Bromley Libraries and the Field Studies Centre to utilise Future Jobs Fund candidates to support the work.

The Project Manager (Universal Services) reported to the Committee that five young people from the Future Jobs Fund were now working in the Central Library and another five were split between Beckenham and Orpington Library.  Bromley Council was currently working within a consortium of other local authorities who were developing the system however; Bromley had developed the system to a greater extent than any other local authority.

A Member congratulated Officers on the implementation of a very positive scheme and asked whether in the future more local libraries could be part of the scheme.  The Project Manager (Universal Services) reported that the possibility of extending the scheme to other libraries across the Borough was being considered for the next phase of the scheme.  The Committee was also informed that the scheme could eventually be extended to day centres, but a detailed communications plans would have to be developed before this could happen.  The communications plan would also identify where support for people using the system could be targeted.

A Member highlighted a small inaccuracy on page 56 of the report, 96% of people had access to the internet at home and work whilst 70% of people had home access to the internet.

In response to a question regarding the ongoing costs of the system, the Director ACS stressed that evaluation of the options available had demonstrated that this  was the most cost-effective route to follow and that the details had been thoroughly scrutinised by Officers.  He added that it was important to measure the   website’s impact  in order to track the benefits and potential cost efficiencies.

RESOLVED that the Portfolio Holder be recommended to endorse the overall strategy of delivering information, advice and guidance via a web-based portal and through Bromley’s libraries.

Report ACS11003

The Portfolio Holder introduced a report outlining the emerging priorities for 2011-2012 following the Portfolio Planning Day held in November 2010, and in the context of the proposed new performance assessment framework for adult social care recently announced by the Government.

The Portfolio Holder highlighted that promoting well-being would remain a constant theme running through the coming year and that the outcomes from the Portfolio Planning Conference were being developed into the Portfolio Plan.

The Information Systems and Performance Manager highlighted that that an Annual Report would have to be completed and reported to the PDS Committee however; this would incorporate much of the statistical information already presented to the Committee.  The seven key social care principles outlined in the Government “Vision for Adult Social Care” were in line with the Council’s current priorities.

RESOLVED that the Portfolio Holder be recommended to:

1. Note the areas of priorities resulting from the Portfolio Planning Conference;
2. Note the proposed Outcome Based Assessment Framework currently under consultation by the Government;
3. Note the outcome of the Annual Performance Assessment for Adult Social Care 2009/10 – Performing Well.

Report ACS11008

The Portfolio Holder introduced a report providing the budget monitoring position for the Adult and Community Portfolio, based on expenditure and activity levels up to 30^th November 2010.

The Portfolio Holder reported that the projected overspend within the physical disabilities budget was unavoidable and the Executive had been asked to take action to minimise the impact of any overspend.  The Interim Head of ACS Finance reported that the budget pressures within Care Services would continue but through management action, the cost pressures had been offset through the realignment of other spending.

In response to a question from a Member of the Committee, the Interim Head of ACS Finance confirmed that the Department used a finance model that accounted for the projected increases in older people however additional cost pressures were caused by services users who were not currently known to the Local Authority presenting themselves for services.

A Member noted that the Local Authority had not identified the impact of the increase of clients with physical disabilities, and sought assurances that Officers understood why this had not been identified.  The Interim Head of ACS Finance explained that the additional pressures had arisen from an increase in the number of adults that had suffered from accidents and strokes.  There were also a number of clients that had degenerative illnesses that had worsened and therefore required a higher level of care.  The Director ACS assured the Committee that action had been taken to mitigate against increased cost pressures within the physical disabilities budget, but noted that it would take time for this action to reduce the pressure on the budget.  The Director stressed that at the current time the pressures were unavoidable, but that work to redesign services would minimise the cost pressures on the budget in the future.

A Co-opted Member sought clarification that the re-ablement programme continued to be a growth area and the Director ACS confirmed that there was no reduction in the funding for re-ablement.  The Local Authority was also working with partners in the Health Service in order to minimise the number people relying on council services.  There was an increasing focus on maximising the independence of clients in their own home.  The Director ACS also confirmed that re-ablement services would be provided free of charge in the same way as intermediate care was free at the point of delivery.  Follow-on services would be means-tested.

The Portfolio Holder reminded the Committee that the Borough would be receiving £3.2 million via the PCT to be used for social care services which benefit health.

RESOLVED that the Portfolio Holder be recommended to note the projected overspend of £192,000 forecast on the controllable budget for the Adult and Community Portfolio as at 30^th November 2010.

Report DR10110

On 3rd November 2010, following scrutiny by the Executive and Resources PDS Committee on 27^th October 2010, the Executive received a report summarising the current position on capital expenditure and receipts following the 2nd quarter of 2010/11. The Executive agreed a revised Capital Programme for the four year period 2010/11 to 2013/14 and the Committee considered a report highlighting the changes agreed by the Executive in respect of the Capital Programme for the Adult & Community Services Portfolio. The revised programme for this Portfolio was set out in Appendix A of the report.

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

To follow

Report ACS11010

The Portfolio Holder introduced the Draft 2011/12 Budget incorporating cost pressures and additional saving options reported to Executive on 12^th January 2011.  Members were requested to consider the savings proposed and to also identify any further action to be taken to reduce the cost pressures facing the Council over the next four years.  The Executive requested that each PDS Committee considered the proposals arising from the   “The Local Government Finance Settlement 2011/12 to 2012/13 and Related Budget Issues” report presented to the Executive on 12th January. Each PDS Committee is requested to provide comments, prior to Executive making recommendations to Council for the 2011/12 Budget.

The Interim Head of ACS Finance reported to the Committee that Bromley Council had incurred net losses in funding of £15 million in 2011/2012 and this would rise to £22 million in 2012/2013.  The Committee were informed that if the proposed savings options were approved, Officers should be in a position to deliver a balanced budget.

The Director ACS reviewed all the savings options presented in Appendix 2b of the report and outline how the savings would be achieved.

The Chairman corrected an error on page 17 of the report suggesting that the comment within line 2 should read “…increasing the amount of commissioned in-house training…”

The Chairman reported that she was uncomfortable with the proposal to reduce spending on the Private Sector Renewals Grant as this had been so successful.  The Director ACS clarified that smaller schemes such as “Staying Put” were unaffected by this proposal.  The Director suggested it would be helpful to present a future paper to the Committee with evidence of the reviewed running of the programme.  The Committee was assured that quality impact assessments would be undertaken on all the proposed saving options.

Another Member questioned whether charges could be placed on properties, and the Director ACS responded that whilst this was one of the options available, charges on properties were complex to administer.

In response to a question, the Director ACS reported that the total spend on the Private Sector Renewals Grant was around £400,000 to £500,000.

In respect of the proposed efficiencies through contracting, a Co-opted Member expressed concern as the contracts with third sector and voluntary organisations were important.  The Director ACS stressed that in future years the voluntary sector would play an increased role in service delivery.  The Director ACS explained that there were other efficiencies in contracting that could be made and outlined an example of a recent saving that had been made to the Committee.

A Co-opted Member highlighted that there was a network of forums that underpinned the relationship between voluntary and statutory organisations, and asked if the networks would be impacted by the savings.  In response the Director confirmed that they would not be affected.

Referring to the ‘Reduced Funding to Sheltered Housing’, the Chairman asked for an indication of the timescales for consultation.  The Director ACS responded that the consultation process was in the hands of the Housing  ...  view the full minutes text for item 76e

Report ACS11006

The Portfolio Holder introduced a report outlining the proposed changes to the Personal Budget and Contributions Policy for Adult Social Care services from 2011 onwards as resolved by the Executive in December 2010.  The Committee was provided with an update on the consultation being undertaken with the wider stakeholder groups.

The Head of Programme Management (LD) outlined the how the consultation had been undertaken and highlighted that 3521 service users had been consulted, and that Bromley Sparks had been engaged to convert the documents into easy read format.  The consultation period would end on 28^th February 2011, and the Portfolio Holder would consider the outcomes of the consultation at a special meeting on 18^th March 2011.

The six main areas of the consultation were outlined in paragraph 3.1.1 of the report.

The Committee thanked Officers for the examples that had been included in Appendix 2 of the report as these had helped clarify the proposals being put forward.

A Member sought clarification regarding whether day services were now included in personal budgets.  The Director ACS outlined the procedure that would be adopted in assessing the costs incurred by individuals.

Responding to a question from a Member, the Exchequer Manager confirmed that the assessments undertaken would take account of rent and mortgage payments.  Advice on the benefits that would be available to service users would also be provided, and once benefits had been reviewed service users needs would be re-assessed.

A Co-opted Member highlighted the support some users might need when making decisions about the services they wanted to access, as if clients made the wrong choices, the Local Authority could face higher long term costs.  The Portfolio Holder reported that he shared the concerns expressed, but underlined the importance of empowering service users and ensuring that they were as informed as possible when making their choices.

Some Members expressed concern surrounding the £10 charge for non-eligible day services.  The Director ACS clarified that the charge for non-eligible day services would only be levied on ineligible users.

The Director ACS confirmed that details of how personal budgets would be calculated and administered would be included in the report presented to the Portfolio Holder on 18^th March 2011.

In response to a question from a Member the Director ACS explained that in future there would be a requirement to ask service users questions around the support they received from family members.  The Committee was reminded that clients who did not receive any support from relatives placed a greater financial burden on the Local Authority.  In the future, assessments would have to consider individuals needs and those needs that could be met by sources other than the Local Authority.  The Director suggested that it was fair to assume that people would help support their relatives however, when this support was not there, the Local Authority would provide services if people were eligible.  The Committee was reminded that it was not possible for the Council to meet the social  ...  view the full minutes text for item 76f

Report ACS11005

The Portfolio Holder introduced a report setting out proposals to close adult social care reception services at The Walnuts and Yeoman House area offices.  The report identified the impact of these proposals on service users, and the financial implications of the proposed changes, including savings and overall redundancy costs.  The proposal to close these services, with effect from 4 April 2011, followed a number of changes which had impacted significantly on the demand for these reception services. This included the relocation of children’s’ social care teams from The Walnuts and Yeoman House to the Old Town Hall.  The majority of callers accessed children’s social care and housing services, and it was now proposed to manage the delivery of these services differently. 

A Member asked whether it would be possible to have a telephone link in some libraries, as this would provide a better level of service to clients with visual impairments.  The Assistant Director (Strategic Development and Performance) agreed that this was something that could be reviewed.

RESOLVED that the Portfolio Holder be recommended to agree the proposed closure of Adult Social Care receptions at The Walnuts and Yeoman House area offices, subject to consideration of the breakdown of redundancy costs, presented as a part 2 item on this agenda.

Report ACS11009

The Portfolio Holder introduced a report setting out the provision of living support services at Padua Road as part of the supported living programme for people with learning disabilities.  The report made recommendations for the award of a support contract for one year from April 2011.  The full financial implications of the proposals were considered by the Committee in Part 2 later in the meeting.

RESOLVED that the Portfolio Holder be recommended to agree, subject to consideration of the full financial implications in Part 2, the award of a contract for one year from 1^st April 2011 to Family Mosaic for support to 8 service users at Padua Road.

Report ACS11011

The Portfolio Holder introduced a report outlining the provision of support services to people with learning disabilities by Elizabeth Fitzroy Support and requesting a waiver of Contract Procedure Rule 13.1 to enable to Council to enter into a further contract with Elizabeth Fitzroy Support.  The full financial implications of the proposal were considered by the Committee in Part 2 of the agenda.

RESOLVED that the Portfolio Holder be recommended to:

1. Grant a waiver under Contract Procedure Rule 13.1 for the need for competitive tendering to allow officers to award a contract for supported services for people with learning disabilities to Elizabeth Fitzroy Support with effect from 1^st April 2011.
2. Agree the proposed length of the contract is one year with the potential to extend for a further period up to but not exceeding one year.  The extension to be agreed by the Director of Adult and community Services in consultation with the Adult and Community Portfolio Holder.
3. Agree the contract will include a break clause which will enable the Council to withdraw from the contract earlier should a review of funding become necessary.

Report ACS11004

The Portfolio Holder introduced a report proposing a short term contract in 2011/2012 to enable the effects of the personalisation agenda on the service to be addressed.  The contract with Kent Association for the Blind for provision of rehabilitation and support services to people with visual impairments would expire on 31^st March 2011 with no option to extend.

The Joint Strategic Commissioning Manager (Older People and Adults with Complex Health and Social Care Needs) confirmed that there were no other providers of the service.

In response to a question from the Chairman, the Joint Strategic Commissioning Manager reported that the Annual Subscription for the talking books service was £50 and the total cost of the service, including equipment was £80. 

The Committee were told that a free audio books service could be obtained from the Calibre Audio Library at http://www.calibre.org.uk/.

RESOLVED that the Portfolio Holder be recommended to waive the requirements for competitive bids pursuant to Contract Procedure Rule 13.1 and approve the proposal to negotiate a new contract with the current provider for the provision of services to people with visual impairments for a period of one year from 1^st April 2011 to 31^st March 2012.  The Portfolio Holder is also recommended to agree to the consultation on the proposal that small items of equipment and talking books will no longer be provided free of charge to people with visual impairment.

Ms Jennie Hall, Director of Nursing, Governance and Patient Experience at South London Healthcare NHS Trust, provided the Committee with an update of the implementation of the ‘A Picture of Health’ proposals and how they would impact on the residents of the Borough,  The presentation can be seen at Appendix C to the minutes.

In response to a question regarding the bad publicity that the Trust had recently been the subject of, Ms Hall confirmed that a communications strategy was being developed and the Trust was working with the local press to address the recent bad publicity.

Ms Hall reported that in the last week, the Trust had exceeded targets surrounding A&E waiting times with 95% of patients being treated within the expected time.  The Trust was monitoring patient flows on a weekly basis and would be monitoring where patients were being treated.

In response to a question from the Chairman, Ms Hall reported that the Trust anticipated that the use of the paediatric unit at the Urgent Care Centre would increase as parents became aware of the service.

In response to a question from a Co-opted Member regarding midwife vacancies at the Trust, Ms Hall reported that there had consistently been some midwifery vacancies, however the Trust had taken action to progress the situation.

Ms Hall reported that the CQC Action Plan would be published following the Trust Board meeting on Wednesday 26^th January 2011.

The Chairman thanked Ms Hall for attending the meeting and providing the Committee with an update.

The Committee considered a summary of the recent White Paper - ‘Equity and Excellence- Liberating the NHS,’ further guidance and considered how Bromley was situated in relation to the proposed changes.

Dr Angela Bhan provided an overview of the report and updated the Committee on the impact of the White Paper on the Borough.

·  It was likely that the three GP clusters across the Borough  would work together as one consortium;

·  The National Commissioning Body would take on the responsibility for commissioning services for rarer disorders, such as HIV and it was likely that there would be regional version of this for London.

Dr Bhan confirmed that the Health and Wellbeing Board would not be undertaking the Health Scrutiny role but that it had responsibility for overseeing the commissioning and delivery of health and social service functions and might also oversee public health functions.  The Director ACS reported that it was hoped to merge public health with the Local Authority sooner rather than later.

The Portfolio Holder highlighted that the Health and Wellbeing Board would reflect the new emphasis on wellbeing.

RESOLVED that the report be noted.

Report ACS11007

The Committee considered a report outlining the impact on service users following the restructure of the Care Management and Assessment Teams for adults with physical disability and older people, which was agreed by the Executive on 8^th December 2010.  The structure was designed to improve the response to service users and was based on the Customer Journey agreed by the Portfolio Holder on 21^st September 2010.

The Director ACS highlighted that the Department was restructuring the Care Services Division with by  replacing the current service structure two operational strands  one that focused on re-ablement and one that focused on supporting people with longer term social care needs.

A co-opted member commented that the new structure was a positive step and was pleased to see the department move away from a structure based on a person’s age,  to one that focussed on the level and complexity of need. 

The Chairman suggested that the Committee should receive an update at its meeting in November 2011.

RESOLVED that:

(a)  the impact of the agreed proposals for restructuring within the Care Management and Assessment Teams be noted.

(b)   The Changes resulting from these proposals should be reported to this Committee in November 2011 in order for Members to assess whether the objectives have been achieved.

Report ACS11001

The Committee considered a report providing an update on the work undertaken to monitor the quality of service provided in residential and nursing homes for adults in the Borough.

The Chairman highlighted that there were fewer one star care homes than there had been the previous year and congratulated Officers on the success of the monitoring system.

The Committee was informed that the CQC was replacing the star rating system with a new rating system, however Officers would continue to visit the lowest ranked homes more frequently than other homes. 

Following a question from Mrs Angela Clayton-Turner, the Committee were informed that a number of care homes in the Borough provided residential respite care for severe dementia.  The Strategic Manager, Procurement and Contract Compliance agreed to provide information to Mrs Clayton-Turner regarding residential respite care for people with severe dementia.

The Committee were informed that there were fewer people accessing residential homes as people were staying in their own homes longer, and as a result of this there was not currently a waiting list for residential care.

RESOLVED that the report be noted.

Report LDCS11019

In April 2010, the Adult and Community Policy Development and Scrutiny Committee agreed to establish a Bromley Mobility Forum, initially for a period of one year.  The Chairman of the Forum provided an update on progress made to date.

Mrs Leslie Marks, Chairman of the Mobility Forum reported to the Committee that the Forum would shortly be undertaking a survey on the use of buses across the borough and were seeking to identify personal accounts of experience of bus usage.  In future, the Forum would also be reviewing Dial-a-ride, street furniture and disability awareness training for public transport staff.

In response from a question from the Chairman, Mrs Marks confirmed that ‘Speaking Up’ groups based in schools were not yet involved with the Forum.

 A Member suggested that London Travel Watch may be of assistance in lobbying Network Rail regarding the development of Bromley South Station to provide access for people with mobility difficulties.

The Committee were told that there was funding in place to sustain the Forum until July 2011.  Any future funding would have to be reviewed.

RESOLVED that the update be noted.

Report ACS10079

The Committee considered a report updating Members on the work of the Drug Action Team in respect of substance misuse, covering areas of progress and activity in relation to specific aspects of performance over the last year and identifying priorities for the future.

The Strategic Commissioner, Mental Health reported that the Local Authority would be undertaking six-monthly reviews of participants following completion of the drug treatment programme to monitor the success of the programme.  The National Treatment Agency measure of success was based solely on participants completing the programme.  Treatment for addiction to prescription drugs was not part of this programme.

The Chairman noted that more detailed information on the success of the drug treatment programme would be available after a year.

RESOLVED that the report be noted.

Report LDCS11009

The Audit Sub-Committee at its meeting on 16^th September 2010 approved an approach to Value for Money (VfM) reporting by Internal Audit. In developing this approach, the Sub-Committee considered pilot VfM work on Adult and Community Services and requested that these be reported to the relevant Committees for consideration.

The Director ACS highlighted a number of inaccuracies within the report and stressed that the pilot had focused on methodology.

RESOLVED that the approach to Value for Money reporting endorsed by the Audit Sub-Committee be noted.

Report LDCS11007

The Committee reviewed its work programme for 2010/2011.

The Chairman agreed to report back to the Committee in March 2011 regarding the progress of the new Health Scrutiny Sub-Committee.

RESOLVED that the Work Programme 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.

Report ACS11005a

The Portfolio Holder introduced a report providing details on the staffing and financial implications arising from the report at Minute 78e.

Report ACS1109a

The Portfolio Holder introduced a report setting out the full financial implications of the proposal considered at Minute 78f.

Report ACS11011a

The Portfolio Holder introduced a report setting out the full financial implications of the proposal considered at Minute 78g.