Agenda and minutes

Apologies for absence were received from Barbara Wall.

Apologies for lateness were received from Councillor Robert Evans.

There were no declarations of interest.

In accordance with the Council’s Constitution, questions to the Adult Care and Health Portfolio Holder or to the Chairman of this Committee must be received in writing 4 working days before the date of the meeting.  Therefore please ensure questions are received by the Democratic Services Team by 5.00pm on Thursday 15^th November 2018.

No questions had been received.

The minutes were agreed subject to the third sentence of the fourth paragraph of Minute 27: Update from the Deputy Chief Executive and Executive Director: Education, Care and Health Services being amended to read:

“Another Member queried whether tenders received for the new Social Care Case Management System would be evaluated using the Local Authority’s standard 60% price and 40% quality split, and emphasised that the cost of the new Social Care Case Management System should be balanced with the needs of the service.”

In response to a query from a Member on the same minute item, the Director: Adult Social Care reported that regular contracts updates would be provided to the Adult Care and Health PDS Committee, and the Member requested that this include key performance indicators.  Another Member noted that Item 15a: Domiciliary Care Services Annual Quality Monitoring Report was an excellent example of a contracts monitoring report and suggested that a similar format be used to monitor other services within the Adult Care and Health Portfolio.  The Assistant Director: Strategy, Performance and Business Support confirmed that work was underway to make arrangements for providers of high value contracts to attend future meetings of the Adult Care and Health PDS Committee.

RESOLVED that the minutes of the Adult Care and Health PDS Committee meeting held on 19^th September 2018 be agreed, subject to the amendment outlined above.

RESOLVED that the minutes of the Health Scrutiny Sub-Committee meeting on 17^th October 2018 be agreed.

Report CSD18145

The Committee considered matters arising from previous meetings and its forward work programme.

In response to a question from a Member, the Director: Adult Social Care confirmed that action was being taken to address a number of Priority 1 recommendations identified by the Audit Team within the Direct Payments and Adult Mental Health services, including the delivery of improvement plans.  A multi-agency Mental Health Board that would include service user involvement had also been established, and the Terms of Reference of the Mental Health Board would be circulated following the meeting. 

The Chairman advised the Committee that Dr Agnes Marossy, Consultant in Public Health, Bromley Clinical Commissioning Group had been invited to attend the meeting of Health Scrutiny Sub-Committee on 16^th January 2019 to present work recently undertaken on the primary care sector in Bromley.

RESOLVED that matters arising from previous meetings and the forward work programme be noted.

The Director: Adult Social Care gave an update to Members on work being undertaken across the Education, Care and Health Services Department. 

The Bromley System Winter Plan was in place and working well, with additional demand for nursing and residential care beds being managed.  Work to procure a new Social Care Case Management System was ongoing and regular updates would be provided to the Committee as the service specification was developed and throughout the procurement process.  Work was underway to develop a new service delivery model for Domiciliary Care in collaboration with key partners, service users and providers.  The Care Quality Commission was continuing to roll out its new approach to inspecting and rating health and social care providers, and an inspection of the Local Authority’s Adult Social Care service was expected during the next five years. 

A Member spoke about a recent Members’ visit to a Supported Living Scheme and underlined the need to promote the opportunities available through Direct Payments to service users, staff, user groups and carers.  The Director: Adult Social Care advised that a range of work had been undertaken to further develop the Direct Payments scheme in Bromley, and that the next step would be to promote the scheme to new and existing service users.  A leaflet had been designed collaboratively with service users and would be provided to Members following the meeting.

In response to a question from a Member, the Director: Adult Social Care confirmed that updates on the impact the new Ambulatory Care ward at Princess Royal University Hospital had on reducing pressure in the Accident and Emergency Department would be reported to Members when available.

RESOLVED that the update be noted.

An update on the Adult Care and Health Portfolio budget was provided to Members as part of Minute 45a: Budget Monitoring 2018/19.

Portfolio Holder decisions for pre-decision scrutiny.

Report CS18179

The Committee considered a report setting out the budget monitoring position for the Adult Care and Health Portfolio for 2018/19, based on activity to the end of September 2018.

The controllable budget was forecast to be in an overspend position of £333k with a full year cost pressure of £1,915k, assuming further management action was taken throughout the year to maintain this position.  This was a result of predicted overspends across a range of services including Assessment and Care Management, Learning Disabilities and Mental Health which was due to a number of reasons including higher than expected demand for services.  The overspend had been offset by the reallocation of Better Care Funding that had resulted in a one-off reduction in expenditure of £369k for Adult Social Care.  It was requested that the Council’s Executive agree the release of funding held in contingency or reserves comprising £500k of Improved Better Care Funding to offset in-year costs across Social Care, and £1.5M from the Clinical Commissioning Group Reserve to support the continued delivery of transformational changes to reduce acute hospital activity.

The Head of Education, Care and Health Services Finance reported that management action used to help contain cost pressures within adult social care services included the work undertaken by the Invest to Save team, as well as ongoing discussions with health partners to ensure that the cost of meeting the health and social care needs of service users was met by the appropriate partner.

In response to a question from a Member, the Head of Education, Care and Health Services Finance advised that a range of work was underway to more accurately project future costs relating to the transition of service users from child to adult social care services; however this could be difficult as it did not account for the changing care needs of some service users or the move of new service users into the Borough.  The Director: Adult Social Care confirmed that families were provided with support during the transition to adult social care services which included work to manage expectations about the adult social care offer.  The Chairman asked if a more effective modelling tool was available to support the Local Authority in projecting future costs relating to the provision of adult social care, and the Head of Education, Care and Health Services Finance agreed to investigate this following the meeting.  The Director: Adult Social Care noted that the Association of Directors of Adult Social Services was working to develop a more accurate model to project future demand for adult social care services. 

In considering a number of other issues, a Co-opted Member noted the work underway to increase uptake of Direct Payments and queried whether this would reduce cost pressures impacting the Adult Care and Health Portfolio.  The Head of Education, Care and Health Services Finance confirmed that some savings might be realised through the increased use of Personal Assistants and reduced administration costs for the Local Authority.  A Member queried a projected underspend  ...  view the full minutes text for item 45a

Report CS18181

The Committee considered a report providing details of the existing contract for the Mental Health Flexible Support Service which was due to expire on 30^th September 2019, with no further options to extend.  There was a need to explore procurement options to determine how the current and future needs of people requiring flexible mental health support within the community would be met from 1^st October 2019 and the approval of the Council’s Executive was sought to commence the procurement of this service in alignment with the Local Authority’s Commissioning Plan and the Joint CCG Mental Health Strategy.

The current Mental Health Flexible Support Service was a specialist service that supported adults with mental ill health to live independently within the community, reducing their reliance on hospital and residential care.  This service enabled the Local Authority to meet its duties under the Care Act 2014 to support people with mental ill health to remain living within the community as well as to be compliant with requirements in the Mental Health Act 1983, relating to hospital discharges.  The key objective of the service was to provide an effective, timely and flexible response to the needs of mental health service users to enable their rehabilitation and well-being.  A range of options had been developed for the future delivery of this service, and it was proposed that Mental Health Flexible Support Service be tendered on a part-fixed (block) basis with one provider with the option to purchase additional hours at a rate stated within the bid.

In considering the report, Members discussed the options for the future delivery of the Mental Health Flexible Support Service and generally agreed that Option 1: Develop a Framework of Providers was the Committee’s preferred option, and that this should include out-of-Borough providers and potential cross-Borough working with other local authorities.  Another Member suggested that consideration be given to in-house delivery by the Local Authority, particularly as there were limited providers of this specialist type of support in Bromley.  The Director: Adult Social Care advised that as a commissioning authority, the Local Authority would not normally take over the delivery of a service except where a provider was identified as putting service users at risk, and that the Local Authority did not have the infrastructure in place to deliver this type of service.  A Member emphasised the importance of building good relationships with social landlords to ensure that the housing needs of people with mental health needs were met.

A Member highlighted the timescales for the new contract that was due to commence from 1^st October 2019, and requested that the Adult Care and Health PDS Committee be provided with regular updates on the service specification and procurement process.  Where there were any proposals to continue with current arrangements, it was important for Members to be provided with detailed information on the quality of existing services, including the outcomes for service users.  The Director: Adult Social Care confirmed that the tender submissions would be  ...  view the full minutes text for item 46a

Report CS18184

The Committee considered a report providing details of the existing contract for Health Support to Schools which was due to expire on 31^st March 2019.  The contract was currently held by the Bromley Clinical Commissioning Group and funded via the Better Care Fund at a cost of £603k per annum; however Better Care Funding for this service would cease at the end of 2018/19, after which recurrent funding would be required if the service was to continue.  The approval of the Council’s Executive was sought to agree a proposed approach to the future funding and commissioning of this service.

The Health Support to Schools service had two elements which comprised safeguarding children and supporting medical needs.  It was the statutory duty of the Local Authority to safeguard children, and school nurses played a key role in bring a health perspective to the oversight of children’s needs, particularly where children may have a disability.  Health Support to Schools was delivered across Bromley using a model in which school nursing provision was specifically targeted to children with medical and safeguarding needs.  A range of options had been identified for the future commissioning of Health Support to Schools from 1^st April 2019, and it was proposed that the Local Authority secure an agreement with the Bromley Clinical Commissioning Group to extend the existing Health Support to Schools contract for a period of 18 months to align its end date with the existing Health Visiting contract and allow the commissioning of a combined Health Support Service for 0-19 years.

RESOLVED that the Council’s Executive be recommended to agree new funding of £603k be included in the Draft Revenue Budget for 2019/20 and a further £302k for 2020/21 for the Health Support to Schools Service (Option 2 in Report CSD18184).

Report CS18187

The Committee received a presentation on the Bromley Safeguarding Adults Board Annual Report 2017/18 by Lynn Sellwood, Independent Chairman and Raynor Griffiths, Manager: Bromley Safeguarding Adults Board.

The Local Authority had a statutory duty under the Care Act 2015 to establish a Safeguarding Adults Board to help and protect vulnerable adults in Bromley.  The Bromley Safeguarding Adults Board had three main functions comprising developing a strategic plan, publishing an annual report and undertaking Safeguarding Adults Reviews (SARs) to investigate serious incidents.  No SARs had been commissioned in 2017/18; however the Safeguarding Adults Review Committee had made the decision to commission a SAR in respect of one case on 29^th June 2018 that was currently in progress, and a further case had met the threshold for a SAR for which the Board was seeking legal advice.  During 2017/18, the Bromley Safeguarding Adults Board had undertaken a range of work in continuing to deliver the Safeguarding Adults Strategy 2016-19, including the establishment of the Safeguarding Adults Review Committee, creating a safeguarding awareness commercial and delivering a number of events to raise awareness of adult safeguarding.  The key priorities for the year had been self-neglect, hoarding, domestic violence and fire safety in homes, and the same key priorities would be carried forward into 2019/20.  The forward work programme included the development of the Board’s strategy for 2020-2023 and a strategy and Borough-wide approach to tackling modern day slavery.  It was also planned to undertake an audit of safeguarding practice in the private, voluntary and independent sectors and develop a community engagement programme to increase awareness of adult safeguarding in Bromley.

A Member underlined the need to continue to raise awareness of adult safeguarding in the Borough to help people in identifying concerns and feeling able to report them.  A Co-opted Member suggested that posters be displayed in town centres across the Borough.  The Independent Chairman confirmed that the Bromley Safeguarding Adults Board undertook a range of promotional activities, including presentations to local groups and a website.  A Member noted the importance of ensuring that people reporting any safeguarding concerns felt reassured that appropriate action would be taken

In response to a request from a Member, the Director: Adult Social Care agreed to arrange a training session for Members and Co-opted Members on adult safeguarding.  The Independent Chairman confirmed that a wider range of training opportunities were available for officers, Councillors and members of the public and the schedule of activities for the Safeguarding Awareness Fortnight taking place between 3^rd-14^th December 2018 would be provided to Members following the meeting.  Sample posters and leaflets promoting the adult safeguarding message would be provided electronically to Members following the meeting as well as hard copies of leaflets for distribution to local community groups.

The Chairman led Members in thanking Lynn Sellwood and Raynor Griffiths for their excellent presentation which is attached at Appendix A.

RESOLVED that the Bromley Safeguarding Adults Board Annual Report 2017/18 be noted.

Report CS18188

The Committee considered a report providing an update on the performance of Public Health commissioned services in 2017/18.

Public Health Programmes were grouped into three broad areas comprising Adult Public Health Services which included NHS Health Checks, Children and Young People Public Health Services which included School Nursing and Health Visiting, and Risky Behaviour for Young People and Adults which included Sexual Health and Substance Misuse Services.  A diverse range of organisations had been commissioned to deliver these services such as third party organisations, local community and health providers including General Practitioners.

In response to a question from a Member, the Consultant in Public Health Medicine confirmed that in 2017/18, 45.1% of the 18,594 people invited had completed an NHS Health Check which was the highest recorded percentage in Bromley since the programme was introduced.  The target figure for NHS Health Checks for 2018/19 and data from the last five years would be provided to Members following the meeting.  Another Member underlined the importance of the Health Support to Schools programme and was pleased to note that the Council’s Executive was being recommended to agree additional funding to support the continued delivery of the service.

A Member highlighted that the Sexual Health London service, which offered an online self-sampling service to support good sexual health, had been launched in Bromley in July 2018.  Whilst the Sexual Health London service provided a cost effective alternative to sexual health clinics, it was noted that a recent increase in the rates of sexually transmitted infections would likely reduce any potential savings realised by the online service.

RESOLVED that the activity and performance of Public Health programmes during 2017/18 be noted.

Report CS18192

The Committee considered a report setting out statistics for complaints and compliments received by the Education, Care and Health Services Department during the 2017/18 financial year.  The report also provided oversight of the annual Local Government and Social Care Ombudsman letter which summarised complaints and enquiries the Ombudsman had received relating to the London Borough of Bromley for the 2017/18 financial year.

The Local Authority had received 510 complaints during the 2017/18 financial year which represented a 3% reduction on the previous year, including a significant reduction of 25% in complaints in the area of Adult Social Care where 183 complaints had been received.  Of the 510 complaints received, 44% were upheld.  58% of all complaints were responded to within 20 working days which was an increase on the previous year but continued to be recognised as an area of development that would be targeted by a training programme during 2018/19.  A number of compliments had been received about the work of individual Local Authority officers as well teams across the Education, Care and Health Services Department.  The Local Authority had been the subject of 165 referrals to the Local Government and Social Care Ombudsman which represented a 3% increase on the previous year.  Of the 165 referrals, 54 underwent a detailed investigation of which 30 (56%) were upheld, which was lower than the London average of 65% and the national average of 57%.  Following concerns raised by the Local Government and Social Care Ombudsman around the compliance rate for implementing Local Government and Social Care Ombudsman recommendations, the Local Authority had revised its approach to monitoring compliance, including where extended deadlines had been agreed, and between 19^th February 2018, when the Assistant Ombudsman had visited the Local Authority, to 31^st March 2018, 42 of 43 Local Government and Social Care Ombudsman deadlines had been met.

The Chairman highlighted that the number of complaints received was very small compared to the number of transactions undertaken for service users.

In response to questions from Members, the Head of Customer Engagement and Complaints (ECHS) confirmed that discrepancies in the response rate to complaints by different services was a result of a number of factors, including variations in the way complaints were handed across services.  Responses to complaints relating to safeguarding were often delayed to allow safeguarding procedures to be initiated.  Complaints were taken very seriously by the Local Authority and robust processes were in place to ensure that the learning from complaints fed into continual service improvement and was reflected in the training programme.

RESOLVED that the report be noted.

Report CS18191

The Committee considered a report outlining progress on the actions within the Adult Care and Health Portfolio Plan 2018-2022 during the six month period from 1^st April 2018 to 30^th September 2018.

The Adult Care and Health Portfolio Plan 2018-22 focused on four priority outcomes which comprised safeguarding, life chances, resilience and wellbeing, integrated health and social care and ensuring efficiency and effectiveness.  There were a number of statements within each priority which were underpinned by actions and measures of success.  By the end of Quarter 2 2018/19, progress had been made on actions across all priority areas.  Key achievements included agreeing the Adult Services Performance Framework, the recruitment of 15 newly qualified social workers, and achieving a 10% increase in participants of adult education courses from disadvantaged areas compared to the previous year.  A “Good” rating had been awarded to the Reablement Service following a recent Care Quality Commission inspection, and improved technology and mobile working arrangements had also been rolled out for Adult Social Care frontline staff.  Further actions to be progressed during the next six month period included the completion of a review into Adult Social Care, work to stabilise the Adult Social Care workforce, and publishing the new Health and Wellbeing Strategy with its associated work plans.  It was also planned to develop the Domiciliary Care Framework and develop and implement new Housing IT systems.

The Assistant Director: Strategy, Performance and Business Support (ECHS) outlined work being undertaken to further embed a culture of customer engagement within Education, Care and Health Services Department that would be supported by the User Voice Framework, an internal tool to support officers in consistently delivering quality engagement.  Further information on the User Voice Framework would be provided to Members following the meeting.

In considering the update, a Member noted that the review of the Occupational Therapy Service had recommended the creation of a permanent Service Lead and additional therapists to support the delivery of a more robust service and that recruitment was underway.  The Member underlined the importance of ensuring that any equipment requested by Occupational Therapists was provided to service users in a timely manner, such as handrails and stair lifts. 

In response to a question from a Member, the Assistant Director: Strategy, Performance and Business Support (ECHS) explained that it was a requirement under the Section 75 agreement that the Director: Public Health spend 40% of their time supporting the National Health Service, but that this primarily related to ensuring that Public Health made a proportional contribution to pieces of work undertaken by the National Health Service.  The Member also noted the aim to define a vision for Adult Social Care to set out a direction of travel for the future delivery of services, and the Director: Adult Social Care confirmed that it was necessary to have a continually evolving vision for the service to ensure it was well-placed to meet the changing demands of service users.

RESOLVED that progress made in achieving the  ...  view the full minutes text for item 47d

The briefing comprises:

• Adult Social Care Local Account 2017/18
• Education, Care and Health Services Risk Register - Quarter 2, 2018/19

Members and Co-opted Members have been provided with advance copies of the briefing via email.  The briefing is also available on the Council’s website at the following link:

http://cds.bromley.gov.uk/ieListMeetings.aspx?CId=559&Year=0

Printed copies of the briefing are available on request by contacting the Democratic Services Officer.

The Adult Care and Health PDS Information Briefing comprised two reports:

• Adult Social Care Local Account 2017/18
• Education, Care and Health Services Risk Register – Quarter 2, 2018/19

A Member highlighted the importance of publicising the Adult Social Care Local Account 2017/18, which should also reflect the voice of the service user.  The Director: Adult Social Care confirmed that the report had been produced in collaboration with a number of key partners and stakeholders, including service user groups, and would be publicised across the Borough, with an easy-read version available.  The Health and Wellbeing Board would be undertaking dementia training with a view to becoming Dementia Champions, and the Adult Care and Health PDS Committee would be invited to participate in this activity.

RESOLVED that the Information Briefing be noted.

RESOLVED that the Press and public be excluded during consideration of the items of business listed below as it was 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 exempt minutes of the Adult Care and Health PDS Committee meeting held on 19^th September 2018 be agreed.

The Committee considered the report and supported the recommendations.