Agenda and minutes

Apologies for absence were received from Lynn Sellwood and Barbara Wall.

The Chairman led the Committee in congratulating Councillor Aisha Cuthbert on the recent birth of her son.  Members also offered their thanks to the Committee Clerk who would shortly be leaving the Local Authority.  The Chairman stressed how grateful she was for the wise counsel and guidance given by the Committee Clerk.

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 Friday 18^th January 2019.

One written question was received from a member of the public and two oral questions were received from a Councillor and these are attached at Appendix A and B.

RESOLVED that the minutes of the Adult Care and Health PDS Committee meeting held on 21^st November 2018 be agreed.

Report CSD19004

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

With regard to Minute 47a: Bromley Safeguarding Adults Board Annual Report 2017/18 from the meeting of Adult Care and Health PDS Committee on 21^st November 2018, the Chairman advised Members that the Bromley Safeguarding Adults Board Manager was arranging an adult safeguarding training session for Members and that the date would be confirmed shortly.  Another Member underlined the importance of providing adult safeguarding training to Local Authority staff, including those within the Housing Service to support them in working with vulnerable Bromley residents.  In considering Minute 42: Update from the Director: Adult Social Care, a Co-opted Member advised that she was working with the Engagement Strategy Manager (ECHS) on revising the ‘easy-read’ Direct Payments leaflet to ensure it was fully accessible and had offered to provide support to the Local Authority on using Image Bank, and the Chairman requested a further update on this workstream at the next meeting of Adult Care and Health PDS Committee on 7^th March 2019.

In response to a question from a Member regarding the forward work programme, the Interim Director: Programmes confirmed that a range of robust measures were in place to monitor contracts and commissioning activity including the Contract Register and Contracts Database which was reported to the Committee on a quarterly basis.  Annual reports that reviewed both performance and service quality were provided to Adult Care and Health PDS Committee on all key contracts, and ad hoc reports were presented to the Committee where any major concerns were identified relating to a contract or commissioning issue. 

A Member suggested that the provision in place to support transition from child to adult mental health services be considered at a future meeting.  The Member also proposed that Oxleas NHS Foundation Trust be invited to attend a future meeting to outline the discharge process from in-patient mental health services and how service users were supported in the community.  The Interim Chief Executive was pleased to report that the Joint Mental Health Strategy developed in collaboration with the Bromley Clinical Commissioning Group would be presented to the next meeting of Adult Care and Health PDS Committee on 7^th March 2019.

The Chairman advised the Committee that the meeting of Health Scrutiny Sub-Committee due to take place on 29^th January 2019 had been postponed due to the unavailability of key health partners and a new date would be confirmed shortly.

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

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

A range of work was underway within the Education, Care and Health Services Department.  This included the recent launch of the ‘Wake up to Care’ workforce development programme which had been developed by the Local Authority in partnership with local education and care home providers.  Funded via the Improved Better Care Fund and the apprenticeship levy this programme aimed to support Bromley residents to build a career within the care system or as a personal assistant to clients in receipt of Direct Payments, and would benefit vulnerable residents in Bromley by developing a highly-skilled care workforce.  An update on the ‘Wake up to Care’ programme would be reported to the meeting of Adult Care and Health PDS Committee in January 2020, and consideration would also be given to marketing the model to other local authorities.  Key strategies including the Joint Mental Health Strategy, Ageing Well Strategy and Learning Disability Strategy had been developed collaboratively with the Bromley Clinical Commissioning Group and would be presented to the next meeting of Adult Care and Health PDS Committee on 7^th March 2019.  The Shared Lives Service was currently being inspected and the outcome of the Inspection would be reported to the Committee when available.

A Member suggested that the Local Authority directly employ care staff trained through the ‘Wake up to Care’ programme as part of a pool of talent rather than acting as a care broker for private providers.  Another Member noted changes to the organisation of Clinical Commissioning Groups towards a more regional model, and the Interim Chief Executive confirmed that the Local Authority was working closely with both the Local Accountable Officer for Bromley Clinical Commissioning Group and the Single Accountable Officer representing Bromley, Bexley, Greenwich, Lewisham and Southwark Clinical Commissioning Groups.  The Local Authority would continue to work collaboratively with its health partners with an increasing emphasis on integrated strategies, systems and processes.

RESOLVED that the update be noted.

Portfolio Holder decisions for pre-decision scrutiny.

Report FSD19010

On 28^th November 2018, the Council’s Executive received the 2^rd quarterly capital monitoring report for 2018/19 and agreed a revised Capital Programme for the four year period 2018/19 to 2021/22. 

The Committee considered the changes to the Capital Programme for the Adult Care and Health Portfolio which included the addition of £3M that had been approved by the Council’s Executive on 12^th September 2018 to fund a replacement Social Care Case Management System.  This would be funded through a total reduction of £0.3M to the existing PCT Learning Disability Programme and £2.7M to the existing Social Care Grant and Mental Health Grant capital schemes.

The Chairman welcomed the funding of the replacement Social Care Case Management System as it was important to ensure that social care staff were provided with the right tools to deliver high quality outcomes for Bromley residents.  The Interim Chief Executive explained that the new system would enable more integrated working with key health partners, and that in scrutinising the decision of the Council’s Executive, Members had requested that the new Social Care Case Management System be introduced as soon as possible.  A Member noted that funding from the PCT Learning Disability Programme would be used to support the scheme and the Head of Finance confirmed that this funding had been held by the Local Authority and was intended for use in capital projects.  A Member expressed concern at the cost of the scheme.

RESOLVED that the Portfolio Holder be recommended to confirm the revised Capital Programme agreed by the Council’s Executive on 28^th November 2018.

To Follow.

Report FSD19009

The Committee considered a report setting out the draft Adult Care and Health Portfolio Budget for 2019/20, which incorporated future cost pressures and initial draft saving options reported to the Council’s Executive on 16^th January 2019.  Members were requested to provide their comments on the proposed savings and identify any further action to be taken to reduce cost pressures facing the Local Authority over the next four years.

The Head of Finance advised Members that a number of pressures would continue to impact the Adult Care and Health Portfolio budget for 2019/20.  This included the challenges of the older demographic of the Borough, the impact of the National Living Wage on the provision of care sector services and the increasing complexity of need of clients presenting to adult social care.  There continued to be significant pressure in the area of Adult Social Care for which the Government had previously agreed non-recurring Improved Better Care Funding of £3.363M in 2019/20 and £1.677M in 2020/21 that would be utilised in agreement with the Bromley Clinical Commissioning Group. 

A Member noted that Chief Officers were exploring savings and income opportunities beyond those outlined within the draft Adult Care and Health Portfolio Budget for 2019/20 and requested further details on any savings or income opportunities identified.  The Member was concerned at references in the draft Budget to projected or planned savings for 2019/20, as anticipated savings may not be realised due to the demand-led nature of services within the Portfolio.  A Member responded by highlighting the robust budget monitoring processes in place to ensure future savings attributed to particular services would be monitored and adjusted throughout 2019/20.  The Interim Chief Executive was pleased to observe that demand-led pressures in the Adult Care and Health Portfolio budget for 2018/19 had been reflected in the increased budget for 2019/20.  In-year mitigation was part of the process of managing cost pressures on the budget, and this would be further supported by a transformation programme to be undertaken across the Local Authority during the first half of 2019 that would include a root-and-branch analysis of every service. 

A Member was concerned at the costs related to the transfer of the Contract Monitoring and Compliance Team from Resources, Commissioning and Contracts Management Portfolio, and underlined the need to monitor the cost of the commissioning process.  The Interim Director: Programmes reported that a full range of budget information was included in all contract reports.  The Head of Finance further noted that any savings realised through commissioned services were reflected in the Portfolio budget and reported throughout the year as part of the regular budget monitoring process.  In response to a query from the Member, the Head of Finance confirmed that a number of information and early intervention programmes would be funded within the Portfolio during 2019/20, including the continuation of long term contracts with Bromley Well and carers support services. 

Another Member queried funding for Public Health services for 2019/20, and the Head of Finance clarified that  ...  view the full minutes text for item 59a

Report ECHS19005

The Committee considered a report providing an update on the current level of Education, Care and Health Services Department debt and the action being taken to reduce this.

The level of Education, Care and Health Services debt as at 30^th September 2018 was £12.3M of which £5.1M was less than a year old.  For the 12 months prior to 30^th September 2018, the Local Authority had raised 5,432 invoices to the value of £26,339,514 on behalf of Education Care and Health Services, and as at 30^th September 2018, £1,787,662, which represented 6.8% of the invoices raised remained outstanding of which 30% were less than 30 days old.  The value of unpaid invoices over one year as at 30^th September 2018 was £1,390,087, which was an increase of £122,318 on the debt position as at 30^th September 2017.  It was recommended that £265k of pre-2015 debts mainly due to deceased clients with insufficient funds in their estate be written off.  There was an increased focus on early intervention and a number of measures were being taken to support vulnerable clients and their families to reduce the build-up of debt and speed up the recovery process for social debt.  This included a six month pilot scheme in which a Care Management Assistant provided support to clients in receipt of services who had been assessed as lacking the mental capacity to manage their finances which had enabled 146 client cases to be reviewed and for £43K of £118k debt to be successfully recovered from 19 clients.  The cases of 127 clients had also been progressed with various solutions applied which were likely to impact the final debt levels for 2018/19.  Funding had now been agreed for a permanent Care Management Assistant role and a Recovery Visiting Officer within the Exchequer Contract with the expectation that these roles would be self-financing as a result of increased income collection.  Debts related to temporary accommodation had also been included in the report and showed an increase in the volume of outstanding debts of £903K in September 2017. 

In considering the report, a Member was concerned to note increasing debt related to temporary accommodation.  The Assistant Director: Exchequer Services confirmed that the increase in debt reflected the increase in the number of households being placed in temporary accommodation.  Work was undertaken to ensure that households residing in temporary accommodation applied for Housing Benefit and other benefits from the earliest possible date and that residents were referred to the Debt Advice Team within the Housing Service where it was identified they required additional support.  Households were not offered permanent accommodation by the Local Authority until outstanding temporary accommodation debt had been resolved.

A Co-opted Member highlighted the difficulties faced by people who had been discharged from in-patient hospital or mental health services as their benefits were often stopped for the duration of their admission.  It was key to provide these vulnerable residents with housing and debt support, and make them aware  ...  view the full minutes text for item 59b

Report ECHS19002-1

The Committee considered a report setting out the quality monitoring arrangements for registered care homes, supported living schemes and extra care housing schemes in Bromley and reviewing performance for 2018/19. 

The Contract Compliance Team was responsible for monitoring social care contracts as well as the quality of care offered to Bromley residents in care homes, supported living and extra care housing schemes.  A range of tools were used by the Contract Compliance Team including a comprehensive Quality Assessment Framework tool that was completed for each care setting during the annual monitoring visit.  The Local Authority adopted a policy in January 2018 to ensure that no new care placements were made with care home providers rated less than ‘Good’ by the Care Quality Commission.  The majority of the care homes in the Borough were rated as ‘Good’, with 8 providers receiving an overall rating of ‘Requires Improvement’ and 1 provider rated as ‘Inadequate’ as at December 2018.  During 2018, Officers from the Local Authority and Bromley Clinical Commissioning Group had continued to work together in the Care Home Programme Board which had realised a number of achievements including the adoption of joint quality assessment framework, the introduction of the red bag scheme and a review of the General Practitioner resources available to care homes with a number of changes due to be implemented in April 2019.  The Committee was advised that changes had been made to the way that the Contract Compliance Team reported the rating for care homes across the Borough. Prior to January 2018, 19 registered care homes for people with learning disabilities and mental health problems had been included in the performance report but this was now reported separately.

The Head of Contract Compliance and Monitoring confirmed that Bromley Park Care Home had been inspected by the Care Quality Commission in late 2018 and was now rated as ‘Good’. 

In considering the report, a Member was concerned that by monitoring care homes, the Contract Compliance Team was duplicating the work of the Care Quality Commission.  The Head of Contract Compliance and Monitoring confirmed that the Local Authority’s focus was to act as a ‘critical friend’ supporting care homes to maintain a consistently high quality service, as it was possible for the quality of care to change significantly between Care Quality Commission Inspections.  The Interim Chief Executive emphasised the Local Authority’s statutory obligation to safeguard care home residents and noted that maintaining high quality care home provision across the Borough was beneficial to Bromley residents.  The Interim Director: Programmes further observed that the Contract Compliance Team was able to provide immediate support in cases where a problem was identified within a local care home including where care home residents might be at risk.

A Co-opted Member queried why there were no care homes currently rated as ‘Outstanding’ within the Borough.  The Head of Contract Compliance and Monitoring explained that the focus of the Contract Compliance Team was on maintaining care home standards and supporting them to improve.  ...  view the full minutes text for item 59c

Report ECHS19006-1

The Committee considered an extract from the Contracts Register which provided key information concerning contracts within the Adult Care and Health Portfolio with a total contract value greater than £50k.

There were 86 contracts within the Adult Care and Health Portfolio with a total value greater than £50k as at 28^th November 2018.  One contract had been flagged as being of concern.  This was in relation to the tight timescales to identify future delivery options for Adult Passenger Transport Services and work was underway to address this issue.

RESOLVED that:

1)  The review of the £50k Contracts Register as at 28^th November 2018 be noted; and,

2)  It be noted that the corresponding Part 2 (Exempt) Contracts Register (Report ECHS19006-2) contained additional and potentially commercially sensitive information in its commentary.

The Chairman led a discussion on the Chairman’s annual report of the Adult Care and Health PDS Committee, due to be provided to the meeting of Executive, Resources and Contracts PDS Committee on 20^th March 2019. 

A Member noted work underway to invite providers of high value contracts as well as service users to contribute to future meetings of Adult Care and Health PDS Committee and suggested that this be included as part of the Committee’s objectives for 2019/20.

RESOLVED that the Members’ comments 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.

In considering the exempt minutes, Councillor Angela Wilkins underlined the need for Part 1 (Public) information discussed in the Part 2 (Exempt) section of the agenda to be reported in Part 1 (Public) wherever possible.

RESOLVED that the exempt minutes of the Adult Care and Health PDS Committee meeting held on 21^st November 2018 be agreed.

Report ECHS19002-2

The Committee considered a report setting out Part 2 (Exempt) information related to the quality monitoring arrangements for registered care homes, supported living schemes and extra care housing schemes in Bromley and reviewing performance for 2018/19. 

The Contract Compliance Team visited every care home in the Borough on an annual basis with more frequent visits made to care homes rated by the Care Quality Commission as ‘Inadequate’ or ‘Requires Improvement’ to ensure that improvement work was being undertaken in line with Care Quality Commission or Local Authority action plans.  The monitoring process was supported by a dashboard of indicators developed by the Local Authority which gave a RAG rating to key areas within the Quality Assessment Framework comprising care documentation and planning, observation of care delivery, management of health needs, nutrition, activities, staffing, Quality Assurance systems, environment and the overall rating.  Concerns had recently been identified regarding aspects of provision at Foxbridge House and Florence House, both rated as ‘Good’ by the Care Quality Commission, and the Contract Compliance Team was working with both care homes to resolve these issues.

RESOLVED that the report be noted.

Report ECHS19006-2

The Committee considered an extract from the Contracts Register which provided key Part 2 (Exempt) information concerning contracts within the Adult Care and Health Portfolio with a total contract value greater than £50k.

There were 86 contracts within the Adult Care and Health Portfolio with a total value greater than £50k as at 28^th November 2018.  One contract had been flagged as being of concern.  This was in relation to the tight timescales to identify future delivery options for adult passenger transport services and work was underway to address this issue.

In considering the contract flagged as being of concern, the Interim Director: Programmes confirmed that it was planned to introduce a joint model for children’s and adults’ passenger transport services from 1^st September 2020.  The existing contract for adult passenger transport services would end on 31^st August 2019 and there was a need to identify how this service would be delivered prior to the introduction of the new service model.  A range of options were being actively explored including working with existing passenger transport providers and referring service users to alternate transport services where appropriate, and the Local Authority was continuing to work with the existing provider to identify if the current contract could be extended for a one year period.  An update on this work would be presented to the meeting of Adult Care and Health PDS Committee on 7^th March 2019.

RESOLVED that:

1)  The review of the £50k Contracts Register as at 28^th November 2018 be noted; and,

2)  It be noted that the Part 2 (Exempt) Contracts Register (Report ECHS19006-2) contained additional and potentially commercially sensitive information in its commentary.