Agenda and minutes

Apologies for lateness were received from Cllr Cuthbert.

In relation to Minute 71a (Joint Mental Health Strategy), Cllr Jeal declared that he was a volunteer at the Homeless Shelter.

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 1^st March 2019.

No questions had been received.

The Portfolio Holder for Adult Care and Health clarified that the Portfolio Holder for Renewal, Recreation and Housing had provided the response to the Supplementary Question concerning the Bromley Welfare Fund.

Concerning Minute 59c, Members also noted that the policy to ensure that no new care placements were made with providers rated less than ‘Good’ was adopted in January 2018 (not January 2019 as stated in the minutes).  The Committee noted that the Care Quality Commission Inspection of Bromley Park Care Home had taken place in late 2018.

Subject to the amendments outlined above, the minutes of the meeting of the Adult Care and Health PDS Committee held on 24^th January 2019, were agreed and signed as a correct record.

Report CSD19025

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

In respect to Minute 59d, the Head of Early Intervention, Prevention and Community Services Commissioning reported that options around the Adult Transport Service were being developed and would be presented to Members at the Committee’s meeting in June 2019.  As soon as a preferred option had been identified staff and service users would be informed.  The Interim Chief Executive provided assurances that there would be no disruption in service delivery in September.

With reference to Minute 84, the Committee recommended that the programme to invite providers and service users to future meetings of the Adult Care and Health PDS Committee commence in the new municipal year.

The Committee recommended that the following additional items be added to the work programme for the June meeting:

• Adult Transport Service
• Update on the  Voluntary, Community And Social Enterprise Support (VCSE) Contract
• Joint Mental Health Strategy Update

RESOLVED: That the matters arising from previous meetings and the forward programme be noted.

The Interim Chief Executive gave an update to Members on work being undertaken across the Adult Care and Health Portfolio.

The Interim Chief Executive began his presentation to the Committee by extending his thanks and best wishes for the future to Stephen John, the previous Statutory Director of Adult Social Care, who had retired at the end of February 2019.  The Committee also extended its thanks to the former Director and welcomed Kim Carey, the new Interim Director of Adult Social Care who would be supporting the work of the Committee in the new municipal year.  The new Interim Director of Adult Social Care explained to the Committee that she had worked within Adult Social Care for over 30 years.  Previously she had held the role of Executive Director for Adults Health and Wellbeing in Cornwall and more recently had held a number of interim roles where she was required to bring a fresh pair of eyes to services and provide challenge and structure.

The Committee noted that in a report released on 27 February 2019, Bromley had been listed as one of the top 10 Councils providing Adult Social Care.  The list^[1] published in the leading trade magazine the Municipal Journal (MJ) by iPOWER considered factors such as value for money and service delivery.  On behalf of the Committee, the Chairman congratulated staff on the remarkably impressive good news story and thanked all those involved in Adult Social Care for their work and dedication.  It was suggested that a press release, outlining the findings of the survey, should be circulated.

The Interim Chief Executive reported that two workforce development sessions were planned for April 2019.  The aim of the sessions were to attract new, permanent Social workers and Care Managers to Bromley.  Levels of pay between social workers for children and social workers for adults had been equalisied and it was anticipated that this would assist with the competition for staff that currently existed between local authorities.  In response to a question, the Interim Chief Executive confirmed that the model that had been used in Children’s Social Care would be rolled out within Adult Social Care.  The aim was to increase the number of permanent social workers within the Local Authority.  The Departmental Senior Leadership Team were working with the Director of HR to identify and highlight the key benefits of working for Bromley.  As with children’s social workers; contracts would be turned around quickly.  Newly Qualified Social Workers would be given full training and there was an acknowledgement that there was a need to support and develop new talent.  In addition to the work around recruitment; there would also be a focus on staff retention in terms of workforce development.  The Interim Chief Executive confirmed that the provision of a lease car would be included in social workers’ contracts if this was necessary for the purpose of recruitment and retention.  The parameters of the car lease scheme were clear and managers would ensure that any expenditure remained  ...  view the full minutes text for item 68.

The Portfolio Holder for Adult Care and Health responded to questions from Members:

In response to a question concerning the preparations for Brexit and specifically the supply of carers, the Portfolio Holder confirmed that no concerns had been raised by senior officers who had been working with providers.

The Portfolio Holder also confirmed that the Joint Mental Health Strategy presented to the Committee was draft and issues arising out of current national concerns around gang affiliation and knife crime could be incorporated into and reflected in the strategy going forward.

Portfolio Holder decisions for pre-decision scrutiny.

Report FSD19026

On 13^th February 2019, the Executive received a report summarising the current position on capital expenditure and receipts following the 3^rd quarter of 2018/19, and presenting for approval new capital schemes in the annual capital review process.  The Executive agreed a revised Capital Programme for the five year period 2018/19 to 2022/23.  The report considered by the Adult Care and Health PDS Committee highlighted the changes agreed by the Executive in respect of the Capital Programme for the Adult Care and Health Portfolio.  The revised programme for the Portfolio was set out at Appendix 1 to the report.

RESOLVED: That the Portfolio Holder be requested to note and confirm the changes put forward for approval to the Executive on 13^th February 2019.

Report FSD19021

The Committee considered a report providing the budget monitoring position for 2018/19 based on activity up to the end of December 2018.

The Committee noted that there was a projected underspend of £13,000 on the controllable budget.  Full year effect cost pressures of £2,064,000 in 2019/20 were also noted.  Members further noted the request for the drawdown of funding Central Contingency in respect of the Adult Social Care Support Grant (£744,000) and the Winter Pressures Grant (£1,190,000).

A Member suggested that in order to enable the Committee to better understand the figures, in future it would be helpful more detailed information surrounding the services being provided within the available budget.

A Member expressed concerns surrounding the possible reduction in the availability of day center services.  The Interim Chief Executive responded by highlighting that direct payments provided the flexibility for clients to decide on their own care package and it was for clients to decide on the services on which they wanted to use their direct payment.  Members noted that the increasing cost of transport and day centers may act as a disincentive for many of the current services users.  This would lead to an unsustainable decline in demand with the services no longer being financially viable.  As this would ultimately limit the choice available to the few who did want to use day centers it could be argued that there was a role for the Local Authority to play in ensuring that the market was sustainable.  The Interim Chief Executive confirmed that through the Commissioning process the Local Authority sought to sustain and develop the market.  Officers were looking at ways to encourage the development of the private market through the provision of advice around key actions that could be taken.  The Interim Chief Executive agreed to provide further information about the work being done around the development of the market following the meeting.

Citing the example of ‘Planned LD savings from management action’, a Member expressed concern about planned savings from management action being included in the budget monitoring figures as such savings may not be delivered.  The Head of Adult Social Care, Health and Housing Finance confirmed that some of the savings had been achieved and it was acknowledged that whilst a plan was in place for the delivery of the savings there did remain some uncertainty.  The Interim Director of Adult Social Care confirmed that work was ongoing to ensure that savings identified through management action were realistic and deliverable.  Members requested that the Financial Outturn Report provided detail of the financial effect of any management action taken in the 2018/19 financial year as it was important for Members to know and understand the impact of any action that was taken, both on the budget and on service users.

The Chairman requested that the Committee be provided with the information it had previously requested about the financial modelling tool as it was important for Members to receive this feedback.

A Member queried the £31,000 credit  ...  view the full minutes text for item 70b

Report ECHS19028

The Committee considered a report seeking approval for an extension of the contract for support services to voluntary and community sector organisations for one year.  This would result in a revised contract termination date of 31 March 2020.

The ‘Support Services to Voluntary and Community Sector Organisations’ (VCSE) contract with Community Links commenced on 1 April 2018 and was due to expire on 31 March 2019.

The service was commissioned to deliver four service components: Volunteer Brokerage; Developmental Advice and Support; Community Outreach; and Policy/Partnership Agendas.

The option to extend for one year was included in the contract, with no further option to extend after the 31 March 2020. There was a budget provision of £48,000 to meet the cost of the one year extension phase.  The aggregate value of the contract and the extension detailed in the contract was £96,000 and would usually fall within the approval domain of the Chief Officer (in accordance with the Scheme of Delegation). However additional funds were made available outside the contract at a value of £24,000 which was a bridging arrangement to support the establishment of the Bromley Third Sector Enterprise.  The value of the proposed extension would result in a cumulative commitment of £120,000. Consequently permission was being sought from the Portfolio Holder, to grant an extension to the contract until 31 March 2020.  The extension phase would facilitate a commissioning options appraisal process which would subsequently inform the future commissioning arrangements for support to the voluntary sector.  The Committee noted that the outcome of an options appraisal for future commissioning intentions post March 2020 would be presented to the Chief Officer and Portfolio Holder in May 2019.

The Committee expressed concern that due to the timescales involved there was very little option but to agree to the extension.  It was noted that an equality impact assessment had not been included in the report to Members and officers were reminded that such assessments should be included where necessary.

Following a detailed discussion it was agreed that a further report should be brought back to the June meeting of the Committee.  The report should provide further information such as: staff breakdown; the number of hours provided; what the staff were instructed to deliver; and details of contract and performance monitoring over the last 12 months.

A Co-opted Member recognised that there was limited HR capacity available to voluntary organisations and it was suggested that a clearer set of objectives would be welcomed.

RESOLVED: That the Portfolio Holder be recommended to approve the extension of the Supported Services to Voluntary and Community Sector Organisations contract for one year, resulting in a revised contract termination date of 31 March 2020.

Report ECHS19029

The Committee considered the Joint Mental Health Strategy for Bromley 2019-2025 developed by the London Borough of Bromley and the Bromley Clinical Commissioning Group.  The Joint Mental Health Strategy for Bromley set out the vision for promoting better mental health and emotional wellbeing in the Borough.

The Committee thanked Officers for the comprehensive document that had been provided noting that the Strategy before Members addressed one of the most significant issues currently facing society.  Members stressed it was therefore important that the actions included within the Strategy were both appropriate and deliverable.  Whilst acknowledging the significant amount of work that had already gone in to developing the comprehensive strategy, Members made the following comments, observations and suggestions:

• The interface between Adult Mental Health Services and Child and Adolescent Mental Health Services (CAMHS) was unclear as was how the development of the 0-25 pathway fitted into the Strategy.
• There needed to be further clarity around re-entry into the system in the event of a relapse.  This would demonstrate an understanding that recovery may not always be permanent and that mental health issues were often cyclical.
• There needed to be further consideration of demographics with an acknowledgement that different mental health issues could affect different groups within society in different ways.  There also needed to be consideration of possible cultural and language barriers experienced by minority communities trying to access services.
• It was noted that the LGBT community was invisible within the Strategy and there was no consideration of the different barriers and difficulties accessing services experienced by the LGBT community.
• There needed to be an acknowledgement that individuals suffering with mental health conditions may need to access services in different ways and that a ‘one size fits all’ approach to access may not be appropriate.  In addition, consideration needed to be given to the most appropriate mechanism for reaching more isolated communities.
• Currently little consideration appeared to have been given to people who had more limited access to the internet or homeless people experiencing mental health episodes who may be prevented from accessing services due to the lack of a permanent address.
• More information about early intervention and how and when it might occur needed to be included within the Strategy.
• Individuals who were held in police custody suites or those coming out of prison or on probation were not reflected in the Strategy and it was suggested this was an oversight as this specific group were known to be vulnerable to mental health issues.
• It would be helpful to have further information concerning extra care and dementia patients along with projections around the number of extra care units that would be needed.
• There was no reference to the “Healthy Mind” work that had been undertaken by King’s.  Reference also needed to be made in the document to the Bromley Health and Wellbeing Strategy as loneliness and isolation were recognised as key issues.
• The Military Covenant and the specific mental health issues experienced by ex-servicemen needed to be reflected  ...  view the full minutes text for item 71a

The Committee considered the Chairman’s annual report of the Adult Care and Health PDS Committee.  The report would be included in the Council’s Annual Scrutiny Report represented to the meeting of Executive, Resources and Contracts PDS Committee on 19^th March 2019 and approved by Full Council on 8^th April 2019.  The Chairman thanked all Members and Co-opted Members for the significant contribution they had made to the PDS Committee during the 2018/19 municipal year.

The Chairman requested that Members provide any further comments on the annual report to the Clerk to the Committee following the meeting.

RESOLVED that the report be noted.

Report CSD19037

At its meeting on 7^th February 2019, the Executive, Resources and Contracts (ERC) PDS Committee considered a report on expenditure on consultants across all Council departments for both revenue and capital budgets.  The ERC PDS Committee referred the report to all the Council’s PDS Committees for detailed scrutiny.

Members sought and received reassurance that processes were in place and guidance issued to managers to ensure that there would be no tax and national insurance liability for the use of consultants going forward.

The Committee noted that there had been a requirement for consultants to conduct independent investigations  into certain complaints concerning Adult Social Care.

RESOLVED: That the report 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.

Whilst noting that the Part 2 were an accurate reflection of the meeting it was noted that there was nothing in the minutes that warranted them being classified as exempt under the Act.  It was therefore agreed that the minutes should be moved to Part 1 and published on the website.

RESOLVED: That the Part 2 minutes be declassified and published on the Council’s website.