Agenda and minutes

Apologies for absence were received from Councillor David Jefferys and Councillor Kira Gabbert attended as substitute.

Councillor Robert Mcilveen submitted apologies as he would need to leave the meeting by 9pm.

Lynn Sellwood declared a pecuniary interest in relation to item 9.e, in her role as Chair of the Voluntary Sector Strategic Network (VSSN).

In accordance with the Council’s Constitution, questions that are not specific to reports on the agenda must have been received in writing 10 working days before the date of the meeting. 

Questions specifically on reports on the agenda should be received within two working days of the normal publication date of the agenda.  Please ensure that questions specifically on reports on the agenda are received by the Democratic Services Team by 5pm on Wednesday 13th November 2019.

No questions had been received.

The minutes of the meeting held on 17^th September 2019, were agreed and signed as a correct record.

A Member requested an update in relation to the systems change referenced in the minutes of the last meeting. The Director of Adult Social Care advised that this was in relation to the Director’s update concerning the Transformation Programme. The Director explained that she had been suggesting that there was not always a systematic approach taken to work flow and processes across the Service. Some “quick wins” had already been implemented, however the Transformation Programme was a four year programme and the review of processes was ongoing. The Assistant Director for Strategy, Performance and Corporate Transformation advised the Committee that the budget for the Social Care Information Management System had been approved, and the tender process had been agreed. It was envisaged that the contract would be award in April / May 2020, and the system would take two years to implement. In response to a question, the Director of Adult Social Care said that they were already seeing changes to staff culture and attitudes, with them “buying into” the Transformation Programme.

Report CSD19162

The Committee considered a report setting out matters outstanding from previous meetings and the proposed work plan for 2019/20.

The Co-opted Member representing Bromley Experts by Experience informed the Committee that the Bromley Mental Health Forum had recently appointed a Chairman, who had expressed an interested in becoming a Co-opted Member of the Adult Care and Health PDS Committee.

The Chairman explained that in respect of the action for providers to be invited to present at future meetings of the Adult Care and Health PDS Committee, she was not satisfied with the reason given for the lack of progress. The Director of Adult Social Care advised that finding appropriate providers to present was a complex issue, as the Council purchased care from a number of single providers, and there was no collective forum representing the providers. Other PDS Committees were able to scrutinise providers as the contracts were delivered by one organisation, but these specific contracts were delivered by a large number of different providers. It could be difficult to select which providers were invited to attend and talk to the Committee, as to the Council must not appear to be offering differential treatment. The Chairman requested that, in order to draw a line under this issue, by the next meeting clear recommendations to Members should be made concerning whether it was appropriate to invite any of the providers to present to the Committee.  If it was not considered feasible to invite particular providers that recommendation should be made to the Committee and the outstanding action laid to rest.

In relation to a schedule of potential visits to care home, the Chairman noted that again, she did not accept the reason given for the lack of progress. It was requested that a visit be arranged in late January 2020 and another in late February / early March. The details of these visits to be circulated to the Members of the Adult Care and Health PDS Committee, and relevant Ward Councillors as soon as possible. The Assistant Director for Strategy, Performance and Corporate Transformation advised the Committee that Officers had been conducting a review of how visits were undertaken, which had contributed to the delay. It was intended that early in the new year, an annual programme of visits would be published to maximise attendance. The Director of Adult Social Care noted that a previous request to schedule visits outside of normal working hours had also been taken back to the department.

RESOLVED: That the report be noted.

Report CSD19163

The Committee considered a report seeking confirmation of the Bromley Healthwatch Co-opted Member to the Adult Care and Health PDS Committee for 2019/20.  Members noted that Healthwatch Bromley had indicated that their representative would attend only meetings of the Health Scrutiny Sub-Committee, unless specific issues required their attendance at any meeting of the Adult Care and Health PDS Committee.

RESOLVED: That Mina Kakaiya be co-opted to the Adult Care and Health PDS Committee and Health Scrutiny Sub-Committee as Healthwatch Bromley representative for 2019/20.

The Director of Adult Social Care gave an update to Members on work being undertaken across the Adult Social Care department.

In respect of recruitment, all but two members of the senior team were now permanent staff, and a strong team had been established to take the service forward. There had also been a continued reduction in the use of agency staff, which was significantly important to create consistent and sustainable teams. In response to a question, the Director of Adult Social Care said that details of the senior team and their responsibilities would be included in the corporate document, and they would be encouraged to attend a future meeting of the Adult Care and Health PDS Committee.

The Transformation Programme was progressing well and staff were actively involved in putting forward their suggestions for driving efficiencies across the Service and promoting change. The Director of Adult Social Care noted that the attitude and energy of staff had been very positive, and a report would be provided to a future meeting of the Adult Care and Health PDS Committee. In response to a question, the Director of Adult Social Care said that they were currently considering around 500 comments received from staff following the session, and would engage with staff and provide feedback in relation to the ways in which the suggestions from staff had been incorporated into the Transformation Programme.

The Director of Adult Social Care advised the Committee that the Service was almost ready to offer a contract in relation to Discharge to Assess (D2A). Proposals would be considered by the Executive in January and the Committee agreed that, due to the tight timescales involved, the proposals would be emailed to Committee Members for comment and pre-decision scrutiny.

RESOLVED that the update be noted.

Report ACH19012

The Committee considered the first 6 monthly update of the Adult Care and Health Portfolio Plan 2018-2022.

The Assistant Director for Strategy, Performance and Corporate Transformation advised the Committee that the document was a three-year plan, which was refreshed annually. It included ongoing actions and anticipated dates for actions to be completed, as previously requested by the Committee. The Director of Adult Social Care noted that the document covered everything that was being undertaken across the department, except the duties carried out day to day.

A Member noted that Priority 2 – Life chances, resilience and wellbeing referenced the ‘Shared Lives Improvement Action Plan’, and requested that a copy of the document be circulated to the Committee.

In respect of the integrated health services, the Committee asked if Officers were happy with how this was progressing. The Director of Adult Social Care said that it was working well and a positive relationship with the health provider had been established. There was only one joint commissioning role (CCG and LBB) that was being considered, whilst all other staff would remain employed by their current organisations. In response to a question, the Director of Adult Social Care confirmed that the Service Level Agreements (SLAs) clearly stated that statutory responsibilities remained with the relevant statutory authority.  It was agreed that the wording of this specific part of the SLA would be circulated to the Member.

Members expressed that it was important to ensure that new IT systems worked well, but noted that the target date of 2022 seemed to be a long way off with a risk that elements could become “out of date” during this time. The Assistant Director for Strategy, Performance and Corporate Transformation advised that during the first year, people with the right expertise had been brought in to write the specification, and there was a nine-month procurement process. The implementation of the software also needed to be aligned with the introduction of the new Council-wide IT systems and hardware to ensure that the database ran on the IT provided. Some users of the system were not LBB staff, and discussions had been taking place with the provider of the Exchequer contract to check that their systems were compatible with the new system. The Chairman highlighted that it was essential that users were involved with the implementation of the system to get buy-in.

The Co-opted Member representing the Bromley Safeguarding Adults Board informed the Committee that a Transitional Safeguarding Workshop had recently taken place, and work had started to review the transition from children to adults. The Assistant Director for Strategy, Performance and Corporate Transformation agreed that this would be added to the end of year report.

RESOLVED: that the report be noted.

Portfolio Holder decisions for pre-decision scrutiny.

The Committee considered the following report where the Adult Care and Health Portfolio Holder was recommended to take a decision.

Report ACH19018

The Committee considered a report presenting options in respect of the contract to provide a respite service for carers of older people with dementia to help them maintain their caring roles in recognition of the current contract expiry date and the pressure upon the allocated budget.  The report sought Portfolio Holder agreement to progress in accordance with the recommended Option 2 detailed in the report which was to extend the contract with Bromley, Lewisham and Greenwich (BLG) Mind for one year at increased rates and introduce charging for services in 2020/21, moving to direct payments in 2021/22.

Noting that there was a Part 2 report accompanying the Part 1 report, a Member questioned whether the Part 2 minutes could be published following the award of contract.  The Committee discussed the suggestion and another Member advised that even once the contract was awarded there would remain sensitivities around some of the commercial information reflected in the Part 2 report.  The Member suggested that it may be possible to publish information around scoring as this would need to be provided to all tenderers however, there needed to be a clear commitment to respect that sensitive commercial information would remain in Part 2 following award of contract.

Members of the Committee expressed a number of concerns with the proposals. The Integrated Strategic Commissioner confirmed that financial assessments would focus on the service users.  However, Members were concerned that in many cases spouses took on caring responsibilities and in these cases the household income would be subjected to the financial assessment.  The Committee was further concerned that, to date, no equalities impact assessment had been completed.

Turning to the financial impacts of the decision, Members were concerned that the report contained no detailed explanation of any additional costs to the Council that may arise as a result of the proposals.  A Co-opted Member highlighted that unpaid carers were a very valuable and much needed network and nothing should be done to discourage unpaid carers.  Another Co-opted Member expressed concern that there could be safeguarding implications for carers arising from the proposals if some service users took the decision not to pay for respite care.  A Member noted that the report did not provide any indication of the cost to the Council in the event that carers were unable to secure respite care resulting in the person with dementia needing to move into a care home.  Ultimately, a number of Members expressed the view that it could be a mistake to introduce charging.  Members noted that the charging would be means tested however there was no clear indication of what the impact of charging would be and this information was essential to enable the Committee to make an informed decision.

The Head of Complex and Long-Term Commissioning explained that BLG Mind had indicated that the contract could not be extended without a change to the hourly rates.  It was also being proposed that there was a move to direct payments in line with  ...  view the full minutes text for item 39a

Report FSD19098

The Committee considered an update on the budget monitoring position for 2019/20 for the Adult Care and Health Portfolio based on activity up to the end of September 2019.

There was currently a projected overspend of £603k on controllable expenditure, based on information as at September 2019. It was noted that this figure assumed Executive approval of £700k Better Care Fund (BCF) underspend being carried forward from the previous year, which the CCG had agreed to the use of this funding. It could not be assumed that similar use of BCF underspends would be available the following year.

In response to a question, the Director of Adult Social Care said that there were savings included in the 65+ budget attributed to discharge to assess (D2A). However, these anticipated savings had not been achieved and the cost to the Council had in fact increased.

In respect of respite care, work would be undertaken to ensure that financial assessments were carried out in a timely way and users were contributing towards their care if they were able to do so.

In response to a question, the Director of Adult Social Care said that the Manager of the Learning Disability Service was now in a permanent role, and only two agency staff remained. The Head of Finance for Adults, Health and Housing confirmed that the figures provided were a year-end projection, and that if permanent staff were to fill the positions, the overspend would be reduced.

A Member considered that there was more demand than had been budgeted for, and asked for an update in relation to the care homes options appraisal. The Director of Adult Social Care advised that a report on this had been provided to the Leader for consideration.

In relation to the summary of care packages, a Member noted that the

projection for 65+ Domiciliary Care packages was 70% above the budget. The Director of Adult Social Care advised that this was linked to the pressures on the budget, and the anticipated D2A and reablement savings not being made. It was further queried why no budget had been included for the Shared Lives element of care packages, both 18-64 and 65+. The Head of Finance for Adults, Health and Housing agreed to provide further information following the meeting.

RESOLVED: That the Portfolio Holder be recommended to

1.  Note the projected overspend of £603k on controllable expenditure, based on information as at September 2019; and

2.  Recommend that Executive approve the allocation of £700k from the Better Care Fund to offset pressures in Adult Social Care as set out in the report.

The Committee considered the following reports on the Part 1 agenda for the meeting of the Executive on 27 November 2019

Report CSD19180

The Committee considered a report presenting the results of a tendering process for the provision of the 0-19 Public Health Nursing Service.

The contracts for the provision of 0-4 Years Health Visiting Service (incorporating Family Nurse Partnership), Primary Screening (Vision screening and National Child Measurement Programme in Primary Schools) and Health Support to Schools would expire on the 30^th September 2020. There were no further options to extend the current contracts. The 0-4 Years Health Visiting Service had an annual value of £3,288k per annum, the Primary Screening Service had an annual value of £165k per annum and the Health Support to Schools Contract had annual value of £603k per annum. On 2^nd August 2019, the Council’s Executive had approved continued funding of all the contracts and to retender a combined service incorporating all three.

RESOLVED: That the report be noted.

Report ACH19017

The Committee considered a proposal to extend the block contract with Certitude for Supported Living, Respite and Day Services for adults with a learning disability (LD) for two years with a new contract commencing on 1st October 2022. The current contract commenced on 1st October 2015 for an initial term of 5 years ending on 30th September 2020. There was an option to extend the contract for up to 2 years to 30th September 2022. The annual value of the contract was estimated at £3,878k, and the cost of the 2 year extension would be £7,576k - giving a whole life contract value of £27,454k.

It was proposed that an LD Strategic Board formed of Service Users, parents and other key stakeholders be established along with a communication strategy to ensure visibility of action and progress and a critical oversight function.

The Committee noted that recommendation 2.2 was for the Executive to nominate an Elected Member to sit on the LD Strategic Board. A Member asked which other stakeholders would be involved in the strategic board. The Strategic Commissioner responded that Terms of Reference had not yet been produced, however he had spoken with Bromley Mencap, and had been looking at the set-up of other LD Strategic Boards across the country. The Chairman therefore suggested that the nomination of an Elected Member should be postponed until Terms of Reference and details of best practice in other areas were available.

The Strategic Commissioner advised the Committee that this was a Gateway “-1 report”, to allow business cases reflecting what Member input to be brought to Committee in spring 2020.

RESOLVED: That the Executive be recommended to

1) Agree the extension of the contract with Certitude for a period of up to 2 years from 1st October 2020 to 30th September 2022 at a total cost of £7,758k.

2) Nominate an Elected Member to sit on the LD Strategic Board, once Terms of Reference had been provided.

Report ACH19010

The Council had operated a number of separate contracts with specialist Learning Disability (LD) providers to provide care and support into various LD supported living properties within the Borough. A report had previously been taken to Executive on 10^th July 2019 where Executive approved aligning the end dates of the current contracts to April 2021 to support a wider commissioning exercise. The Committee considered a report detailing the strategy for undertaking the major procurement exercise that would deliver the alignment and restructure of what was currently 5 contracts covering 16 properties providing accommodation based care and support to 78 adults with a learning disability. The annual value of the contracts related to the tender was estimated to be £4.7m per annum and £37.4m over the proposed 5+3 year contract term. The report sought Executive approval to commence the procurement of services in accordance with the arrangements set out in the report and to enable the commencement of new contracts on 25^th April 2021.

Details were provided of the contract schemes and number of clients. The Strategic Commissioner noted that two contracts would be approved through the Committee and Executive, while the other three contracts were for Chief Officer approval by delegated authority. It was intended that the contracts would go out to tender early next year.

RESOLVED: Executive be recommended to agree to proceed to procurement as detailed in the report.

Report ACH19015

During consideration of this item Councillor Robert Mcilveen tendered his apologies and left the meeting.

The Committee considered a report detailing the procurement strategy for the framework contract for multiple Domiciliary Care services and recommending proceeding to procurement for contracts to meet the relevant needs from 28^th August 2021. The framework contract for multiple Domiciliary Care services was due to expire on 27^th August 2021 with no further extension options remaining. The framework contracts had an estimated annual value of £13.4m with estimated cumulative spend over the life of the contracts of approximately £112m. The Gateway report (CS18147), presented to Executive on the 11^th July 2018, recommended a co-designed Domiciliary Care service model which would incorporate opportunities for more efficient and effective services that took account of the current and emerging changes in provider markets, technology, outcome-based services and ‘enabling’ approaches; all of which would support a model that gave more choice and control to service users, their families and their personal support networks.  Members noted that work on co-design of the Domiciliary Care service had taken place. 

The Committee noted that the report had been reissued following publication of the agenda with the re-issued report reflecting revisions to paragraph 6.1.

In response to a question from the Vice-Chairman, the Integrated Strategic Commissioner confirmed that it was not anticipated that there would be any rare demands that would not be covered by Lot 5 – Specialist Services for Learning Disability / Mental Health Service.

A Co-opted Member queried the level of staff that would be involved in the reablement service, and noted that there were concerns around how the ‘enablement ethos’ may come across to the disabled community. The Integrated Strategic Commissioner said that the reablement service was linked to discharge to assess (D2A), and the Care Act stated was a period of up to six weeks. The initial reablement was a separate service, and these proposals were for providers to deliver enablement care beyond this to promote independence. The Director of Adult Social Care advised that the term ‘enablement’ had been used relating to giving the maximum opportunity to be as independent as possible. This was echoed by the Portfolio Holder for Adult Care and Health, who noted that enablement was for people to have goals to achieve, which were agreed with the individual. It was agreed that the Integrated Strategic Commissioner would speak with the Co-opted Member representing Bromley Experts by Experience following the meeting.

A Member highlighted that Lot 4 was commercially much smaller than the other Lots, and questioned how they would differ. The Integrated Strategic Commissioner said that Lot 4 would deliver a complete package to a lower number of users, however the area covered was more difficult to get to due to a lack of adequate public transport, and particularly during bad weather, which had been noted by providers. There was to be a shift in what was provided, with users of the service being asked what they  ...  view the full minutes text for item 40d

Report ACH19019

Having declared a pecuniary interest Lynn Sellwood left the meeting during consideration of this item.

The Committee considered a report setting out the commissioning options for Support to the Voluntary, Community and Social Enterprise Sector (VCSE) in Bromley. It was proposed to combine funding from the existing services and proceed to procurement for a single contract with an estimated annual value of £160k and with a planned contract start date of October 2020.

The Council currently provided support to the VCSE Sector in Bromley via two separate contracts:

·  ‘Support to VCSE’ – a contract with Community Links Bromley with an annual value of £48k that would end in September 2020.

·  ‘Support to the Sector’ – part of the Primary and Secondary Intervention Services (Bromley Well) contract delivered by Bromley Third Sector Enterprise. This was a relatively small part of the much larger contract with an annual value of £112k. ‘Support to the Sector’ was also delivered by Community Links Bromley as a partner within Bromley Third Sector Enterprise.

In response to a question, the Senior Commissioning Officer confirmed that this was a Gateway 1 Report, as the Committee had previously been presented with reports relating to support to the VCSE Sector in Bromley.

RESOLVED: that the Executive be recommended to approve proceeding to procurement, as detailed in paragraph 4.2.1 and in section 6 of the report, for a new Support to the Voluntary, Community and Social Enterprise (VCSE) Sector in Bromley for a contract period of five years from 1 October 2020 to 30 September 2025, with an option to extend for a further two years at an estimated cost of £160k pa (whole life value of £1.12m).

Lynn Sellwood returned to the meeting following consideration of this item.

Report ACH19021

The Committee considered an overview of the Bromley Safeguarding Adults Board’s (BSAB) Annual Report 2018/19. Under the s43 (1) of the Care Act 2014 the Local Authority was required to establish a Safeguarding Adults Board. The primary objective of the Board was to help and protect adults in Bromley by co-ordinating and ensuring the effectiveness of Board partners. The Board had an unrestricted remit in what it was able to do to achieve its objectives.

The Board was required, under Schedule 2 (4) the Care Act 2014 to produce an annual report outlining its achievements and those of its members in relation to the Board’s strategic objectives. It was noted that efforts continued to be made to make the report accessible for the target audience. The Annual Report outlined the work of Bromley Safeguarding Adults Board, its priorities and its reach. Members were advised that some information was missing from the dataset at the back of the printed document pack but this information could be viewed online.

Performance of Bromley Safeguarding Adults Board was in line with the rest of London, however there was a larger percentage of older people in the borough, which brought vulnerabilities. The width and breadth of the Board had been developed this year in relation to prevention, with representatives from the Department for Work and Pensions (DWP), MET Detention, St Christopher’s Hospice and links with the voluntary sector. The Board were working on a new strategy, which was currently in draft form, and would be published in the new year. In response to a question, the Chair of the Bromley Safeguarding Adults Board said that homelessness linked to a number of their priorities, and work would be undertaken to develop this.

The Chair of the Bromley Safeguarding Adults Board informed the Committee that as part of National Adult Safeguarding Week, hour-long sessions were taking place to raise awareness. It was requested that information relating to these sessions be circulated to Members.

The Chairman led the Committee in congratulating the Chair of the Bromley Safeguarding Adults Board on an excellent Annual Report.

RESOLVED: That the report be noted.

Report ACH19016

The Committee considered the annual quality report detailing the performance of agencies working in Bromley during 2018/19 and setting out the work undertaken by the Contract Compliance Team to improve standards of care delivered to people living in the community. The Contract Compliance Team closely monitored and reviewed the performance of Domiciliary Care Agencies used by Bromley Council to support people living in the community. The team used intelligence gathered from monitoring visits, CQC reports, quality reviews with Service Users, safeguarding alerts, complaints and information from other professional partners.

It was noted that the current monitoring of Domiciliary Care providers showed continued improvement. Standards were being driven up by the regulator, and swift action was taken if it was determined that providers were not working as they should be.

The Head of Contract Compliance and Monitoring advised the Committee that the inclusion of two additional providers on the current framework would allow domiciliary care packages to be placed in a timely manner. In respect of the proposed changes to the provision of domiciliary care services, a Member asked what the expected impact on monitoring would be. The Head of Contract Compliance and Monitoring said that it was anticipated that the number of providers to monitor would be reduced, however it was not yet clear how many providers would be listed on the framework. Quality impact work continued to be undertaken with users of the service.

In response to a question, the Head of Contract Compliance and Monitoring advised that for any new procurement consideration was always given to the appropriateness of the 60:40 price:quality split

The Chairman asked that the Portfolio Holder for Adult Care and Health and the Director of Adult Social Care keep in mind that an increase in the London Living Wage may have an impact on the sector going forward.

RESOLVED: That the Portfolio Holder be recommended to agreed that the following providers be added to the current framework of domiciliary care providers:

·  Care World Agency Ltd.

·  Eminent Domiciliary Care Agency.

ACH190014

The Committee considered an extract from the October 2019 Contracts Register for detailed scrutiny by the PDS Committee. Members noted that the Contracts Register contained in Part 2 of the agenda included a commentary on each contract.

The Head of Complex and Long Term Commissioning advised Members that there was one contract that had been “red flagged”, which was the Older People – Dementia Respite at Home Services, which had been discussed earlier in the meeting. This was due to the extension being sought with less than six months remaining on the current contract.

In response to a question, the Head of Complex and Long Term Commissioning advised that a change in Lead Officer had resulted in this situation being highlighted late.

RESOLVED: that the report be noted.

The briefing comprises:

• Minutes of the Health Scrutiny Sub-Committee meeting held on 8^th October 2019
• Adult Care and Health Risk Register

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 2 items:

• Minutes of the Health Scrutiny Sub-Committee meeting held on 8^th October 2019
• Adult Care and Health Risk Register

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.

The Committee considered the following Part 2 (Exempt) report where the Adult Care and Health Portfolio Holder was recommended to take a decision.

Report ACH19018

The Committee noted the Part 2 (exempt from publication) financial implications contained within the report.

The Committee considered the following reports on the Part 2 agenda for the meeting of the Executive on 27 November 2019

Report CSD19180

The Committee considered the report and supported the recommendations.

Report ACH19017

The Committee noted and commented on the Part 2 (exempt) information within the report.

The Committee noted the exempt information contained in the report.

The Committee noted the exempt information within the report.