Agenda and minutes

Apologies for absence were received from Vicki Pryde.

Report CSD20088

The Committee considered a report which sought confirmation of the appointment of Co-opted Members to the Adult Care and Health PDS Committee for 2020/21.

The clerk reported that there was an amendment to the list of Co-opted Members to be appointed to the Committee, with Ms Vicki Pryde nominated as the Bromley Mental Health Forum representative.

The Chairman welcomed Francis Poltera, the new nominated representative for Experts by Experience (X by X), to the meeting, and expressed her thanks to Lynn Sellwood and Justine Jones for the contribution they had made during their time on the Committee.

In response to a question regarding the Our Healthier South East London Joint Overview and Scrutiny Committee, the Portfolio Holder for Adult Care and Health advised that feedback from these meetings was provided through the Health Scrutiny Sub-Committee.

RESOLVED that:

1.  The following Adult Care and Health PDS Committee Co-opted Member appointments for 2020/21 be agreed:

2.  Councillor Judi Ellis be reappointed, and Councillor Gareth Allatt be appointed, to the Our Healthier South East London Joint Overview and Scrutiny Committee for 2020/21.

There were no declarations of interest.

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 onWednesday 23^rd September 2020

Two oral questions were received from a Councillor and these are attached at Appendix A.

The minutes of the meeting held on 22^nd January 2020 and 13^th May 2020 were agreed, and would be signed as a correct record.

Report CSD20084

The Committee considered a report setting out matters outstanding from previous meetings and the proposed work plan for 2020/21.

A Member noted that previously, Committee meetings had an item during which the Portfolio Holder could be scrutinised, which she considered to be good practice. The Chairman noted that this would be reflected upon outside of the meeting.

In response to a question, the Director of Adult Social Care informed Members that they had been working closely with the care homes to safely reintroduces visits and contact with residents’ families. This was a priority, and it was not felt to be appropriate to create an extra burden to care homes which were already struggling, by asking them to facilitate virtual visits by Committee Members. The Care Quality Commission (CQC) had restarted their visits – care homes with infections had been closely monitored by the Local Authority, and support had been provided to them by colleagues in Public Health. Assurance was given that they had kept in regular contact with providers throughout the pandemic. The Assistant Director for Integrated Commissioning had met with all care and nursing home providers, and the Director of Adult Social Care would be meeting with domiciliary care providers the following day. It was noted that visits would be reintroduced once it was safe and practical to do so. The Operations Manager – Healthwatch Bromley advised Members that they had started undertaking some virtual ‘enter and view’ visits at care homes and would notify the Committee once the reports were complete.

A Member noted that there were items currently listed on the work programme as ‘to be scheduled’ and asked when these would be brought to the Committee. The Chairman suggested that an update could be circulated to Members following the meeting.

RESOLVED that the report be noted.

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

It was noted that everyone had been living and working in extraordinary times over the last seven months. Staff had been dealing with concerns from residents, service users and carers; providing practical and emotional support to providers; support to colleagues; finding out ways of working remotely and also dealing with the personal impact of the COVID-19 pandemic on their day to day lives.

The Director of Adult Social Care stated that she was incredibly proud of all that her team had achieved, and provided some highlights of the work that had been undertaken:

• Receiving and getting to know new the IT kit, new systems and new ways of working remotely.
• Carrying out assessments and reviews, largely remotely but some face to face.
• Working to find alternative support arrangements for service users where services had been forced to close.
• Providing financial and practical support to providers.
• Procuring and delivering over 1 million items of PPE.
• Working with Public Health colleagues to provide advice on how to deliver care safely, including re-writing national advice to make it simpler.
• Providing testing to all providers of residential and nursing care, domiciliary care, testing for residents and piloting an approach within Extra Care Housing.
• Put in place new discharge arrangements with Bromley Healthcare and the CCG by setting up a SPA (Single Point of Assessment) to effect swift discharges keeping beds free in the PRUH.
• Commissioning new services to enable people to be discharged.
• Providing support for the 13,787 people identified as Clinically Extremely Vulnerable and required to shield.
• Providing additional support over and above food and medicine delivery for 472 of those shielding.
• Logged and communicated with 4,495 people who volunteered to assist, matching 1,151 of them with people needing assistance.
• Dealt with daily information from central government, made sense of it and implemented it.
• Distributed and accounted for numerous grants that were passed through the Council – i.e. COVID Grant, Infection Control Grant, Emergency Assistance Grant.
• Reported all activity on a regular basis.
• Set up a call team to assist with Test and Trace.
• Surveyed everyone who had received help through the assistance and volunteering route to facilitate learning for Wave 2.
• Joined national webinars with the Social Care Institute for Excellence (SCIE) to share best practice.
• Plus “keeping the business running”.

The Director of Adult Social Care advised that it was important to note that the Local Authority had not introduced the use of Easements, which gave the power to relax some of the rules around the Care Act responsibilities, and these had continued to be delivered. During this period, waiting times had been reduced and social workers had kept on top of reviews. Work had also continued with the Transformation Programme, and in some instances was moving faster than had been anticipated, particularly with regards to integrated working.

Looking forward, work had been undertaken to review learning from Wave 1  ...  view the full minutes text for item 7.

Report ACH20-044

The Committee considered a report providing a refresh of the Adult Care and Health Portfolio Plan for 2020-21, and the update for Quarter 1.

The Adult Care and Health Portfolio Plan 2018 to 2022 had been refreshed for 2020/21 in line with the Council’s Transformation Programme and Building a Better Bromley Plan.The Plan continued to focus on four priority outcomes:

·  Safeguarding;

·  Life chances, resilience and wellbeing;

·  Integrated health and social care; and

·  Ensuring efficiency and effectiveness

Within each priority there were a number of statements which were underpinned by actions and measures of success within the work of Adult Care and Health Services. Progress had been made on the majority of the actions within the refreshed Portfolio Plan. The impact of COVID-19 had seen new ways of working in partnership with health partners and these positive changes were being evaluated and incorporated into ways of working and future plans. Some re-commissioning of services had been delayed, however the adjustment in timescales had been minimised as much as possible.

In response to a question from a Co-opted Member, relating to the establishment of a Learning Disability Partnership Board, the Assistant Director for Strategy, Performance and Corporate Transformation confirmed that service users would be represented in the membership.

The Co-opted Member noted the reference made to ‘developing evidence-based commissioning programmes’ for a number of services and questioned what evidence would be used, and how would it be measured. The Assistant Director for Strategy, Performance and Corporate Transformation advised that there were demand measures from service users already accessing these packages, in terms of what was being delivered and how much it was being utilised. As the borough was subject to significant growth pressure, other evidence used was a range of data relating to the awareness of the Local Authority and Clinical Commissioning Group (CCG), as well as national data sets which provided an understanding of the baseline demand. This ensured thoughtful understanding of the demand pressures that services would face, and that the right amount of services were commissioned.

In response to a question from a Co-opted Member, the Director of Adult Social Care advised that information relating to the quality standards across Adult Social Care could be shared with the Committee. A Practice Advisory Group, with staff from across the service, had recently been established. Work would be undertaken to gather their experiences of what made a difference to the lives of individuals with whom they worked. The standards focussed on areas such as how it made a difference to an individual; the outcomes they identified for themselves to achieve; if referrals were being dealt with in a timely manner; and if reviews were being picked up when required.

A Member noted that the end date of the Portfolio Plan was April 2022 and enquired if any actions had needed to be reconsidered, or caught up on, due to the impact of the COVID-19 pandemic. The Director of Adult Social Care said it was actually the opposite,  ...  view the full minutes text for item 8.

Report ACH20-045

The Committee considered a report providing the current Adult Care and Health Services’ Risk Register – Quarter 1 2020/21 and the existing controls in place to mitigate the risks.

Risk Management was the identification, analysis and overall control of those risks which could impact on the Council’s ability to deliver its priorities and objectives. The Adult Care and Health Services Risk Register fed into the Corporate Risk Register, via the Corporate Risk Management Group, and comprised the high level departmental risks which were underpinned by more detailed registers contained within the divisional business plans. 

The Council’s Audit Sub-Committee had agreed that the Corporate and Departmental Risk Registers would be reviewed at their meetings twice a year, and then subsequently scrutinised by the relevant PDS Committee. Internal processes required that the departmental risk registers be updated and agreed by the Departmental Leadership Team (DLT) on a quarterly basis and be reviewed by the Corporate Risk Management Group. The Adult Care and Health Risk Register 2020/21 Quarter 1 update was agreed by Adult Services Leadership Team in July 2020.

The Assistant Director for Strategy, Performance and Corporate Transformation highlighted that the following risk had been increased on the Risk Register since November 2019:

·  Risk 1 – Failure to deliver financial strategy – change of net/current risk from 20 to 25. Some of which was demand pressure directly linked to the COVID-19 pandemic; and

·  Risk 6 – Transport – Children and Adults – change of net/current risk from 9 to 12. However, it was noted that the contract that had caused this increase had now been awarded in April 2020.

The following risks had decreased:

·  Risk 4 – Deprivation of Liberty – change of net/current risk from 6 to 4;

·  Risk 7 – Social Care Information System – change of net/current risk from 15 to 4; and

·  Risk 11 – Failure to deliver partial implementation of Health & Social Care Integration – change of net/current risk from 6 to 4.

Mitigating actions had seen four high risks reduced to significant risk; one high risk reduced to medium risk; two high risks reduced to low risk; one significant risk reduced to low risk; and two medium risks reduced to low risk.

A Member highlighted the impressive reduction made to Risk 7 – Social Care Information System. The Assistant Director for Strategy, Performance and Corporate Transformation reminded Members of the agreement to replace the Care First system, and some of the largest risks had been around procurement. The Council’s Executive had agreed the contract in May 2020, and it had recently been awarded. The other major risk identified had been regarding the competency and experience of the team brought in to implement the system. However reassurance was offered with regards to a strong Programme Manager being in place, who reported to the Assistant Director for Strategy, Performance and Corporate Transformation, and had brought in a number of experienced staff. The system was currently on schedule to go live next year, was on  ...  view the full minutes text for item 9.

Portfolio Holder decisions for pre-decision scrutiny.

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

Report FSD20060

On 8^th July 2020, the Leader received a report summarising the current position on capital expenditure and receipts following the 1^st quarter of 2020/21, and agreed a revised Capital Programme for the four year period 2020/21 to 2023/24. The Committee considered a report highlighting changes agreed by the Executive and Leader in respect of the Capital Programme for the Adult Care and Health Portfolio.

The Head of Finance for Adults, Health and Housing advised Members that a £137,000 net underspend had been re-phased at the 2019/20 outturn. Following a restructure, the Strategy, Performance and Corporate Transformation budget had been transferred to the Resources, Commissioning and Contracts Management portfolio which was mirrored in the capital programme, resulting in the Social Care Case Management IT scheme transferring.

Earlier in the month the Leader had approved the property disposal programme, part of which would look at the Council’s assets This would tie in with the review of the Learning Disability (LD) schemes, and would look at the use and options of LD day centres.

RESOLVED that the Portfolio Holder be recommended to note the changes agreed by the Leader on 8^th July 2020.

Report ACH20-041

The Committee considered a report which outlined the contract performance of the Adult Extra Care Housing – Lot 2.

Mears provided care and support services into three Extra Care Housing (ECH) schemes within Bromley – Norton Court, Crown Meadow Court and Durham House.The annual service review was being presented in line with LBB Contract Procedure Rules and provided an analysis of Mears’ performance during the current contract term.

Key Performance Indicators (KPI’s) formed a key part of performance monitoring and were submitted on a four-weekly basis. Contract management meetings were held quarterly and the KPI’s used as a basis for monitoring performance and highlighting areas that may require improvement. The KPI’s referred to quantitative activity that was carried out by the provider and was regularly evaluated by the contract manager. The KPI’s helped to identify some areas requiring improvement two years ago and were used by Mears, along with associated action plans, to improve their performance. Mears were now consistently meeting the targets set out in the contract specification. A Member requested that in future reports, KPI data was included on annual reviews. It was agreed that this information would be circulated following the meeting.

The Commissioning Officer noted that during the COVID-19 pandemic, Mears had been proactive in the implementation of various measures to ensure the safety and wellbeing of ECH clients and staff.

In response to a question relating to supply and demand of ECH, the Commissioning Officer advised that there was long term potential for growth. These schemes were growing in popularity with residents in the borough, and the current schemes were proving to be very successful.

A Member noted that the most recent customer satisfaction survey results indicated that 9% of Norton Court residents felt that the quality of care and support services ‘required improvement’ and asked if these issues had been addressed. The Commissioning Officer said he believed this feedback related to the activities provided to residents. Over the last twelve months, Mears had worked hard to improve this, offering a larger number and more varied activities. Reassurance was offered that when speaking to residents, they were always very positive about the ECH scheme.

It was noted that the annual review of the Creative Support Contract would be presented at a future meeting of the Committee.

RESOLVED that the Portfolio Holder:

i)  Note the information contained within the report in relation to Mears performance of this contract and that this provider was consistently meeting the Council’s standards under the contract.

ii)  Note that the provider was to be reviewed again in 12 months to provide an update on performance and progress made.

iii)  Note the introduction of revised KPI’s that would gather additional data in relation to provider performance.

The Chairman welcomed Tim Spilsbury – CEO, Healthwatch Bromley and Mina Kakaiya – Operations Manager, Healthwatch Bromley to the meeting. A copy of the Healthwatch Bromley Annual Report 2019-2020 had been provided in the Adult Care and Health PDS Committee agenda pack.

Key points from the Annual Report were highlighted as follows:

-  Over 2,000 patient experience had been collected, allowing feedback of Bromley residents response to service which had been mainly positive.

-  A new service of ‘enter and view’ visits had been launched, and visits had been made to care homes and non-residential settings.

-  During the COVID-19 pandemic, services had been adapted to stay connected and reach out to communities.

-  28 volunteers had carried out 159 days of work.

-  A Healthwatch Director had been introduced in Bromley.

-  A deep-dive relating to Autism 18+ had been undertaken, and would be used to inform the Autism Care pathway and the Learning Disability Strategy.

-  Involvement as part of the South East London cohort, enabling residents to share their views on the NHS Long Term Plan.

In response to a question, the Operations Manager – Healthwatch Bromley advised that they were working with the South East London cohort to create a collaborative approach to initiative relating to Black Lives Matter. Work would be undertaken to raise awareness around inequalities; digital poverty; getting information out to specific communities; translation and navigating services. Work was also underway to obtain patient feedback for foodbanks, and with the Primary Care Networks and GP Practices to communicate with their patients. The CEO- Healthwatch Bromley noted that they had an emerging communities programme, which specialised in engaging with minority and hard to reach groups. This allowed then to identify and engage with these groups more and more through their volunteer service, and they hoped it would continue to expand.

A Member said that surgeries encouraging the use of digital connection were welcomed, but noted that some in the older population may be unable to, or fearful of, connecting in this way. It was considered that this cohort of patients could be included in a study. The CEO – Healthwatch Bromley advised that a study was being undertaken across two other boroughs, looking at digital access to GP’s, exclusion factors and barriers, and any learning from it could be shared. The Operations Manager – Healthwatch Bromley informed Members that a report from the CCG looking at engagement and the impact of COVID-19 was imminent.

The Chairman thanked the CEO – Healthwatch Bromley and Operations Manager – Healthwatch Bromley for their presentation to the Committee.

RESOLVED that the Healthwatch Bromley Annual Report 2019-2020 be noted.

Report ACH20-047

The Committee considered an extract from September 2020 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 the Contracts Register was RAG rated. It was noted that a red RAG rating did not indicate that there were concerns with a contract, and highlighted that a contract was nearing its end date. In response to a question, the Head of Complex and Long Term Commissioning informed Members that some the contracts flagged as ending on the 30^th September 2020 remained on the Register despite there being an alternative contract in place from 1^st October 2020. Others had been extended under the COVID-19 delegated authority process. Any contract that was of a concern, they would have been flagged as such by the central team.

The Portfolio Holder for Adult Care and Health advised that the new 0-19 Public Health Nursing contract would be implemented from 1^st October 2020.

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.

The following summaries

Refer to matters involving exempt information

The Part 2 (exempt) minutes of the meeting held on 22^nd January 2020, were agreed and would be signed as a correct record.

Report ACH20-047

The Committee noted the exempt information contained in the report.