Agenda and minutes

There were no apologies for absence.

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 on Wednesday 18^th November 2020.

Please note that all public questions will be answered by written reply.

One written question was received from Councillor Ian Dunn and is attached at Appendix A.

Councillor Judi Ellis noted that her apologies for being unable to attend the meeting had not been recorded.

With this amendment, the minutes of the meeting held on 29^th September 2020 were agreed, and signed as a correct record.

Report CSD20120

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

In response to a question, the Director of Adult Social Care noted that a copy of the Adult Social Care Winter Plan 2020 had been provided to Committee Members in the Information Briefing.

A Member highlighted a point raised at the previous meeting, with regards to an agenda item which allowed for scrutiny of the Portfolio Holder. The Chairman responded that the Director of Adult Social Care would provide an update on the work undertaken within the Portfolio, after which Members would be invited to ask questions of the Portfolio Holder.

A Member noted that an LBB workshop would be taking place on 15^th December 2020, regarding the shape of day care in the Borough. It was requested that a report of the key findings from this workshop be provided to a future meeting of the Committee.

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 the Service had continued to be busy, and was continuing to deliver to the national requirements. Whilst there had been a temporary reprieve between the two waves of the pandemic, services had continued, although there had been a brief opportunity to ‘catch breath’ a little. That being said the Department had continued to:

·  Support service users and their carers, including giving extra support where services had not yet returned to normal.

·  Kept hospitals clear by effecting timely discharges.

·  Continued to work with colleagues at the SPA, increasing the numbers of people supported post discharge through the reablement service.

·  Dealt with an increase in referrals, including safeguarding referrals.

·  Supported providers, particularly with rolling out the 2^nd Infection Control Grant; responding to infections within care provisions; continuing to give advice and support.

In relation to the last point, the Director of Adult Social Care commended the work carried out by the Contract Compliance Team Leader and her team, who had supported providers, and worked with colleagues in Public Health resolved any issues experienced by providers.

The Director of Adult Social Care noted that there had been a short amount of time to prepare for Wave 2, during which the department had:

·  Made use of the modelling work delivered by the Assistant Director for Strategy, Performance and Corporate Transformation – which had been shared nationally as a beacon of good practice.

·  Refreshed the volunteer and helpline guidance, ready for restart on 5^th November 2020.

·  Put plans in place to support those who had previously been told to shield, including making local plans to link people into food deliveries.

·  Set up a local Test and Trace system, picking up those people that the national scheme had been unable to contact.

·  Rolled out testing across all care settings, including home care, and the mass testing programme.

Whilst energy levels had begun to flag, there was still lots to celebrate:

·  Sickness levels amongst staff had remained low and staff were generally coping very well.

·  Relationships with care providers had vastly improved, with more partnership working – they had managed to keep care homes open, dealt with infections swiftly, and worked with homes to reinstate visits from relatives in a limited way.

·  The modelling work undertaken by the Assistant Director for Strategy, Performance and Corporate Transformation was showing to be accurate, and provided confidence in plans going forward.

·  A large number of emails had been received from Bromley residents, thanking the Council, and stating that they felt very well supported and informed.

·  The Department continued to work well with all partners across health, and as a system.

·  The Adult Social Care Winter Plan was completed to time, and listed the achievements of the Department.

·  Work on the Transformation Programme had continued, and the new Practice Framework would be launched in December 2020.

·  The Department had continued to deliver on the  ...  view the full minutes text for item 21.

Portfolio Holder decisions for pre-decision scrutiny.

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

Report ACH20-068

The Committee considered a report which outlined the contract performance of the Advocacy Service, which was currently provided by Advocacy for All.

Advocacy for All were contracted by LB Bromley to deliver the statutory independent advocacy service function. The Advocacy contract provided statutory advocacy services for both adult and children's services.

The Council approved the commissioning a new single point of access Advocacy Service in April 2018, with the aim of providing a seamless, accessible Service, where different forms of Advocacy were delivered in a holistic way centred on the needs and requirements of Service Users. Advocacy for All provided the following advocacy services: Care Act Advocacy; Independent Mental Health Advocacy (IMHA); General Mental Health Advocacy (CMHA); Independent Mental Capacity Advocacy (IMCA); Independent Health Complaints Advocacy (IHCA); Children and Young Persons Advocacy (CYP); and Learning Disabilities Advocacy.

The contract with Advocacy for All supported the Council to fulfil its statutory duties in providing an Advocacy Service to those who had been assessed as meeting the eligibility criteria for care services. The contract was awarded following a competitive tender and had commenced on 1^st April 2018 for a period of three years, with the option to extend up to a further two years on a 1-year + 1-year basis. Advocacy for All subcontract the provision of Independent Mental Health Advocacy, General Mental Health Advocacy and Independent Health Complaint Advocacy to ‘The Advocacy People’ (previously known as ‘Support, Empower, Advocate and Promote/SEAP’).

In providing the Advocacy Service, the single point of access advocacy service delivered the following service outcomes:

§  Simple and accessible referral routes to the Service;

§  Ensuring all communities, including those who were traditionally difficult to reach, were aware of and able to access the services;

§  Work with Service Users through the use of Advocates so that they understood their rights and how to exercise them, e.g. how to make a complaint or challenge a decision;

§  Service Users should be allocated a trained and suitable Advocate, specific to the type of Advocacy required;

§  Encourage individuals’ voices to be heard through their own choice of language and expression and not through language that was standardised or using terminology that the Service User was not happy with or would not use of their own accord;

§  Actively work to produce solutions to problems that the Service may encounter and to overcome barriers both on a service level and in terms of individual’s cases;

§  Work in partnership with Service Users and their carers as well as the relevant organisations to develop and maintain the Service; 

§  Maintain effective working relationships with partnership organisations to promote the needs of Service Users so that regular channels of communication were open to ensure effective referral pathways and joint working arrangements were in place.

§  Partnership working with frontline staff in Health and Social Care organisations such as the Local Authority’s Initial Response Team, as well as the wider community, to facilitate a better understanding of Advocacy  ...  view the full minutes text for item 22a

To follow

Report ACH20-072

The Committee considered a report on the draft Learning Disability (LD) Strategy. The report summarised the progress made and sought Member scrutiny and input to inform the continued progression and implementation of the Strategy and the LD Partnership Board. 

The Council and the CCG had jointly developed a LD Strategy that sets out the direction in relation to young people and adults with a learning disability. The Strategy had included significant co-production that had been facilitated with Bromley Mencap who, along with other providers, were developing services that were aligned with the outcomes in the Strategy. Delivery of the LD Strategy would be overseen by the LD Partnership Board which had been formed of service users, carers and representatives from key stakeholders including third sector organisations, an elected Member, the CCG and relevant departments from within the Council.

The LD Strategy had identified five priority areas: 1. Autonomy, voice and control; 2. Relationships and connections; 3. Education, training and employment; 4. Being active and well, and 5. Right support at the right time. These would be used to form the basis of action plans and commissioning priorities going forward. The delivery of the LD Strategy would be overseen by the LD Partnership Board, and working groups linked to each priority would be formed.

The Co-opted Member representing Bromley Experts by Experience enquired if it would be possible for the organisation to put itself forward as an associate member of the LD Partnership Board. The Head of Complex and Long-Term Commissioning said that this could be considered. Several people with learning disabilities would sit on the LD Partnership Board, and it would be beneficial to utilise the help and assistance of Experts by Experience to facilitate this.

The Co-opted Member further asked if the LD Partnership Board would receive input from young carers, as they would be required to balance caring responsibilities with personal needs, such as education. The Head of Complex and Long-Term Commissioning advised that as it was an LD Partnership Board, this would be dependent on a carer’s individual circumstances. However, if further detail could be provided, this was something that could be looked at going forward.

Due to technical issues, Councillor Robert Mcilveen temporarily assumed chairmanship of the meeting.

A Member enquired if older representatives from special schools would be invited to attend, as this would allow input from those who would benefit in the future from these plans. The Head of Complex and Long-Term Commissioning responded that it was difficult to arrange in the current circumstances, but this was the intention, and once conventional meeting were resumed, school representatives would be sought. It was noted that there were also SEND and Children’s Social Care representatives on the LD Partnership Board.

In response to a question, the Head of Complex and Long-Term Commissioning advised that going forward, they would look to commission services that were different, and reflected the younger cohort of users. Traditionally, there had been building-based day activities, but it was proposed to  ...  view the full minutes text for item 22b

Report FSD20082

The Committee considered a report providing the budget monitoring position for 2020/21 for the Adult Care and Health Portfolio based on activity up to the end of September 2020.

The Head of Finance for Adults, Health and Housing advised that the current position of the Adult Care and Health Portfolio was a projected overspend of £679k on the controllable budget, which excluded the impact of COVID-19. However, it was noted that there were areas of underspend within this, particularly in relation to Assessment and Care Management.

It was estimated that the impact of COVID-19 on the Adult Care and Health Portfolio budgets could potentially be around £11m. It was noted that the majority of this would be funded through Government grants or the recovery of hospital discharge costs from NHS England.

The Head of Finance for Adults, Health and Housing advised the Committee that in the next quarter, there should be a significant reduction in the overspend. The CCG had allocated one-off funding of £500k which, if approved, could help offset pressures, and there may be additional COVID grants that could be utilised.

In response to questions received from a Member, the Head of Finance for Adults, Health and Housing said that there were substantial amounts of savings to be delivered. Some savings had already been achieved, and work was continuing in order to achieve further savings. It was noted that this had been impacted by the pandemic – however if a department could evidence this impact, it would not appear as a pressure within their Portfolio budget. In relation to the Mental Health overspend, the Head of Finance for Adults, Health and Housing advised that this was mainly due to the number of new clients entering the service. This would also be considered as part of the 2021/22 budget and four-year forecast.

RESOLVED that the Portfolio Holder:

i)  Note the projected overspend of £679k on controllable expenditure (excluding the impact of COVID-19), based on information as at September 2020; and

ii)  Agree the release of amounts carried forward from 2019/20 as set out in section 3.7 of the report.

To follow

Report ACH20-079

The Council had a contract in place with the Southside Partnership (also known as Certitude) to provide learning disability supported living and community-based day and respite services. Executive approval was obtained in November 2019 to extend the contract for a period of up to two years from 1^st October 2020 to 30^th September 2022. The Council was unable to reach mutual terms to extend the contract as originally intended, and subsequent negotiation had resulted in a six-month extension of the contract to 31^st March 2021.

A Gateway report had sought agreement for the commencement of a procurement process in relation to the supported living element of the Southside contract. This had been approved by the Leader in September 2020, and this service was currently out to tender. In parallel with this, work had progressed to determine options in relation to learning disability community day and respite services.

The current contract value of the day and respite elements was approximately £1.74m and £0.56m per annum respectively, therefore the commencement of tendering as set out in the report required the Leader’s agreement.

Members were advised of the outcomes of the work to determine future models for learning disability day and respite provision and approval was sought to commence procurement to ensure continuity of service provision in relation to respite and to minimise service interruption in relation to day services. The Head of Complex and Long-Term Commissioning said it was proposed for day services would be divided into two parts. The first was complex needs, for those requiring building-based services, and a full procurement exercise would be undertaken. For those not requiring building-based services, services would be developed and delivered from locations within the community.

With regards to the respite provision, it was noted that on occasion, use of planned respite had been low, however use of the emergency respite provision had increased considerably due to the pandemic. As a result, it was proposed to re-procure the existing provision at 118 Widmore Road, and undertake a review of future respite provision.

Councillor Mary Cooke re-joined the meeting and resumed the Chair.

A Member noted concerns regarding elements of the proposals and sought reassurances. In particular, this related to moving the community provision to direct payments, as this could result in fewer services being sustainably delivered. A further concern was raised regarding the 50 complex and 150 non-complex split, and the implications if this balance changed significantly. The Head of Complex and Long-Term Commissioning said that it was not anticipated that all service users would move to direct payments immediately, and it would have to be something that they wished to do. Several providers had been contacted in relation to this, and their sustainability had not currently been identified as a cause for concern. With regards to the 50 / 150 balance, the Head of Complex and Long-Term Commissioning said they were aware that this split was likely to change, and with projected growth both were likely to increase.  ...  view the full minutes text for item 23a

Report ACH20-067

The report sought approval from the Leader to award a contract for the Direct Payments Support and Payroll Service, following the expiry of the existing contracting arrangements on 7 April 2021. The service had been exposed to competition via an OJEU compliant tender and in accordance with the Council’s financial and contractual requirements, the report set out the results of this tendering process.

In considering the item Members expressed concerns around the proposals to grant delegated authority to the Director of Adult Services to approve contract extension options, subject to Agreement with the Portfolio Holder and other relevant Officers.  Whilst recognising that the proposals outlined within the report were in line with processes set out within the Council’s Contract Procedure Rules, some Members highlighted that in the past there had been a number of reports that had been presented to Committee prior to the decision to extend a contract being taken and the report contained no justification for a departure from this type of Member scrutiny.  Concerns were expressed that any decision to grant delegated authority in this instance may set a precedent for future reports. 

The Portfolio Holder highlighted that there would be opportunities for Member scrutiny through the regular contract monitoring procedures against the KPIs that had been set.

Following discussion, it was agreed that the Committee recommend to the Leader that the contract be awarded for a period of 5 years to enable the work being delivered as part of the contract to continue.  The Leader should then be recommended to defer a decision regarding delegating authority to extend the contract to enable investigation into the circumstances under which such authority is routinely delegated to Officers.  It was suggested that the Committee be provided with an update on the principles surrounding delegated authority to Officers for contract extensions at its next meeting in January 2021. 

RESOLVED: That the Leader be recommended to

1. Approve award of a contract for the Direct Payments Support and Payroll Service as per the resolution in the accompanying Part 2 minute. Subject to approval, the contract will commence from 8 April 2021 for a period of 5 years with an option to extend for up to two years on a one plus one basis.

2. Defer a decision to grant delegated authority to the Director of Adult Services to approve the extension options, subject to Agreement with the Portfolio Holder and relevant Officers as determined by the Contract Procedure Rules.

Report ACH20-066

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 using intelligence gathered from monitoring visits, CQC reports, quality reviews with Service Users, safeguarding alerts, complaints and information from other professional partners. The annual quality report detailed the performance of agencies working in Bromley during 2019/2020 and set out the work undertaken by the Contract Compliance Team to improve standards of care delivered to people living in the community.

In response to a question concerning the reasons for the reduction in spend for domiciliary care in 2019/20, the Head of Finance explained that a slight reduction would have been expected where there had been savings in previous years (from reablement for example) and where there were increases in direct payments which would consequently reduce the direct spend on domiciliary care.

RESOLVED: That the report be noted.

Report CSD20109

At its meeting on 8^th October 2020, the Executive, Resources and Contracts (ERC) PDS Committee considered the attached report on expenditure on consultants across all Council departments for both revenue and capital budgets. ERC PDS resolved that the report should receive detailed scrutiny at all service specific PDS Committees. The report presented to the Committee set out details of revenue expenditure in 2019/20 and the first quarter of 2020/21. There had been no capital expenditure in this timeframe.

It was agreed that an explanation concerning the increase in expenditure on consultants would be provided to the Committee following the meeting.

RESOLVED: That the report be noted.

The briefing comprises:

• Minutes from the Health Scrutiny Sub-Committee meeting held on 21^st October 2020
• Adult Social Care Winter Plan 2020
• Mental Health and Wellbeing Strategy – Action Plan

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

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

• Minutes from the Health Scrutiny Sub-Committee meeting held on 21^st October 2020
• Adult Social Care Winter Plan 2020
• Mental Health and Wellbeing Strategy – Action Plan

Questions relating to the Information Briefing had been received in advance of the meeting and are attached at Appendix B.

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 following summaries

Refer to matters involving exempt information

RESOLVED that the exempt minutes of the Adult Care and Health PDS Committee meeting held on 29^th September 2020, be agreed and signed as a correct record.

The Committee noted the Part 2 information within the accompanying Part 2 report.

The Committee noted the Part 2 information within the report.