Agenda and minutes

Apologies for absence were received from Councillor Aisha Cuthbert and Councillor Simon Fawthrop attended as substitute.

Apologies for absence were also received from Co-opted Member, Francis Poltera.

Councillor Fawthrop declared that he was an employee of British Telecom (BT) who were referenced in the report for the item relating to the Transformation Update.

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 onFriday 3^rd September 2021.

Two written questions were received from a member of the public and are attached at Appendix A.

The minutes of the meeting held on 29th June 2021 were agreed and signed as a correct record.

Report CSD21094

The Committee considered a report setting out matters outstanding from previous meetings and the proposed work plan for 2021/22.

A Member noted that the Work Programme presented at the June 2021 meeting had listed two report that had not been brought to the meeting that evening and enquired when they would be scheduled. The Portfolio Holder for Adult Care and Health advised that the Disabled Facility Grant (DFG) fell within the remit of the Housing, Planning and Regeneration Directorate. The Assistant Director for Housing was leading on the DFG workstream and would present a report at the November 2021 meeting of the Adult Care and Health PDS Committee. The Assistant Director for Integrated Commissioning said that work on the Extra Care Housing Strategy had been delayed due to the COVID-19 pandemic. Work would continue on this through to the spring and it was anticipated that a report would be brought to the Committee in the summer or autumn of 2022.

In response to a further question, the Assistant Director for Integrated Commissioning advised that the Day Centre Opportunities report, which would be brought to the November 2021 meeting of the Committee, would set out how the Local Authority would create more opportunities for day activities for older people.

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.

The Director of Adult Social Care advised Members of a number of staffing changes within the Directorate. At the beginning of August, Nicola Gage had joined as the Assistant Director for Operational Services. This role would oversee the delivery of all operational services covering older people, younger people with disabilities and those with mental health needs, as well as overseeing the delivery of their directly provided services. Nicola had joined from East Sussex and brought with her a wide range of experience across all adult services.

Trevor Thompson had joined the Directorate on an interim basis to cover the Head of Service role for Learning Disability Services. Henrietta Brown had also joined to cover the senior post left vacant following the retirement of Alex Pringle whilst the permanent recruitment to this post was in progress. Nicola, Trevor and Henrietta had joined Carol Brown and Jane Campbell in embedding the new structure within the operational service. The changes in team structure had gone well – staff had coped well with the change and were settling into their new functions. The new structure set up a clearer entry into the service; removed the handoffs between teams that led to delays; and was an integral part of the Transformation Programme.

In response to a question, the Director of Adult Social Care said that the staffing structure was currently in the process of being updated. It was agreed that once completed, a copy of the structure and contact details would be circulated to Members of the Committee.

The Director of Adult Social Care advised that a review of the partnership working arrangements with Oxleas Mental Health Trust had just commenced, the outcome of which would be presented to a future meeting. Other reports to be presented to the Committee would include:

-  A review of Extra Care Housing Provision in Bromley and subsequent recommendations – this work was underway and linked into the Transformation plans within the Housing Division.

-  Plans for the future delivery of the Saturday Club and Employment Support service for adults with a learning disability currently provided by Mencap – this formed part of the work to review day activities and would be subject to consultation with those that used the service and their carers.

Work was also continuing with SEL CCG to develop the Place Based Structure for the Integrated Care System (ICS) with ongoing dialogue to ensure that the needs of Bromley residents remained paramount.

The Director of Adult Social Care informed Members that the Directorate continued to monitor the take up of vaccinations for both staff working in care homes and its own staff who would be required to visit care homes as part of their duties. The take up within care homes was good (82.5%), and they were not envisaging any lack of capacity when the new requirement formally came into place on the 11  ...  view the full minutes text for item 24.

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 FSD21051

On 15^th July 2021, the Executive received a report summarising the current position on capital expenditure and receipts following the 1^st quarter of 2021/22 and agreed a revised Capital Programme for the four-year period 2021/22 to 2024/25. 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 as there were no new schemes, only a couple of changes had been made since the last report was presented. The changes within the Adult Care and Health Portfolio Capital Programme related to the net underspend 2020/21 being rephased into 2021/22, and the rephasing of the Learning Disability (LD) scheme from 2021/22 to 2022/23 as the majority of the expenditure was expected to be required next year.

In response to a question, the Head of Finance for Adults, Health and Housing said that the £10.7m total approved estimate for the LD scheme, listed in Appendix A, dated back a number of years and related to LD provision that had been decommissioned. This money was ringfenced for LD schemes – at the time the report was written it was anticipated that around £100k would be spent this year on furniture and equipment for day centres, however an increase to this figure may be seen in the Quarter 2 report.

RESOLVED that the Portfolio Holder be recommended to note the

changes agreed by the Executive on 15^th July 2021.

Report FSD21055

The Committee considered a report providing the budget monitoring position for 2021/22 for the Adult Care and Health Portfolio, based on activity up to the end of May 2021.

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 £23k. It was noted that in the table provided in Appendix 1A of the report COVID grants were listed under the ‘Adult Social Care’ heading. This was an assumed amount at this point and would be revised during the year, with a report presented to the Council’s Executive requesting approval to draw down the final allocation to help cover the significant pressures that had arisen in Assessment and Care Management due to the impact of the COVID-19 pandemic. The Head of Finance for Adults, Health and Housing informed Members that this included pressures relating to post-discharge packages. Previously NHS England had funded packages of care for six weeks following a patient’s discharge from hospital, but from July 2021 this had been reduced to four weeks. Hospital discharge funding had been due to end in September, but the government had recently announced that would be continued, although it was not known for how long.

In response to a question, the Head of Finance for Adults, Health and Housing said that the £1m of COVID grant funding that was assumed had been provisionally allocated from the Contain Outbreak Management Fund – there were some conditions, but it was broadly to be used to help the Local Authority manage the pandemic. The COVID grant funding was presented as a separate line within the ACH Portfolio Budget Monitoring Summary to provide transparency – it was noted that this would be refined later in the year, but at present a significant amount of the pressures that had arisen in Assessment and Care Management were related to the COVID-19 pandemic. Another Member suggested that, going forward, consideration could be given to presenting two version of the accounts with, and without, the COVID grants included.

A Co-opted Member noted the underspend on Mental Health and enquired where this had occurred. The Head of Finance for Adults, Health and Housing advised that this related to the Oxleas NHS Foundation Trust contract and it had been agreed that a review of the s31 arrangements would be undertaken. £20k would be carried forward and added to the budget to be used specifically for this review.

A Member highlighted a statement in the report, relating to services for the over 65’s, that “domiciliary care is projected to underspend by £927k and direct payments to overspend by £123k” and asked how both had arisen. It was agreed that the Director of Adult Social Care would look at this in further detail and provide a response following the meeting.

Members noted the ringfenced funding which had accumulated in the Public Health budget over recent years and queried whether purposes were being fulfilled if this money was  ...  view the full minutes text for item 25b

To follow

Report ACH21-039

The Committee considered a report providing a summary impact review of the Winter Plans for 2020/21 and details of the priorities and emerging plans for the Winter Plan 2021/2022. The report also included proposals on making the ONE Bromley Discharge Partnership (previously known as the Single Point of Access or SPA) a permanent service.

The Assistant Director for Integrated Commissioning advised that it had been intended for the consultation draft of the Winter Plan 2021/22 to be brought to the meeting, however the NHS funding for the second half of the financial year had only been announced the previous day and Bromley’s allocation would not be known until the following week. The final version would be presented at the October 2021 meeting of the Health Scrutiny Sub-Committee for Members’ comments.

The One Bromley System Winter Plan brought together a single view of how the local health and social care system would proactively manage additional demands felt throughout winter. This year, in addition to the usual winter pressures, the Plan also provided a response to the likely continuing impact of COVID-19 on the local community and health and care arrangements. The Plan and its associated actions were important as there were likely to be further challenging times ahead for the health and social care system in Bromley.

The 2021/22 Winter Plan aimed to deliver on the successful elements of the previous year’s plan, building on specific areas to further strengthen the offer and respond to new emerging needs and system changes. The Plan was being built on five pillars as follows:

1.  Increasing System Capacity

2.  Data Sharing and Escalation

3.  Single Point of Access and Discharge Arrangements

4.  Admissions Avoidance

5.  Communication and Engagement

In response to questions, the Assistant Director for Integrated Commissioning emphasised that pillar number 4 – Admissions Avoidance would be key part of the Plan. The 284 additional GP hours would be provided over the Christmas and New Year period to maintain full capacity throughout this time and avoid admissions wherever possible. With regards to increasing the system capacity, it was noted that unfilled staff posts were a national issue – the system had coped well last year, although the demands on it were expected to be greater this year which again highlighted the importance of admissions avoidance.

A Member asked for clarification regarding the statement made in the report that there had been “a reduction in readmissions month on month, up to as much as 50%”. The Associate Director – Discharge Commissioning, Urgent Care and Transfer of Care Bureau advised that this was a national KPI which monitored whether a patient was readmitted to hospital within 28 days of discharge and compared it to the same month the previous year. The Member suggested that the actual numbers of readmissions should be stated to provide context, and it was agreed that the would be looked at following the meeting.

Members thanked the Assistant Director for Integrated Commissioning for the excellent report provided to  ...  view the full minutes text for item 25c

Report ACH21-040

The Committee considered a report detailing the outcome of the procurement process for the Learning Disability Supported Living contract which sought Executive approval for the award of contracts for the four Lots to the providers detailed in the Part Two report for a period of 5 years with the option to extend for a further period of 3 years. The estimated total cost of the awards over the full 8-year term (excluding inflationary increases and fluctuations due to individual client need) were detailed in the Part Two report. Contracts would commence on 25^th January 2022.

The Council had five separate contracts with specialist learning disability providers to provide care and support into 16 supported living properties within the Borough. A Gateway Report, setting out the strategy for undertaking the re-procurement of these services, was agreed by the Council’s Executive at its meeting on 27^th November 2019. It had been intended for the procurement process to take place during 2020 but the COVID-19 pandemic precluded this taking place. Chief Officer agreement (in consultation with the Portfolio Holder) to delay the procurement in accordance with report CSD20062 (Covid 19: Procurement Implications) was given in September 2020 to extend the contracts for 9 months to 24^th January 2022 and enable the re-procurement of these services.

In response to questions from a Member regarding the length of the contract, the Head of Complex and Long-Term Commissioning advised that it was standard process to contract for a set period, with an option to extend after that time if it was in the Council’s interest. It was noted that the figures provided in the Part Two report represented the full contract term if the option for a further three years was taken. The 5 years was a “checkpoint” at which the contract could be reviewed, and a decision made as to whether it should be continued – this provided an option to do so without a retendering exercise and the actioning of a large procurement process. The contract would be continually reviewed, and quality monitored, throughout its term. The 5 year “checkpoint” allowed consideration of whether the contract was still performing as required in light of any further guidance or legislation that may have since been issued.

Members thanked the Head of Complex and Long-Term Commissioning for presenting a very well written report to the Committee.

RESOLVED: that the Executive be recommended to:

i.)  Award the contract for the provision of supported living services to the providers detailed in the Part Two report with estimated annual / whole life values (excluding inflationary increases and fluctuations due to individual client need) for each Lot as also detailed in the Part Two report.

ii.)  Delegate to the Director of Adult Social Care, Education, Care & Health Services, in consultation with the Portfolio Holder for Adult Care and Health Services, the Assistant Director Governance & Contracts, the Director of Finance and the Director of Corporate Services, authorisation to exercise the 3-year extension period.

Having declared an interest, Councillor Fawthrop left the meeting during consideration of this item.

Report CSD21086

At its meeting on 30^th June 2021 the Executive considered a report on the Council’s Transformation Programme and referred the report to all PDS Committees and General Purposes and Licensing Committee. The report had already been considered by the Executive, Resources and Contracts PDS Committee at its meeting on 23^rd June 2021.

The Assistant Director for Strategy, Performance and Corporate Transformation noted that the report outlined what had been achieved during the first two years of the Transformation Programme and the successes within the Adult Social Care Directorate during the pandemic, as well as setting out key projects for the future.

A Member highlighted that one of the key emerging priorities over the next two years was the Adult Social Care digitalisation agenda and asked for further information relating to this. The Director of Adult Social Care advised that a small amount of assisted technology was provided, such as via the CareLink system, however it was considered that there were opportunities to do more to support people in ways that were less intrusive. Lots of time and money was spent in relation to overnight monitoring and the Directorate was scoping a piece of digital technology work that would allow people to live more independently. This would not reduce the amount of time that was spent with patients but would instead add value and support. Further updates regarding this work would be provided to the Committee at future meetings.

In response to a question, the Assistant Director for Strategy, Performance and Corporate Transformation advised that combined records had greatly assisted quality of care planning. The Local Authority had invested in Liquidlogic software, which was due to “go live” in November 2021 and would provide the ability for the further sharing of information and would assist in the understanding of trends and future needs.

A Member said she was particularly pleased to see that key priorities included regular review of adult social care cases to ensure that people were supported to live independently and working with self-funders to develop programme guides and improved advice, information, and guidance. Both of these elements were what the community had been asking for, and thanks were extended to the Director of Adult Social Care, and her staff, for listening, and developing these programmes.

RESOLVED that the progress with the Transformation Programme be noted.

Councillor Fawthrop returned to the meeting following consideration of this item.

The briefing comprises:

• Adult Performance Management Framework
• Complaints and Compliments Annual Report 2020-2021

·  Minutes from the Informal Health Scrutiny Sub-Committee meeting held on 13^th July 2021

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:

•  Adult Performance Management Framework

•  Complaints and Compliments Annual Report 2020-2021

•  Minutes from the Informal Health Scrutiny Sub-Committee meeting held on 13^th July 2021

Adult Performance Management Framework

The Vice-Chairman noted that this was an extremely good document, and thanked officers for the work undertaken in producing it.

Complaints and Compliments Annual Report 2020-2021

A Member noted that this was a very thorough report and suggested that actual figures could be included in order to provide context of the percentages provided. The Director of Adult Social Care agreed, and further noted that most of the complaints related to the quality of services received – these were mainly services that were purchased and, other than during the commissioning process, it was often difficult to have an influence on them.

In response to a question, the Assistant Director for Strategy, Performance and Corporate Transformation advised that there was a complaints telephone line that was live, the details of which were published on the Council’s website. This allowed residents to speak with someone regarding any concerns, and, depending on preference, this would then be followed up with either a letter or telephone call.

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 June 2021 be agreed.

The Committee noted the Part 2 information within the report.