Agenda and minutes

Apologies for absence were received from Councillors Felicity Bainbridge, Thomas Turrell and Jessica Arnold, and Councillors Simon Fawthrop, Adam Grant and Tony McPartlan attended as their respective substitutes.

In relation to agenda item 10 (minute 64), Councillor David Jefferys advised that as Chairman of the Health and Wellbeing Board he sat on the Bromley Safeguarding Adult Board.

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 January 2023.

No questions had been received.

The minutes of the meeting held on 22^nd November 2022 were agreed, and signed as a correct record.

Report CSD23016

The Committee considered a report setting out matters outstanding from previous meetings and the proposed work programme for 2022/23.

The Chairman noted that the matters outstanding relating to minute items 45, 47e and 48 were now complete. In response to a question regarding the possibility of re-establishing the programme of Member visits, the Chairman advised that this had been paused due to the prevalence of COVID-19, however this would continue to be monitored.

Councillor Jefferys, Chairman of the Health Scrutiny Sub-Committee, noted that the work programme had been updated following the meeting on 17^th January.

RESOLVED that the update be noted.

Including an update on Adult Social Care Reforms

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 informed Members that since the last meeting the service had been extremely busy, preparing and delivering plans to get through winter and also formalising the proposals for the transformation programme for the coming year, which would be shared later in the meeting.

The festive period proved to be very busy, particularly in the acute sector, with high numbers of infections of both COVID-19 and other respiratory infections, and therefore high numbers of attendances. This was made worse by high levels of staff sickness, but the Director of Adult Social Care was pleased to inform Members that the system had stood up well and appropriate discharges continued throughout the festive period. Staff from Adult Social Care had also stood up to provide cover over the days of health staff strikes, ensuring that the system continued to operate well.

The Director of Adult Social Care advised that plans for winter continued and, having been based on what was known to have worked well in the past, had been successfully delivered. Despite increased demand, the budget was holding up well and was in a more positive position than may have been hoped for at this point in the year. Additional funds granted by the government would be used to offset pressures, particularly around the cost of placements, in order to ensure that discharges could continue. The adult social care reform agenda, as reported at the last meeting, had been delayed, apart from the ambition to move towards a fairer cost of care. Led by the Assistant Director for Integrated Commissioning, the commissioning service had been dealing with a high number of requests for increases in payments. This process was being managed in a realistic way, ensuring that the service did not make commitments that it could not afford on an ongoing basis when the grant monies were used. This required a careful balance of expectation against affordability. The service continued to prepare for the assurance process with the Care Quality Commission (CQC) and they were actively working with staff to engage them in this process, and hear from them about the challenges that they faced.

The Director of Adult Social Care noted that she would not ordinarily single out staff for mention, but she did not want to miss the opportunity to advise Members that, regrettably, Colin Lusted, who led on the commissioning of services for people with a learning disability, was retiring and would leave the Local Authority in February. Colin had made a huge difference to the service, and she was sure she would not be the only one who would miss his calm, thoughtful and thorough approach to his work which had reaped huge rewards. The Director of Adult Social Care wished Colin a long and healthy retirement and thanked him for all he had done in his time at Bromley. These  ...  view the full minutes text for item 60.

Report FSD23011

The Committee considered a report setting out the draft Adult Care and Health Portfolio Budget for 2023/24, which incorporated future cost pressures, planned mitigation measures and savings from transformation and other budget options which were reported to the Council’s Executive on 18^th January 2023. Members were requested to provide their comments on the proposed savings and identify any further action to be taken to reduce cost pressures facing the Local Authority over the next four years. It was noted that there were still outstanding issues and areas of uncertainty remaining and further updates would be included in the 2023/24 Council Tax report to the next meeting of the Executive.

The Head of Finance for Adults, Health and Housing advised Members that a balanced draft budget was proposed for 2023/24. However, there were a number of unknowns in the years ahead, relating to levels of government funding and inflation, and a budget gap of approximately £30m was projected in 4 years’ time. With regards to Appendix 1 (page 44), it was noted that £5.8m had been added to the budget for increased costs (mainly inflation), and £6.2m of growth. There were also savings targets of £2.5m (mitigation) and £1.8m (Transformation Programme). The Head of Finance for Adults, Health and Housing said there were challenges, but echoed the comments made by the Director of Adult Social Care, regarding the plans that were already in place to achieve these savings and, on balance, considered it to be a fair budget for the portfolio.

A Member highlighted that despite Bromley having the sixth largest borough by population, the report noted that it received the second lowest settlement funding per head. The Head of Finance for Adults, Health and Housing advised that this was a historical issue relating to the level of government funding received. These comments were echoed by another Member, who said that this historic issue related to the funding formula and advised that the London Borough of Bromley had been campaigning for fairer funding for a number of years.

A Member highlighted the reference made in the report regarding the borough’s council tax being ‘the average of the four other low grant funded boroughs, our income would increase by £30.2m’. It was noted that this figure was similar to the projected budget gap and queried if the average council tax of these other boroughs was known. The Head of Finance for Adults, Health and Housing advised that this information could be provided to Members following the meeting.

In response to questions, the Head of Finance for Adults, Health and Housing emphasised that the vast majority of savings that were being proposed were not a result of making cuts in services. The Director of Adult Social Care advised that at the last meeting, the transformations made within Adult Social Care had been highlighted. Appendix 2 of the report provided a summary of what had been delivered through the Transformation Programme over the last three years – things were being done  ...  view the full minutes text for item 61.

Report ACH23-008

The Committee considered a report providing an update on the delivery of the Tackling Loneliness Strategy Action Plan. The Tackling Loneliness Strategy was approved by the Adult Care and Health Policy Development and Scrutiny Committee in November 2021 and was launched later that year. At the time, Members were advised that an updated action plan would be brought to the Committee with evidence of progress throughout the lifetime of the strategy.

Councillor Mike Botting, Executive Assistant for Adult Care and Health and Loneliness Champion, informed Members that the strategy was moving in the right direction, and he was pleased with the progress being made against the action plan.

The Principal Loneliness Champion informed Members that key successes in recent months had included:

-  An intergenerational project with schools, Children and Family centres and Mytime Active afterschool clubs to create Christmas cards for people experiencing loneliness within various care settings. 900 cards were created and delivered to 6 care homes, 6 Extra Care Home settings and 4 domiciliary care agencies across Bromley. The remaining cards were donated to care leavers, St Christopher’s Hospice patients in Sydenham and the PRUH/Orpington Hospital.

-  A borough partnership had been formed with London South East Colleges (LSEC). From 1^st February 2023 they would be piloting ‘Warm Wednesday’, where individuals could come for a meal prepared by students and talk to others. It was hoped that this could be made a more regular occurrence.

-  A poster had been submitted to the Campaign to End Loneliness’s poster competition, to highlight the work which the Council and statutory, private and voluntary partners were undertaking throughout Bromley. This was part of their international conference, which was taking place on 2^nd February 2023. The Principal Loneliness Champion was pleased to announce that the poster submission had been placed as runner up.

-  Work had been undertaken to look at how they communicated loneliness – they had spoken with the voluntary sector and organisations across the borough about this topic. This aimed to connect people and signpost individuals, residents and organisations to the help and assistance that they may need to tackle loneliness.

Members thanked the Principal Loneliness Champion for providing an excellent report and enquired if more could be done to publicise the work undertaken. The Executive Assistant for Adult Care and Health and Loneliness Champion agreed that people needed to be aware of this work and further communication would be beneficial. It was emphasised that they wanted this to be part of “business as normal” and the Principal Loneliness Champion was looking to develop ‘Loneliness Champions’ roles in all departments across the Council. The Principal Loneliness Champion advised that work was taking place across the borough partnership and a training course would be delivered to local residents. This would provide an opportunity to learn what loneliness is, how to start a conversation and the resources available. There was a Tackling Loneliness Action Group, working across the borough to get the messages out, and they  ...  view the full minutes text for item 62.

Report ACH23-005

The Committee considered a report outlining the current arrangements for the provision of Bromley’s Integrated Community Equipment Service (ICES), commissioned through the London Community Equipment Consortium (London Consortium), and the results of the tender exercise for the provision of the new service.

The Senior Commissioning Officer advised that the current contract for ICES ends on 31^st March 2023 and both 1+1 extension options had been utilised. The Council’s Executive previously approved re-procuring the service through continued membership of the London Consortium (report ECHS19049) and for Bromley Council to participate in the joint re-tendering exercise, which was activated in April 2022. Approval to call-off the new contract was being sought to support the conclusion of the Consortium-led tender exercise and the new Framework Agreement, in order for the new service to commence on 1^st April 2023, and for Bromley to continue to support and meet the needs of Bromley residents. It was noted that the Contract Award report (Part 1) made recommendations for the new ICES provision in Bromley and should be read in conjunction with the Part 2 Contract Award report.

A Member questioned how it could be tested if the Consortium was still considered to be the best route and, if so, were there others that could be considered. The Senior Commissioning Officer noted that the Consortium was the biggest in the UK, and across Europe. It continued to grow, with a further three local authorities joining in recent years. This reflected the strength of the collaboration, especially in terms of buying power for supplies. It remained a powerful establishment and had a lot of relevance in the market, and would be able to provide supplies and negotiate prices. The Director of Adult Social Care agreed that this was a fair challenge, and advised that the rationale for the Consortium had been laid out in the earlier report to the Executive.

In response to a further question regarding the length of the contract, the Portfolio Holder for Adult Care advised that this contract was being procured by a third party on the Local Authority’s behalf, as part of the London Consortium.

RESOLVED that the Executive be recommended to:

i.)  Support the London Consortium award of the Framework Agreement to the successful bidder for the new ICES. The new provider will operate as the single supplier to a framework agreement to provide an Integrated Community Equipment Service on behalf of the London Community Equipment Consortium. The new contract is scheduled to commence on 1^st April 2023;

ii.)  Approve to call-off the new contract for the provision of ICES, with an initial period of 5 years, with one plus one-year extension periods;

iii.)  Approve Recommendation iii, as detailed in Part 2;

iv.)  Delegate to the Director of Adult Services, in consultation with the Portfolio Holder for Adult Care & Health Services, the Assistant Director of Governance & Contracts, the Director of Finance and the Director of Corporate Services, authorisation to extend the contract for up to two years;  ...  view the full minutes text for item 63a

Report ACH23-001

The Committee considered an overview of the Bromley Safeguarding Adults Board’s (BSAB) Annual Report 2021/22.

The Chairman highlighted that this was a great example of partnership work, particularly through a difficult period, and welcomed members of the Bromley Safeguarding Adult Board to the meeting – Teresa Bell – Independent Chair of the Bromley Safeguarding Adult Board (“Independent Chair – BSAB”), Bulent Djouma – Bromley Safeguarding Adult Board Manager (“BSAB Manager”), Dirk Holtzhausen – LBB Assistant Director for Safeguarding, Performance and Provider Relations (“Assistant Director”), Fi Martin – Detective Superintendent BCU, Claire Lewin – Head of Safeguarding, NHS SEL ICB (Bromley) and Paul Sibun – Adult Safeguarding Manager/MCA Lead, NHS SEL ICS (Bromley) (“Adult Safeguarding Manager/MCA Lead”).

A video providing an overview of the Annual Report was shared with Members, and can be viewed via the following link: BSAB Annual Report 2021-22. The Independent Chair – BSAB noted that the video would be uploaded to the BSAB website, along with the full Annual Report and the Easy Read version. Members thanked the Bromley Safeguarding Adults Board for providing an excellent report, which was well laid out and easy to digest.

In response to questions relating to Trading Standards, the Independent Chair – BSAB said that Trading Standards were an active member on the Board. The BSAB Manager advised that they were exploring various methods of raising awareness of the Trading Standards alerts, and there was a dedicated Trading Standards section on the BSAB website. The BSAB had also been working closely with the Trading Standards team to develop bespoke training sessions targeted at those in the community with a learning disability. They were also using the opportunities provided by road show events to spread these messages. The Detective Superintendent BCU confirmed that Trading Standards did prosecute rogue traders, and this could be discussed in further detail following the meeting.

A Member considered that the data collection needed to provide an idea of the severity of an issue. The Independent Chair – BSAB agreed that it would be useful to have more information on how the statistics compared regionally, and with national comparator groups. It was noted that this could be considered for future reports, and looked at by the Board when reviewing performance data. The Assistant Director advised that, in terms of hospitals, referrals were sent through quickly and a with low threshold, which was positive. There was a multiagency forum held every 4 weeks in Bromley, where all providers were discussed – this was very well attended, and the hospital had not been identified as an institution with a systemic problem. In response to questions regarding the data on modern slavery offences, the Detective Superintendent BCU advised that these cases were likely to have been picked up from county lines investigations, then fed back into the system.

In response to a question regarding the Board’s business plan, the Independent Chair – BSAB advised that they had moved to having a 2-year business plan. Previously they had operated  ...  view the full minutes text for item 64.

Report ACH23-004

The Committee considered a contract monitoring report for Learning Disability Supported Living Services.

The Council had five individual contracts with specialist learning disability providers to deliver care and support into 25 supported living properties within the borough. These contracts were with Achieve Together, the Brandon Trust, Lewisham Nexus Service, Diagrama and the Avenues Group. These five providers supported 113 adults with learning disabilities in the community. It was noted that the annual monitoring report was being presented in line with the Council’s Contract Procedure Rules where the contract value exceeded £0.5m and presented an analysis of the providers’ performance during the initial contract mobilisation period and the current contract term. The Strategic Commissioner informed Members that a representative from the Quality Checker team had been due to attend the meeting to provide feedback, however they were unwell and therefore unable to attend.

In response to questions, the Strategic Commissioner advised that key performance indicators (KPIs) and outcomes were used to measure feedback, as well as the quality assurance framework which covered a wide range of activities. Quarterly monitoring report were received from the providers and contained numbers and percentages against the KPIs and outcomes. They were currently looking at the monitoring reports and discussing the data with the providers, such as ensuring they were reporting safeguarding issues within 24 hours. The Director of Adult Social Care advised that feedback was collected from service users by the Quality Checkers. These individuals may use the services themselves, and were likely to gather better feedback than officers. This provided a good measure of how services were performing, and this feedback was being used to identify any issues. With regards to how speedily a provider could be reviewed by the CQC, the Strategic Commissioner said that this was not something that the Local Authority had control over. The provider could resubmit and request a review; however when this took place lay in the hands of the CQC.

The Chairman thanked the Strategic Commissioner for providing an update to the Committee and noted that Appendix 2, providing examples of positive outcomes for service users, brought the report to life.

RESOLVED that the update be noted.

Report ACH23-003

The Committee considered a report providing an overview of the delivery of the domiciliary care contracts in accordance with the service specification.

The Committee could review contracting arrangements on an annual basis, where the contract value was over £500k. The Domiciliary Care Frameworks for both the Patch and Framework providers contracts commenced on 28^th August 2021 and had an annual aggregate value that exceeded this threshold. Given the number of providers (40 in total), the report focused on the mobilisation and performance reporting to provide an insight into the first year of these contracts.

The Integrated Strategic Commissioner advised that the providers of domiciliary care were divided across four quarters (East, West, Central and South). There were 8 providers working across these patches, providing care to 1,400 weekly service users. They were also supported by a smaller framework of 32 providers. The contract had been successfully mobilised during the first year and was meeting demand. The Head of Service for Community Living Commissioning advised that the Local Authority had been a trailblazer for this particular model. The Integrated Strategic Commissioner had forged good relationships with this smaller number of providers who were focused on delivering outcomes for service users. They were finding out more about what service users wanted, and what they could do for themselves – they also ensured that providers worked closely with the voluntary sector to prevent people from being isolated at home. This was considered to be a very good model which brought financial efficiencies. It was highlighted that the tender for this contract had been undertaken by the Head of Service for Community Living Commissioning and her team during the pandemic, which had been a difficult time, and demonstrated that the providers wanted to work with the Local Authority.

The Director of Adult Social Care emphasised the huge amount of work that had been undertaken in relation to this contract. This had been part of the transformation programme from previous years – as well as creating financial efficiencies it was changing the way that people were supported in their own homes, and had been an excellent piece of work.

In response to questions regarding outcomes and the data provided, the Integrated Strategic Commissioner advised that they were based on a 360-degree model – this included strength-based assessments that identified strengths that service users had and enabled them to maintain them. The trusted assessor model also allowed packages to be reframed when safe to do so. Increasing skills and reducing care packages helped service users to remain independent. The Head of Service for Community Living Commissioning advised said that the trusted assessor model allowed the team to have a closer relationship with the care workers, who provided regular feedback on the interventions that care management could support. The Director of Public Health said that her team would be happy to look at how the data could be presented more clearly for future reports.

With regards to stakeholder engagement, a Member noted that 262  ...  view the full minutes text for item 66.

Report ACH23-002

The Committee considered a report providing monitoring updates on the infrastructure support to voluntary services.

The support to the Voluntary, Community, Social Enterprise (VCSE) sector contract was provided by Community Links Bromley (CLB). The Council supported the capacity, capability and sustainability of the local VCSE sector by funding a dedicated resource to coordinate, advocate and strengthen the sector and to support the needs of the local population. The current contract was awarded to CLB in September 2020, following a competitive tender. It commenced on 1^st October 2020 for a five-year period to September 2025, with the option to extend for up to a further two years to September 2027. The annual value of the contract was £156k with a whole life value of £1.09m to September 2027. The report provided a summary of how the service had performed from October 2020 to September 2022, in addressing the requirements of the specification, in demonstrating how community-based support could be a key element in prevention and early intervention and to help to reduce demand for Council and health funded services.

The Integrated Strategic Commissioner advised that the key areas CLB focused on were:

-  Providing information, advice and guidance to the sector so they were aware of key issues. This communication was provided through emails, bulletins and social media platforms

-  Drawing external funding and investment into the sector. This was a key challenge for the voluntary sector, however a significant proportion of the 5-year target had already been leveraged.

-  Hosting the Simply Connect Bromley database, including a central point for registering volunteers and linking them with organisations. They had also launched a volunteering awards ceremony.

-  They were the voice of the voluntary sector, participating at a key strategic boards, including the Health and Wellbeing Board and Bromley Safeguarding Adults Board.

In response to questions, the Integrated Strategic Commissioner said that there were further individual elements of work being undertaken in the community. There were a number of projects helping to tackle loneliness and Bromley Well had produced a map pinpointing the various organisations offering warm hubs across the borough, and the other referral/signposting services provided. This was available on their website and CLB also highlighted this in their weekly bulletin. With regards to increasing the number of contacts for encouraging people into volunteering, the Head of Service for Community Living Commissioning advised that the Principal Loneliness Champion was working with CLB to link with the work being undertaken to tackle loneliness. CLB hosted the Simply Connect Bromley database and Members were encouraged to identify any service gaps they were aware of. The Executive Assistant for Adult Care and Health and Loneliness Champion noted that, as mentioned earlier in the meeting, the Principal Loneliness Champion was looking to ensure that every department within the Council considered loneliness as part of its day to day work, and it was hoped that this would assist these communications.

RESOLVED that the content of the contract monitoring report on the performance  ...  view the full minutes text for item 67.

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 22^nd November 2022 be agreed.

The Committee noted the Part 2 information within the report.