Agenda and minutes

There were no apologies for absence.

The Chairman noted that this was the final Adult Care and Health Policy Development and Scrutiny Committee meeting of the municipal year and thanked Members, Co-opted Members and officers for their contributions throughout the year.

In relation to agenda items 9 and 13 (minutes 79 and 83) Co-opted Member, Vicki Pryde declared that she worked for Experts by Experience (X by X), Oxleas NHS Foundation Trust and Bromley, Lewisham and Greenwich Mind. Co-opted Member, Rona Topaz also declared that she worked for Experts by Experience (X by X).

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 onThursday 9^th March 2023.

No questions had been received.

The minutes of the meeting held on 24^th January 2023 were agreed, and signed as a correct record.

Report CSD23040

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

The Chairman noted that the matter related to re-establishing a programme of Member visits was in progress, pending a drop in the number of COVID-19 cases in care homes. With regards to minute 61, information on the average council tax of other boroughs had been circulated to Members, and could now be marked as complete.

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, work to consult with the provider market about the Market Sustainability Plan had almost reached completion. It was noted that the Assistant Director for Integrated Commissioning would present a report in relation to this later in the meeting. The Director of Adult Social Care was pleased to confirm that the department were on target to report this to the Department for Health and Social Care (DHSC) as required.

Members were advised that draft guidance had been received from the Care Quality Commission (CQC) regarding the Assurance process, and would begin to be rolled out from April 2023. Internally, a great deal of preparatory work had been undertaken, including carrying out self-assessments; updating policies and practice guidance; working with staff to prepare them for the reintroduction of an assurance process; and gathering evidence that could be shared with the CQC as part of the process when they visited Bromley. Whilst the guidance was still in draft form, any changes were likely to be minimal as the process was rolled out – 6 authorities had initially been trialling the process, with others to follow. It was noted that Bromley was not one of the authorities to be looked at initially. The Assurance process would look at four areas:

·  how the Local Authority worked with people;

·  how the Local Authority provided support;

·  how the Local Authority ensured safety within the system; and,

·  leadership.

The CQC would apply their Single Assessment Process, which would look at six evidence categories which the department were preparing for. These were:

·  people’s experience;

·  feedback from staff and leaders;

·  feedback from partners;

·  observation;

·  processes; and,

·  outcomes.

From looking at current performance and other data supplied, the CQC would apply a baseline from which to measure. The scoring framework would currently grade local authorities as follows:

1 = evidence shows significant shortfalls in the standard of care

2 = evidence shows some shortfalls in the standard of care

3 = evidence shows a good standard of care

4 = evidence shows an exceptional standard of care.

The department would aim to be graded as highly as possible; however they were aware that any new process would take a while to be embedded. The Director of Adult Social Care emphasised that preparation for the Assurance visit must become one of the major focusses going forward, although all the work being undertaken around transformation and reform would stand the department in good stead for this. It was noted that the team were also engaging with the Assistant Director Strategy, Performance and Corporate Transformation, and other colleagues in Children’s Services, to take appropriate learning from their experience of Ofsted, although it was hoped that the approach taken by the CQC would be less onerous. The Director of Adult Social Care said that, from her perspective, if they were doing  ...  view the full minutes text for item 76.

Portfolio Holder decisions for pre-decision scrutiny.

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

Report FSD23023

The Committee considered a report providing the budget monitoring position for 2022/23 for the Adult Care and Health Portfolio, based on activity up to the end of December 2022.

The Head of Finance for Adults, Health and Housing advised that an underspend of £57k on the controllable budget was currently projected, which was similar to the figure projected in the last quarter. Key variations were highlighted in Appendix 1B of the report and provided explanatory notes on the movements in each service. Within Assessment and Care Management there had been gross overspend of £174k. This was mainly due to overspends on care packages; there had not been any significant increase in client numbers, so this was mainly related to increased costs, particularly the provision of 1-2-1 support following hospital discharges. Placements that were above the Council’s guide rates were another factor that had contributed towards the overspend.

The Head of Finance for Adults, Health and Housing highlighted that, although there had been some significant increases in the spend on care packages, additional funding, specifically for hospital discharges, had been received from the government which had helped to offset this. It was noted that, arising from this, there were potential pressures going into the new financial year, but there were plans to further improve the hospital discharge process and reduce these costs. A Member asked if information on mitigations going into the new financial year could be provided. The Head of Finance for Adults, Health and Housing said that work had been undertaken to look at the single point of access (SPA), and processes were in place to reduce the amount of time spent carrying out Care Act and financial assessments post-discharge. It was suggested that further information could be provided in a future budget monitoring report.

A Member commented that a projected underspend of £57k on the controllable budget was highly commendable. It was noted that the Portfolio had benefitted from funding (£2,314k) from central government, which had helped but, with the additional pressure faced, it was considered that all those involved with achieving this position should be congratulated.

In response to questions regarding the Shared Lives project, the Director of Adult Social Care advised that there had been a number of issues related to staffing within the service. However, there were a number of new placements available, and work was being undertaken to look at how these should be prioritised. Assurance was given that, for every package that went through the funding panel, the opportunity for the Shared Lives project was considered. They were also considering extending the use of the Shared Lives project for people placed outside of the borough. It was recognised that the Shared Lives project was a very good scheme, and it was hoped that it would gather pace with a new manager, and team, in place and new families looking to enter the scheme. Members were advised that further support was also being received from the national programme, Shared Lives Plus.  ...  view the full minutes text for item 77a

Report ACH23-011

The Committee considered a report setting out the proposed Bromley Adult Social Care Market Sustainability Plan for agreement. The report also sought agreement on the spending of the Council’s allocation of the government’s Market Sustainability and Improvement Fund that supported the changes outlined in the plan.

In support of government social care reforms, the Council was required to submit an Adult Social Care Market Sustainability Plan to the Department of Health and Social Care (DHSC). The purpose of this plan was to assess the impact the Council’s current fee rates were having on the local adult social care market; and how the Council was preparing for the introduction of legislative change that would give self-funding social care service users a right to ask councils to find their care, and access the same rates that councils paid for the care and support, from October 2025.

The Assistant Director for Integrated Commissioning advised that in December 2021 the government had published a white paper, People at the Heart of Care, which outlined a 10-year vision for adult social care. Included in the white paper were proposals for a Fair Cost of Care and Market Sustainability policy that intended to address the practice of councils paying provider fees for care homes and domiciliary care services that did not adequately cover the cost of these services. The impact of this policy change for the Local Authority was significant due to Bromley having a large and elderly self-funder population, as well as there being a large number of care homes located in the borough. For these reasons the gap between what the Council paid for care and support services, and what local care homes and domiciliary care services charged self-funders, would  be greater than that for other areas. The Council would need to put in place additional care assessment and brokerage and placement resources to meet a new demand for support from self-funders. Without government support the cost to the Local Authority of levelling up its fees with that of self-funders could be in the region of £10m per annum.

Members were advised that officers engaged with the local market and had undertaken a cost of care survey of the older people’s care homes and domiciliary care agencies based in the borough. The providers were asked to complete a government designed questionnaire on their activities and the actual costs of providing services – there had been a very positive response rate from local providers, with useful data received. The survey results were used to arrive at a median cost of care for the borough for these types of provisions, and to make an analysis of the local market of providers, which would allow the Council to ‘move towards’ paying a ‘fair rate’.

The Assistant Director for Integrated Commissioning advised Members that the Market Sustainability Plan was a requirement of the reform preparations, and had been completed using a template of criteria provided by the DHSC. It provided an analysis of the care market  ...  view the full minutes text for item 78a

Report ACH23-010

The Committee considered an extract from the February 2023 Contracts Register which was presented to Members for detailed scrutiny. The Contracts Register contained in Part 2 of the agenda included a commentary on each contract to inform Members of any issues or developments. It was highlighted that no contracts had been flagged as a concern during this quarter.

The Assistant Director for Integrated Commissioning noted that the report provided a snapshot as at the 19^th January 2023. There were three contracts rated as ‘amber’. The first of these was the Integrated Community Equipment Service (ICES), which was presented at the last meeting and had now been awarded. The other two ‘amber’ contracts were awaiting the decision of the Director of Adult Social Care and were in the process of being finalised.

RESOLVED that the report be noted.

The briefing comprises:

• Minutes from the Health Sub-Committee meeting held on 17^th January 2023
• Capital Programme Monitoring 2022/23 Q3
• Draft Adult Social Care Strategy 2023-2028

Members and Co-opted Members have been provided with advance copies of the briefing via email.  The briefing is also available on the Council’s website at the following link:

http://cds.bromley.gov.uk/ieListMeetings.aspx?CId=559&Year=0

Printed copies of the briefing are available on request by contacting the Democratic Services Officer.

The Adult Care and Health PDS Information Briefing comprised 3 reports:

·  Minutes from the Health Scrutiny Sub-Committee meeting held on 17^th January 2023

·  Capital Programme Monitoring 2022/23 Q3

·  Draft Adult Social Care Strategy 2023-2028

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 24^th January 2023 be agreed.

The Committee noted the Part 2 information within the report.