Agenda and minutes

Apologies for absence were received from Councillor Robert Evans and Councillor Christine Harris attended as substitute.

Apologies for lateness were received from Councillor Kevin Kennedy-Brooks.

In respect of Item 12, Councillor David Jeffreys declared that, by virtue of his position as Chairman of the Health and Wellbeing Board, he was a Member of the Bromley Adult Safeguarding Board.  In respect of Item 13 (Annual Monitoring Report – Dementia Post Diagnosis Support Services), Councillor Jefferys declared that he worked with a company who developed dementia drugs.

In accordance with the Council’s Constitution, members of the public may submit one question each on matters relating to the work of the Committee. Questions must have been received in writing 10 working days before the date of the meeting – by 5pm on Tuesday 7^th November 2023. 

Questions seeking clarification of the details of a report on the agenda may be accepted within two working days of the normal publication date of the agenda – by 5pm on Wednesday 15^th November 2023.

One oral question was received from Councillor Jeremy Adams and is attached at Appendix A.

The minutes of the meeting held on 5^th September 2023 were agreed, and signed as a correct record.

Report CSD23122

The Committee considered a report setting out matters outstanding from previous meetings and the proposed work plan for 2023/24.

The Chairman noted that a briefing on the reintroduction of a scheme of visits for ACH PDS Committee Members to care providers in the borough had been tabled.

The Committee agreed to go paperless as far as practicable from the next meeting.  It was noted that an email would be circulated to all Members of the Committee to provide the opportunity to opt-out and request paper copies of agendas.  The Chairman emphasised that the option to request paper copies would always be available to Members.

RESOLVED that the update be noted and the Committee go paperless, where practicable, for future meetings.

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 that there were a number of issues that needed to be brought to Members’ attention, which largely related to items on the agenda.

At the last meeting it was reported that the Assistant Director for Safeguarding, Practice and Provider Relations team had moved into the new offices at Churchill Court – the team had settled in well and were really appreciating being in new, shared surroundings. Better team working was being reported, and the ease of communication meant less need for formal meetings and a real sense of how good it was to work in modern and pleasant surroundings.

Members were advised that preparation for the CQC Assurance visit continued. They were gradually working through those areas identified as needing more attention and were gaining confidence in their preparation. Whilst this had flagged some areas for attention, it was important that they had an honest appraisal of the current position and the work they need to do. Work was continuing on reviewing the hospital discharge arrangements; work to better support carers; use of technology and they were moving on to reviewing the work around Safeguarding practice.

The first phase of work with the Social Care Institute for Excellence had concluded and they were working up a bid for some internal transformation funding to move onto the next steps with the programme. This had been an exciting piece of work, funded by grant funding from government – the next stage would require some internal funding, but delivered efficiencies both in terms of cost and capacity. It was noted that this could be reported on at the next meeting.

The Director of Adult Social Care advised that their continued to be a number of challenges related to obtaining care at an affordable rate to the Council, which was shown in the later budget report. Whilst it was acknowledged that costs had risen, the Council had invested significantly in the increased fees paid for care, but providers were still requesting more. They were working on a detailed report to present to the Portfolio Holder, Chief Executive and Director of Finance to quantify this and present options for managing this, in the event that further money was not made available by central government. It was highlighted that this was not just a Bromley issue.

The department were working to develop robust efficiency options for the financial year 2024/25 and onwards, and these would be presented in detail at the next meeting. However, to give members some headlines, they were currently considering the following areas for exploration (total options circa £1.8m):

-  Strategic Needs assessment of Supported Housing offer;

-  Extend Extra Care Housing offer;

-  Direct Payment in place of Discharge to Assess Funding;

-  Reduction in Agency Staffing spend;

-  Digital Transformation - CareLink, Self-Assessment, Online information and advice;

-  Enhanced Domiciliary Care offer;  ...  view the full minutes text for item 36.

Report ACH23-048

The Committee considered a report providing an update on the Adult Care and Health Portfolio Plan for the first half of 2023/24.

The Adult Care and Health Portfolio Plan was refreshed each year in line with the Council’s Transformation Programme and the Corporate Strategy ‘Making Bromley Even Better’. The Plan also aligned with the new Adult Social Care Strategy. Within each priority were a number of statements which were underpinned by actions and measures of success within the work of Adult Care and Health Services. The first six months of 2023/24 had seen progress on the Portfolio Plan. Work also continued as part of the Transforming Adult Social Care programme to develop the working practices of front-line officers and the structure in which they operated to ensure best value support and services for vulnerable residents. The Portfolio Plan 2023-24 focuses on two of the ambitions from Making Bromley Even Better which reported into this Portfolio:

-  Ambition 2 - For adults and older people to enjoy fulfilled and successful lives in Bromley, ageing well, retaining independence and making choices; and,

-  Ambition 5 - To manage our resources well, providing value for money, and efficient and effective services for Bromley’s residents.

Members noted that progress had been made across all actions within the Portfolio Plan which reflected the partnership work undertaken to deliver and commission services.

In response to a question, the Strategy Officer explained that discussions at the Residents’ Voice Group had revealed the volume of engagement with and feedback from service users and carers that had not been previously bought together.  As such, the establishment of the Residents’ Voice Group had been a positive step.

A Member highlighted the potential role of the Business Improvement Districts (BIDs) to support and encourage independence by improving access to the high street and shopping.  It was agreed that consideration should be given to taking this forward.

RESOLVED that the progress on the actions associated with the Adult Care and Health Portfolio Plan for the first half of 2023/24 be noted.

Report ACH23-049

The Committee considered a report providing the current Adult Care and Health Services’ Risk Register – Quarter 2 2023/24 and the existing controls in place to mitigate the risks.

Since June 2023, when the ACH PDS last saw the Risk Register, two new risks had been added:

-  Risk 13 – Adult Transport; and,

-  Risk 14 – Community Equipment

The following changes had been made to the gross and net (current) risks:

-  Risk 4 – Deprivation of Liberty - change of gross risk from 16 to 12.

The Committee noted that all risks across the Service had been managed through mitigation.

In respect of the Public Health risk, the Director of Public Health explained that within the Public Health community there were ongoing risks, particularly around Covid and the funding for services, as the grant was awarded on an annual basis.  It was recognised that a cautious approach was being taken but this allowed the position to be closely monitored.

In response to a question concerning risks around funding, the Director of Adult Social Care confirmed that, on behalf of the Council, the Director of Finance lobbied for a fair share for Bromley and, nationally, Directors of Adult Social Care lobbied for fair funding for Adult Social Services.

The Committee noted that recruitment was an ongoing risk.  There was a great deal of competition across London and staffing and recruitment required careful monitoring.

In respect of the risk around failure to provide effective Learning Disability Services, the Director of Adult Social Care confirmed that through the efficiency programme there were a number of focus areas in relation to learning disability services.  There was a focus on providing appropriate local services for young people transitioning into Adult Social Care through the further development of in-borough capacity.

RESOLVED that the current Adult Care and Health Services’ Risk Register and the existing controls in place to mitigate the risks be noted.

Report ACH23-054

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.

The Principal Loneliness Champion informed Members that through the Tackling Loneliness Workshops over 250 professionals in Bromley had been trained.  Work was underway to get accreditation to enable the workshops to form part of professional development.  A number of events had taken place across the Borough for “Silver Sunday” and “Befriending Week” had taken place at the start of November.  Finally, the Principal Loneliness Champion reported that a meeting had taken place with a group of South Korean Social Workers who had researched the work being done by Bromley in relation to tackling loneliness and had wanted to discuss initiatives around how to connect people.

In response to a question around how the impact of the initiatives could be measured, the Principal Loneliness Champion, explained that a resident survey had been developed and the aim of this was to analyse the impact of the initiatives.  The survey was quantitative as well as qualitative and partners were helping to trail the survey.  The results from the survey would support the service to obtain quantifiable data which would be reported back to the Committee, it would also enable the Service to develop an evidence base of the impact of the loneliness initiatives and feed into national research.

In response to a question, Members noted that the Team were working with the Business Improvement Districts (BIDs) around the support they could provide to the Tackling Loneliness Strategy.

In response to concerns raised around whether there would be suitable premises to deliver some of the initiatives, the Assistant Director for Strategy and Performance explained that a response had been provided to the request for cheap and freely accessible premises and the list of suitable premises could be shared with Members of the Committee upon request.

RESOLVED that the progress made in delivering the Tackling Loneliness Strategy Action Plan 2022–2026 be noted.

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 ACH23-053

The Committee considered a report requesting approval to vary the current Primary and Secondary Intervention Service (PSIS) Contract. This service (also known as Bromley Well) was managed by Bromley Third Sector Enterprise (BTSE). The London Borough of Bromley was the lead commissioning organisation for this contract acting on the behalf of both the Council and the South East London Integrated Commissioning Board (ICB) Bromley.

The PSIS service consisted of nine pathways with a single point of access providing a triage function and eight specialist service pathways for those that needed further support following triage. The contract variation would revise the service offer of one of the nine PSIS service pathways. This pathway was the Elderly Frail Pathway and the contract variation would change the existing service offer and the PSIS contract in the following ways:

i.  Expand the capacity of the current Handyperson service pathway to include the activity that had been previously commissioned and funded through the ICB;

ii.  Enable the one-off purchase of an additional van for use by additional handyperson, which was not currently part of the PSIS contract;

iii.  Incorporate the Frailty Navigator service, which was currently not part of the PSIS contract; and,

iv.  Enable the allocation of additional funds to the PSIS contract over a 4.5-year period.

The current PSIS contract commenced on 1^st October 2022 and was a 5-year contract which expired on 30^th September 2027, with the option to extend for another 2 years to 30^th September 2029. The contract variation would mean an increase in contract value over the whole life of the contract. The cost of this variation and full contract costs were included in accompanying Part 2 report.

RESOLVED that the Portfolio Holder be recommended to agree the variation to the PSIS contract.

Report FSD23071

The Committee considered a report providing the budget monitoring position for 2023/24 for the Adult Care and Health Portfolio, based on activity up to the

end of September 2023.

In response to a question, the Director of Adult Social Care confirmed that with respect to the overspend in mental health, there were ongoing pressures around increasing prices, but the Team were working to make up the pace.  The intention was that the Trust would work to recover the position.

Members noted that the forecast was the full-year projection and was therefore profiled.  The full-year effect was based on known funding and it was therefore hoped that the position would improve.

RESOLVED that the Portfolio Holder for Adult Care and Health be recommended to note the projected overspend of £1,501k on controllable expenditure based on information as at September 2023.

Report ACH23-052

The Committee considered a report seeking Executive approval to extend the partnership arrangement for the provision of Adult Mental Health Services between the London Borough of Bromley and Oxleas NHS Trust. The extension would enable the partners to continue to operationalise the required improvements that were set out in the s31 Review (2021), and ultimately enable the Council to recommend a service model for the longer term. The current agreement was due to expire on 30^th November 2024.

On 21^st July 2004, the Council’s Executive granted permission for the London Borough of Bromley to enter into an agreement with Oxleas NHS Foundation Trust for the provision of Adult Mental Health services. The agreement established the framework for Oxleas NHS Foundation Trust to undertake their role as the lead provider for Bromley’s Adult Mental Health Services (including the Community Mental Health Team), permissible under s31 of the Health Act 1999. Subsequently the London Borough of Bromley and Oxleas NHS Foundation Trust established a pooled budget to deliver the service and transferred/seconded staff to the new arrangement.

Members noted that this was a very specialist service and in response to a question, the Head of Community Living Commissioning confirmed that alternative options were not currently being considered although an options appraisal was always undertaken.

The Committee congratulated Oxleas NHS Foundation Trust for their recent success in winning the prestigious Trust of the Year award.

RESOLVED that the Executive be recommended to:

i.)  Authorise that the Council enters into a 2 year (extension) agreement with Oxleas NHS Foundation Trust resulting in the continuance of their role as the lead provider of Adult Mental Health Services including operational management. Resulting in an estimated cost of £3,787,914 over the two year extension period (up to 30^th November 2026);

ii.)  Agree the extension of the pooled budget provision, the value of which will continue to be in line with CPI and the National Minimum Wage (which preserves the current value for money arrangement);

iii.)  Agree that the power to sign this agreement and to finalise negotiations is delegated to the Chief Officer (Director of Adults Social Care) as the agreement primarily relates to staff who would normally be directly located in the Adults Social Care Directorate; and,

iv.)  Note that the Integrated Commissioning Board supports and has consented to the Trust retaining these arrangements with the Council.

To follow

Report ACH23-056

The Committee considered an overview of the Bromley Safeguarding Adults Board’s (BSAB) Annual Report 2022/23.

The Chairman welcomed the Independent Chairman of the Bromley Safeguarding Adult Board, Teresa Bell and Bulent Djouma, Bromley Safeguarding Adult Board Manager, to the meeting.

A video providing an overview of the Annual Report was shared with Members and can be viewed via the following link: BSAB Annual Report 2022-23

Members noted the tremendous volume of work completed by the BSAB and paid tribute to the work of the Independent Chairman.

In response to a question, the Independent Chairman of the Board confirmed that there was a recognition of gaps that could emerge in the level of support from mental health services for vulnerable families during periods of transition from Children’s to Adult’s Services.  There was good representation from Bromley Mencap on the Board and consideration could be given to any additional support that could be given to vulnerable families.  The Independent Chairman explained that an area of focus for the Board was to ensure that there was no disruption to care arising from transition.

In response to a further question, the Director of Adult Social Care provided assurances that transition from Children’s to Adult’s Services did not have a negative impact on waiting times for services.  In addition, for the past year the Council had been operating a 0-25 Service which sat within Children’s Services.  This helped to facilitate better management of transition.

A Member highlighted that, in terms of transition, there was also flexibility within Health Services to ensure services to young adults were not disrupted by transition.

RESOLVED that the Bromley Safeguarding Adults Board’s 2022/23 Annual Report be noted.

Report ACH23-036

The Committee considered a report providing a summary of how the Dementia Post Diagnosis Support Service had performed over the last 12 months in addressing the requirements of the specification. This demonstrated how community-based support was a key element in meeting the Council’s statutory duties by preventing or delaying the need for more expensive accommodation / health-based provision, whilst meeting the primary aim of achieving the best possible health and wellbeing outcomes for service users and their carers.

The report was presented in order to meet the requirement regarding monitoring updates for Policy Development and Scrutiny Committees. The Dementia Post Diagnosis Support, (Dementia Hub) Service was currently provided by Bromley, Lewisham, and Greenwich (BLG) Mind, in partnership with Age UK Bromley, with BLG Mind as the Lead organisation. The Dementia Hub was a specialist service that delivered a one stop support service for adults who had a diagnosis of dementia, their carers, and the professionals who supported them. The current contract was awarded to BLG Mind on 1^st July 2020 – 30^th June 2025, with the option to extend for a further 2 years.

Members noted that the contact was working well, and the Service had developed a good relationship with the provider.

In response to a question around respite care for families caring for people living with dementia, the Integrated Strategic Commissioner confirmed that there were a couple of options with the assessment identifying the most suitable package of care.  A respite home service was available as was overnight stay respite.  The Dementia Hub also provided opportunities for carers to have a break.  It was noted that there was lots going on and there was a vibrant offer in the Borough.

In response to a further question, the Committee noted that there were a number of referral pathways with referrals generally addressed within 10 days.

It was agreed that details of the Befriending Service would be provided to Members who could share the information in the wider community.

In response to a question, the Director of Adult Social Care confirmed that following the winter, the Saxon Centre would be closing for essential maintenance.  Officers were currently working with Age Concern to ensure that support continued to be provided to service users during the period of the closure.

RESOLVED that the contract monitoring report on the performance of BLG Mind be noted.

Report ACH23-051

The Committee considered an extract from the September 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.

RESOLVED that the report be noted.

The briefing comprises:

• Minutes from the Health Scrutiny Sub-Committee meeting held on 5^th September 2023
• Local Account 2022/23
• Capital Programme Monitoring Q2
• Annual Complaints Report and Local Government and Social Care Ombudsman Letter 2022/23

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 4 reports:

• Minutes from the Health Scrutiny Sub-Committee meeting held on 5^th September 2023
• Local Account 2022/23
• Capital Programme Monitoring Q2
• Annual Complaints Report and Local Government and Social Care Ombudsman Letter 2022/23

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 5^th September 2023 be agreed.

The Committee noted the Part 2 information within the report.

The Committee noted the Part 2 information within the report.

The Committee noted the Part 2 report.