Agenda and draft minutes

Apologies for absence were received from Co-opted Members Stacey Agius and Jo Findlay.

There were no declarations of interest.

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 27^th February 2024. 

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 6^th March 2024.

No questions had been received.

The minutes of the meeting held on 30^th January 2024 were agreed, and signed as a correct record.

Report CSD24036

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

The Director of Adult Social Care advised that some teething problems were still being experienced with regards to setting up Member visits, and this would be followed up with the Assistant Director for Strategy, Performance and Corporate Transformation. A Member noted that they had recently visited Southmore Court (Petts Wood), which had been extremely interesting and encouraged others to attend when presented with the opportunity. These comments were echoed by another Member who advised that, as a local Ward Councillor, they regularly visited Cedarmore Court (Chislehurst). In response to a question, the Director of Adult Social Care said that invites for future visits would be sent out in a timely manner to provide as much notice as possible. The request from Members to explore the possibility of evening and weekend sessions had been noted, however this was not always appropriate.

In relation to the Assistive Technology session, the Director of Adult Social Care advised that these would be arranged at the beginning of the new municipal year once the membership of the Adult Care and Health Policy Development and Scrutiny Committee was confirmed.

RESOLVED that the update be noted.

The Director of Adult Social Care gave an update to Members on work being undertaken across the Adult Social Care department.

In relation to the budget, the Director of Adult Social Care advised that whilst there had continued to be a number of pressures relating to the spend, a downturn in spend against Discharge to Assess was being seen following work undertaken to tighten up on the process of ongoing funding post hospital discharge. Care costs continued to present challenges and they were about to enter into negotiations in relation to inflationary increases for the coming year. It was anticipated that, going forwards, there would be some challenging conversations as the expectations of providers were unrealistic in terms of growth that the Council was able to afford.

Members were advised that as part of the work to deliver transformation savings in the next year, the department had started a piece of work to explore the potential of the Council delivering a care home direct. It was noted that some other London Boroughs had gone down this route, so they were seeking to learn from them whilst exploring this for Bromley – previous work indicated that this was not a cost effective model, but it was considered to be worth exploring again. In response to questions, the Director of Adult Social Care said that the Assistant Director for Integrated Commissioning would be leading on this work and a wide range of options would be considered. This would be a significant piece of work and therefore findings would not be available until the autumn. The Portfolio Holder for Adult Care and Health noted that proposals had previously been considered in 2018 and 2019, and therefore a template had already been established that the Assistant Director for Integrated Commissioning would be working to. The work undertaken would need to be thorough to ensure they met both service delivery needs and remained within the financial envelope.

The Director of Adult Social Care said she was pleased to report that the department was on target to deliver 100% of the efficiency and transformation savings that had been planned for this year, a sum of over £3.5m – huge thanks were extended to every team member that helped to achieve this.

The Director of Adult Social Care informed Members that the department continued to prepare for the Care Quality Commission (CQC) Assurance process and were making good progress with the new Principal Social Worker who was taking a forensic look at all the work undertaken, particularly in relation to practice.

Members were advised that, sadly, two long standing Heads of Service would shortly be leaving the Council. Grace John-Baptiste, who had headed up the mental health service in Oxleas was retiring and Jane Campbell, Principal Occupational Therapist and Service Lead had also decided to leave her role, to take up opportunities to work more directly with service users. The Director of Adult Social Care expressed her thanks to both for all their work and wished them  ...  view the full minutes text for item 68.

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 FSD24022-A

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 December 2023.

The Head of Finance for Adults, Health and Housing advised that the current position for the Adult Care and Health Portfolio was a projected overspend of £1.9m on the controllable budget – this was an increase of £0.4m from the quarter 2 forecast. The main area of increase was within Assessment and Care Management which included an overspend on the Community Equipment contract budget – it was noted that further information was provided within the Part 2 appendix.

The Head of Finance for Adults, Health and Housing advised that an underspend of £160k was forecasted in Quality Assurance and Safeguarding, which would be offset against the Learning Disabilities overspend of £155k, based upon the current level of client numbers and costs. In response to questions, the Head of Finance for Adults, Health and Housing said that the Quality Assurance and Safeguarding underspend was mainly against the Deprivation of Liberty Safeguards (DoLS) and Mental Capacity Act supplies and services budget, which was responsive to the in-year needs. The Director of Adult Social Care advised that the DoLS budget funded staff and the medical assessments undertaken by doctors – as demand was lower, they did not need to pay for as many assessments which had created the underspend. It was difficult to say if this would continue as they would not know if DoLS would apply until a referral was received. However if the lower numbers going into residential nursing care continued to be maintained the demand for assessment was likely to be less.

A Member noted that domiciliary care had areas of overspend within all categories. In response to questions, the Director of Adult Social Care said that this related to the demands of the individuals they were supporting – needs were more complex, and the packages of care required were more costly. It was noted that the number of people being supported in their own homes was increasing and consideration may need to be given to moving the budget to sit within the right service area.

In response to a question regarding the Integrated Community Equipment Service contract, the Assistant Director for Integrated Commissioning confirmed that the use of credits had been included in other contracts. Members were advised that in this contract credits were paid to the Council against returned equipment which could be recycled and reused by the provider.

RESOLVED that the Portfolio Holder be recommended to note the projected overspend of £1,925k on controllable expenditure based on information as at December 2023.

Report ACH24-006

The Chairman welcomed Members of the Children, Education and Families Policy Development and Scrutiny Committee, and the Portfolio Holder for Children, Education and Families, to the meeting for consideration of this item.

On 29^th June 2021 the Executive agreed the award of geographical Patch contracts to deliver domiciliary care services for a up to an eight-year period (5+3 years) that commenced on 28^th August 2021 (Report ACH21-031). The current value of the contract spend was an overall value of £16.4 million per annum. The overall remaining whole life value of £82 million for 2+3 years (both Framework and Patch). Since the award of the contract, two of the four patches (East and South) had delivered well and had progressed to accept circa 70% of the domiciliary care packages at the end of year two of the eight-year contract. However, because some designated providers had not been able to deliver packages of care the Integrated Commissioning Service was now seeking to replenish the Central Patch with one new provider alongside four back-up providers to be used when required.

In response to a question, the Head of Finance for Adults, Health & Housing advised that confirmation of the Children and Young People’s element of the domiciliary care budget could be provided to Members following the meeting.

Post-meeting note:

Following the meeting, the Head of Finance for Adults, Health & Housing clarified that paragraph 3.13 of the report should read:

‘With reference to Children and Young people (CYP) there are ninety-nine children and young people in receipt of a domiciliary care package. Currently with an estimated cost for 2023/24 at £2.4m.’

RESOLVED that the Executive be recommended to approve permission to procure up to five new Patch providers, these contracts will run co-terminus with the Patch providers that have been delivering services since 28^th August 2021. This action is due to one provider ending their contract. The additional four new providers will replace any providers that are not able to meet the terms of the contract.

Report ACH24-018

The Committee considered a report seeking Executive approval for the award of a residential home care block contract for 20 Bromley based beds to the provider named in the accompanying Part 2 report. The block contract would result in the Council securing access to more in borough residential care provision and would also support achievement of medium-term financial savings targets with regards to managing the market more efficiently. The proposed arrangements would yield efficiencies in commissioning costs by continuing to secure a reduced purchasing rate per placement through a block contract as compared to existing spot placement rates and help to manage the increasing pressure of seeking and finding suitable placement in Bromley.

In response to questions, the Strategic Commissioner for Extra Care and Care Homes said that if the block contract was successful they could look to increase the provision over time. It was noted that the proposed provider had a ‘good’ CQC rating.

RESOLVED that the Executive be recommended to:

i.)  Approve the award of the Residential Care Services block contract as set out in the accompanying Part 2 report, the block contract being for 20 beds for a two-year contract commencing 1^st April 2024 with the option to extend for up to a further two years; and,

ii.)  Approve delegated authority to the Director of Adult Social Care, subject to agreement with the Portfolio Holder, the Assistant Director Governance & Contracts, the Director of Finance and Director of Corporate Services, to apply the two-year extension option.

Report ACH24-014

The Committee considered a report seeking Executive approval to award the Support@Home service contract in accordance with the arrangements set out in the report and the accompanying Part 2 report to commence the new service on 1^st October 2024.

Mental Health recovery and rehabilitation accommodation-based support and floating support services aimed to support mental health service users away from reliance on hospital and residential provision towards enabling and cost-effective services such as supported accommodation, support in the community and targeted support towards independent living. The LBB Mental Health Flexible Support Service contract would expire on 30^th September 2024. The current contract had been in place since 1^st October 2019 and had no further options to extend.

The South East London Integrated Care Board (SELICB) Adult Mental Health Residential and Supported Accommodation Services contract would expire on 30^th September 2024. The current contract had been in place since 1^st April 2019 and had an estimated value of £1,432k per annum. The contract had no further extension options remaining and had a cumulative value of approximately £6,963k over the 5-year term. In addition to the block contracted services, LBB held individual placement contracts for clients placed into SELICB contracted provision. In 2021/22 the combined annual value of these placements was estimated to be approximately £1.12m per annum. In total these two services had an estimated combined value more than £2.94m per annum.

The Gateway 0 report ACH22-018, presented to Executive on 29^th June 2022, advised Members on the procurement options for future housing support mental health services in Bromley and gained approval to replace the existing service model with a new joint adult mental health recovery and rehabilitation Support@Home service contract in 2024, underpinned by the section 75 agreement between LBB and SELICB, and with a combined total contract value estimated at £2.66m per annum, split 50:50 between LBB and SELICB. The Gateway 1 report ACH22-035, presented on 30^th November 2022, sought and obtained Executive approval to commence the procurement of the service in accordance with the arrangements set out in the report with the intent to commence the new service on 1^st October 2024 with LBB acting as the contracting authority.

In response to questions, the Associate Director of Integrated Commissioning – NHS South East London ICB (Bromley) said that, with regards to residents being able to take up tenancies, these would be in place for as long as required. Residents would have more rights with a tenancy than they did in a residential care home, and they would be assessed to determine when they were able to move on. The model being developed was for service users and providers to deliver floating support – this would provide an opportunity for people to move on to their own homes and receive ongoing support. This would allow for better planning when service users moved out and it was not expected to cause any bottlenecks.

A Member noted that, in terms of service  ...  view the full minutes text for item 70c

To Follow

Report ACH24-015

The Committee considered a report seeking Executive approval to draw down capital funds. An analysis of the work and resources required to complete the upgrade of all the devices currently in operation for the Bromley residents that use the Council’s Carelink Service to support the Council’s statuary obligation to support vulnerable residents as directed by the Care Act 2014 had been provided.

The Public Switch Telephone Network (PSTN) would close in December 2025 – this in effect meant that there would be a switching off the old analogue telephone network. It would be replaced with an all-digital fibre-based network and was consistent with an imperative for digital transformation of all related services including telecare. The report outlined recommendations of the resources required to meet the digital upgrade before the end of 2025.

In response to questions, the Assistive Technology Project Manager – Adult Services said that the figures provided were based on the scale of the current employees and included on-costs. It was noted that this covered a period of 8-10 months.

RESOLVED that the Executive be recommended to:

i.)  Note the options explored and analysis in this report;

ii.)  Approve the plan and budget for the phase of work (procurement and transition) as set out in Section 8 of this report. This will incur costs estimated at £416k in total (£139k in 2023/24 and £277k in 2024/25);

iii.)  Approve delegation of authority to the Portfolio Holder for Adult Care and Health and to the Director of Adult Services for agreeing any relevant decisions to enable the implementation and delivery of the recommendations in this report that are agreed by Executive; and,

iv.)  Consider the preferred procurement option of a new call handling platform to replace the current service provider contract which expires in November 2024.

The briefing comprises:

• Minutes from the Health Scrutiny Sub-Committee meeting held on 30^th January 2024
• Capital Programme Monitoring Q3
• Loneliness Action Plan Update
• Contract Register

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:

The briefing comprises:

• Minutes from the Health Scrutiny Sub-Committee meeting held on 30^th January 2024
• Capital Programme Monitoring Q3
• Loneliness Action Plan Update
• Contract Register

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

The Committee noted the Part 2 information within the appendix.

The Committee noted the Part 2 information within the report.

The Committee noted the Part 2 information within the report.