Agenda and minutes

To receive apologies for absence and notification of any substitutes present

Apologies for absence were received from Mr Homewood, Mr Koowaree and Mr Lymer.  Mr Bird and Mr Davies attended as substitutes for Mr Koowaree and Mr Lymer respectively.

To receive any declarations of interest made by Members in relation to any matter on the agenda.  Members are reminded to specify the agenda item number to which it refers and the nature of the interest being declared

(1)       Mr Maddison made a declaration of interest in Item A5 – Verbal Updates (Advocacy Contract Award) as he was a trustee of Invicta Advocacy that had been unsuccessful in their bid for the contract.

(2)       Mrs Allen made a declaration of interest in Item B2 – Integrated Adult Learning Disability Commissioning Section 75 Agreement and Item C4 – Commissioning Domestic Abuse Support Services as she was the co-chair of the Dartford and Gravesham Learning Disability Partnership Board and a non-executive director of a women’s refuge.

To consider and approve the minutes as a correct record

RESOLVED that the minutes of the meeting held on 11 September 2015 are correctly recorded and that they be signed by the Chairman.

To receive a verbal update from the Cabinet Member for Adult Social Care and Public Health, the Corporate Director of Social Care, Health and Wellbeing and the Director of Public Health.

Adult Social Care

1.         Mr Gibbens gave a verbal update on the following issues:

·         Lyn Romeo, Chief Social Worker at the Department of Health had visited Kent County Council

·         13 October 2015 - The annual Kent Learning Disability Partnership Awards at County Hall. Awards were made to businesses and services which have gone above and beyond in supporting and improving the lives of people with learning disabilities

·         14-16 October – He had attended the National Children and Adult Services Conference in Bournemouth. Mr Alistair Burt, MP - Minister of State for Community and Social Care had spoken at the conference.

·         10 October – Attended the Canterbury and Coastal Rethink Carers’ Support Group as a part of a series of events to mark World Mental Health Day

·         10 November – attended the South East Mental Health Commissioning Network in Guildford

·         17 November - Kent Dementia Awards had been held at County Hall.  Particular reference was made to the Dementia Café being run at the Oasis Academy, Sheerness.

2.         Mr Ireland gave a verbal update on the following issues: 

·         Advocacy Contract Award

The advocacy services had been re-tendered following the Care Act 2012 and had been awarded to SeAp (Support, Advocate, Empower, Promote)

·         Community Mental Health and Wellbeing Service Tender

In January 2015 this committee had considered a proposal to end grants and commission a community mental health and wellbeing service.  Following a range of engagement and co-production events with key stakeholders a decision was made to end grants and commence a tender process.  A public consultation in May indicated that the vision for the service should be to provide a holistic offer of support for individuals living with mental health and wellbeing needs in Kent.  Organisations that had achieved a minimum of a 50% quality score following a pre-qualification questionnaire were invited to complete an Invitation to Submit an Outline Solution and organisations that had expressed an interest in becoming delivery partners were invited to complete information for strategic partners to take forward.  The final tenders would be evaluated in December and the contract awards made in January 2016.  A report on the outcome would be presented to Cabinet in March

·         Visit to teams operating from Kroner House

Mr Ireland said he had visited a number of teams based in Kroner House including the Central Referral Unit, the Out of Hours team, the Autism team, the Shared Lives team and the Mental Health Temporary Cover team.  He said it was useful to see the teams in operation.

·         14-16 October – Attended the National Children’s and Adult Services Conference.  Mr Burt MP had made his speech to the conference before the announcement relating to the Comprehensive Spending Review and this had limited what he could say.  Mr Ireland had however asked a question about the difficulties of recruitment and retention of care workers which was one of only three answered by Mr Burt.

He responded to comments and questions as follows:

·         The authority worked with voluntary organisations and expressed concerns when  ...  view the full minutes text for item 53.

To receive a report from the Cabinet Member for Adult Social Care and Public Health and the Corporate Director of Social Care, Health and Wellbeing and to comment on and either endorse or make a recommendation to the Cabinet Member on the proposed decision to re-commission the short breaks service for adult carers of vulnerable adults across Kent for a further two years, until 31 March 2018.

Emma Hanson (Head of Community Based Services) was in attendance for this item

(1)       Mrs Hanson introduced the report which asked the committee to consider and endorse, or make recommendations to the Cabinet Member for Adult Social Care and Public Health with regard to the re-commissioning of short breaks for adult carers of vulnerable adults in Kent for two years until 31 March 2018.

(2)       Mrs Hanson said the short breaks contract was jointly funded by Health and Kent County Council, the contract had been in place for three years, and that funding had been identified to re-commission the service.

(3)       In response to questions, Mrs Hanson said respite care was provided for vulnerable adults away from their homes and was commissioned in conjunction with clinical commissioning groups.  The contract being considered referred to short break service provided for carers in the home.

(4)       During the discussion Members acknowledged the valuable role played by carers.  It was also confirmed that the provision of a short breaks services was a statutory requirement.

(5)       RESOLVED that the proposed Cabinet Member decision, to re-commission the short breaks for adult carers of vulnerable adults and to delegate authority to the Corporate Director for Social Care, Health and Wellbeing, or other nominated officer, to authorise the letting of the contract, be endorsed. 

To receive a report from the Cabinet Member for Adult Social Care and Public Health and the Corporate Director of Social Care, Health and Wellbeing and to comment on and either endorse or make a recommendation to the Cabinet Member on the proposed decision to enter into a Section 75 agreement with the seven Kent Clinical Commissioning Groups which will agree arrangements for integrated commissioning for adults with a learning disability.

Sue Gratton (Project Manager – Integrated Commissioning for Learning Disability) was in attendance for this item.

(1)       Penny Southern (Director of Disabled Children, Adults Learning Disability and Mental Health) introduced the report which described the proposed integrated commissioning arrangement for Adult Learning Disability between Kent County Council and the clinical commissioning groups which, if approved in January 2016, would become operational from 1 April 2016.   The report also asked the committee to consider and endorse or make recommendations to the Cabinet Member for Adult Social Care and Public Health on a proposed decision to enter into a Section 75 agreement with the seven clinical commissioning groups in Kent.

(2)       Ms Southern tabled a diagram setting out the current arrangements to deliver integrated community learning disability teams.  Ms Gratton explained the current agreements and said that a more formal arrangement was a logical progression and would ensure a consistent approach across Kent.

(3)       In response to questions, Mr Lobban (Director of Commissioning) said that the proposed arrangement of having two NHS staff within the commissioning teams would make the commissioning and service more sustainable. He also confirmed that Newton Europe was not involved in this particular commissioning process.

(4)       RESOLVED that:

(a)       The proposed Cabinet Member decision to enter into a Section 75 agreement with the seven Kent CCGs, which would agree arrangements for integrated commissioning for adults with a learning disability, be endorsed;

(b)       The delegation of authority by the Cabinet Member for Adult Social Care and Public Health to the Corporate Director for Social Care, Health and Wellbeing, or other nominated officer, to arrange the sealing of the contract, be endorsed.

To receive a report from the Cabinet Member for Adult Social Care and Public Health and the Corporate Director of Social Care, Health and Wellbeing on progress on the implementation phase of the Adult Social Care Transformation Portfolio, including the work with the Efficiency Partner, Newton Europe.  The report also provides a brief update on other significant commissioning activity included in the Directorate’s Business Plan 2015/16.

(1)       Mr Lobban (Director of Strategic Commissioning) introduced the report which provided an update on the progress of the implementation phase of the Adult Social Care Transformation Portfolio including the work with Newton Europe and other significant commissioning activity in the SCHW Business Plan 2015/16.

(2)       He referred in particular to the programmes being supported by Newton Europe listed in paragraph 2.1 of the report and to the case studies.

(3)       In response to comments and questions he said:

·         The Enablement Service had sometimes been by-passed when hospitals where on “Black Alert” but the new Access to Independence Service would meet service users’ needs more efficiently and would generate more capacity.

·         A number of other initiatives, including two pilot schemes to test the ability to deliver the accommodation elements, as well as other work with housing providers to support the Access to Independence were underway.

·         There were capacity issues particularly in the homecare and domiciliary market however maximising independence and a return to optimum health would help generate capacity in domiciliary care.

·         He would provide an update, outside the meeting, on current activities in Swale as it had not been mentioned in paragraph 2.4.1 of the report.

(4)       RESOLVED that the report be endorsed.

To receive a report from the Cabinet Member for Adult Social Care and Public Health and the Corporate Director of Social Care, Health and Wellbeing on the services available to help vulnerable adults into employment in Kent and the Kent performance against national indicators to see how well the Council is doing in relation to other authorities.

Sue Dunn (Head of Skills and Employability), Steve Chapman (Service User and Kent Learning Disability Partnership Board), and Steph Smith (Head of Performance for Adult Social Care) were in attendance for this item

(1)       Mrs Dunn said the refreshed Learning, Employment and Skills Strategy was designed to achieve a fundamental shift towards a more comprehensive offer for young people aged 14-24 including vulnerable adults.  The strategy included a priority to support adults into employment.  She also drew attention to the work being done by the Kent Supported Employment Education and Young People's Service. Good models of practice were in place throughout the county but every opportunity to bid for funding was taken to further extend services. 

(2)       Mr Chapman spoke about his experience of work and support to find work over the last 14 years as well as his work to improve the experiences of people with learning disability of gaining employment and of volunteering.

(3)       Members of the committee were pleased that the targets were challenging and in particular that the proportion of adults with a learning disability in paid employment in Kent was higher than the England average.  Questions were also asked about how employers might be supported to employ more people with learning disabilities, how carers might be supported to encourage those with learning disabilities to apply for paid work and how the County Council could be a good advocate for the employment of people with learning disabilities.

(4)       In response to comments, officers said:

·         the fact that the strategies had been developed by experts in education rather than social care meant that they addressed the desire of people with learning disabilities for access to universal services and raised awareness of the issues within schools and colleges.

·         models used by other authorities had been investigated and it was anticipated that changes would be made to some services when contracts were re-let.

·         data could be disaggregated to identify vulnerable learners.

·         the issue of the loss of benefit when employment was more than 16 hours per week had been raised with the Department for Work and Pensions.

(5)       RESOLVED that the approach planned for the future, which included work to increase the authority’s performance and ability to find meaningful employment for vulnerable adults, be endorsed.

To receive a report from the Cabinet Member for Adult Social Care and Public Health and the Corporate Director of Social Care, Health and Wellbeing on progress of the formal consultation on the future of the County Council’s four older persons residential care homes; the Dorothy Lucy Centre, Maidstone, Blackburn Lodge, Sheerness, Kiln Court, Faversham and Wayfarers, Sandwich.

Christy Holden (Head of Commissioning - Accommodation) was in attendance for this item

(1)       Ms Holden introduced the report which provided an update on the formal consultation underway on the future of the County Council’s four older persons’ residential care home provision: the Dorothy Lucy Centre in Maidstone; Blackburn Lodge in Sheerness; Kiln Court in Faversham; and Wayfarers in Sandwich. The consultation had commenced on 28 September 2015 and was due to end on 20 December 2015.

(2)       Ms Holden drew the committee’s attention to the drivers for the proposals, the consultation activity, initial results from the consultation and the proposed next steps. 

(3)       Mr Smith invited Mr Clark and Mr Gates to address the committee.  Mr Clark said he was concerned that if the Dorothy Lucy Centre closed a well-regarded local service would be lost and it would not be possible to commission replacement respite care beds resulting in a loss of service.  He said that in addition to the 28 beds, 15 day places were offered four days each week with 30 places on one day.  He referred to concerns raised by the West Kent Clinical Commissioning Group particularly in relation to increased pressure in the whole health care system and to concerns expressed by current residents that the independent sector would not be able to provide such high quality respite care.  He also asked if it would be possible to increase the services delivered at the Dorothy Lucy Centre.

(4)       Mr Gates said he agreed with everything Mr Clark had said and spoke about his concerns in relation to Kiln Court in Faversham.  He said he had attended the Town Council meeting and the Save Kiln Court Group meeting held the previous evening.  He said officers had responded well to difficult questions and asked that their efforts be recognised.

(5)       In response Ms Holden said that the current services were underused partly because they could not provide support for increasingly complex needs, it was not possible to book respite care directly with the independent sector as services were not commissioned in that way, and alternative proposals as part of the consultation process would be welcomed.

(6)       Members of the committee expressed concern that closing these facilities might be short sighted in the light of a national shortage of good quality residential care and might result in delayed discharge from hospitals. Concerns were also expressed that a well-regarded service would be lost to local communities and about the ability of the independent sector to provide the same standard of service.

(7)       Ms Holden outlined the next steps and said a summary of the needs analysis, market responses and consultation responses would be included in the recommendation reports for each home to be presented to the committee in January 2016.

(8)       RESOLVED that the progress to date be noted.

To receive a report from the Cabinet Member for Adult Social Care and Public Health and the Corporate Director of Social Care, Health and Wellbeing on the proposed reshaping of Domestic Abuse services, and to endorse the commencement of a procurement process to commission an integrated Domestic Abuse service across Kent, based upon the plans provided.

Melanie Anthony (Commissioning and Development Manager) was in attendance for this item

(1)       Ms Anthony introduced the report which set out proposals for collaborative commissioning of an integrated model of domestic abuse support across Kent and asked the committee to consider the proposed re-shaping of the service and to endorse the commencement of a procurement process.

(2)       Ms Anthony said the funding arrangements for domestic abuse services were complex with duplication of activities in some areas and a lack of services in others. Current services tended to concentrate on those at high risk of harm with very limited support for those deemed to be at a lower risk.

(3)       In response to questions and comments, Ms Anthony said it was unlikely that any one organisation could provide all the services required in the county and a strategic approach to commissioning would put services on a more sustainable footing.  She also acknowledged the risk that partner organisations, such as local community safety partnerships, might not continue to allocate funding for domestic abuse services however it was considered that the risk would be no greater than it was now and a more strategic approach would ensure better value.

(4)       Mr Ireland said that the Kent Safeguarding Children Board was taking a significant interest in domestic abuse particularly where concerns warranted involvement from the statutory services. He also said that a lack of funding security for domestic abuse services created a risk for the fulfilment of statutory safeguarding duties.

(5)       It was confirmed that the committee would receive a further report in April 2016 prior to a decision being made about an award of contract for domestic abuse services.

(6)       RESOLVED that:

(a)          The report be noted; and

(b)       The commencement of a procurement process to commission an integrated domestic abuse service across Kent, based on the plans provided, be endorsed.

To receive a report from the Cabinet Member for Adult Social Care and Public Health and the Corporate Director of Social Care, Health and Wellbeing, outlining progress against targets set for key performance and activity indicators for September 2015 for Adult Social Care.

Steph Smith (Performance Manager) was in attendance for this item

(1)       Miss Smith introduced the report which provided an update on progress against the targets set for key performance and activity indicators for September 2015 for Adult Social Care.  She said that performance was improving across many indicators and drew attention to performance in relation to the number of completed “Promoting Independence Reviews” and “Referrals to Enablement” which were now being met as a result of focussed effort.  

(2)       Miss Smith said performance in relation to domiciliary care had been rated “red” as the number of clients had increased over the past months.  This was linked to the reduction in the number of people in residential or nursing care and to the number of direct payments.  A year ago, almost 1,000 people chose to transfer from home care to direct payments following the homecare re-tender and over time the number receiving direct payments decreased with new people coming into homecare instead of replacing the direct payment clients.  The overall position of homecare and direct payments had not increased significantly.

(3)       Miss Smith said that if the number of people aged 65+ in permanent nursing care and the number of people aged 65+ who in permanent residential care were considered together targets were being met. However, the target for residential care was not being met.

(4)       Miss Smith said that performance continued to improve into the current quarter.

(5)       In response to questions and comments Miss Smith said performance in relation to the delayed transfer of care looked at the proportion of delays that were as a result of social care and that such delays were primarily a result of patient choice and the availability of places in residential care.  Services such as enablement and discharging home to assess were having a positive impact on performance.

(6)       RESOLVED that the report be noted.

To receive a report from the Cabinet Member for Adult Social Care and Public Health and the Director of Public Health, outlining the performance against indicators of commissioned services which specifically relate to adults, and selected Public Health Outcome Framework indicators.

Karen Sharp (Head of Public Health Commissioning) was in attendance for this item

(1)       Ms Sharp introduced the report which provided an overview of the Public Health key performance indicators for its commissioned services which relate to adults and selected Public Health Outcome Framework indicators.

(2)       She said that the proportion of annual target population with a completed NHS check had dropped from 50% to 48% however there had been significant improvement in the number of people having this check over the last year.  There was now a clear focus on areas with the greatest health inequalities and health trainers were working to ensure this and other health checks were taken up.  Performance against the indicator “Proportion of clients accessing community sexual health services offered an appointment within 48 hours” was consistently good and pilot programmes had been introduced in Dartford, Canterbury and Dover to increase performance in relation to the chlamydia positivity detection rate.  The Stop Smoking Service had narrowly missed its quit-rate for the first quarter and the “cut down to quit” programme being trialled was targeting people who were less likely to quit without more prolonged support

(3)       In response to questions Ms Sharp and Mr Scott-Clark said:

·         there was no system to weigh and measure adults.  GPs measured and weighed adults and as it was likely that obesity rates were under reported surveys were used to collate the data

·         Smoking Cessation programmes did not currently have good reach into target groups and research had been commissioned to understand how best to make these services accessible. The results of this research would inform commissioning decisions

·         People who received health checks because of their employment should also attend an NHS Health Check when called as it was specifically targeted at assessing cardiovascular risk.

(4)       RESOLVED that the report be noted.

To receive a report from the Head of Democratic Services on the Committee’s work programme.

RESOLVED that the committee’s work programme for 2016/17 be noted.

RESOLVED that Decision No 15/00089 – Establishment of the Provisional Guide Price for Older Persons’ Residential and Nursing Care Homes from April 2016 - which was taken by the Cabinet Member for Adult Social Care and Public Health, in accordance with the County Council’s decision-making procedure rules, set out in Appendix 4 part 7 of the constitution, be noted

To receive a report from the Cabinet Member for Adult Social Care and Public Health and the Corporate Director of Social Care, Health and Wellbeing on the final version of the Local Account for Adult Social Care for 2014/ 2015.

RESOLVED that the final version of the Local Account 2014/15, which had been published in mid-November 2015, be noted.