Agenda and minutes

To receive apologies for absence and notification of any substitutes present.

Mr R H Bird was present in place of Mr S J G Koowaree and Mrs J Whittle in place of Mrs A D Allen.

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.

There were no declarations of interest.

To consider and approve the minutes as a correct record.

RESOLVED that the minutes of the meeting held on 3 December 2015 are correctly recorded and they be signed by the Chairman. A question was raised about the name of the company delivering advocacy services but the initialised version of the name was subsequently confirmed as being the correct trading name. 

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.

1.            Mr G K Gibbens gave a verbal update on the following adult social care issues:

8 December – Visited Hi Kent offices in Canterbury

15 December – Attended Sandwich Town Council Public Meeting on the future of Wayfarers Residential Home

22 December – Visit with the Chairman to Westview Integrated Care Centre in Tenterden, at which he met staff and residents, Highlands House offices in Tunbridge Wells and Adult Social Care and Public Health staff at Headquarters. The County Council had a joint arrangement with Kent and Medway NHS and Social Care Partnership Trust for the provision of mental health care services, and staff working in this field were accredited mental health practitioners.

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

Hospital discharge arrangements over Christmas and New Year - social care staff had been present in all hospitals every day except Christmas Day and so were a very visible resource.  Work with NHS England before Christmas had aimed to reduce bed occupancy to 80%, to allow space for emergency admissions over the holiday period, and the system had worked well. There has been less pressure on beds than at Christmas 2014 but it was expected that pressure would increase through January as the weather grew colder.

Independent Chair of Safeguarding Vulnerable Adults Board (SVAB) – a new independent Chair, Deborah Stuart – Angus, was now in post, thus bringing arrangements in line with the requirements of the Care Act, ie that such boards be chaired by an independent person. Responding to a question about a youth centre in Rochester which had received recent media coverage regarding safeguarding concerns, he advised the committee that Medway Council and the Medway Safeguarding Children Board were responsible for the running of the centre but the County Council,  as a potential future user of the service, had an interest in its good running.

National response to Comprehensive Spending Review – this had recognised the County Council’s ability to raise additional precept (the social care levy) and hence recognised the importance of funding increasing care needs.  However, the County Council’s social care budget was still short of what had been identified by the Association of Directors of Adult Social Services as a required level of funding.

3.            Mr G K Gibbens gave a verbal update on the following adult public health issues:

4 December – Spoke at Family Nurse Partnership Event in Sessions House, Maidstone – this had included the presentation of awards to families and children.  

9 December – Spoke at West Kent and Medway Singing Project event in Sessions House, Maidstone – singing had been identified as being of great benefit to people living with dementia and mental health problems, and it had been good to see the happiness that it could bring to patients and carers.  

4.            Dr F Khan then gave a verbal update on the following issues:

Update on Dry January and online Know Your Score test – the aim of the Dry  ...  view the full minutes text for item 69.

To receive a report from the Cabinet Member for Adult Social Care and Public Health and the Director of Public Health, and to consider and endorse or make recommendations to the Cabinet Member on the proposed decision to award the contract in West Kent to the successful bidder, from those listed in the exempt appendix to the report, and to extend the existing contract in East Kent.

Mr M Gilbert, Commissioning and Performance Manager, was in attendance for this item.

1.            Mr Gilbert introduced the report and responded to comments and questions from Members, as follows:-

a)    by seeking a co-design arrangement with providers, the County Council would work together with them to identify priorities to ensure that needs could still be met within reducing funding.  Bidders for the West Kent contract and the current provider of the East Kent contract had given assurances that they could and would continue to deliver services within the available budget; 

b)    as part of the procurement process, the County Council had identified areas of risk, and would always be proactive in meeting with service users in the early stages of a new contract to identify any problems or shortcomings in the service they received from the provider and would then be proactive in addressing those issues with the provider. Mr Gilbert offered to report back to the Committee to Members assurances on the performance of the service; and

c)    differing levels of spend in East and West Kent reflected the different levels of need in the two areas. There was a substantially higher number of drug and alcohol users in treatment in East Kent compared to West Kent, and this warranted a higher contract value for East Kent.

2.            The Cabinet Member, Mr Gibbens, thanked Members for their comments and emphasised his commitment to providing a strong drug and alcohol service across Kent.  He added that the contracts which the County Council had been able to negotiate for this service were an example of the benefit of the Public Health function now being within the County Council.  

3.            RESOLVED that:-

a)    the progress of the procurement of the West Kent Drug and Alcohol Service, and the contract extension for East Kent, be noted;

b)    the decision proposed to be taken by the Cabinet Member for Adult Social Care and Public Health, to:-

i)             award the contract for the West Kent Drug and Alcohol Service to the successful bidder (from those listed in the exempt appendix to the report); and

ii)            invoke the one-year contract extension option within the East Kent Drug and Alcohol Service contract (provided by Turning Point), to enable it to run until 31st March 2017,

taking account of comments made by this committee, 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 endorse or make recommendations to the Cabinet Member on the proposed decision to extend the Healthwatch Kent contract from 1 April 2016 to 31 March 2018, with an optional one-year break clause at the end of year one (31 March 2017).

Mr R Gough, Cabinet Member for Education and Health Reform, was present and Ms E Hanson, Head of Strategic Commissioning, Community Support, was in attendance for this item.

1.            Ms Hanson introduced the report and explained that, although the funding for Healthwatch had moved into the Social Care, Health and Wellbeing Directorate, the responsibility for the service, due to the need for objectivity, remained with the Cabinet Member for Education and Health Reform, Mr R Gough, and it was he who would be taking the key decision to extend the contract. Ms Hanson and Mr Gough responded to comments and questions from Members, as follows:-

a)    tendering arrangements for a new contract would start in the autumn of 2016 and the new contract was expected to start in April 2018;

b)    the County Council had been continuing to work with the provider to refine and apply a robust performance framework to measure the performance of the contract and ensure that it delivered value for money. Mr Gough added that, when awarding the original contract, he had been keen to establish robust monitoring, eg of Healthwatch’s profile, its engagement with clinical commissioning groups and contribution to the Kent and Medway Health and Wellbeing Board. Monitoring also needed to be objective, and the County Council needed to be able to demonstrate objectivity, if challenged, as it commissioned both Healthwatch as well as some of the services on which Healthwatch was required to comment;

c)    Healthwatch services were funded in part from the revenue support grant (RSG);

d)    a view was expressed that Healthwatch was not as effective a consumer champion as the former LINks had been.  Ms Hanson explained that Healthwatch was improving its reach and visibility, and worked with existing patient groups.  Members would have input into the shaping of the next contract;

e)    in response to a query about the number of contacts with Healthwatch, and if these were increasing or decreasing, which areas of service attracted the most comment and complaint and how successful the current contract had been to date, Ms Hanson undertook to supply this information outside the meeting; and

f)     a view was expressed that much valuable work had been done for the Care Quality Commission by working with Healthwatch.

2.            RESOLVED that the decision proposed to  be taken by the Cabinet Member for Education and Health Reform, to:-

a)   extend the Healthwatch Kent Contract from 1 April 2016 to 31 March 2018, with an optional one- year break clause available at the end of year one (31 March 2017); and

b)     delegate authority to the Corporate Director of Social Care, Health and Wellbeing, or other nominated officer, to undertake the necessary actions to implement the decision,

taking account of comments made by this committee, 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 endorse or make recommendations to the Cabinet Member on the proposed decision to close Blackburn Lodge once suitable alternative provision is established on the Isle of Sheppey.

Ms C Holden, Head of Commissioning for Accommodation Solutions, was in attendance for this and the following three items.

1.            The Chairman asked Members if, in debating agenda items B3 to B6 they wished to refer to the information set out in the exempt appendices F2 to F4.  Members confirmed that they did not wish to and discussion of these items took place in open session. 

2.            Ms Holden introduced the report and responded to comments and questions from Members, as follows:-

a)    the County Council owned the Blackburn Lodge care home, however a covenant on the site from the Ministry of Defence stated that the site should be used for health and social care purposes only. The County Council had approached the Ministry to have the covenant lifted, however this was not currently seen as a priority; and

b)    as part of the Equality Impact Assessment which the County Council had carried out, every service user likely to be affected by the proposed closure would have a personalised review to assess the impact upon them.

3.            The Cabinet Member, Mr Gibbens, thanked Members for their comments and said that he viewed the proposed changes as a positive move forward for social care provision on the Isle of Sheppey. He said he had long been concerned about the lack of nursing care facilities on the island and stated his commitment to addressing this issue.

4.            RESOLVED that the decision proposed to be taken by the Cabinet Member for Adult Social Care and Public Health, to:

a)    close Blackburn Lodge, once suitable alternative provision is established on the Isle of Sheppey; and

b)    delegate authority to the Corporate Director of Social Care, Health and Wellbeing, or other nominated officer, to undertake the necessary actions to implement the decision,

taking account of the comments made by this committee, 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 endorse or make recommendations to the Cabinet Member on the proposed decision to secure the transfer and sale of the Wayfarers care home as a going concern.

1.            Ms Holden introduced the report and explained that the County Council was confident of being able to secure a trusted provider to run Wayfarers as a care home.  She assured Members that the contract of sale would include a requirement that the purchaser undertake to continue to do this, for a term yet to be defined.  The sale was expected to take approximately twelve months to complete. Ms Holden responded to comments and questions from Members, as follows:-

a)    concern was expressed that County Council Members had not been notified of or invited to attend meetings about the proposals which had been held in Sandwich in November.  The Chairman agreed that it would have been useful for County Council Members to have had an opportunity to attend but advised that the meetings concerned had been organised by the Sandwich Town Council, so the County Council had no input into who was notified or invited. Ms Holden added that the officer team had attended and made presentations at several related meetings in Sandwich. At these meetings, the strength of local feeling and wish to retain Wayfarers as a care home had been clear, and the County Council’s drive to achieve this via a covenant in the contract of sale was supported; and

b)    concern was expressed that the County Council’s in-house unit cost across various types of social care provision was generally higher than unit costs achieved by private providers for comparative services.  The public trusted the local authority to provide care services so should continue to offer this option for those who wanted it.  Although the unit cost of local authority care services was higher, the authority had the advantage of being able to have its services formally scrutinised and be held to account for the quality of service it provided.   

2.            The Cabinet Member, Mr Gibbens, reported that he had attended a meeting in Sandwich at which it had been clear that the Town Council did not support the sale of Wayfarers as a going concern.  He sympathised that people were generally fearful of change.  It was important that older people in Sandwich should continue to have a choice of services.  He stated his commitment to securing the best way forward for Wayfarers and said he would give it all the support necessary to ensure that it would thrive.

3.            RESOLVED that the decision proposed to be taken by the Cabinet Member for Adult Social Care and Public Health, to:

a)    secure the sale of the Wayfarers registered care home, Sandwich, as a going concern; and

b)    delegate authority to the Corporate Director of Social Care, Health and Wellbeing, or other nominated officer, to undertake the necessary actions to implement the decision,

taking account of the comments made by this committee, be endorsed.

Mrs P Brivio and Mr T Maddison requested that their abstentions from this resolution be recorded.

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 work undertaken to date. A formal decision will be taken by the Cabinet Member following further work and discussion at this committee’s March meeting.

Mr B Clark, County Council Member for Maidstone South, was present for this item. 

1.            Ms Holden introduced the report and made amendments to the figures quoted in paragraph 2.5 of the report for the number of signatures received, to include both the paper and electronic petitions (a total of 3,095), and the number of beds available in Maidstone for short-term care, quoted in paragraph 3.3.2 of the report, which should read 30 rather than 14.  She explained that it had not yet been possible to formulate a clear proposal on which the Cabinet Member could be asked to take a decision.  Further work would be undertaken and a formal proposal brought to this committee on 10 March 2016 for comment, prior to a formal decision being taken by the Cabinet Member.

2.            Mr Clark welcomed the deferral of a formal decision as the private sector did not yet have sufficient capacity to accommodate local need, particularly for those on the waiting list for dementia care beds. There had been a disappointing take-up of the tendering options, and not all of these options were in the control of the County Council. The current service was well regarded locally, but if the proposal were taken to the market now, without there being much appetite to tender, future reviews in a more difficult economic climate may find no interest at all and the service might then be lost. Mr Ireland commented that the independent care sector model was well established and had proven to be successful. Since the Community Care Act in 1993, there had been an expectation that the majority of services would be provided by the independent sector, and in Kent this had indeed been the case.  

3.            Ms Holden, Mr Ireland and the Cabinet Member, Mr Gibbens, then responded to comments and questions from Members, as follows:-

a)    despite the extent of independent sector provision, the local authority retained its obligation to provide appropriate local care places for those who needed them.  The independent sector had limited capacity and appetite to increase provision. Day care was important and use of it would increase as use of residential care reduced. The Dorothy Lucy centre should be considered for development as a specialist day care centre. Ms Holden suggested that the market could be asked to respond to a tender for day care provision, to test the appetite to take it up. Mr Gibbens confirmed that use of the Dorothy Lucy centre as a specialist day care centre was a possible option and would be considered;

b)    concern was expressed at the lack of dementia care beds in Maidstone.  Independent sector care provision in Maidstone was thriving and there were many good local examples. The suggestion that the Dorothy Lucy centre be developed as a specialist day care centre was supported and should be taken forward.  In exploring options, it was important that clear pictures of demand and provision were identified;

c)    concern was expressed that two months may not allow  ...  view the full minutes text for item 74.

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 work undertaken to date. A formal decision will be taken by the Cabinet Member following further work and discussion at this committee’s March meeting.

RESOLVED that the content of the report and the work undertaken to date be noted, and that further work be undertaken (as detailed in section 5.4 of the report) and a report seeking a formal Cabinet Member decision be presented to this Committee in March 2016.

To receive a report by the Deputy Leader and Cabinet Member for Finance and Procurement, the Cabinet Member for Adult Social Care and Public Health and the Corporate Director Social Care, Health and Wellbeing, which sets out the proposed draft Budget 2016/17 and Medium Term Financial Plan (MTFP) 2016/19 as it affects the Adult Social Care and Health Cabinet Committee.  The report includes extracts from the proposed final draft budget book and Medium Term Financial Plan relating to the remit of this committee (although these are presented as exempt appendices as item F5 below, until the Budget and Medium Term Financial Plan are published on 11 January)

Mr D Shipton, Head of Financial Strategy, was in attendance for this item.

1.            Mr Shipton introduced the report and said this would be the most difficult budget the County Council had faced.  He outlined the following:

a)    one of the biggest issues had been that the County Council had not have the spending plans from Central Government until the announcement of the spending review on 25 November 2015.  This meant that officers did not know the total financial envelope within which they were working.  The County Council did not receive its own individual settlement until 17 December 2015;

b)    the settlement on 17December included a significant re-distribution of Revenue Support Grant  which officers had not been able to anticipate. The net impact of that re-distribution was a £15million reduction to the Council’s budget;

c)    papers for this committee had been published with an assumption that there was still £8m of the £15million to be found, and this was included in the appendices of the papers for this committee.  The County Council’s draft budget had subsequently been published on 11 January.  That draft identified another £4million of the £8million, so there was now only £4million left unidentified, and this would nearly all be taken from financing items.  However, having a small gap still to close would make scrutiny of the budget somewhat difficult, as Members were unable to scrutinise a whole budget;

d)    the provisional settlement also included the spending power calculation, which  measured the County Council’s change in funding, both through council tax and through government grants.  It took no account of the additional spending requirements the County Council was facing, through the effects of inflation, the effects of the rising population or the impact of increasingly complex needs. Mr Shipton’s request to Members was that they bear in mind that the spending power figure in the report represented only the funding half of the equation and not the spending half; and

e)    the County Council faced real-term reductions in its funding. The Council  would not be able to raise enough through council tax to compensate for both the spending demands and the reductions in central government funding, and therefore needed to make substantial savings.

2.                  Mr Shipton then explained that the impact upon this committee’s work area of having to find £4million of additional savings was that the savings identified for housing-related support would need to increase from £1.5million to £2million. The appendices to the report set out the extracts of the published budget which related to the Social Care, Health and Wellbeing and Public Health portfolios. A statement of variation would be prepared later as it had not been possible to produce this level of detail in the time available since the spending review announcement.

3.                  Mr Shipton, Mr Ireland and Mr Lobban responded to comments and questions from Members, as follows:

a)      in response to a question about the income generated by raising the precept to 2% and the extent to which this would help  ...  view the full minutes text for item 76.

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 priorities which Cabinet Members wish to see reflected in 2016/17 business plans, and to comment on these before plans are drafted.

Mr M Thomas-Sam, Strategic Business Adviser, was in attendance for this and the following item.

RESOLVED that the Cabinet Members’ priorities for the 2016/17 directorate business plans be noted.

To receive a regular update report from the Cabinet Member for Adult Social Care and Public Health and the Corporate Director of Social Care, Health and Wellbeing on the implementation of the Care Act 2014, following on from the update given to this committee on 10 July 2015.

1.            Mr Thomas-Sam introduced the report and explained, in response to a question, that the strategic guidance to accompany phase 2 of the Care Act was expected to be received from the Government in late January.

2.         RESOLVED that the key implementation issues highlighted in 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 on the development of a revised approach to public health commissioning.

Mr M Gilbert, Commissioning and Performance Manager, was in attendance for this item.

1.            Dr Khan introduced the report and, with Mr Gilbert, responded to comments and questions from Members, as follows:-

a)    to help address the large discrepancy in health outcomes across the county, local County Council Members could become more involved in the delivery of health campaigns.  They would need to develop a way of being kept up to date about events.  Dr Khan agreed that this was a good idea and advised Members that there was still scope to build into the model some way of engaging them. She undertook to consider how this could be achieved;

b)    there would always be some people who did not wish to have help with addressing their unhealthy habits and were happy with their lifestyle. Following ‘Dry January’ could be ‘Fatless February’!  Dr Khan confirmed that the model of health improvement was based on influencing behavioural change.  Many people were unaware that their habits were harmful to their health. Behaviours also tended to ‘cluster’, for example, smokers tended also to drink, and one behaviour may depend on the other, making either difficult to give up in isolation. Harmful habits also tended to ‘snowball’ or increase and become entrenched. To be effective, campaigns should relate to the communities they were trying to influence, and reach them via the most appropriate means for the intended audience, eg by using social media;

c)    in response to a question about the sample used by Behavioural Architects, and whether or not this sample was large enough to be representative, Mr Gilbert explained that, although the number of people sampled by Behavioural Architects, a specialist behavioural science agency, was small, it was selected to be as representative of the population as possible, and the research undertaken with the sample was detailed;

d)    a view was expressed that Kent could look at and learn from public engagement campaigns run by other local authorities, eg the ‘Born in Bradford’ scheme;

e)    in response to a question about monitoring people’s engagement with the daily digests of ‘healthy living’ guidance produced by district councils, Dr Khan explained that patient and stakeholder engagement were studied when preparing contracts specifications, to check that the specifications were right;

f)     in response to a concern about reaching sectors of the public which were traditionally hard to reach and were often most likely to use unhealthy behaviours as a ‘crutch’, Dr Khan agreed that people in the lower socio-economic groups tended to view health messages as the least important concern they had, and consequently were traditionally hard to incentivise; and

g)    a group which had not historically been a concern but was known to drink and smoke more than a few years ago was middle-class women, many of whom were struggling to balance career and children as well as caring for elderly parents.  Dr Khan added that statistical evidence supported this concern, as well as the fact that rates of breast cancer and ovarian cancer  ...  view the full minutes text for item 79.

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.