Agenda and draft minutes

Apologies were received from Mrs Parfitt-Reid.

Mrs Game attended the meeting virtually. 

RESOLVED Ms Wright was duly elected Vice-Chair of the Adult Social Care Cabinet Committee. There were no other nominations. 

1.    Ms Meade noted that she was an unpaid carer.

2.    Mr Shonk noted that a family member worked for the NHS. 

RESOLVED that the minutes of the meeting held on 23 November 2023 were a correct record and that a paper copy be signed by the Chair.

Dave Shipton, Head of Finance (Policy, Planning & Strategy) was in attendance for this item.

1. Mr Oakford introduced the draft budget and provided a high-level overview. It was noted that since the previous meeting, the draft budget had now been balanced. Mr Oakford thanked the work of the Adult Social Care leadership team which had put forward measures to build resistance to demand growth pressures and identified savings of over £50 million. It was noted that difficult decisions had been made to balance the budget and an overview was provided of the key measures.  

2. Mr Watkins noted that due to increasing cost pressures, the Adult Social Care budget was on course to reach £1 billion. It was said that since the last meeting considerable work had gone into the delivery plans on how to implement the £50 million of savings.  

3. Further to comments and questions from Members, it was noted that: 

1. Mr Watkins said that if no action was taken then demographic changes alone would have added £100 million to the Adult Social Care budget, but the range of measures the directorate had taken would save £53 million of this meaning there would still be a net increase to the overall Adult Social Care Budget. It was said that all statutory support, assessments and care packages would not be threatened.  

2. In response to a question about capital receipts, Mr Oakford said that previously capital receipts went into the capital programme to avoid borrowing. A change in regulations had allowed transformation projects to be funded by capital receipts to offset base budget pressures and contribute to savings going forward. It was noted there would be £15 to £16 million generated from asset disposal, of which £8 million had been highlighted to come into the base budget for Adults and Children's Social Care transformation programmes.

3. Mr Watkins noted that the contract extensions to be discussed later in the meeting would not affect the 5% savings in contract negotiations outlined in the budget. Other measures would be taken to deliver this saving. Richard Ellis said that the recommissioning of contracts was not dependent on the savings attributed to commissioned services. There was a lot of work needed to manage demand growth and achieve fairer pricing which would lead to savings. A Member said that a satisfactory reason had not been provided as to why these contract extensions were in line with the budget proposals. 

4. Much work had been done to move people from non-framework providers to framework providers and noted that this meant that some people may have to wait longer for care as framework providers were prioritised, but all statutory responsibilities would be met. A Member said that more information was needed on what impact these savings would have on the people of Kent and statutory duties. Mr Watkins said that changes in the commissioning of capacity and care home services would occur within the extension periods. Richard Ellis provided an overview of changes that were to be made during the extension periods,  ...  view the full minutes text for item 175.

1. The Cabinet Member for Adult Social Care and Public Health, Mr Dan Watkins, gave a verbal update on the following:

One You Kent – The Cabinet Member encouraged Members and residents to visit the One You Kent website for advice and support on positive lifestyle changes. One You Kent offered a series of free 1-1 sessions were available with a lifestyle advisor to guide and motivate users to make manageable changes and get better health support. More information can be found here: One You Kent - Kent County Council 

Consultations on Charging Policies – It was noted that two public consultations, on the fees charged for arranging care for self-funders and the charging policy for non-residential care receivers in receipt of an Attendance Allowance, Personal Independence Payment and Disability Living Allowance, would run from February to April 2024. Mr Watkis would notify the committee membership when the consultations go live. 

Visits – Mr Watkins noted that he had visited

1. The Freedom Centre in Sheerness with Member Mr Whiting, the centre provided support and activities for those with disabilities.
2. The Abby Physic Community Garden in Faversham, helped residents improve their physical and mental wellbeing and build up their skills and confidence. 

Blackburn Lodge – Mr Watkins noted that the public consultation on Blackburn Lodge’s future was due to launch in mid-February 2024. 

2. In response to comments and questions, it was said. 

1. A Member said that the Council’s support and advice had a small online and social media presence. The Cabinet Member and Richard Ellis noted that the content of Facebook and Twitter/X was strong but more could be done to utilise snapchat and other platforms more commonly used by younger people.     

2. It was noted that the consultations would feedback into the policy and potentially be presented in the form of a ‘you said, we did’ format. 

3. The Corporate Director for Adult Social Care, Mr Richard Smith, gave a verbal update on the following:

Adult Social Care Team Update – Mr Smith welcomed Sydney Hill as the new Interim Director Manager. Mr Smith thanked Akua Agyepong for their service as they were going on secondment to the Care Quality Commission (CQC) for 12 months. 

CQC Workshops – Mr Smith said that several workshops had been held on CQC assurance with frontline staff. 

Festive Key Workers – Mr Smith thanked those key workers who worked over the festive period. 

ADAS Downing Street Meeting – Mr Smith noted that he had been invited to Downing Street to attend a round table where it was discussed if the NHS overprescribes care and a number of innovations to manage this were showcased. 

Social Care Awards – Mr Smith said the event was to highlight good work and it was hoped that it would become an annual event.

Heidi Ward was in attendance for this item. 

1. Mr Mitchell introduced the report. 

2. In response to comments and questions from Members, it was said. 

1. A Member sought clarity on what alternatives had been considered. Richard Ellis said the only potential alternatives were to recommission on different terms or move to individual contracts for each service. It was said that the option presented today was the most efficient and effective way to work with providers. It was noted that there would be more options to consider going forward. The Member requested that more information was needed on the contracts.  

2. Richard Ellis confirmed that the bed-buying option remained as part of the contract. 

3. Ms Ward confirmed that several care homes were marked for improvement and those classed as inadequate would not have new individuals referred there. It was noted that teams would work with care homes to make the required improvements and ratings were public so that individuals can choose where to receive care.  

4. Ms Ward noted that there was a very good working relationship with the CQC. 

3. RESOLVED the Adult Social Care cabinet committee endorsed the SS14142 Older Persons Residential and Nursing contract extension.

4. In accordance with paragraph 16.31 of the Constitution, Mr Brady, Ms Meade, Mr Campkin, Ms Hawkins and Mr Streatfeild wished for it to be recorded in the minutes that they voted to abstain on the endorsement of the proposed decision.

1. Mr Mitchell introduced the item. He noted the current contract was due to expire in the next few months and that extensions were built into the contract for up to three years. It was noted that work was ongoing to review the cost of care, the future contract models and how the work could be done jointly across the system. Project governance was in place to ensure that this work was completed within the three-year extension period. 

2. In response to comments and questions, it was said. 

1. A Member asked what the yearly costs of the extensions were compared with the initial contract cost. Richard Ellis said that the contract value would remain similar to the previous year’s contract value, subject to the impact of any yet-to-be-agreed uplifts with providers, and lower than the initial contract value. 

2. A Member asked why the ongoing work did not include an option to look at providing the service in-house or whether some of the Kent Enablement at Home service could be covered by this contract. Richard Ellis said the work of Kent Enablement at Home was very different to the contract being discussed. 

3. Members questioned the length of the contract extension and why it was not in line with the other contract extensions which were for a period of two years. Richard Ellis said the extensions were needed to undertake the significant recommissioning exercise and it was not their intention to use the whole three years. 

4. Members expressed concerns that they were given no alternatives to consider other than to grant the contract extensions as requested.

5. Mr Streatfeild moved and Mr Brady seconded a motion that “the committee recommends to the Cabinet Member that the Care and Support in the Home contract be extended for no longer than one year to allow time for alternatives to be presented to the committee for consideration in a timely manner”. 

6. Members voted on the motion. The motion failed. 

7. Mr Watkins and Mr Smith said that changes to commissioning arrangements would mean that going forward the committee would be presented with contract extensions in good time and with alternative options. 

3. RESOLVED that the Adult Social Care Cabinet Committee endorsed the Care and Support in the Home Contract Extension. 

4. In accordance with paragraph 16.31 of the Constitution, Mr Brady, Ms Meade, Mr Campkin, Ms Hawkins and Mr Streatfeild wished for it to be recorded in the minutes that they voted to abstain on the endorsement of the proposed decision.

1. Richard Ellis introduced the report and noted that the extension was required while extensive work on recommissioning was ongoing.

2. In response to comments and questions, it was said. 

a.    A Member asked how the quality of care was being monitored and what oversights were in place to ensure quality for residents. Mr Mitchell said that there was a team of commissioners that would go out to providers and have meetings with the CQC to gain intelligence. It was noted that there was a robust process of sanctions in place and support available to help providers improve. The Member requested that performance data be included in such reports going forward. 

b.    A Member asked for reassurance that the contract extension was in line with the budget proposal to negotiate a 5% reduction in contract value costs. Richard Ellis said that although there were no savings against any of the contract extensions being presented today. They were consistent with the budget proposals as work was ongoing to reduce the number of people receiving residential care, which had increased during and since the COVID-19 pandemic and switch to more support at home and in the community. Mr Watkins noted that the change from procurement to strategic commissioning would generate savings going forward. The Cabinet Member would look into including a 3-year budget line when the contract returns to the committee. 

c.     A Member asked if providers were penalised with financial penalties for poor performance. Richard Ellis said that financial penalties were not used but relationships with providers could be terminated for not delivering the quality of care expected based on CQC inspections or findings of the Council teams. It was noted that if an individual experienced issues they would be supported and switched to the best provider for their needs.  

d.    Following requests from Members it was confirmed that sanction information could be included in reports going forward and that this information was publicly available. 

3.    RESOLVED that the Adult Social Care Cabinet Committee endorsed the Learning Disability, Physical Disability and Mental Health Residential Care Home Services Contract Extension

4.    In accordance with paragraph 16.31 of the Constitution, Mr Brady, Ms Meade, Mr Campkin, Ms Hawkins and Mr Streatfeild wished for it to be recorded in the minutes that they voted to abstain on the endorsement of the proposed decision.

1. Mr Mitchell introduced the report. 

2.    A Member said that as this area was marked to see an increase in users to create savings elsewhere it was requested that the cost projects over the lifetime of the contract be provided along with the expected savings this produced across other service areas. This data was necessary to show that the extension was consistent with the budget proposals.  

3.    RESOLVED that the Adult Social Care Cabinet Committee endorsed the Supported Living contract extension. 

4.    In accordance with paragraph 16.31 of the Constitution, Mr Brady, Ms Meade, Mr Campkin, Ms Hawkins and Mr Streatfeild wished for it to be recorded in the minutes that they voted to abstain on the endorsement of the proposed decision.

1. Ms Rickman introduced and provided an overview of the report. 
2. In response to comments and questions from Members, it was said. 

1. A Member said that this report presented a good alternative to commissioning and how services could be provided in-house which could be an example for other services.  

2. Ms Rickman noted that this service supported the Council's work with the NHS as part of the integrated Home First team, which delivered a single service for the transition from hospital to home.  

3. A Member was said that must ensure that savings do not risk the non-provision of any statutory duties. Richard Ellis said that this was just one part of the hospital discharge services and that the risks had been identified and would be managed alongside other services. 

4. Mr Watkins said that the service was brought in-house to facilitate a close working relationship with the NHS in this area. 

3. RESOLVED the Adult Social Care Cabinet Committee endorsed the expansion of the Kent Enablement at Home service. 

1. Mr Mitchell introduced the update and provided a summary of the strategy. 

2. In response to comments and questions from Members, it was said. 

1. Members noted the importance and value of community social prescribing services which support thousands of residents across the county. 

2. A Member said that research was needed to understand both why people go access and what stops people from accessing these services. It was noted that the Council could help with signposting and raising awareness. 

3. A Member said that the cuts to community wardens in the budget would have an impact on social prescribing provisions. Mr Watkins said that the ICB would take on much of the community navigation work that was previously handled by community wardens. 

4. A Member raised that it was important to consider how to scale up both the breadth of the services and participation going forward. 

5. A Member noted the necessity of the communication and training strategies required going forward. It was said that a plan for the services operationalisation was ongoing. 

3. RESOLVED the Adult Social Care Cabinet Committee noted the update. 

1. The Chair noted that decision 23/00115 - Pathway 1 - Discharge to Assess Service Contract had been taken outside the committee cycle in accordance with the process in Part 2 paragraph 12.36 of the Constitution.

2. Mr Watkins and Richard Ellis provided further details on the decision following a request from a Member. Further information would be provided after the meeting.   

3. RESOLVED the item was noted. 

The work programme 2024 was noted.