Agenda and minutes

Apologies had been received from Mr Simon Webb, Mrs Lesley Game and Mr Nigel Collor. Mr Dirk Ross was in attendance virtually. 

Mr Mike Dendor was in attendance as substitute for Mr Simon Webb.

Ms Meade noted that they were a full-time carer and had experience of a family member subject to a deprivation of liberty order. Mr Shonk said that a family member worked for the NHS. Mr Brady noted that his partner was a senior lecturer at the Tizard Centre, University of Kent with a qualification to undertake autism assessments. partner hospitals. Ms Hamilton noted that she had a young person in her care. 

RESOLVED that the minutes of the meeting held on 17 May 2023 were correctly recorded and a paper copy be signed by the Chairman.

1. The Cabinet Member for Adult Social Care and Public Health, Mrs Clair Bell, gave a verbal update on the following.

National Awareness Weeks Update – Mrs Bell gave an overview of awareness weeks that had taken place in June and July. 

• Carers Week took place from 5-11 June and raised awareness of caring, unpaid care challenges and carers' contributions to families and communities. Events took place to celebrate the work carers do and how others could identify  carers and access support. 
• Learning Disability Week took place from 19-25 June, the Council joined Mencap by encouraging people to share stories of what it is like to live with a learning disability. Mrs Bell said that they supported the week by speaking on the matter and drawing attention to how people can support those with a learning disability and build a more inclusive future. 
• Shared Lives Week took place from 26 June to 2 July, Shared Lives allowed those with difficulty with day-to-day living the chance to move in with their carer and live an ordinary life in a safe environment. The Council's  Shared Lives program provides the carers short breaks, day support and longer-term support for adults in social care. Carers receive a weekly allowance, tax breaks, full training and ongoing support. Residents were being encouraged to open their homes to adults who needed extra care and support. Further information could be found on the Council website here: Sharing a home - Shared Lives scheme - Kent County Council  
• Alcohol Awareness Week took place 2-9 July, to mark this the Council and partners were encouraging residents to take the ‘Know Your Score’ test, an online quiz which would help show how drinking was affecting yourself and others, depending on the score it would offer appropriate advice on where to find help from experts. Specialist help was available for dependent drinkers. Mrs Bell said that last year Council support services provided help to over 5000 people to cut down their drinking or break the cycle of alcoholism. More advice and support can be found on the KCC website: Alcohol and drug support - Kent County Council

Kent and Medway Integrated Care Strategy Focus Group - Mrs Bell thanked

Members of the committee for their attendance at the focus group on 13 June 2023 and welcomed any further feedback on the 6 priorities of the interim strategy. The feedback would be reported back and would contribute to the engagement activities that would take place across the summer along with the results from a survey that was open to the public, which could be found on the Lets Talk Page of the KCC website and here: Kent and Medway Integrated Care Strategy | Have Your Say In Kent and Medway.

Deputy Chief Medical Officer Visit to Kent – Mrs Bell said that on 26 May 2023 one of the three deputy Chief Medical Officers for England, Dr Jeanelle de Gruchy, visited Kent to see first-hand Public Health funded initiatives across the county. Mrs  ...  view the full minutes text for item 140.

Xan Broker, Senior Commissioner, and Marie Hackshall, System Programme Lead – Learning Disability and Neurodiversity Kent and Medway, were in attendance for this item. 

1. Xan Brooker introduced the report. An overview of the agreement which was replacing the Section 75 Agreement, it was noted there had been a memorandum of understanding with Medway Council which had enabled more open communication and further developed partnership working. Ms Brooker said there had been language changes due to the outcomes of a review and co-production with neurodivergent-affected people. It was said that upon approval of the recommendations the partnership agreement was ready to be signed on 1 September 2023.  

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

(a) A Member asked about the governance arrangements as many authorities had divergent procedures in place. Ms Hackshall said that the partnership aligned with the Mental Health Learning Disability and Autism Provider Collaborative a system-wide arrangement of different organisations with governance and oversight, alongside this each organisation would also follow its own governance arrangements. It was noted that processes were in place for joint discussions on commissioning, funding, staffing and workforce arrangements,  

(b) Asked by a Member to give further details on tier 4 contributions and what the funding covered, how many staff were employed and aftercare costs. Ms Brooker said that tier 4 funding was what was provided to the pooled fund from NHS England as a result of net discharges of adults of in-patients who had learning disabilities or autism totalling around £770,000. This covered aftercare costs of those in the community as well as some social care staff. It was noted that the Integrated Commissioning Team had a budget of £300,000 for staffing. 

(c) Mrs Bell noted, in response to a question from a committee Member, that similar papers to the one presented would be brought to the committee as a result of further integration with NHS colleagues and governance requirements. 

(d) Members asked if more inclusive language and terminology could be used in the paper going forward. Ms Brooker said it was very important to recognise the use of inclusive language and that it was of high importance. Mrs Bell noted the importance of inclusive language, and that progress was being made. The language and terminology used would be constantly reviewed and Mrs Bell welcomed Members input. 

3. RESOLVED the recommendations were agreed as outlined in the report. 

Nicola McLeish, Senior Commissioner, was in attendance for this item. 

1. Nicola McLeish introduced and gave an overview of the paper. It was noted that the paper asked for the direct award of a 1-year contract from 1 April 2024 to 31 March 2025. The contract value was over £3 million of which the Council contributes £2.5 million and the rest from the Integrated Care Board (ICB). It was said that the provision of this service was to meet part of the Council's statutory responsibilities under the Care Act.  

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

(a) Asked by a Member if the provider had been consulted on the contract length, as the 1 year-long contract would not offer stability for them. Mr Simon Mitchell said that Crossroads Care Kent, the provider, had been engaged with and it was noted discussions had taken place with both the provider and the ICB to ensure the sustainability of the model going forward.

(b) A Member asked if the procurement strategy for the long-term plan for this service could be brought to the committee within the next six months. Mr Mitchell said that the plan for the future model was that it was co-produced with carers, to understand exactly what type of support was needed. Once this was completed the procurement strategy would be developed and this could be brought to the committee when ready. The Member responded saying that a long-term strategic view was needed rather than the annual renewal of contracts. Mr Mitchell noted the importance of co-production to get the service procurement right for the needs of carers.  

(c) A Member asked what other authorities had done to provide this service. Mr Mitchell said other authorities were looked at to inform best practice. It was noted that there were several variations some offered the support completely in-house while others relied on external providers. 

(d) Mr Smith said that there was a need to recognise that Adult Social Care both locally and nationally was in a difficult sustainability environment, with workforce issues and lack of funding. Carers were very important to Adult Social Care but there needed to be found new ways to provide services. It was noted the important role the NHS had in procuring and commissioning caring services. It was said that carers were not a homogenous group as they had many different needs and requirements that varied by geographical location, therefore a one-size-fits-all approach would not be feasible. There would need to be flexibility to offer bespoke support. The long-term sustainability would need to be understood and would inform the procurement strategy.

(e) The Chair said that a report on the long-term plan for the service should be brought to the committee in the future. 

RESOLVED recommendations were agreed upon as outlined in the report.

Akua Agyepong, Assistant Director - Adult Social Care and Health, and Rachel Westlake, Senior Commissioner, were in attendance for this item.  

1. Akua Agyepong introduced the paper and gave an overview of the needs and responsibilities of the framework. 

2. Rachel Westlake then provided further details. Since 2021 the Council had been awarded funding to deliver statutory duties under the Domestic Abuse Act, the full allocation was not spent in 2021-2022 and 2022-2023. It was said that the underspent money would be held in reserves and used in future budget forecasting for safe accommodation support services. The Department of Levelling Up, Housing and Communities said the Kent County Council was to receive 3.2 million per year up to 2025. The Framework was to decide how the funding, and that held in reserves should be spent going forward. It was noted that A Key Decision taken by the Leader was expected at a later date. 

3. In response to questions from Members, it was said.

(a) The Chair asked about the future funding, as just two years of funding had been guaranteed in the report. Ms Agyepong said that it was difficult to permit future decision-making. The framework would be used to understand what the emerging need is around domestic abuse following the impact of the Covid-19 pandemic and demographic changes. It was said this would help realign and rest how the Local Authority responded to domestic abuse. It was noted that domestic abuse had usually been held within the adults directorate but going forward would be across the whole Local Authority and this framework was leading the way on this. 

(b) A Member asked what outcomes were expected from this and the All Member Briefing on the Kent and Medway Domestic Abuse Strategy would take place on 15 September 2023. Ms Agyepong said that this would allow Members to inform the strategy as part of the consultation period. It was noted that it was a partnership agreement, with key partners including Kent Police, all 12 District Councils and Kent Fire and Rescue. 

(c) Asked by a Member how this could be made sustainable over the long term and if there was the opportunity to provide some of the services in-house. Ms Westlake said there were restrictions on how the funding was used. It was said they were looking at streamlining the services that were currently being provided and the new services being developed and aligning them with the statutory services would make it more sustainable in the future. The Sanctuary Access for Eligible Residents (SAFER) scheme was given as an example. 

(d) Asked by a Member if there were any additional reasons as to why the full allocation of funding had not been spent. Ms Westlake said that the original funding was announced late which led to an underspend in the first year which was then followed up in the second year, the current amount held in reserves was £2 million. The Framework would allow the procurement of new services that would deliver  ...  view the full minutes text for item 143.

Akua Agyepong, Assistant Director - Adult Social Care and Health, was in attendance for this item. 

1. Ms Agyepong introduced the update and gave a presentation. (Please find the presentation attached). 

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

(a) A Member asked if there was an assurance that there would be stability even if there was a change in government within the next two years. Ms Agyepong said that it was uncertain what could happen in the future, but if there were to be any changes the Cabinet Member would be briefed, and the committee informed.   

(b) Asked by a Member about the training programmes if both legal and psychological literacy were offered and if the local universities were involved in the training. Ms Agyepong said there was a mix of external and internal training provided. It was noted the internal training was of high quality provided by expert Best Interest Assessors.

(c) Asked about data protection measures. Ms Agyepong said that they were working closely with sister teams to ensure a high standard of information governance and information integrity. If there were any changes a Data Protection

Impact Assessment (DPIA) would be completed. 

(d) Asked by a Member for further details of what happens to those cases where their liberties are affected. Ms Agyepong said all would be screened to understand the level of risk. Parents in hospitals and care homes have been encouraged to call if they have concerns about patients and they will be screened. Mr Albiston said there was a need to recognise the weaknesses with the current Deprivation of Liberty Safeguards (DoLS) system as it was largely reactive. It was noted there were still weaknesses but would not want to lose the frontloading of people's rights including the well-being principle and the specificity of restrictions following the assessment so that they are justified. It was noted that alongside the Deprivation of Liberty perspective, there would also be a Duty of Enquiry under the Care Act to ensure that any immediate safeguarding issues are addressed under the correct legal process.

(e) Asked by a Member about the sustainability of the process due to the ever-increasing number of people needing to be reviewed and the lack of staff to review every case. Ms Agyepong said that it was a difficult situation. There was a focus on the workforce and a need to ensure that more people were trained as Best Interest Assessors in the Local Authority. There would be multiple pathways to help manage the level of risk. It was noted that there was now a shorter more focussed assessment period. There was hope this area would become a priority for future parliaments.  

(f) Asked about the risk of misdiagnosis and lack of medical staff to review cases. Ms Agyepong said about the importance of legal literacy and that people’s rights were fundamental to the work going forward. 

3. RESOLVED that the update was noted. 

Susan Ashmore, Assistant Director – Adult Social Care and Public Health, was in attendance for this item. 

1. Ms Ashmore introduced the update and gave a presentation. (Please find attached).

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

(a) Asked by a Member how the cost pressures from transitions to the Adult Social Care budget were being managed. Another Member asked about the implications of the Care Leavers budget being underfunded and its impact on the Adult Social Care budget going forward. Mr Smith gave details of how the Adult Social Care Budget was set for those who come through the transition. It was noted that managing the cost pressures of transitions within Adult Social Care was one part of the sustainability programme of work, work was ongoing through governance meetings across the Council. Mark Albiston noted, as the senior responsible officer for the sustainability programme, would ensure that changes in one area would not result in a cost pressure elsewhere.  

(b) A Member asked to be reassured that young people were fully informed and were proactively engaged when decisions were made on their care and that young people informed future decision-making. Ms Ashmore said that the language used was of importance and engagement with young people was key as a part of their co-design principles. It was said that decisions on a young person's care would be based on their terms.  

3. RESOLVED the presentation was noted. 

1. Mr Simon Mitchell introduced the update and gave a presentation. (Please find attached)

2. Mr Mitchell provided a further update that the strategy would go to Integrated Care strategy governance in November 2023.

3. In response to questions from Members, it was said.

(a) The Chair asked about the length of the document and Mr Mitchell said that it was over 50 pages. It was noted that the current version contains all the various information and work done so far and would be edited down to be both accessible and readable.

(b) Asked by a Member about the role of Social Prescribing in preventative healthcare. It was also asked if an update on a recent pilot with children could be shared with the committee and if there was an evidence base being developed on the benefits of social prescribing interventions. Mr Mitchell said more information on the children’s pilot would be gathered and shared with the committee. It was noted that the construction of an evidence base was ongoing focussed on what works. Work was ongoing to collect data and evidence from various partners so that there were clear insights into the outcomes of various projects and to understand what further work is needed going forward.

(c) A Member asked how well all the partners and groups work together. Mr Mitchell said that providers had been pulled together so that they worked as if they were a partnership and there was a strategic partnership that brought many of the providers together and prevented duplication.

4. RESOLVED the presentation was noted. 

RESOLVED the work programme for 2023/24 was noted.