Transcript

Transcript

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So good evening everyone. If I can just call the meeting to a start please. And thank you everybody for coming this evening. Just to say from the get go if you could speak into the microphone and make sure that you project your voice as well so that everybody can be aware of what we're all saying. And also if health colleagues could be aware that not everybody in this room has a health background. We're all lay people so jargon or any acronyms, you know, could be helpful if you wouldn't mind explaining those as well. So, may I welcome you to tonight's meeting and to those who may be watching via the council's website. And to note that the webcast is also being recorded. You'll be aware that I've been appointed to chairman of this committee and I've invited Councillor Carew to remain as vice chairman which is accepted. I would like to say thank you to Councillor Chris Taylor, the outgoing chairman of this committee to thank him for his excellent work and to wish him well in his new role as cabinet member for children's services and education. I would remind members that we are in the pre-election period and as a result we are bound by certain rules. In essence, this means the meeting should not be used to highlight party political support or campaigns and I'll be very grateful if we could all make sure we keep to this tonight. Thank you. Also, very importantly, I am aware that the England team are playing this evening and I recognise that some of you may be clock watching. So, I'll do my best to set an ambitious ending of 9 p.m. And just to say, Councillor Kraske will need to leave the meeting early but he has dispensation to do so. And finally, in the event of a fire, please disperse away from the building and our scrutiny officer will lead the evacuation. So, now we move on to the agenda pack and item one, apologies and substitute members.

• Apologies have been received from Councillor Lucia Hennes and apologies have been given by Councillor Daye and Councillor Ferguson is a substitute member under the urgency procedure.
• And I'd like to say thank you to Councillor Ferguson for stepping in at the last minute. Minutes of the previous meeting held on the 19th of March. Does the committee agree the minutes is an accurate record for me to sign? And the minutes of the primary care recovery plans subgroup held on the 15th of May. Do the subgroup members that are present agree that it's an accurate record? Thank you, thank you. And I will sign those minutes at a later date 'cause we don't have a copy here. Any declarations of interest and dispensations? Any member? Councillor Mayne?
• I just have a standing one which is, I work for NHS England, London region. And I'm a governor on Oxley's Council of Governors. Thank you. Are there any other items of late business? No, there are no items. So then on to item five, which is establishing subgroups and joint health overview and scrutiny committee membership. The report is to be taken as read. So to item two in the report. Let me go to that. Does the committee agree that subgroup recommendations as set out in the report? Thank you, thank you. And item three in the report. So this item is actually repeated in the work plan on page 116, but we'll deal with it at this point. So the committee is asked to agree that Councillor Lisa Moore and myself be appointed as the committee's representatives on the South East London Joint Health Ophiums Greeting Committee. Does the committee agree? Thank you. Whizzing through this. So then to the next item, which is the Care Quality Commission Assurance Program. So this item is for information discussion and any comments the committee may wish to make. I will take the report as read. So this report provides the overview and scrutiny committee with an update on BEXI's Care Quality Commission self-assessment, self-assurance and action plan, as well as an update on the new adult social care vision and market position statement that were published in March, 2024. The report pack includes the main report, the slide pack summary of self-assessment and an action plan. We'll now have a brief introduction from officers, plus of course the cabinet member is welcome to provide comment should he wish to do so. So I'll now hand over to the Director Yolanda Dennehy and Deputy Director Jim Beale, Adult Social Care. Thank you.
• Thank you. So as has already been outlined, this paper is an overview about our progress around CQC assurance. We know that CQC have started their assurance program of local authorities, adult social care departments, Care Act duties. Thankfully we haven't been called up yet and fingers crossed that gives us a little bit more time to prepare. We have done a lot of work since last time we updated this committee, which was about a year ago. I have now developed a self-assessment which will be under constant review, not least from a recent peer review that occurred in May once we received the report, we will be updating the assessment to reflect some of the findings that that also raised with us. Just a bit of an overview of where our self-assessment indicates in terms of our kind of strengths and where there's some areas of development. I think we recognize that we've got some real strengths in how we work with partners and particularly our level of integration with our health partners through Bexley Care and also with our colleagues in the ICB in terms of commissioning services as well. But also the level of integration we have through our pathways model with the voluntary sector and one Bexley. We also believe one of our strengths and some of this has been informally confirmed to us through our peer review, so we do also know that we've got real strength around our safeguarding adults board where it is also a really strong partnership of committed partners to kind of the agendas around safeguarding adults. We know we do respond well to urgent, particularly urgent support and our kind of process of triage and managing. Waiting lists are good, although the fact that we have got some people waiting longer than we would expect for assessments is an area that we're under constant development and improvement and we know that some of our ways of procuring services such as our individual service funds have already been recognized nationally as good models that really give people choice and control. But there are areas as we have highlighted in other times to this committee that we are still working on developing. One of those key areas dual remains is our personalization and I know this committee did a really good piece of work on how to improve around personalization, particularly in making direct payments, which is the essence of choice and control for individuals much more accessible and we are still working on those actions to make sure we make those necessary improvements. We also understand that we've got some work to do around making sure our assessments and when we work with people that we really reflect the voice of the person in everything we do and make sure we're working to their hopes and aspirations. So that still is also work under the personalization agenda that we're doing. There is also, whilst we've got some really good co-production and partnership boards, we know that that is also not as embedded in our practice and how we deliver services as we would like it to be, so we are still working on actions to improve that. And we also know we've got some gaps in the borough in terms of services, the most obvious one being the fact that we are limited with extra care, sheltered accommodation and so we don't have that available for our older population and we are eager to continue to do what we can to develop those in the borough where we get those opportunities. So that's where our self-assessment is at the moment. As I say, we are working to develop that self-assessment and develop that further improvement plans based on the peer review. We haven't been able to fully include that update in the report, quite honestly, because we haven't had the report yet. But so what we've done is try to interweave some of the initial feedback. But once we get that full report, we'll be updating our improvement plan, our self-assessment and hopefully we'll be invited back to the committee to give you a further update on the learning that we got from there. So yes, that's where I was going to leave it.
• Thank you very much for that introduction and for all the hard work which has clearly gone into this and the efforts of the team to prepare for inspection, which by definition will also improve service provision. Any member? Councillor.
• Thank you, Madam Chairman. I've just got a couple of questions and just an observation really. On page 36, the adult social care vision, it references in the final paragraph or says, adult social care are working with managers and operational staff to embed and implement the vision in practice. How are they working with staff and what are they doing that is different now from the way they were working before? Because it's easy to say these things but actually it's not always quite as easy to translate those words into actually something that generally happens. On the page 37, the market position statement, the second paragraph there, it says it's been shared with staff and providers, et cetera. And are the providers taking this on board and how do we monitor that? And are we including the voluntary sector in that and are we receiving the support and cooperation and interest and enthusiasm that we would like to think that we would get from them? And finally, and it's really, there's not so much a question, there's just an agreement. The CQC assurance program next step, second paragraph, it says that the peer review can be presented to the scrutiny committee at a future date if required. And I would have thought it would definitely be required. So I would support that, definitely. Thank you, Madam Chairman.
• Thank you.
• Thank you.
• I'll pass to Mr. Beall to give you the update about how, and Mrs. Travers, how we're working with staff because they are the ones directly doing that. And I will pass over to Mrs. Rogers to give you the update on the market position statement 'cause they're the ones that are actively working.
• All right, I'm gonna give you a little bit of the start and then I'll hand over to Mr. Beall. So in regard to the adult social care vision and how we embed it in practice, we've been working quite hard to make sure that some of those principles that were drawn out of the vision are shared and discussed on a regular basis in team meetings with our managers that then disseminate down. But we've also done some very practical things. So the vision and some of the core fundamental principles of that have been put into a visual display around the office. We have things like backgrounds on our teams calls that also share that vision. So it's just starting to kind of seep into people's kind of thinking practice. But culture shift does take time and I'll pass over to Jim to add a little bit more detail about some of those plans as well. What we are looking at is how we work with individuals, how we think through when we're working with someone. Are we really meeting the aspirations of that person and considering what's important to them? Giving them that choice and control. So we're developing things like case file audits. So when we're working with individuals, we look at the records that are written up to see if it's reflecting our practice and our aspirations. And then, but it's actually teams themselves that are doing that kind of measurement and exploration to try and create that culture shift. I'll pass across.
• Thank you, Mr. Abbess. So yeah, so I think some of that around that culture shift is very much, I mean from my perspective, it's very much about talking to people. It's getting people together in groups and it's starting to talk about what that really means, what the vision means in practice. 'Cause as you say, otherwise it can just be lots of words on a page. And I think it fits into everything we're doing in relation to the CQC preparedness work. 'Cause really, all the work we're doing there is making sure that everything we do for our business as usual is in the right place. So everything we do around strength-based practice, personalization, will all fit towards that overarching vision, which then fits into the corporate vision around making Bexley even better. But I think lots of it is going to be that continuous, the conversations, making sure that the principles around the vision are sort of the golden thread through all our discussions, through the meetings that we have, through any of the forums we have in relation to practice, when we look at safeguarding, 'cause that has making safeguarding personal, which is all about putting the person at the focus, making sure things are outcome focused so you're building on people's strengths. So I think this is about starting from the top, making sure that the leadership team, that's all of us, a senior leadership team, and then working down the leadership team. Because if you've got the right, everybody really understands what we should be doing, then it all becomes part of your everyday conversations, doesn't it? And I think that's what we want to try and really embed. 'Cause I think lots of people are out there, they're doing a really good job, but you've got to be able to articulate that in everything you do, and it's got to run through, and it's got to run through our commissioning, it's got to run through safeguarding. And when we look at sort of the quality as well, the quality through our quality audits, and we need to make sure we have that continuous improvement loop. So it becomes part of our everyday conversation. And if I'm quite blunt about it, under the CARE Act, these are all the things we need to be doing. So there's another element is that this is how we need to be working, this is the framework that we'll be working to, this is the practice framework we're working to, but it's making sure you're taking people with you. And I think it just starts from the top, we put it down. So I think it's going to be positive, and we'll definitely get there, and that's why it'll be good to be able to come back on a regular basis to feed back to you on that progress. Thank you.
• Thank you, and as you know, my team leads on the market position statement and the commissioning element of what colleagues have just been talking about. And your question, Councillor Reid, was around engagement with providers. And I suppose I would just articulate that engagement with providers is an ongoing, business as usual, everyday practice for us. The team are constantly talking to providers, listening to staff. I think we're probably doing more of that now, hearing from staff about the needs that they're encountering as they're doing the strength-based work that's been described, channeling that into the conversations with providers. And seeking their ideas and asking them to work with us to develop new approaches. Examples of that, of what my colleague Mrs. Williams is doing around working with some of our care homes to try to modernize our approach to dementia care, and to look at different models for that. And other providers working with us around different models of day opportunities. For example, for people with physical disabilities. So, lots of engagement with providers. We also have regular provider forums, and the market position statements. The commissioning intentions we've set out in that statement are discussed at those provider forums. And as I say, the feedback loop really goes between those forums and back through to the staff so that we can pick up the needs. And of course, the work that went into developing our vision, all of that engagement with our residents and our providers. And you talked about the voluntary sector. And again, our partnership with the voluntary sector, you're aware of the prevention and early intervention schemes that we jointly commissioned with the ICB. Those partners also working with us to identify gaps in the market and help us to close them. And our carer's partnership, for example, has been quite operational in seeding some of that work and some work that we've started around looking at residential respite opportunities for people with learning disabilities. So, it all links together and remains a fluid, ongoing interaction with both providers, staff, voluntary sector partners, and channeling that into our thoughts and plans for the future.
• Thank you very much. Do you have any further questions, Councillor Reid? So, if I just pick up on the coming back to the OSC. So, on page 36, as Councillor Reid highlighted, the Assurance Program Inspection Readiness Group will undertake a revised self-assessment again every quarter on a rolling program with the aim of achieving improved performance and outcomes, and therefore impose self-assessment ratings. So, I'm going to ask if that can go on the work plan. Would we be in agreement with that? To follow the quarterly reviews. Thank you. Councillor Taylor.
• Thank you, Chair. It's really clear that you've done an awful lot on this, and it's really good to see that you've identified your strengths and that you can do that, but sorry, I wouldn't be me if I hadn't concentrated on the areas for improvement. They are considerable, and I'm aware that they would take you quite some time. So, my first question is, have you worked out a priority for those? Because there are two in particular that stand out for me. One is supporting unpaid carers. I think what was really clear to us during the direct payment project was that the burden of care does rest quite a lot on unpaid carers in Bexley, and although we say we value them and we do, absolutely, that needs to be followed with actions and not just words, and I think that if that had a priority, I think that would send that message. The other one is about transitions, and we note that the feedback from the sending inspection was that we needed to work more on preparing for adulthood, and I wondered if you could expand if we've done any more on that since that, and if that is of a priority in terms of the improvements. I think that's all for now. Thank you.
• Who would like to take?
• Yeah, so, I also likewise focus on the areas of development, so yes, really important to kind of really seek that improvement. In terms of the priorities, I think how we're going to prioritize is going to be based on some of the feedback that we've got from the peer review, and I think because what that is is an objective, 'cause obviously self-assessment's our own kind of review of how things are, and what the peer review does is give it a kind of objective viewpoint on that, and they have really used the same framework and model that we know CQC are currently using, and we assume that that will continue. So we will use that to help us put the absolute priorities. That said, everything in there is on our action plan to do that, but we might have to give more focus to some areas based on that feedback. In terms of carers, that has been an important aspect for us, and the carers' partnership work really well actively with us to really put those improvements in place, and I know we are updating our carers' action plan based on that being a co-produced piece of work through our carers' partnership, because I think it's really important when we're talking about the improvements we need to make with carers, actually we're talking to carers about what is going to be beneficial. So I think it's through that carers' partnership that that will, that work around that carer support will really kind of firm up that action plan, although we do recognize that through some of our audit work, for instance, that sometimes we've completed carers' assessments and people haven't really felt that they've had any benefit from that assessment, and so we are really eager to make sure every interaction we have with carers is to the benefit of that, and so that was a piece of audit work that we did through some of our carers' support and voluntary sector helped us with that audit, so it's some real good feedback. So some of that's already implemented into our action plan. Transitions is an absolute priority, because we are obviously part of that priority action plan for the SEND, whilst we do recognize the SEND inspection did highlight that for people with more complex needs, that there was better preparing for adulthood than with less complex needs, and clearly our cohort are the more complex needs. We know that there are still people that fall through the gaps that come to us a lot later than we would have liked them to, because they weren't necessarily on our radar. And certainly through our consultation through the PFA and SEND strategy work, we've had some direct feedback from people about actually what we can do better in terms of making sure we get that engagement from an early age and that engagement is really meaningful for people. So I think our focus will be on those areas in the SEND from the people with complex needs part of the jigsaw, focusing on those areas where we know we perhaps need to do more improvement, and that's primarily around people with needs such as autism that perhaps don't always get referred to us, or when we assess, we don't always highlight the, we don't always recognize those care act needs because they're in a quite stable position when they're at school. But actually when that changes, when they reach adulthood, we know that that can sometimes trigger some episodes that then bring around a crisis or bring about increased needs so we really wanna get in and work out how we can do, what we can do to support them to prevent that because it'd be much better to help that transition to be as smooth as possible. So that's probably our main area of focus as well as the things that we've already committed to in the SEND support which we're doing collaboratively and supporting our children's colleagues, which is things like recognizing when people need to be referred to us and making sure that any of our interactions, which we do do a lot before people turn 18, so we do engage quite from age 16, well age 14, but certainly start assessments at age 16, but just to make sure that is as meaningful as possible because I think sometimes we're engaging, but actually what are we doing with that engagement to really help people prepare for adult life, which is very different, the support and the expectations as an adult is different from when you're a child and that's no different for someone with needs and so it's about supporting them through that to be as independent as possible. So they are areas on the priority list, but obviously when we get the peer review response back, we will be looking at where they've really highlighted some areas that we need to perhaps do a little bit more of an urgent focus on and so we will want to kind of focus on that first and then still carry on with the other action plans.
• Thank you, Mr. Henny.
• That all sounds really good, Yolanda. I'm just wondering, and I know we've got, obviously, our KPIs in the status report. I'm just wondering if you would kind of share with us those targets that you're aiming for. Obviously, I totally appreciate that's gonna have to wait until the peer review comes through and you've worked out that order, but I think it'd be really good for us to know what it is you're aiming at, what's our SMART objectives and are we achieving it really, that's all, thank you.
• Thank you, Councillor Taylor. I'm sure that we're in the minutes for us to follow up on. Thank you. Councillor Carew.
• I'm sorry.
• No? Councillor Sandro.
• Thank you, Madam Chairman. I've got one question. It spreads over two pages, actually. Page 42, the bottom paragraph, we refer to a summary of other implications and it talks about equal opportunities and it says there in the paragraph, it mentions the people who are most likely to experience inequality. And then again, the similar thing on page 55, areas for development, it says on there about reaching out to different community groups, in particular, black, Asian and ethnic minorities. I just wanted to get an idea of how we are looking to reach out to these different community groups. Is there any idea? 'Cause on one of the pages, I think it just refers to some figures. So is it a data thing or is it a case that we would be actively engaging with them? Thank you.
• Thank you.
• Yeah, so I mean, I think some of the information in the report is about evaluating our equality's impact for the paper. So that's why it's very much data-driven. But actually making sure we're accessible to all our parts of our borough and our residents is really important to us. And we know that from some data analysis that we're perhaps not reaching all our residents. So for instance, we know in adult social care when we compare to our census, that for people of sort of over 65 or older age range that we are underrepresented from people from background of an Asian background or and also from our white other background are just from looking at the data. So that's at very early stages of thinking of what it is we need to do. And just because they're highlighted in our data doesn't mean there isn't other work to do with other groups to make sure that we're being as accessible as possible and that people aren't not getting the support they need or in the way they need it just because we haven't kind of looked into that. So we are currently doing some work to get underneath that data but also to go and speak to people about their experiences. We shall be doing that through different community groups, our community champions. That is a joint resource through Bexley Wellbeing Partnership are really in touch with some of those groups that we perhaps don't readily have those conversations with. So we'll be using our contacts through the community champions and through other community groups to really start engaging with different parts of our community to find out what their experience is, what their need is, are there barriers because at the moment, I'm not sure we really know what the situation is. And once we've done that initial kind of engagement piece and understanding piece, we'll then start thinking about whether there's things that we need to do differently to make sure that we are being accessible to all of the community.
• Thank you. Do you want to come back? Any other member? Councillor Seymour.
• Yeah, thank you, Madam Chairman and thank you. Sorry, congratulations on your appointment, well deserved. I know you're doing an excellent job in the first agenda. Says that, I mean, this item really sort of traverses the whole of the adult social care portfolio area. And, you know, I'm very lucky. I mean, sitting around amongst these people at the top table hearing them speak, I realise how little I actually know. I've just got the privilege of representing them and giving them political support. But in terms of the peer, sorry, the peer review, I think really what it did, I mean, I don't think we need to underestimate it or over evaluate it really, because I think a lot of the things that they've actually identified, I know that speaking from Mr. Dennehy and Mr. Bill and other officers as well, that I think we were quite aware of that. So we were working towards that anyway, instructors were in place to address that. What that's done is given us an opportunity to focus on where we need to focus. But I think since I took over the post just over two years ago now, and when I first took over, I just, you know, I didn't know what I was doing, quite frankly, for quite a while, but these guys took me through it. I think I was made aware of three words, really, transformation, integration and personalisation. Now the transformation work took place some while before that. In actual fact, the previous incumbent on this, Councillor Brad Smith, I think, deserved an enormous praise for the journey that you took us through with adult social care. And I just think it showed, when we talk about all these homogenous items, it really comes down to evolution, the way we changed about the way that we look at people. And I'm sure many of us have got real life experiences where people have had learning difficulties or physical disabilities, and there were times in our society, not that long ago, where people were literally pushed into a corner and forgotten about. That, quite frankly, is not acceptable, regardless of what your colour of your skin is or the name of the God that you pray to. Everyone is entitled to courtesy and respect. And I think that shows through in the adult social care vision, which these guys have put together and which I was very privileged and happy to support. What it does is it puts individuals at the heart of what we do. Now, is everything we do right? No, it's absolutely not. Have we got that aspiration within the officers team to make sure we do the right things? Absolutely. And my fervent wishes, and I believe of every inch, every five of my being, is that regardless of your upbringing or the disability that you have, you are absolutely entitled to aspire to be the very, very best that you can be and to have a fulfilled life. And I think that this vision that we've put together will ensure that long-term. And I'm very, very proud of the work that these guys have done to ensure that, and they are deserving of enormous credit, and I hope that's reflected in the minutes. In terms of other things, but I think in saying that, and yes, that's great, but you have to have an open conversation and debate about where things may need improvement. Now, I'm particularly keen on communication, but I don't think communication's a one-way street. I've not looked it up in the Oxford Dictionary, but I'm sure it's not. I'm sure it's a difficult between two people. Now, for instance, my first wife was a Turkish shepherd, so she was Muslim by religion, so we're quite happily divorced, I'm pleased to say, but I got on very well with my mother-in-law, strange enough, and I still see her and I still speak to her. Now, she's a devout Muslim lady. Culturally, she would find it very difficult to engage in any process around this, around her health, whether it might be physical, mental, sexual, whatever, so we have to find out, we have to think of ways to do that, but communities have to reach out as well. I spoke to Councillor Sander earlier about something else, but we've suddenly touched on this. Communities and cultural communities need to have a voice, but they need to make that voice known to us. We can't be, you know, we're not psychic, we can't be all things to all people, although we want to be, and I'm sure we can be, so I think all, I mean, I know, for instance, Councillor Ferguson is a member and a very good Councillor for Thames Meet East, and I've attended some meetings there with Peabody. There's a huge Nigerian and West African population in Thames Meet. Very much have got their own issues, and they've got their cultural concerns and health concerns, which, you know, Peabody are doing some really good work around that in conjunction with our officers as well, so we need to keep that, but Mr Denny is right. You know, we've got the care. We've got great carers in this ballot, and I think that successive governments over a period of years, not just the government, you know, that we've got at the moment, but previous governments of a different persuasion, have ignored carers and carers at home because it saves money. Let's be quite frank. It does, you know, people who, I don't know if I'd be mad enough to administer the level of care that some people are doing. I'm quite honest about that. Well, that says about me. I don't know. You can make your own way up, but we mentioned about our community champions. That's a really important piece of work, but in terms of carers, carers are valued in this ballot, and I attended a meeting at the Holiday Inn, two weeks ago, two and a half weeks ago, something like that, where there must've been about 25 stands of different agencies that do work in the borough around mental health, around signposting, all sorts of things that people can go to. There was, you know, a rising on health, mental health, and an increased signposting, which does show that, you know, carers, who take, and very often the carers need the most care when the person that they love and care for is gone. You know, they've got the full laugh, and that in a way that I couldn't possibly imagine. So we do place value on them, but as I said to you before, you know, I fervently believe that the team that we've got in adult social care, you know, I'm quite unapologetic for me. They're the best team in the council, by and by none, but they do put the individual at the heart of every one of their processes, and I know that's where we're going, and I'm sure that the peer review will find that, and I'm sure that the work that's done on the back of that to the CQC will prove that as well, because we've got a great story in this borough. We don't often shout out loud enough about it, but we have, and it's largely due to the officers that fulfill that view for us. So I'd like to thank them. Thank you for the opportunity to make me speak about it. Thank you.
• Thank you. Thank you for that, Councillor Seymour, and we will put our grateful thanks to you, the team, in the minutes, because I'm sure that all of us are grateful to you for the work that you do, not just bringing reports to this committee, but everything that goes on behind it. So thank you very much for that, and we'll move on to the next item on the agenda, which is Care at Home Transformation Update. Again, this item is for information and discussion. I will take the documents as read. The report provides an update on the progress of the adult social care, care at home transformation, previously reviewed by the OSC on the 24th of January, 2023. The report focuses on residents' experiences of care and how BEXE quality assures a new model of care. We'll now have a brief introduction from officers, and again, the Cabinet member is welcome to provide comment should he wish to do so. I'll hand over now to the Director of Adult Social Care, Mr. Henney, and the Associate Director for Integrated Commissioning, Alison Rogers. Thank you very much.
• Thank you. Just to say, obviously, this home care transformation has come a couple of times to the committee. It was quite a transformational approach where we commissioned on a population basis, and the aim of that was to really improve outcomes for individuals, improve the quality of the home care service, and also recognizing that we had a number of different providers, and so there was an aim to reduce that. This report, and Mrs. Travers and Mrs. Williams have done some work to try and get some feedback on direct from people on their home care services, and I think that's documented in the report. But that said, we know that there is still some areas of quality that we will always need to continue to work with in terms of that provision, but we also recognize the model is still partway through its implementation, and we are still working very hard to really realize all of the outcomes that we had hoped for, but I'll pass over to.
• Thank you. I think Ms. Denny has probably said much of what I was gonna say, but I was struck by Councillor Seymour's three words, transformation, personalization, and integration, and I think that this home care transformation or care at home transformation really does encapsulate all of those three aspirations and is one of many examples of the work that we're doing to try to achieve a transformation in the quality of care for people who need to receive services at home, to enable them to remain as independent as possible, to make it as personalized as possible. As Ms. Denny mentioned, we were working with a very large number of providers, 42 I think at its most, and we didn't feel that we could enter into the kind of partnership we needed to to work with those providers to improve that quality of care and to take that much more personalized approach, working with that very large number of providers, so some members who have been with us on the journey will remember that we've worked to reduce that number and the providers that we've commissioned are mentioned in the report. They are commissioned to work in our local care network areas, our three localities, and to work with, and this is where the integration part comes in optimally, to be working with health providers, with general practice, and to look at the needs of the population, as has already been mentioned, working on a geographical basis with geographical budgets for those providers to identify, assess, and meet needs in as personalized and integrated a way as possible. So that is the journey that we have been on. We remain on that journey, we're not there yet. We're still working on it. We have our three care at home providers and we have our three reablement providers. They've all been on the journey with us. They remain on that journey with us. We remain working really closely with them to help them to transform those services. And I think all of my colleagues would acknowledge it isn't just about those providers. It is also about some culture change in our own services and the way that we work with those providers, which is also an ongoing journey. But we're on that journey towards fewer providers. But we, as again, I think I've articulated to members in the past, we haven't wanted to just transfer people from one provider to another. We've wanted people to remain with their provider if they wish to, which meant that we continue to work with more providers than just those listed in the report. And so when we met you last time, you asked us about quality and about what difference this was making. And so this report really does focus more on the feedback that we've been getting and how we've been getting it and what our mechanisms are for ensuring that we receive that feedback. And our quality assurance team and my commissioners are, again, as I mentioned earlier, in constant contact with providers and in constant contact with users of services and make active efforts and contacts with service users to try to generate those kind of open conversations which allow people to be honest and open about their feelings about the services we provide. We try to avoid sort of direct questions like is the service, does it meet your needs? We want to sort of generate those opportunities for a conversation where we can get both the positives and the negatives. And I think that's really, when you see some of the feedback that we've articulated in the report, you will see, and I have highlighted it, that we have both sides of the same coin, as it were. We have good feedback about timings and people, home carers arriving on time. And we've also got feedback that the clients don't always call, aren't always called when people are running late. So there is no one single voice. Of course, all of our clients are different. All of their family circumstances are different and how we work with them will obviously be different. But that's, of course, about how we personalize those services. So we remain in that dialogue. We remain working with those providers to continue on that journey. We do still have more work to do in terms of moving to the geographical financial model. And that, I think, has been reflected in the review that we've recently had done, which has pointed out to us what we already knew, which is we've still got a way to go with that. And we'll need to think about how we resource that ongoing work to really move fully to that model and to make it work, taking into account, of course, that not all of our clients actually, some of them contribute to the cost of their care and others don't. So more work to do around that. But I hope we've sort of set out for you the journey that we've been on and that members who haven't been with us before have a better understanding of what we're aiming to achieve and obviously happy to take any questions.
• Thank you, Ms. Rogers. Just before I go to members for their questions, a very, very simple question for me. Would you please just outline what the difference is between time and task and the population geographical model? Because it's reflected a little bit in the feedback. Care has stated the correct allocated time. So just very briefly, that'd be very helpful, thank you.
• Sorry, yes, absolutely. So I mean, what we're trying to move away from in a perfect world is you're allocated 15 minutes and you will have 15 minutes whether all of your needs are met in 15 minutes or whether you needed half an hour. And so we're trying to work towards a more personalized approach whereby your needs are met in accordance with your assessed needs. They might be, you might need an hour one day and nothing the next day and 15 minutes the next day. So it's much more flexible. It can be adjusted on a regular basis in conversation and in agreement with clients and their carers. But moving away from that very rigid allocation of time. But it's not an uncomplicated thing to achieve. And some service users expect us to work in that way and want us to work in that. So we do need to take people on the journey with us and help people to understand that their needs can be met more flexibly. But by moving away from a methodology of paying for care in that way and moving to giving our providers a budget for a whole locality, our hope is that they'll be able to be much more flexible and responsive and get better value for the budgets that they have and meet clients needs more flexibly. So that's the vision. But as I say, it's a journey that we remain on and there is more work to do to get to that point. But having those much more limited number of providers to work with obviously is a significant starting point because going on that journey with 42 was always going to be much more difficult.
• Thank you very much. That was a very, very helpful outline. Thank you. Come to Councillor Taylor, thank you.
• Thank you, Chair. Yeah, I think that was probably an immense bit of work going from 42 to six. And it's good to see the bit about quality there. I think what I'm looking for really is some reassurance that that quality monitoring will be ongoing and regular and that actually it will be robust. The thing I want to say is that effectively going down to those six partners creates what IT terms is called a single point of failure. And that actually you could have issues with any one of those which would have a substantial impact. We've already got disparity across the borough and I would hate to see the issues within those companies exacerbate that disparity. And you speak about socioeconomic differences. Some people can pay for additional care, some people can't. I think when we're noticing that those in the North are more likely to not be able to pay for additional care. So I think that that's something that really needs to be highlighted. The other thing that I'm wondering if you can assure me is that if any of these companies, if we had, we're monitoring the level of their care and so on, but also at the end of the day they're businesses and we can't afford for any of their financial irregularities or whatever that may come up. I'm not saying they would, but I'm just saying they might, it may impact on the care that we give as a borough. So I'm kind of looking also what is our plan B in case any of these companies go to the wall or also what is our plan B in case there are serious issues with any of these companies. Thank you.
• Thank you, Councillor Taylor. Can I just add one other aspect to that, please? So if there is a staffing capacity issue in one of the partners, is there an arrangement where another partner will be able to pick that up? So I'm assuming we're coming to Ms. Rogers. Thank you.
• I'm sure other colleagues might want to come in, but I'll start off. I mean, as members know, we have a very robust quality assurance team in my operational colleagues, part of the directorate, and they work relentlessly with our providers to monitor that quality. And you are quite right that a reduced number of providers does expose us to greater risk if there is a provider failure either on a quality or a financial front. The other providers in the market haven't gone away, although, of course, there is a risk that there will be reduced other providers in the market going forward because of what we're doing. So we do monitor capacity in the home care market all the time, and as you know, we have to submit market sustainability plans and NHC, et cetera. So we are keeping a constant watch on the availability of care in the market, and if we need it, we can commission it elsewhere, and we have done. Sorry, I've lost my train of thought there for a second. So obviously, then, if we did have a provider financial failure, then there would be those opportunities. But our quality monitoring is around that relationship that we have with those providers, having that open and transparent relationship when we do identify issues, having those honest conversations, and working to make improvements and to support them to make improvements if they need to make them. But I don't know, Laura, do you want to come in with any more?
• I think that the one main difference with the particular, their partners, this was a contract built on strategic partnership. So actually, this wasn't, I think, one of the true things that has happened. It's about how we elevate home care within our borough. And actually, what we're doing at the same time to make it right for our residents, and the quality is actually you increase the skills, the expertise, and the knowledge that sit within quite an incredibly sized workforce for Bexley. And actually, we found that a lot through COVID. One of the workforces that held strong, actually, during that period of time, was that particular workforce. So actually, what we've done through this contract, and obviously, this has very much been about the residents, and obviously, the quality, is actually how you increase the quality, and actually, the value behind that particular workforce. So actually, these contracts were built as strategic partnerships. So whilst we do all the contract monitoring, and yes, the quality assurance team do a phenomenal, robust job, I'm not gonna say it's not difficult, because we are still working with a number of other providers so we've got eyes in all the different places. Another element of that is the strategic partnership. So by joining us, and because of the configuration of the local care networks, what we're saying is you come in as part of our problem solutions, how we work together, what's going on in your different areas. So actually, they become part of that. From a financial monitoring point of view, we do have mechanisms within the council that keep a very close eye on all of our providers' finances. And again, if you'd like, these are other things that came out of COVID. Again, about some of our providers actually lost quite a lot of business. In particular, it was the care home providers, not necessarily the home care. So we keep an eye on the medium and the low risk, because again, as you say, whilst we might have still a number of agencies that come to us on a daily basis and say, Give us some work, and we say, Well, actually, find different opportunities for our residents," we keep a very close eye on the financial stability, because again, that's really key to how we make sure that our residents are safe and within that area. So I do think the model is different about how we want to and continue to raise actually where our care at home providers and partners should be. And as I said, it's a significant workforce. It's our workforce. These are people that live in Bexley. These are people that work and come, and they could well be within that, your unpaid carers. There is a skill set within there that we want to encourage and endorse. And as part of that, they are part of our Professional Skills Academy. They come to a number of our own training opportunities that we give to our social work teams and others. And I think that's really important, 'cause in order to do the things we want to do and increase the quality in residents, that's another workforce you have to bring with you. So we talk about our vision, but that vision has to be related to this. This is the biggest and greatest workforce to support our residents living at home. And I have to say, and I hope with the integration and the others, it's more than just home care, and that's the work we're trying to achieve. It's actually helping someone live at home. And that might be that actually that's helping somebody become part of their community about social stimulation. It's coming away from the traditional time and task. And I think that's really important, and that's the journey we're on, and it feeds very much into the vision. So and actually what we're trying to do is move them and align them together. And it is very much moving parts on a daily basis, and we stay positive as much as we can. I hope that answers the question. Yeah, should come back.
• Chair, I'm sure you've already got this in hand, but it's a really important project, and it would be really good if this came back to this committee for an update as we progress through. Thank you, thank you.
• Councillor Moore, thank you.
• Thank you, Chairman. Page 68, section four on next steps. It mentions that we've commissioned a review of a project from an external agency to assist in evaluating our progress and helping us to frame our priorities for the future. Is it possible for you to tell us what that review said, please? And also whether there's anything that needs to go into the action plan, and whether there's anything that needs to come back to this committee.
• Thank you. So the review, I think, reflected back to us a lot of what we already knew. I think what was interesting for us was the review looked at what else was going on around the country and looked at how the progress that we were making in BEXI compared to other areas that have attempted similar transformations. And it's fair to say that other areas have started transformations like this and stopped and not gone any further forward because some of the challenges are quite significant. And I think the feedback we had was that we are, you know, we're still there. We're still progressing. We have made progress. We have made inroads. We have something to build on. I think what it did was reinforce for us the fact that this is a bit of a marathon rather than a sprint, and it's a journey that we're going to be on for some time, and that there are still significant avenues that we need to really go into, including on the financial modeling and making that robust and work for the future. And we've been put in touch with other areas where there are, you know, where colleagues are wrestling with similar challenges around making the sort of the geographical budgeting actually work. So I think what it did was reinvigorate us, give us a sense that we're, you know, we are, you know, we have a prize to keep working towards, but I think we have to be realistic in terms of how long it might take and the resources that we might need to make it, you know, to really deliver it. And you've mentioned, you know, you'd like to hear from us again. I'm sure it may be more than once going forward. But I think as a leadership team, it's reinvigorated us and given us that sense that we're on the right path, but that we've just got to be diligent and keep plugging away at it, and problem solving around some of the challenges.
• Thank you. I'm gonna come to Councillor Sandhu and then to Councillor Gill.
• Thank you, Madam Chairman. I've just joined you today on this journey for the first time. So forgive me if I'm asking a couple of questions that perhaps I should have known the answers to. Page 66, the six partners, the providers that we've got, I've actually got two questions. Firstly, could you just confirm, were they from the original 42? Are they part of the original 42 or are they new providers that we're using for the first time? And secondly, page 69, under the financial implications, where it says on the second paragraph, new partners will be paid monthly in advance. Having read all of that, I've actually written here a little bullet point of more work. To me, it seems as though we're kind of creating more work by paying them in advance, because then we're gonna have to go back and check for hours and any discrepancies, et cetera. Could you just sort of enlighten me on that? Is that just, am I reading sort of too much into it? Is it not as complicated as I think it is? Thank you.
• No, I don't think you're reading too much into it. No, it isn't uncomplicated. In answer to your first question about the providers, Laurie, you might, I was gonna say, the only one who wasn't an existing provider was Hartwig. They were new to our market when we went out to this procurement, thank you. And yes, and when I talk about the work that we still need to do and learning from colleagues and working through some of these problems with other areas that are working through, that's exactly what I'm talking about. I mean, obviously, we're not in a position when we're still working with other providers to pay all of this money to those providers in advance. We're having to do that bit by bit and feel our way through making that work. You know, in the long term, the expectation is that those providers will be our partners. We will pay them on a regular basis. They will, they're our trusted partners. We will work together to understand whether they are, you know, in effect, making savings on our budget by working more efficiently, or whether they've got far more people than we projected they would have, and it's costing them more. Those are the kind of ongoing conversations we'll have to have when we have fully moved to that model, but we're still in the process of working towards that model, and I think it's fair to say it's, you know, it isn't, it's not an uncomplicated piece of work, and it's still, and there are still problems for us to resolve to get to it.
• Miss Danny.
• Yeah, just, I know it seems crazy of us to complicate things, but there is some good reason for that, to pay providers in advance, it kind of goes with what we've started off today talking about in terms of our population model, so that is really about asking those providers to meet the need of that population, 'cause we've split them, obviously, into the three local care networks in Bexley, and to actually really focus on outcomes for individuals, rather than rigid, or obviously the tasks of washing, dressing, half an hour for this, actually getting someone ready, that might mean something different on different days for individuals, so it is really trying for us to use a procurement and commissioning model to really look at outcomes for individuals, and that's what, if we can get to that part of the model, will really drive up the quality and the customer satisfaction, for want of a better word, of what people's experience of home care, but as has been pointed out, we are still on that journey, we are paying in advance, but obviously because not all of the providers have got the bulk of the population, it's really hard for them to really realize that model, so it has been a bit more chipping away over time, but I'm really pleased to say all of the providers that are working with us are really committed to that model, that was one of the things, actually, that whilst we haven't really completed looking at the review at the moment, so we've had the review done, but we are still digesting what our next steps need to be, and certainly we can talk about a future update on this, but what they did tell us is when they spoke to all our providers, they were really committed to the model, and I think that's a really positive thing, I think, work together, we can work together to really realize our ambition for our residents around home care.
• Thank you, did you want to come up? Councillor Gill.
• Thank you, Madam Chair. I was actually asking the providers from 42 to six, the same question I was going to ask, and secondly, Councillor Nicola already asked for how we monitor the care, because I bumped one yesterday on the doorstep, and there was about 90-year-old female, and she barely woke, and she said, I'm going to shopping for my milk. I said, Mom, you can't walk. It's not safe for you to go out. That's where your care come. She said, Yeah. She come, go on 10, 15 minutes. So I know she got good feedback on here, on the papers, but in a reality check, I don't know how many more residents do we have in the area sitting at home alone, and they can't put their voice up. Thank you.
• Thank you, Councillor Gill. Would anybody like to comment on that? Thank you, Ms. Henning.
• So I'm really sorry to hear that, and certainly, that still isn't uncommon to hear that people feel that care is coming in and rushing. Certainly, with this model, our aim is for those providers to work differently, and that is starting to shift. Obviously, not everyone, so with those providers, I don't know whether this person is or isn't, and certainly, we're happy to look into any individual concerns. If outside this meeting, you can pass that to us. We do have our quality assurance team that are still overseeing, as I think Mrs. Rogers had alluded to earlier, all our service provision in borough, and that includes the home care. I think what has been alluded to in the report, and I just want to pull out, which is slightly new methodology, is that our quality assurance team, particularly for home care, really wants you to find a way to really get the voice of the person in terms of that feedback, because you can go and you can look at records, but it's stories like that and people's feedback like that. That's really important to actually assess the quality, and when, obviously, our quality assurance team go into care homes, they get that directly from residents and family members, and we don't always have a good way of collecting that, so they have introduced some different methodologies, including surveys out to people, and are arranging to do some visits and checks with individuals that are receiving home care, which is another way just to really triangulate the information we get through our quality assurance of the actual provider and their paperwork. And of course, as you said, reality checking, and I know that this committee has done some reality checking with our home care providers, which is always welcome as well. So we do have a number of ways of checking that quality and getting that voice heard, and our quality assurance team are eager to make sure that works.
• Thank you, Mr. Henny. We can add that in the work programme, Councillor Gill. Maybe you would like to be involved in that piece of work going forward. So, Councillor Seymour.
• Yeah, thank you, Madam Chairman. But I was gonna go back to the point, sorry, that Councillor Taylor raised, but just from what Councillor Gill has just raised, I mean, if any member has any issue around case work that they get within their ward that they think needs looking into, as Miss Stanley said, any member of this table can be emailed around that, and certainly if they feel they want to email me to take it forward, I'm more than happy to take it forward for any ward, Councillor. They've all got my number, they've certainly all got my email address, so I'm quite happy to do that. In certain, I mean, I think Councillor Taylor raised a very valid point about A Plan B. And nothing is perfect, any system can go awry, but just to, if I can provide some reassurance around that, it was about probably 18 months ago that we had a fire in a care home just around the corner, and I always forget the name of the care home, I don't know why, but I do. I've actually got a friend of mine now who's a service user, and he's very happy there, like, you know? But that was, I think there's about 30, 40 people in that home, yeah, who, partly, you're very right, I can read it for you as well, all suffering from various degrees of dementia. Now, that obviously provided an enormous challenge. But the team, not just the leadership team here, but the backroom staff had to step forward to do those jobs so that the corporate leadership team, the senior team, without social care, could take that forward. I was briefed, I came in and was briefed in the afternoon, I was working in the morning. And it was obvious to men that the dynamic, you know, the thrust to do the right thing, not only did these people have to be fed and sheltered, all those service users had different medications that they needed to have. All of them needed to be provided with accommodation. And they were, within the day, every one of those people was provided with accommodation. And I think officers would admit, although they did a fantastic job, some of our providers did come to the aid of the party, they did provide accommodation for them. And it wasn't just that, it was a whole communication process around informing children, husbands, wives, spouses, or whatever, that their loved ones were going to be moved. And it was a long process. I think most of those are back now. And I think that just shows that we've got rigidity in place to do those. And no one in this borough is not going to have the statutory service that they deserve. So I would just like to make that reassurance here. Thank you.
• Thank you very much for your comments there, Councillor Seymour. So I think everybody's finished with their comments. I would just say thank you to the team, once again, for this big piece of work. And I think transformation is definitely a very descriptive word for it. Thank you. So we'll move on to item eight, which is the Primary Care Recovery Plans Scrutiny Projects Subgroup. And we have Diana Braithwaite with us this evening to take any questions that maybe we might find difficult. So the report and recommendations are included in the agenda pack for the committee's information and consideration, which I shall take as read. Would Councillor Reeder and Councillor Gill wish to say a few words about our work on this subgroup? Thank you, Councillor Reeder.
• Thank you, Madam Chairman. I think it is appropriate for me to extend my personal thanks to you because what we have in front of us tonight is the culmination of a number of hours spent visiting various doctors, surgeries, et cetera, and which was driven by yourself, to be quite honest. And for that reason, I think, you know, and of course also for the assistance and forbearance we had from committee services, Mr Duckworth in particular, praises worth a great deal. The only, I'm personally happy with the six recommendations we come forward with tonight, which I believe go before our national health partners for observation. The only area which, you know, I was a little bit disappointed in was the area of community pharmacies. I would have liked us to have been able to actually undertake some work there to actually include that in our report tonight. But I know we're going to be doing that going forward. But I'm happy, very happy with the six recommendations we've come forward with. They do reflect the work that we've undertaken. And I think that's perhaps all I have to say, Madam Chairman.
• Thank you very much, and I appreciate your kind words too. Councillor Gill, would you like to say anything?
• Madam Chair, we actually met so many people on the time, and basically same issues we getting from most people. And we did enjoy actually work as well with you guys. And hopefully as we recommendation is, if we go through and somebody work on it, then hopefully be better for our residents as well. And especially GP surgeries and the family pharmacies as well.
• Thank you.
• So I'd like to just continue that. So my thanks to the subgroup colleagues, to Councillor Gill, Reeder, and to Councillor Chris Taylor. He's not here this evening. He's moved on as we know to cabinet member position. And thanks also to Councillor Nicola Taylor for subbing one of the meetings, which was much appreciated. My thanks to all those who provided their professional expertise and knowledge for us, and to our residents who took part in conversations about their experiences of primary care. And of course, our committee secretary, Matthew Duckworth, who worked very hard on this for us. It was an interesting, challenging, and time consuming piece of work. And I know Councillor Chris Taylor would wish to thank all concerned, and it was established under his chairmanship. The subject matter was an evolving picture, as the new general practice model is being implemented. Hence the recommendation that this should come back again to the OSC before the end of the financial year, which is March 2025. And we do recommend before the end of this year. Diana Braithwaite, the place executive lead, is here to answer any questions that the committee may have. I'm grateful to her. And then please be mindful that there will be a formal response to the report, and any recommendations in due course, which will be reported to this committee. Any member? Councillor Carew.
• Thank you chair, I've got a few questions for Diana tonight. I don't know where they sit in this recommendation. I know we had a meeting with you about four, six weeks ago, and regarding capacity within the GP surgeries, and how they improve patient outcomes in the surgeries. I was wondering if there is a figure as to the number of GP trainings that we have on average in the north part of the borough, and how many of them do we retain? I know, you know, we don't have the means to compel anybody to work where they don't want to work. And the people that move on from Bexley after their three years training, do we have like an exit survey as to the reasons why they wouldn't take up employment after their training with us? And if those exit surveys are analysed to say maybe there are recurring issues, perhaps around wages, maybe somebody's going to Bromley for argument's sake, because they're being offered 5,000 pounds more than we would have offered them, and the cost implication as to how, you know, how much it costs us to actually fill those positions because of maybe those issues that perhaps we could have addressed, and they end up increasing and eating into our budget of clinical care, where they have to cover those positions with agency, prescribers, and all sorts. So that's one. And also about the issue, I was looking at the Bexley, sorry, status report. I don't know, maybe that comes under your remitters, but I think it does, because we had a chat around that in one of the meetings, about the increase in uptake of NHS checks in over 40s, and that ties into uptake of vaccinations, whether it's flu, the main one, and I'm not quite sure whether we offer the meningitis and the, oh, what's it called now? There's one more. No, not flu, flu is with pneumonia, whether it's something that we do, and shingles, yes, that's the other one. Thank you.
• Ms. Wothwa, are you happy to take those?
• So, the first question I can say a bit about, but I think one of the things we discussed when we met is that we would need to come back and do a piece of work around training GPs. I think the key thing to say is that, obviously, we don't employ the GPs as the NHS. We offer a contract in perpetuity to individual limited companies. So, where people, whilst the training is obviously NHS, and we do have GP trainees, what they then decide to do after the training, whether they stay in Bexley or not, is really a matter for those individuals. I think it's a fair question to say, have we done any work to understand when people do the training here, why they decide not to stay? So, Dr. Clive Agensire, I know he's been supporting with the primary care subgroup. We have discussed that with him, whether we could provide any more information on that, and I think that is one of your response back questions where we said we need to do a piece of work on that to better understand that. So, he leads on the training, and I know we had quite a substantial amount of trainees recently, and I know there's been lots of work in terms of getting them to understand the area, not just to do the kind of clinical stuff, but to infuse them about staying in Bexley. In terms of GP pay, that is a matter for the partners and what they pay their individual GPs. We don't agree the sum, the NHS pays GPs on the number of people they are registered, and that's under what's called a personal medical services contract. So, it's a national contract or a general medical services contract. I believe we only have the 21 practices, either one or two that are still on the general medical services contract. So, the contract is on the number of patients you have registered. And then, as you know, there are various layers of additional contracts that NHS England will support with additional funding that, again, that comes down to those individual practice, but core primary care is contracted on patient registration numbers. And then, the models that GPs offer is actually up to those individual partners. So, absolutely, I can come back on the training bit, and we said we would, 'cause I think that is something we do need to explore, particularly as one of your other questions as a response from the primary care sub-group was around the number of GPs. And I've provided some information on that, but I can speak about that if that's helpful. The second one, I'm gonna have to look some of that up for you. Just, I think it's worth explaining to you about what we're responsible for as place and a borough in the ICS in terms of things like vaccinations and our rates, 'cause that data is available. It comes to the Lexi will be in partnership committee every other month in terms of our performance. To be fair, we are doing well on the areas that we are responsible for in terms of that core delivery, things like immunizations for things like flu, et cetera, and young children. So, I'm just gonna literally look for that for you. So, is that helpful in terms of response? Just give me a minute, I'm just gonna pull that up.
• Thank you very much. Councilor Reed, oh, sorry, Mr. Henney.
• Yeah, so the status report is, so the indicators you're looking at are actually from public health. So, Dr. Kleinman isn't able to be here today, but obviously she could give you more detail on the work that she's doing to improve the NHS health checks uptake and increase that. The vaccinations that are included in the report are the ones that are monitored. So, there's the flu, vac, and the MMR vaccination that's included. I have to say like, Mrs. Braithwaite, I'm not clear whether we collect any data on any of the other vaccinations. So, I can follow up with Dr. Kleinman and together with Mrs. Braithwaite, we can get back to you.
• Oh, you're ready to, yes please, thank you.
• So, yeah, so in terms of the borough, in terms of the ICB and what we monitor in terms of vaccinations with GPs, they are to do with the children receiving the MMR. So, that's at 24 months at five years and later. And then also around children receiving preschool boosters. And then also we have the flu vaccination rates. So, we get what is basically a quarterly report. So, I'm reading you from the latest report that we've had in, so that was April. So, in terms of where BEXI are, in all of the areas that we are delegated to the borough to be where we are performance reviewed basically against all the other six boroughs, our performance figures are either equal to or just below. So, we don't actually, whilst we say red, either you've delivered it or you haven't in terms of our performance. So, I can give an example around children receiving MMR at 24 months. So, the actual target in terms of the England average is 89%, BEXI are at 88%. So, in all of these areas we are very close or just above. So, we haven't had any major concerns in some of those areas. The flu vaccination rate we get assessed on is for the over 65s. We were at a benchmark of 74% for last year and this year we were at 73%. So, I don't know if that's helpful in terms of just understanding as in what we would expect. And this is around GPs in terms of delivering immunizations, obviously COVID and also flu. So, that's in terms of what's within our gift. So, I know that's helpful, Councillor.
• Thank you, Mr. Braithwaite. Councillor Reid.
• Thank you, Madam Chairman. I'm slightly surprised 'cause I hadn't put my hand up, but I do have a question to ask. On page 81, recommendation one, and I think you referred to this earlier, it talks about the need to ensure all aspects are delivered by March 2025. Obviously, it's important, I think, that this committee should be able to review that in advance of March 2025. Much better to look at it ahead and address any issues that there might be rather than to look back and think, oh, we didn't actually achieve that. And the other is on page 82, recommendation two of the overview of scrutiny committees. It says there, scrutiny should follow up and review the impact of the Pharmacy First programme on primary care at the appropriate point. Well, what is the appropriate point and who decides what that appropriate point is and when is it likely to be? Because I think that's very vague, that particular recommendation.
• Thank you, Councillor Reid, and for sight of that question earlier on as well. So, in terms of the review, we are looking to December to review the subgroup report and for the updates on that because, as we know, it's a moving programme. And in terms of the Pharmacy First, because Pharmacy First was launched at the beginning of the year, it does need time to embed and to get some data. So, I'm gonna look to Ms. Braithwaite to see if she's got an opinion on that, but I would imagine that we could do that at the same time in December, but in the meantime, do some reality checks.
• Thank you, Ms. Braithwaite.
• Yeah, so I absolutely support that, Chairman, in terms of Pharmacy First. It was only rolled out at the beginning of this year and it wasn't, we need to be minded, this is an additional ask of community pharmacists. It's not a requirement, so it's an opt-in or opt-out on their contracts. And so, in terms of the information, we're still gathering that, to be fair, as to understanding how it's being used and whether people are seeing the better. We have actually recently launched a campaign around encouraging people to go to their pharmacist and ask for some of these services, recognizing that different pharmacists are offering different components, because there isn't a requirement as to what bits of the menu you decide to offer, if that makes sense. So, I think happy that it's the end of the year, that's a good 12 months to bring that back. And just to give some assurances around the primary care access recovery plan, we need to be minded, this was a national program launched in May last year. The Bexfield Partnership Committee reviews this program every quarter and our primary care delivery group, which is a subcommittee of our primary care, sorry, of our Bexfield Bean and Parchment Committee, actually reviews these actions on a monthly basis. The reason why is because there is a substantial amount of money that's been associated with that, that nationally has been rolled out partially, and then there is an agreement as to the residual amount that gets paid to primary care practices. I think what we've seen, and to be fair, the work that Councilor Taylor did was timely, because it almost parallel with when the national program was given to us to roll out. I have to say that there have been some shifts in terms of what the requirements are. So, BEXI is unique, as always, in that we went hell for level on this in terms of what was required and ensuring delivery, and we probably got one of the most robust performance management mechanisms around delivery of all of these components, and we're probably one of the only boroughs that brings this into our public meeting every few months. There is still room for improvement, so obviously I have reviewed the recommendations and we will be providing the formal response back to the committee, but in terms of some of the deliverables within that primary care access recovery plan, a lot of those have been delivered. There is still work to be done, as always, but I think the thing I would stress is what we have seen in parallel to this is a growth in the number of people who are registered with BEXI GP practices, which we probably should have been expecting and should have really, I would say, probably had a grip on maybe a year or so ago, but over the last few years, there's been a massive increase. So that's good, it looks like it's people moving into the area from our analysis, but it does mean there are more people requiring core primary care services. So we just need to balance some of that with some of those expectations. But from what I've seen of the primary care access recovery plan, we are on route to deliver against the requirements. One of the changes that came nationally is it was originally a one-year program, and then we were told it was actually two years. As I said, components have been delivered. Things around improving access and delivering on the 8 a.m. rush, we know that all of our practices now have moved over, those who needed to, to the iCloud system, and that will start to be properly embedded, but we now have all of them live. So there should be, we should be seeing improvements in terms of how people get through to their practices. Similarly, online needs a bit more work, and also then there is something about public perception. And to the work the practices have been doing over the last year is those very frequent sort of snapshot surveys of people who've actually experienced their GP practice services in the last few months, as opposed to last year, I couldn't get through. So we are gonna continue that, so I just wanna give that assurances while you've got December, we are required to, as an ICB, to ensure that we are delivering against that national framework.
• Thank you very much, that's very, very helpful. And of course there's the online registration as well now, which has improved matters for people. And one of the recommendations is very much about communications and getting the message out there, and in terms of the ARS roles as well. So, Councillor Taylor, you have a question?
• Thank you, Chair. Well, really just to say thank you, firstly, to the subgroup for doing this. I think it was a really interesting thing to look at. We have been calling on this side for a number of issues that there are that we're getting our constituents come up to us with issues in GP services, so it was really an important piece of work. So thank you all for doing that. I think what was really clear to me, and from reading this report and being involved in the one meeting, that GPs are being asked to do more and facing financial challenges, and that is really, really clear and evident. It's also really clear that the impact of issues that there are within primary care are compounded and move on to secondary care and create this sort of downward spiral. And that's obviously where we've got to intervene and stop that happening. So if somebody isn't getting care from their doctor and going into A to A and E, or the condition may get worse and they end up being hospitalised, eventually it's gonna cost more, so it isn't a stitch in time. And so in terms of economics, that's one of the things we need to get right, but it's also about quality for our residents. And coming on to the subject of quality, the thing that I would have liked to have seen addressed a little bit more was the disparity of quality of GP services across the borough. It's really clear to me that there is a postcode lottery of support. When you talk to people, they'll say, My GP is great. Other people will say, My GP isn't. And there is a definite disparity of perception, if you like, but there's also disparity of care. And I think that that's something we really do need to look at, because you don't get a choice. If you're not within the boundary, everyone might want to go to Burstead Wood, so I understand it's a fantastic GP service. If you're lucky enough to be within that area, you will get a good GP, but if you're not, you won't. And that's not where we wanna be, is it? We want all of our residents in Bexley to get a good service. And the last thing I wanted to raise, really, was about the reliance on digital. And I did say it in the subcommittee, we have to always be mindful that there are gonna be a portion of people who are digitally excluded, and I'm really pleased to see the work that there is being undertaken with BVSC to increase that. But there's always gonna be people who don't have access on their phone or can't do it for whatever reason. You know, they may not have data. One of the biggest key issues for me is if you are hanging on the phone, you may not have the minutes on your phone in order to keep on waiting for a doctor's appointment. And similarly, you may not have the data to access that app on your phone. And it's all very well to say there are places to go. In our part of the borough, in the north of the borough, access to libraries and digital services aren't always as open as they should be. So I really want to stress there, we should not be pushing that as a reliance. Thank you.
• Thank you, Councillor Taylor. Does anybody want to, any of the officers or Councillor Seymour wish to comment on that or should we just take that as, Councillor Seymour?
• Yeah, in terms of GP access at the north of the borough, I would take some, you know, persuading that that is the case. I mean, I live in the north of the borough and it's fair to say that services are under pressure. I think what's more incumbent upon us as an authority is to promote the prevention agenda to stop it from getting to a point in time where they need to go to GP. Obviously, some people always have to. But, you know, our health and well-being strategy, our health and well-being board, have identified four key areas. That's children's mental health, obesity, and frailty, although that's changed now, I think, to better living or something. Frailty, even including people in my age group, which I don't think I look fraile, but, you know, at 40, I'm not looking too bad. But if, while you're laughing, if only. If only. But no, I think that's where we are. And in terms of, it's like I came back earlier, the earlier point I made around, you know, cultural and ethnic integration, you know, is a two-way street. Those services are there for people to access. They know that. You know, you can only hold someone's hand so far and, you know, it's down then to do it. I think within this borough, we've got a fantastic partnership, a voluntary service where people can access a whole range of provision and mental health signposting and general health signposting. And in terms of libraries, I do accept that not everyone's got a laptop or even wants to use one. I mean, I'm quite happy to go back to, you know, slate and a piece of chalk, but that's just me. But, you know, no one in this borough is more than a mile from a library. I think that's something that this borough should be extremely proud of. And although some of those are now community libraries, that in itself is not a bad thing. So I think there is access out there. It is down for individuals to access it themselves. We need to provide it. I believe we are providing it. And I think incumbent upon political leaders and political representatives to make sure that people know about it and encourage them to do so. If they can't provide it, or if they can't access it, as I said before in my comment to Councillor Gill, you know, they only have got to email me and I will look into it and make sure that those issues are addressed. So I'd just like to clear that, Madam Chairman, thank you.
• Thank you very much for that. And yes, you know, the open access to your Councillors to come back if there's any particular residents that do face an issue. Can we just be very quick with this one? Yeah, thank you.
• Really brief on the libraries issue. You may be one mile away from it, but is that library open? And I think we do need to take that into account. When we are saying that libraries close for particular days throughout the week, and in fact, speaking for Erith residents, we've gone through a projected period when the library hasn't been open because of maintenance issues. So all I'm saying is, you may well be within a mile of it, but is it open?
• Yeah, thank you.
• It's right to say, and that's not my portfolio area, like, you know, I sat in that chair when I was, the place is over in Scootenham for over 12 years. Obviously there were maintenance issues with Erith, and that's one of those things. That's one of those things that is cyclical and comes to any building. You know, there are maintenance issues within this building, even though it's quite new around the air conditioning, which we're all finding tonight. Yes, libraries aren't open seven days a week, but then I would suggest that most facilities are not open seven days a week. They are open within the economic framework that we have to live with. And I think, you know, members around this council, this table, whatever their political relation are, have to accept that. The fact that these libraries are still a facility for most, for all of our communities is something that we should be enormously proud of. So I don't accept at all that they are awkward to access. They are there to access. And of course, I accept that people, a lot of people haven't got IT provision, but all people can contact at some point their council through the civic offices, through the contact centre, and it's incumbent upon their members to take those issues forward for their members. Thank you.
• Thank you very much, Councillor Seymour. So the committee is asked to approve the report and recommendations to be forwarded to the NHS for consideration and to agree that the overview and scrutiny committee should monitor the response to and the implementation of recommendations and add to the work programme anything that may be pertinent to the committee.
• I wanted to say something to you. I wanted to say something to you.
• Sorry, I'll go for it. So I just wanted to say there is, which we didn't cover in here, but again, it will be a part of our formal response to you. We are about to launch our Better Access Bexley campaign. It's something our head of comms, Aisha Awan, is leading on. And it is about some of the things that actually Councillor Seymour has mentioned around helping people to access the services that they need and the right services. So there's a lot of kind of social media here in the Councillor's concerns about digital stuff. There's a lot of work around engaging, how we bring the community champions on board to help us to get those messages out. So it's quite a substantial programme. It's more than we did last year because we're trying to plan ahead for winter 'cause obviously that's where we get, we see some of those increases in activity, and as the Council was talking about in terms of the impact on our ED departments, recognising we've got the challenge of two hospitals, mainly that our patients and public use, or Queen Elizabeth and obviously Daron Valley. So there is quite a substantial programme due to be launched shortly on all of those aspects. Obviously we'll do what we do every year. We'll use the Council's Bexley magazine, which we'll set out with a pull-out that says, where can you go to find the services that you need? So it's quite substantial this year, and the ICB place are investing quite a lot of money in it this year in terms of really trying to push that message home, and also it will incorporate the community pharmacist programme as well, just to give you that assurance.
• Thank you very much. I'm very grateful for you to reminding us of that strategy. Better care access. (muffled speaking) Yeah, perhaps if somebody could just send a paragraph to the committee secretary to circulate that.
• What I can do is, we can... There is actually a full presentation that has been developed by a head of comms engagement. We can share that.
• So, again, the committee has asked to approve the report and recommendations to be forwarded to the NHS for consideration, and agree that the OSC should monitor the response to and the implementation of recommendations, and add to the work programme anything that may be pertinent to the committee. Can we have agreement? Thank you very much. Just looking at the time, we need to move on. Don't worry, Councillor Moore. Moving on now, very quickly, to item nine on the work programme. It's 10 past nine. I know people are looking at the clock. So, I'm gonna take the report as read, and the committee is asked to do, or to agree, item one, to note the list of proposed agenda items and topics for 2425, appendix A, on page 119, to discuss and identify further potential items to include in its work programme for 2425, and that will be added to the long list of consideration. And just to note that the vaping item will be on hold until more data regarding this issue is available to our public health team. So, are there any items to add? I'm gonna come to Councillor Reed first. Thank you.
• And this time, I signal. Thank you. The annual work programme on page 113, the decisions there, the first one, it references, obviously, the topics in appendix A. And if you look at January, it's got the draft budget and financial plans for 2025/26 there. I do believe that we ought to be looking at that prior to January, just to give us a little bit more time to discuss, consider, and question. So, if we could move that backwards, forwards, whichever way you wanna call it, I think that would be a good thing, Madam Chairman.
• Thank you, Councillor Reed, and we will, with agreement, move that then into the October meeting. Thank you very much. Councillor Sandhu.
• Thank you, Madam Chairman. Could shared lives be added on to the work programme?
• We happy for that? Thank you. Shared lives. Councillor Taylor.
• Chair, given the comments from the director tonight, with regards to preparing for adulthood and the issues regarding autism, I'm wondering if we could move up the agenda, autism strategy, and make sure that that's on for this year at some point. So, I know on page 120, autism strategy is other items suggested for the municipal year, and the director did mention earlier, with regard to the preparing for adulthood piece of work, that autism has a role to play there. I'm wondering if we should move autism strategy and schedule that somewhere for this year?
• Preparing for adulthood will come up under the SEND subgroup as well.
• Yeah, I'm just wondering, in terms of being joined up, it makes sense, doesn't it? If we've got the autism strategy and we've discussed it at OSC, then actually that would lead into that work on that, and should hopefully link in, hopefully. Thank you. Any other items to go on the workbook? I've got to share those. The community day hubs would be useful to have on. Yep, yep, put that on there.
• An update on Inspire would be good.
• Yeah, did you hear? Update on Inspire, if we're happy with that one. Thank you. And I'd also like to have the Better Care Fund on there as well, and update on the direct payments recommendations. So secondly, to identify any forthcoming decisions during the forward plan that the committee wishes to be consulted on. I will just say that the decision on the SEND and PFA strategy will be presented at public cabinet on the 11th of July. Therefore, the committee has no power to be consulted on this now, so it's just for noting. Item three, to identify any reality checking visits it wishes to undertake, and any items to add. And I'll just mention Councillor Gill's item about transformation care at home. I also wonder as well what the committee thinks to reality checking visits with Queen Elizabeth Hospital and Down Valley, so residents do go there, and just urgent care, or we'll put that on the long list just to consider that. And then item four is to consider the Bexley status report. We've all got a colour copy of this. And also there's a note in the pack provided by the committee secretary. Any member? Thank you. And then item five, agree to establish in principle a joint delivery of the SEND priority action plan standing subgroup with the Children's Services and Education of Eunice Gritney Committee. And further details, such as the duration of the joint subgroup and meeting intervals will be discussed and agreed by the two AUSC chairmen, having considered officer capacity to support this work, and the action plan's key delivery milestones. Is the committee agreed on this? Thank you. And then just finally, the committee is also asked to note a brief update on the Southeast London Joint Health Ovary and Scrutiny Committee in the report page 116, including reference to the outcome of the Children's Cancer Principle Treatment Centre proposals that the JOSC were consulted on last year. That's just a note, and I'm sure you've all read it. And then just to our final item this evening is an update on the NHS Synovus cyber attack. So we've previously received information on this via email, but I'm grateful to Ms. Braithwaite, place executive lead for Bexley, for attending tonight to provide a brief update on it for us, thank you. Okay, yes, so what I can say, obviously, is in the papers we gave you the most recent update in terms of the cyber attack that took place for SynLab, which is a provider of the pathology services for guys in St. Thomas' and King's College, and the impact that has had on those services, some of the services they provide, but also for the GP practices, so in relation to Bexley. Obviously, the attack took place on the 3rd of June. What has happened since is an enormous amount of work by colleagues in South East London to ensure and secure mutual aid for our GP practices, 'cause obviously you'd imagine we've just talked about going to GP and they need to refer you for bloods. At the moment, it is still critical requests, not urgent, and even I wasn't clear that there was a difference between the two. We've been fortunate that St. George's have stepped up to help us in terms of mutual aid, and so referrals from GP practices in Bexley are going over to St. George's. Obviously, not literally, obviously by transport, they're not taking them on the bus or anything. The other thing to say is that Lewis and McGrennies Trust have also supporting our practices as well, because our GP federation had originally been running a service that supported the GPs, and we've had to step that down. So anyone who requires critical bloods from the GP, their referrals will make it through. Obviously, the other boroughs, there are different mutual aid offers depending on the borough, and this is not about distance. This is about the technology that supports, that's already in place, that supports our GP practices, that is, has commonalities with other providers around London, and it's called T-Quest, and that means we can keep it digital as opposed to paper referrals and creating more work for GPs, and you can imagine in this situation, things would get lost and all that sort of stuff. So that is why we've been matched with St. George's, because we have a similar system in terms of T-Quest, and some of the types of blood requests are very much similar to what they provide. So it's about what was gonna be able to get us over the line with those critical requests. This is gonna take some time to unravel in terms of understanding the impact. We are publishing information on a weekly basis, which does go to the leader and the chief executive of the council on terms of what has been canceled. I can't give you information what breakdowns are for individual boroughs, 'cause it's done at a kind of a SEO-wide in terms of things like inpatient appointments, cancer treatments, but what I can say in the recent weeks, the number of cancellations or redirections has been dropping. So in terms of where we're seeing our trust being able to manage some of that, redirect activity to other hospitals, that is actually improving. The most recent update, as I'm sure you probably heard, was for Thursday, Friday morning, was the information that came out around the data that had been obtained from the pathology system. What we do know is that we have clarified today that some of the information does relate to the data that the pathology lab has in terms of Southeast London. We have to be minded that there is a major piece of work by the crime agency and the cyber agency, and this has all been dealt with nationally, to really understand what this means. It is not clear that it's everything. It is not clear what that means, and there is a national helpline. So I know there have been reports of the press. Nothing is definitive, but we know there is some, but not everything, and that still requires a lot more unpicking investigation. So it's really important that we don't alarm people unnecessarily, but if people have got concerns, the main thing we say is don't bring your GP practice. There is a national helpline. All of this is published on our website, ICS, and there is information on the NHS England website as well. So I think that is the latest in terms of the initial analysis has said that it has been stolen from some of their systems. But the amounts, and I know there's been a lot of misinformation in the press, that's not necessarily confirmed. Is that helpful?
• Yes, thank you very much. Does any member have any questions or? In that case, I will say thank you very much for that update, and thank you to our officers, and for members here, and our committee secretary, for all that hard work. And go home and enjoy the football, what's left of it. Thank you. [BLANK_AUDIO]