Transcript

I am Councillor Gilani Choudhury and I am chairing tonight's meeting. Please note that we are not expecting a fire alarm test this evening. So if the alarm is sounded, please allow my instruction and evict the building. This meeting is being webcasted to allow those who cannot attend in person to follow the proceeding. Please could I ask you to turn on your microphone when invited to speak and to remember to turn off your microphone when you have finished speaking. Please could committee members and officers introduce themselves starting on my right. Councillor Joseph Croft for St Mary's and St James and Vice-Chair of this committee. Councillor McGill, Gantt, Tollerton Ward. Councillor Proffel, Nargan, Barnsbury Ward. Councillor Janet Burgess, Junction Ward. Councillor Bligh, Hamdash, Highbury Ward. Thank you. We also have two external guests attending virtually. Could you introduce yourself when you introduce your agenda? Thank you. Good evening. My name is Jeremy Porteus. I am the founder and chief exec of the Housing, Learning and Improvement Network. Delighted to be with you all this evening, albeit from the South West of England. Thank you. Good evening. I'm Ian Coatman, business director of the Housing Lin. Thank you. I think the floor is better because you can introduce yourself and others. Please. Yes, I'm Councillor Florian Sin and I am the executive member for Health and Adult Social Care. I'm Jody Pilling. I'm the director of strategic commissioning and investment in the council. Hi, I'm Nikki Ralph, assistant director for age well commissioning and adult social care in the council. I'm Victoria Nestor, deputy director for adult social care at the Linton Council. Thank you. Thank you. Apology for absence. We have received apology for absence from councillor staff and councillor clerk. If anyone other? Apology? No. There are no substitute members for this meeting. Declaration of interest. Are there any declarations of interest? No. Minutes of the previous meeting. Can we all agree the minutes of the previous meeting of the Health, Well-being and Adult Social Care Scrutiny Committee held on 15 October 2024? Thank you. Thank you. Chair report. The agenda pack contains three written evidence documents which were submitted to the committee. These reports have been approved at executive and is for noting. I have agreed to vary the order of business this evening. We will take item B3, the quarter one performance report, adult social care as the first item. Public questions. We will consider any questions from the public after each agenda item. Item B3, the quarter one performance report, adult social care. I think Victoria would like to present. Thank you, Chair. Hopefully everyone has had sight of the adult social care quarter one performance report. Just a reminder, this is quarter one, so April to June. The committee are asked to note performance against targets in quarter one for measures relating to health and independence. A suite of corporate performance indicators have been agreed for 24-25 which help track progress in delivering the seven priorities set out in the Council's Islington Together 2030 plan. Targets are set on an annual basis and performance is monitored internally through departmental management teams, corporate management board, joint board and externally through the scrutiny committees. Taking us through the performance reporting, we have first of all the percentage of people with an outcome of no support needed after reablement. For quarter one it's 75% and the target was 74% for quarter one. New admissions to nursing or residential care homes. We have quarter one at 37 admissions and the target was 50 per quarter. Percentage of adult social care service users receiving long-term support who have received at least one review at quarter one were at 20% and the quarter one target was 13%. Percentage of service users receiving services in the community through direct payments. Quarter one's at 29% and the quarter one target was a stretch target at 31%. Percentage of service users who have been supported with safeguarding who are able to comment report that their desired outcomes were fully or partially achieved. Quarter one was at 96% and the target was 95% and the proportion of section 42 safeguarding inquiries where a risk was identified and the reported outcome was that this risk was removed or reduced or removed. Quarter one reporting was at 94% and the quarter one target was at 96%. Just to draw the committee's attention to a couple of items. As you'll notice there's nothing significant there. There's no surprises for us. No significant changes. In terms of the new admissions to nursing and residential care homes, there have been slightly more admissions compared to quarter one last year. However, performance has still met the target of having no more than 50 new admissions each quarter. In terms of service users receiving long-term support who have received at least one review, quarter one performance has reached an all-time high driven by increased activity across the service and enhanced data capture. So the end of year projections estimate performance will exceed the 52% target. So I would like to invite committee members if there's any questions you have on the performance reporting. Thank you. Thank you. Thank you for the support. I guess my feedback is a little bit similar to the last time we made where I kind of brought out the fact that I think there's not many directly budgetary items and reporting lines in this. So I guess for me it's a little bit hard to track that concern. I guess one thing from some of the other reports that particularly drew my eye was the fact that spot placements are such a big part of our accommodation spend. Do we have targets about minimising or number of spot placements that we're using in adult social care? Because I'm conscious it's potentially something that's quite a big part of the adult social care budget. So do you mean specifically in terms of placements into care homes? Yes, and so the difference between spot and block, because obviously the more block we're doing the better. The fuel spot, well all the grass show, right? I think context around care homes is quite important because there's obviously the dynamic that we would like to reduce the number of people going into care homes. But obviously for some people a care home is the the best and safest place to be. And actually some people want to go to a care home when professionally we would be saying that you don't need that level of support. And I guess the block and spot contracts is it's a similar thing in that, you know, we would like people to remain in Islington where we have those connections with MDTs, with our GP federations. It's easy for us to get to them. We can, in terms of our social work teams, our contract monitoring. But obviously some people would like to be placed out of borough where they're nearer families, particularly as families tend to migrate out of London. They're going out further to the suburbs or different counties. And so sometimes people say to us, mum needs a care home but actually I would like mum to be near me and I'm in Hertfordshire. I think the discussion I think is go to the when we do the witness evidence. It would help us to get the answer. Yeah. Thank you very even go. Richard, I guess it'd be great to look at indicators that perhaps whether or not it's about spot versus block placements but something that kind of brings out more clearly whether or not we're you know we're on target with budget because I'm just very conscious that when it comes to adult social care it is the biggest thing that sinks council's budgets. Thank you very much for the report. I just wanted to ask a question about ASC2, the new admissions to nursing or residential care homes. So I understand that it's under 50 per quarter, it's just 50 per quarter so it is on target. But given Q1 last year being 33 and the total for last year being 174, is 50 a generous limit? Should it not be lower given that we seem to be quite a bit below that and you know quite a bit above where we were Q1 last year? Thank you. It does seem a rather generous target. However what we do is we look at trends over a period of time and that has changed since Covid. So what we do each year is we relook at those targets and we reset those targets. So certainly the end of this year we'll be resetting the targets and we will look at that. Anyone else? Okay then I have some few questions then I'll come back to just first question is our service for rehabilitation care and it is now in-house. Yeah and I understood that in-house. Do you think this is a better to be in-house and get a good outcome for providing in-house service? I think it's quite a subjective question in relation to performance. Certainly in terms of performance on the number of people that we currently see we are achieving a relatively good outcome for those people. I think whether it's better to be in-house or not probably isn't a question for this performance report. And I have another question is like on the review and what is the our policy as a council when you do the review do you do the face-to-face review or do the virtual review? It very much depends on the person so we obviously have a huge demand in adult social care. Our preference is always to see people in person face to face particularly when we part of our assessment will be the person's environment so how they're functioning in their environment and obviously you can tell quite a lot when you walk into someone's home through things that you wouldn't necessarily pick up so maybe you know odours maybe you can see the map that they're tripping over or the phone wire but there are occasions where we do do virtual type assessments but we would make a risk assessment about taking that option to do that and it would wouldn't usually be for a first assessment more likely if it was a review of someone's situation and it depends again about we do proportionate reviews so sometimes there's a change in someone's situation where we would maybe do that over the telephone with them if it was a significant change we would want to see the person. So the answer is a combination but based on what we would assess the risk as. What is the percentage of the face-to-face and virtual? What is the percentage? Like how many percentage you do? I don't have the percentage number but we can look for that. Thank you and also we have another question is you can go through the direct payment here I think when people can take a direct permit it is good for us and also residents and it's constantly similar why is the similar why people are not taking more direct payment? So we certainly encourage direct payments it's one of the first offers that we make to people in terms of once they've had their assessment they have a care and support plan we will talk about direct payments. There are challenges around direct payments so some of the challenges are that people find it a real struggle despite support services that we put in place to actually manage the direct payment they become the employer and that can seem quite overwhelming for people at times so they choose not to take that option and they prefer a council commission service. Also the PA market so having people wanting to work as a PA we do an awful lot of work of advertising trying to recruit trying to skill people to be PAs but it's a real struggle. I think that from talking to colleagues across London you know it's quite a London issue in that the cost of living in London and the wages you get as a you know as a PA it makes it challenging so when you work for a care provider you would go and see different people all day long when you're a PA you would have to build your portfolio yourself if you're only you know if you've only got that one person you've got to build that portfolio of people up so it's definitely a challenging recruitment market for PAs so I think it's you know there's it's multifaceted but they're probably the two big issues in increasing the numbers of direct payments. Anyone else has any question? Thank you. Thank you Victoria for coming here. Many thanks for your presentation. Now B1 scrutiny review adult social care accommodation witness evidence presenting virtually Ian and Jeremy for us to present. Please keep presentation to a minimum and present key point only. Thank you. Who's going to start? Ian or Jeremy? Chair it's going to be me Jeremy and if it's okay I shall either share my screen or I don't know whether you have the the powerpoint presentation to hand. Please share on the screen. Okay. Can you see the slides? Yeah. Okay well good evening everybody and delighted to join you and I very much hope you can see the the screen and the slides. This is a presentation in two parts and we shall be very succinct as requested and we are and we're looking specifically at adult social care accommodation in relation to older adults as well as people of working age with disabilities. In particular through the lens of extra care housing and and the reason why we we're delighted to be here is that our combined knowledge in the mine around the extra care housing market and supported living market has borne out through our work for 10 years within the Department of Health as part of their integrated care team to support the transition of people away from residential and nursing care or prevent admissions into hospital by providing more effective housing-based solutions at home including extra care housing and technology to enable that independence that you've just heard about in terms of your your quarter one report and as part of that we sit on a number of national bodies. I sat on the government's older persons housing task force until recently and that is due to report later this year we hope next month indeed and we continue to provide expert advice to the local government association the GLA ADAS both through our free learning events are what we call happy hours our website as well as our more detailed research and advisory services we're drawing on our free offer of learning and improvement we provide more dedicated support and advice to organizations to help them in terms of their performance but also to aid improvement in in both their translation of latest policy and research but also to support their practice development and service transformation. By way of background context you'll be very familiar that a national level majority of older adults actually live in their own homes whether that's owner occupied or social housing mainstream there's a small minority that live in specialist housing particularly retirement housing or sheltered housing as particularly known as nearly three quarters of a million across the UK but of that only about 10 percent about 71,000 or so people live in extra care housing it's still a small but important market for people who both want independent living at home but also access to on-site care and support but the difference from a residential or nursing care home is that person has a tenancy or a lease to that property and has the control of the premises and as a person centered wraparound care and support to enable them to live well as long as possible and I'm going to touch on some of the evidence that demonstrates that. At a national level Lord Darcy and others are also making it much more clear that when we're looking at our stock we need to think about the well-being of individuals but also the quality of those home for living for better life and while I'm going to be talking a little bit more on new supply and improving our existing housing there is a big issue around high levels of poor housing conditions and its impact on health and well-being which I'm sure your environmental health your public health colleagues and then housing providers both in the commercial sector and the social housing sector will be very very familiar but linking back to the item that you've just heard we know nationally that at least a quarter of a million people could be living in accessible homes and that part of the challenge for our NHS and indeed sometimes our adult social care is that we don't have the right homes in the right places and that puts a high level of demand on limited resources in the public sector both in relation to the access to discharge from hospital but also into the community as well as preventing as I said a move into more mainstream housing. Research that's been undertaken by Lord Best the all-party parliamentary group on HAPI which stands for our housing our ageing population panel for innovation shows that we're at an all-time low in developing more appropriate housing in the UK we had a high of about 12-15 000 units per annum we're now down to about 6 000 annually. Are you going through your presentation or not? I am yes is that following you? Oh just one slide you just still in the one slide. I am moving my slides I'm not aware is that moved for you? No just first slide is still there. Ian I don't know if you could help but my system is working at my end I think I think they're driving the slides so you'll have to say which slide you want to be shown I think I'm on the slide which says what difference could a national older person strategy make for councils I don't know whether you can control that I just slide is not moving just the same the beauty of technology I'm very sorry about this are you able to take control if I stop sharing I have stopped sharing in case you're able to load it to your end and then I can continue and I'll just say next slide please if that's possible I mean are we good to follow through on the agenda yeah okay yeah because I'm broadcasting remotely as well I've got to like show yeah okay okay just you can go to which slide you are then we can because we have an end effect in front of us okay okay well I'm on I'm on slide um four which is tied to what difference could a national strategy make I'm providing national context before I sort of drill down a little bit more into specifics go ahead let me go ahead yep I can see a screen but it doesn't look like the slide that I'm I'm currently on um just you can go through your one we are we have a slide in front of us you have the pack to hands as well okay in which case I shall continue what I was going to go on to say is that the link between housing and adult social care has been very well articulated by ADAS the directors of adult social services and as part of their white paper they have highlighted that every decision about care is also a decision about housing in terms of looking at the quality both of the physical fabric of the accommodation but also the how care and support is delivered both for people in planned care but also for for self-funders as well and this is something that the older persons housing task force that I referred to that was set up by the previous government but will be reporting and responded by this government in the next eight weeks has demonstrated that we need to have the right products in terms of the extra care housing the access to adaptations and improvements to existing stock as well as future proofing our homes and our communities to ensure that they're age-friendly and part of its challenge is to make sure that both our national planning policy frameworks but also our local supplementary planning documents and delivering through a housing delivery program aligns both the housing and the social care objectives there's also something which ian will refer to a little bit more which is around the supported housing regulatory oversight act and the requirements for local authorities to better understand both the market for supported living in their localities but also the quality of that accommodation both exempt accommodation as well as registered social landlord and other providers and help with that market shaping is something that nhclg the ministry of housing and local government will be taking forward in partnership with the department of health the local the national picture post the recent budget no new money has been allocated for specialist housing accommodation that links to care there was money set aside for the national affordable homes program another 500 million pounds of which moves is being made to enable the gla and homes england to allocate some of that for specialist supported housing so schemes like the housing 21 scheme at mild maze typical schemes like that that yourselves and other authorities are keen to to develop the homes england are also currently working on their 26 to 2031 affordable homes program and the part of that will also be to deliver a new housing strategy for the government and you will be aware of the talk around 1.5 million homes over five years well there'll be targets set for local authorities to as guidelines around the type of accommodation that needs to be developed and ian and i and the team are working with government to come up with some metrics to help better understand what the aspirations for that provision could be i'm moving on to a site called aligning with other policy i mentioned building regulations in an earlier slide there's currently a increase there's currently a consultation out on looking at something called part m of the building regulations it is about enabling properties to be care ready so that they will be future proof to be accessible and adaptable to cater for a changing life course because of disability or infirmity or old age it's something that the gla and others are keen to see both as a mandatory requirement but also to enable other areas combined authorities and district councils to develop more accessible and age-friendly housing there's also a big move to think more about how new towns and urban settlements and existing settlements can be regenerated to take into effect healthy living and aging well into later life and there's work being done on the new towns commission that the new government has set out now that probably won't affect islington but some of the learning about how to create healthy places it will be critical i would recommend and it would also link into things like the nhs 10-year plan which is looking at how to create more preventative and early intervention services and housing and support could very well play a role in that the evidence that you were talking about in your previous item is something said that we've been working on with government to better understand that and ian has been leading on that and i'm going to ask ian just to give you a very quick overview of the ipsos mori report ian thanks jeremy i think our understanding is that you've all read the slide so i'm going to be very brief we have been commissioned by ukri to undertake research with a representative sample of 6 000 older people across the uk we're going to be publishing that in december very much look forward to publishing that and we expect that early in the new year we'll be using all of that evidence to assist local authorities across england to develop a modeling tool so they can at a local level determine the level of different types of housing and accommodation need for their older citizens jeremy back to you and this picks up another key question that one of the councillors asked you know what's the evidence and why is why you know in terms of performance and looking at very tight budgets the research that comes out of this demonstrates that it has a number of different dividends or benefits for people it becomes much more outcome focused in terms of service improvement and being able to improve quality of life the evidence shows that providing good quality extra care housing prolongs life and livability by upwards of five years it has significant benefits for adult social care budgets in terms of reducing spend it also has contributory benefits which are actually not cost cash releasing for adult social care but for nhs budgets both in acute sector and primary and community health services by reducing demand on things like gp visits out of our services a and e and inpatient care and support so we know that there is a lot of uh there's a lot of evidence here to demonstrate that and again we've provided some links to the documents that enable that as part of this we're looking at and want to support how islington and others are developing a more contemporary uh care ready type of accommodation for local populations not just for older adults but people of working age as well and indeed there's an increasing interest in intergenerational living as well but the premise is that this has to be age-friendly technology enabled in the right location and supported through care and support as well which is again whether it's socially prescribed planned or spot purchased as well just moving on a little bit more we have a few slides which just give examples of contemporary housing from london and around and around the country and this is both in terms of new build but also retrofitting existing stock and again we see a lot of emphasis on making improvements to existing older people's housing such as sheltered housing as well as some of the older extra care or re-providing existing residential care so a question early about you know should local authorities be taking over or control or one of the options would be to say is there opportunities to um to strengthen that through regeneration or remodeling and indeed it's a report that the law the house of lords committee on housing and care published earlier this year on regenerating sheltered housing setting out some very clear guidelines how local authorities can both do that themselves where they have retained stock or through their almos or indeed their registered providers so there's some significant benefits of looking not just at the new build but making better use of the assets already in ownership either by local authorities or the stewardship in local anchor institutions such as housing associations i mentioned intergenerational living there's a growing interest in that and i think more will be coming through the housing strategy that the government is making public imminently there's also growing interest in the use of technology to support people at home both in terms of telecare and upgrading existing community alarm infrastructure but also looking at robotics artificial intelligence as well as looking at better building management systems for climate change and sustainable development as well and these are things that we're seeing a number of authorities adopting in terms of their building specs and design briefs but i'm going to pass back to to ian to talk just a little bit more about what local authorities are doing and also to talk a bit about the supported housing landscape as well okay thanks jeremy for those of you keeping track of this in your packs we're currently at page 14 which is called planning for the housing needs of an increasing older population the point that that's making essentially is that councils that are effective in developing a range of housing options to suit their older populations including those with social care needs are increasingly using their planning policy in particular their local plans and the evidence base behind that as well as supplementary planning documents to to bring that to life and to embed it in terms of their expectation of what developers will bring forward in their boroughs and local authority areas the next slide slide 15 where it says but it's also about our future selves jeremy's put up a few pictures there that's just making the point that this isn't about some other group of people this is about all of us including myself heading in that direction this is about how we plan for our entire population as we age in terms of the housing options that people need to stay well stay healthy and ideally to stay out of some of the settings that you were alluding to at the very beginning of the meeting like care homes despite perhaps a small minority of people wanting to move into those sorts of settings the remainder of the slides essentially summarise and mirror what jeremy's just been describing but in relation to working age adults so we're talking here in the context of social care about people who may have learning disabilities people who are autistic people with severe mental ill health those types of needs and the kinds of accommodation that people may need over and above access to mainstream housing so different types of specialists and supported housing the slide that's headed up planning and delivery of supported housing for working age adults for care and support needs a bit of a mouthful refers to the legislation that jeremy referenced earlier snappily titled the supported housing regulatory oversight act from last year we haven't yet heard the new government's view on that but the expectation is that that will be implemented it will mean that islington along with every other council in england with adult social services responsibilities will have to have an accurate understanding of the housing supported housing needs of its local population of people with care and support needs so that includes older people working age adults with eligible care and support needs as well as people who might be at risk of homelessness people experiencing domestic abuse vulnerable young people like care leavers so it also ties in with your corporate parenting responsibility and essentially every council will have to have a written five-year plan that says how they are going to meet the needs of those groups within your local population we've then got a couple of slides just to finish up which give a flavour of the kind of trends and i suppose practice in development of contemporary supported housing both for working age adults with eligible care needs but for people who need support but maybe you don't need and you don't have an eligible care need so maybe some people who are experiencing homelessness and you know the general trend that we're seeing is towards more share self-contained supported housing and away from shared supported housing so away from hmo type accommodation that obviously presents challenges particularly in where you're located in terms of site availability and the types of opportunities there are to develop new supported housing we've also got a couple of slides at the end which give you some hyperlinks to a whole range of resources that we have on our website that go into a lot more detail about what jeremy and i have just referred to so we'll finish that there and open it up to questions and discussion thank you thank you thank you i hope we have lots of questions from the member who'd like to start thank you very much for the presentation really interesting and useful um i would ideally like to ask a couple of questions but i'll ask one the more important one first given all of your experience do you have any specific best practice advice for a borough like islington which is you know very dense very little space um will have a much a greater aging population in the years ahead and in particular i'd reference you know are there any rules of thumbs on location that potentially are the best place for example near hospitals or near clinics as an example and also i saw in your pack lots of so we also lots of pictures with quite high buildings so i'd also just be interested to know you know is going up going taller part of the solution for a place like us that would be my first question should i kick off in and come yes so on uh we are seeing a trend towards vertical living you're absolutely right and also making better use of new schemes where there are in effect flats over shops the key thing from a gla perspective as well will be issues around fire access and fire egress but also looking at the the use of that space where there's access to close public communities whether that's nhs clinics community community hubs or indeed day opportunities but often it's more about public transport green and blue space as well so there's both a health in tackling some of those health inequalities but also looking at creating more social connectedness and especially in somewhere like islington where where my mother used to live just off essex road to think about how she was able to participate actively both in her local faith community but also on the high street in terms of accessing things to make meet her particular needs including the gp service so yes you you hit a really good point in relation to looking both going vertically but also looking qualitatively at the quality of that type of accommodation in an urban centre ian uh just yeah just give you a practical example so jeremy referred in his slides to something called sheltered housing a lot of which was built in the 1960s to 80s often at relatively low densities so i think for urban boroughs it's really important to look at the existing specialist and supported assets that exist particularly in terms of affordable housing in your borough for example we did a similar exercise with westminster about four or five years ago and as a consequence they effectively came up with a strategy to demolish some of their 1970s sheltered housing schemes that were very low density on prime sites and through a mixture of kind of realizing capital assets but also redeveloping for social housing they've created both new and more additional housing for their older citizens and also retail space as well actually as well so it's part of a it's a part of an economic growth and regeneration program not just an adult social care program thank you uh just before i take him there just i would like to clarify one thing that i want to get from you uh regarding the shelter accommodation my understanding is uh islington and other uh is the london borough had a shelter accommodation which is accommodated uh people 55 plus yeah but after uh 30 funding cut all the shelter accommodation there's no more center accommodation all the housing position they've changed this criteria this says saying older people because there is no support funding available uh that means uh from your uh possibility that there is a need for the shelter accommodation can you just tell us uh more about the uh decision was taken during the shelter accommodation funding and now the emotional recognition what is the view over that we're seeing a diversity of provision to be honest chair um we're seeing both uh sheltered housing being repurposed into supported living but also on the very pressures that you've identified in terms of the lack of accommodation choices for people with complex needs often sheltered housing is a last resort that puts pressure on a lot of providers in terms of managing people with more complex needs and therefore some providers are questioning whether the sheltered housing they got is suitable for a more diverse population with it with a number of other vulnerable and long-term conditions but there is still a growing demand for good quality sheltered housing and we're seeing both the commercial sector and the private sector as well as some housing association exploring that so a housing operator close to you one housing for example now part of the riverside group are developing that type of sheltered housing as well as extra care yeah very quickly uh you mentioned the nppf uh changes i'll just be interested what's your wish list if you can have it with the nppf changes right that's a that's a that's of tool order so the the number one thing is to ensure that issues around housing for older people are explicit more explicit in there we would also like to see a guidance given for local authorities to look at both the youth class orders which is under the nppf but also making sure that there is supplementary planning guidance that can be created at a local level to reinforce the the planning intentions of local authorities like islington so there are currently debates whether there should be a dedicated youth class order for example for extra care housing or whether youth class order two or three is sufficient so there are some still some interesting debates to go on that and it was interesting to see that the former chief planner for the government was talking today at the county councils network conference about you know how we must have a better system for planning for an aging population thank you council billigan hi there yeah you mentioned about the um you outlined the um the new towns and intergenerational housing and i just wonder um you know it's good that is supported by the chla uh you mentioned that it's not really at the moment it's not really going to uh island it's not really going to affect us but in a long plan i mean i just wondered like the affordability of it um for families um obviously some of the cost will come down to social care but i just wonder how this works out um for families that are struggling if you like really yeah so um most of the new towns in fact all the new towns i think barking and dagenham is the nearest one to you um and these are looking between five and five and ten thousand new units of accommodation of which a proportion are affordable housing so again there will be allocations for supported living and extra care within those but the premise that most of them are developing is that the accommodation being provided is age friendly so that they can be adapted at a later time should people need it as to both as opposed to being specifically a care offer right from the outset if that makes sense um the principle being around creating a healthy place and a healthy neighborhood as opposed to a standalone scheme i don't know that answers your question a invite covered that yeah i think i think with the the new towns clearly it's about taking any useful elements and lessons for boroughs like islington we're just doing some work with london borough herringgate at the moment um and i suppose they're to some degree taking from that how they can blend a sort of a sort of purposeful intergenerational component to some new build housing that they're developing both market and affordable some of which will be aimed at older citizens who are in inverted commas over occupying family general needs social housing it's not sheltered housing there will be an age designation but none of the traditional elements of sheltered housing like communal space or additional staffing it's essentially designed to be an attractive proposition that enables people to move out of their existing family home but into a multi-generational housing setting thank you thank you for the presentation that was very interesting um i've just got a couple of comments really um you mentioned retrofitting of course that's really difficult in islington where we have a lot of victorian houses with lots of steps and even the new the relatively recent housing that was built uh what 70s 80s 90s there seem to be steps going down to the basement and then steps going up to the first and second floor so it's really difficult to to make those um suitable for people with disabilities or older people but i do think the the points you made on your side a health and social care dividend were were amazing actually and those stats are really huge and i think although we won't be able to have lots of individual schemes of sheltered housing for example we must remember this and make sure that we do include our older people in the community so that just comments my question is not to to um to our speakers but but to our clock is there any way of stopping that girl blowing on the back of my neck can i just quickly come back yes yes um we see that things like the better care fund and the way that islington and other local authorities apply that for disabled facilities grant is critical last week was occupational therapy awareness week and the role of your ot's in assessing speedily enabling fast track adaptations to take place if possible both for self-funders but also for people in genuine housing need is critical and so any accommodation review i mentioned is not just about the new build but as the councillor rightly points out that how to retrofit and adapt existing stock where possible but what ian is highlighting from other councils they're also thinking whether if by offering an attractive alternative could that free up the family or a property that could be made vacant for for for family accommodation to relieve pressure on other budgets as well like homelessness and temporary accommodation is any more questions from you just i have a two question one is a mention the bme people yeah yep i work in the voluntary sector and i i did a decision of the outcome of the if you do give the culturally appropriate service then you can get a good outcome for bma people and that time i visited one in the shoe accommodation was purpose built for the bma community in sunali garden in tower hamlet yeah yeah tower hamlet yeah my question is because uh that especially is the bma people uh they are it's my parent generation and now generation is totally different yeah because our children born and brought up they are educated they are going out they are not no more look after their parents what we used to do are look after parents here and they are finding very difficult to stay at home yeah and and that and also they can't choose the care home because there's not appropriate for themselves don't mean as the uh what your advice for that is linked on which is in uh more than nearly 50 percent bma people live in here what is your advice of the culturally appropriate care home shelter and everything first my question is yeah great question we're doing two pieces of work one we did a major piece of work with the south asian community in kirklees and i'll ask ian just to draw attention to some of the findings and we're currently working with the bangladeshi communities across newham tower hamlets hackney and redbridge to better understand the very point that you made we'll be very happy to share the findings from that report but ian do you just want to quickly touch on kirklees oh yeah so so just a couple of things really so it's primarily about working with you know mainstream providers of both care homes sheltered housing and extra care housing to ensure that their service model is culturally relevant and culturally competent inverted commerce so that they're you know much more attuned to the diversity in their local communities in terms of the people they appoint into frontline roles in services where meals are provided that those reflect the you know cultural and dietary needs of the community in which they serve so so relatively straightforward things that can be done to make existing forms of specialist accommodation much more relevant to people from black and minority ethnic communities the other work that jeremy's referred to we specifically work with gateway housing association in east london which was looking at demand for multi-occupancy accommodation for people from bame communities and i suppose addressing some of those kind of perhaps previous stereotypes that you've just referred to to the extent to which people may or may not want that sort of accommodation so i think it's a mix both in terms of types of accommodation and size but also the way in which local authorities whether they provide those services in-house or more likely they commission them externally or they've got external providers like registered providers housing associations how they work with them to make their services as culturally relevant as possible to their local communities thank you and another question from me as is lincoln we have health and social care budget is because of the lack of adult care home and everything but questions we now we need a care home and shelter everything but we can't build now but there is accommodation is within lincoln which is run by the housing association purpose build lots of building yeah as your expert what is your advice short term medium term and long term is lincoln older people seriously how we can target like on the reduce this kind of thing how we can sort out the care home provision older people housing provision in islington million dollar question that is in terms of the the short term an asset review of the stock the quality of the stock and its suitability for that and how people are accessing it both in terms of allocations assessments and allocations as well as thinking whether people need to to move on to more appropriate accommodation in the in the short term in the short term in the medium to longer term it is also to look at the demand this demand modeling that ian was referring to the the five-year plan to think about the type of arc of provision that can be offered it's not about just all one type of hand but it's it's what we're seeing is a number of authorities are looking at a multitude and different of a more diversity of opportunities as well in terms of the the housing so it's not just extra care it's also about providing more housing with care for people with dementia for example we haven't touched on that this evening but we also recognize that a lot of the accommodation needs to be dementia friendly and what we're seeing is that local authorities are looking both at providing a very targeted amount of specialist accommodation and supported living but also looking how mainstream housing can be better changed so that the design of that is much more suitable in the long term and enables people to have better quality living experiences both in the homes but in the communities that they are the fabric of thank you do you have any more questions from anyone no flora do you have any question from you thank you many thanks jeremy and ian you did really really good report and it helped us a lot and if we need future anything from you please i will call you to come back again if you need any information especially like on that one report what you're going to produce in december would be great if you can share with us which will help us to write our report and you it's going to really please send to us and thank you many thanks for giving your valuable time to us thank you thank you thank you for inviting us thanks a lot bye i think it's really nice report and elaborate report and it will help us for to write our report for future report thank you yes i have a second screen on the other side sorry we used to have a second screen on the other side i wonder if it's possible next meeting with facilities department could set that up just a strain on the neck really okay now we have a b2 adult social care accommodation cost return evidence i believe that's going to be already everyone read it and in here who's going to answer the question if anyone is well if if nick you or i will answer any questions if you have them anyone has any question i think you made a quick question counselor yeah thank you so i'm conscious that this represents quite a big part of our budget and i'd be really interested to know actually how much these accommodation costs have changed over years because we've got the 24 to 25 costs you know have these written with inflation or have they increased above inflation and how much of uh price pressure is a pressure okay so i'm not going to be able to answer that specifically we could but we could definitely go away because of course we have all that data and yes absolutely the costs have risen whether they've risen in line with inflation i can't answer until i go back and look at the detail what i would say is that we have a very robust approach to talking to our providers about uplifts and the council is supportive of adult social care in that we get a budget to to do that with obviously there's a limited envelope and we have quite a complicated process by which we assess what we're paying our current providers both in accommodation and in home care and then we agree and approach with our north central london colleagues to try and keep pricing similar across the patch so that we're not competing with each other for placements obviously that has to be nuanced to a local area but we try and keep as in line with each other as we can and then we have quite a long and drawn out process where we negotiate uplifted costs so it's really important as part of our care act duties that we try and keep what we're paying providers in line with inflation because we have a duty to create a sustainable market where there is choice and obviously as we see in the press all the time there's real risk for providers in the current climate in terms of sustainability so our duties under sustainability mean that we do try and keep those costs as in line with inflation as is manageable for our providers at the same time as protecting the council's straightened finances thank you that's really helpful i mean yeah the figures on trends would be really helpful because i guess one of the things that i'm conscious of and you know a number of campaigners have kind of raised is kind of the trend on ownership and the number of kind of hedge funds and capital funds entering this space and buying up care homes and driving up costs and i wondered whether that was anything that we'd observed as a council as a trend or changing ownership or is it something that's maybe a bit more regionalized so definitely we experienced changing ownership and definitely that the market is as you've described we work very hard in islington to create a balanced market that ensures that our local providers are empowered enabled feel uh enabled to bid for our contracts and therefore we do have quite a mixed market and so we do have a number of contracts with local providers we don't see the increases in costs that the the change of control doesn't bring increases in pricing in the way it does in children's so it is a different impact in children's that's a much bigger challenge and costs in placements rise because the market is held by those sorts of organizations it's it's not we have broader choice in islington anyone okay just to is that like now that looks like sports purchase is more expensive than if we have an in-house or something yet i would say that spot purchase is not necessarily more expensive than in a house it's more expensive than our block contracts with that we commission um i think that uh the cost of spots will depend on the level of need and support that an individual has so where we have somebody who has what we call behaviors of concern um often we don't have that specialist provision and that will be very expensive to spot purchase because somebody will require very high levels of staffing um but uh spot purchase is almost always more expensive than those block contracts that we negotiate not absolutely always but as a rule of thumb you can assume that it will be thank you uh just one more question from me uh i did ask them also as an officer we need islington now present we need more accommodation for older people here we had older people whom shelter accommodation and my understanding is there is a housing association purpose-built accommodation still there which is not our islington council is the housing association contour do can we have anything we can talk to the housing association to get one or two scheme because we we need now our accommodation for the older people can you have do you have any idea you can talk to them and get make one accommodation or shelter accommodation or care home which already there we can negotiate them with them so we do talk to our local providers quite regularly um i think last time ian presented he said that um in his conversations with housing associations they had not expressed an interest to develop uh sheltered housing but we are always trying to think of creative ways that we try and add to our portfolio and as as you all know that is challenging for us but we do have for example currently a conversation in train about a small number of units that are being developed that we hope will um come live soon so those are conversations that we do have uh quite regularly um obviously if anybody had any knowledge that there might be some interest then we'd be happy to pick up a conversation with others but the opportunities are quite limited in the borough and the asks on accommodation beyond adult social care are quite great as ian described when he was presenting in terms of our challenges for our homeless population as well but it is we are always willing to talk to people and have those conversations and as we said when we first presented in the the kickoff meeting if you like for this scrutiny that we are looking for innovative solutions so we are um would welcome any suggestions just like another because it's uh it's a you saying that new development or something where uh housing association are not interested or something that means we need to impose them to that but we have already some purpose-built older people who used to be a shelter accommodation i can give you the example uh cut bush uh the what's called is one is the there's a three or four uh so far i know the clarion housing there uh is to it used to be a circle yeah it's a it's already purpose-built for the older people do you think you can negotiate them to get one or two for uh short-term solution to make it a care home it used to be belmore house used to be extra care which to be provided by the islington council that it was decommissioned something do you have this kind of plan because we have already purpose-built some building in islington so i think we don't have a specific plan to talk to people at cut bush as the example you gave yeah no i understand i understand um we do have um uh a process in terms of new builds where we liaise very closely with our planning colleagues and our new bill colleagues uh we have um a bi-monthly meeting with our colleagues from across housing and estates and planning and new build where we talk about whatever is in the pipeline be they refurbishments um and or or um new builds and we make sure that the adult social care voice if you like is heard and actually certainly i've been here nearly two years and i would say that we are approached more and more often than we were when i first arrived with um proposal suggestions questions about what might be possible um so i guess that's um that's very positive um and we will continue through that forward to have those conversations um thank you thank you the chair's question sorry um so in the chair's report we've got the adult accommodation strategy will we have a separate bit of questioning about that or will we know so i wonder whether maybe now's a good time to quickly ask a question in yeah great thank you um so um i'm conscious that we the executive of past accommodation strategy um you know there's some really good stuff in that i was wondering how you saw the approved strategy and the scrutiny working together because the topics are the same yeah no it's a good question so i would say the first thing and the really a really important thing is that any strategy we write is a live document so if there are recommendations that come from scrutiny that are not covered currently in the in the strategy we will update the strategy to reflect that um because uh we're really keen that none of our documents sit still that doesn't mean that we change them every five minutes obviously but you know as we've seen over the last few years the world's slightly unpredictable so it's really important that we revisit and review um so um i think that if there as i say if there's anything that doesn't quite fit we'll review where we would should fit or add it i would say that uh what i would hope is that the committee will look at the uh strategy and help us come up with some ideas about how we actually deliver it because it's um in some way you know it's ambitious but it the specifics aren't necessarily throughout because this is a volatile changing world uh with lots of challenges um so really our hope we felt that this the timing of the scrutiny committee was excellent for us as officers to get uh the advice of committee members on how we actually deliver on those ambitions thank you councillor flora olympia yeah it's just quickly coming in that and i got a very similar question from your colleague executive um the way i see it is they're really like they're completely interlinked with each other um so the strategy is very much the long term where we need to be going and the the scrutiny is going to be helping us figure out how to get there um so the structure is setting the road map the scrutiny is helping us to drive the car basically yeah please so very quickly just from the the strategy and then maybe the overlaps from some of the evidence that we've had um i'll start by asking because we heard last time about the over 55 accommodation that plus 55 accommodation in the borough light crowfield house which is in quite an uncertain stage with housing about how committed they are to those schemes i'm conscious that that's not in the adult accommodation strategy at all so i wonder if that's an intentional oversight or it might indicate that we're not continuing with those kind of schemes um could you sorry could you repeat the name of the scheme so crowfield at the last meeting i brought up crowfield house crowfield house is a accommodation block in hybreed that is designated to be for over 55 year olds uh and so i it strikes me as a type of accommodation that is part of this strategy i know there's been real issues with delivering those kind of schemes i know there's been real issues with delivering those kind of schemes because people have relatives who aren't over 55 and suddenly in the block there are people who are of different ages um but i'm conscious that this is a document that might want to have something to say about that category of housing because i'm conscious that housing find it a bit of an inconvenience and difficult to manage but i'm conscious that adult social care might have a different opinion because it might be a really important and valuable part of the offer well i think i think probably at this stage what i'll say is we'll take that away to look at it because i think um uh it's it we haven't been as specific in the strategy about those buildings but you're right it could form part of our our future plans but we need to review it because i'm not familiar with it so we'll take that away as an action i guess the only other thing i'd say very quickly is i was struck by the scheme that we heard mentioned today about infill and using infill to create some of the housing that we're talking about for generations and i'm very conscious that the opportunity to get people who are under occupying into shelter care on the estate that they live on is a really interesting one i'm also struck by the fact that the housing team told us they're not planning to build any of this housing in the forthcoming period i'd love for us to maybe try and take that some of those examples that either in a harring or so it was a harring gay to and think about how they might fit into this strategy because i think if if they're an opportunity to solve uh sorry i don't really like the term under occupying but i'll i'll use it here um that would be i think really interesting um just uh it struck me just looking at the 24 25 forecast um the uh drastic increase in learning disabilities which has come up a lot in our case work you know um struggling families with young probably teenage or or people in their 20s now and it's uh they're looking for like better accommodation to suit for their suitability um with uh with children we've grown up children should i say with learning disabilities and i just wonder that that quite staggers me but it's a reflection of what we get on our case work i think just wonder you know uh the long-term plan out of this well i think um we are obviously very mindful of the growing numbers and i think that um our colleagues from the lin talk very uh articulately about uh the sorts of housing options we need to develop for uh people of working age with learning disabilities and and other needs and and it is about thinking about uh accommodation types like supported housing and we've got um rosehip uh aka winter street coming online with 11 units um but we do have to do more to develop uh more housing but also work with our colleagues across north central london because we know the challenges we have here in islington but also the range of uh needs that that is still a small population and so that can present a challenge in terms of how much accommodation you you develop locally or how much you might share with your neighboring boroughs for example so that you can uh create those uh the right uh conditions for uh purchasing services um so you know we're looking as with everything else at a sort of mixed economy the sort of approaches that we can take and again as i said earlier talking a lot to our estates colleagues our planning colleagues to think about where the opportunities lie for the future as well thank you anyone else thank you thank you i think it's many thanks it's a really helpful contribution from everyone uh now uh i think before what program do committee members have any comments no uh i think it's like we are making record that we are finishing the meeting now is a quarter to and nine uh and this the next meeting of the health well-being adults meeting the 17th of 17th of december and there being no further business i declare the meeting closed thank you