The Adult Social Care & Health Overview and Scrutiny Committee met on Tuesday 25 June 2024 to discuss updates on the Care Quality Commission (CQC) Assurance Programme, the transformation of care at home services, and the final report from the Primary Care Recovery Plans Scrutiny Project Sub-Group. The committee also agreed to establish new sub-groups and reviewed its work programme for the upcoming year.

Establishing Sub-Groups and Joint Health Overview and Scrutiny Committee Membership

The committee agreed to establish formal sub-groups for scrutiny project work, with a limit of four such groups operating at any one time across all Overview and Scrutiny Committees. They also agreed that one-off sub-groups could be formed for specific policy issues or key decisions. All sub-groups will have clear terms of reference and will conclude with a set of comments for executive or officer consideration. Membership for these sub-groups will consist of three Conservative members and one Labour member, agreed in consultation with the Chairman and Opposition Spokesman. Nominations can be drawn from any Overview and Scrutiny Committee members or substitutes.

Additionally, Councillors Janice Ward-Wilson and Lisa Moore were appointed as the committee's representatives on the South East London Joint Health Overview and Scrutiny Committee (SEL JHOSC).

CQC Assurance Programme: Update on Self-Assessment, Adult Social Care Vision and Market Position Statement

An update was provided on Bexley's Care Quality Commission (CQC) Assurance self-assessment and action plan, as well as the new Adult Social Care Vision and Market Position Statement, published in March 2024. The self-assessment highlighted strengths in partnership working and responses to urgent support, but identified areas for improvement in the personalisation of services and ensuring the voice of the individual is reflected. The committee was informed that the full report of the Local Government Association Peer Review would be shared once received and added to the work programme.

Discussions also covered how the Adult Social Care Vision is being shared and embedded with staff, with acknowledgement that culture change takes time. The committee heard that core principles of the vision are being communicated through visual displays and regular updates, and that continuous conversations are needed to embed it in practice. The inclusion of the voluntary sector in the Market Position Statement was confirmed, with ongoing dialogue with providers and staff. Areas for development, such as better support for unpaid carers and prioritising transitions, were also noted. The Cabinet Member emphasised that the peer review had identified areas for focus, and that the new vision places individuals at the heart of all services.

Resolved: The outcome of the Peer Review, including targets and objectives, to be added to the work programme.

Care at Home Transformation Update

The committee received an update on the transformation of Adult Social Care's (ASC) Care at Home services. The transformation aims to improve the quality and personalisation of care for individuals with Care Act eligible needs. The new model is being implemented, which will reduce the number of home care providers from 42 to six (three Care at Home Partners and three Reablement and Recovery Partners across three Local Care Networks). The focus is shifting from a traditional time and task model to an outcomes-based approach.

Members expressed concern about the reduced number of providers, but officers assured them that market sustainability plans are in place to ensure a robust supply of home care capacity, and that other providers continue to be utilised. The Quality Assurance team maintains regular contact with users and providers. The new population model aims to change how carers work by focusing on meeting individual needs and outcomes.

Resolved: To explore reality checking visits and add Care Transformation at Home to the work programme for further updates.

Final Report and Recommendations of the Primary Care Recovery Plans Scrutiny Project Sub-Group

The committee received the final report and recommendations from the Primary Care Recovery Plans Scrutiny Project Sub-Group. The sub-group's work highlighted that while Bexley has a high number of appointments and face-to-face appointments compared to some other areas in South East London, patient experiences vary. Challenges remain in accessing appointments, with some practices still experiencing an 8am rush and inconsistencies in the implementation of new tools like Cloud-Based Telephony (CBT) and AccuRX.

Key findings indicated that digital tools have mixed reception, with some patients struggling with online access and older systems. The sub-group recommended that support and training be provided for patients using digital tools, and that computers or tablets be made available in reception areas. They also highlighted the need for ongoing communication about available services, such as Pharmacy First and extended access hubs, and for tailored messaging to different audiences. The report also noted difficulties in recruiting to Additional Roles Reimbursement Scheme (ARRS) roles due to a shortage of trained staff and a lack of premises space.

The committee agreed that the recommendations would be forwarded to the NHS for a response. The Better Access Bexley campaign, being launched by the Integrated Care Board, was mentioned, and it was agreed that the presentation would be shared with the committee.

Resolved: To share the 'Better Access Bexley' presentation.

Work Programme

The committee noted the proposed work programme for 2024/25. Members requested several additions and amendments to the programme, including:

• Vaping to be put on hold due to data collection challenges.
• The draft budget to be moved to October.
• Shared lives, the Autism strategy, Community Day hubs/Inspire, and the Better Care Fund to be added.
• An update on Direct Payments and further review of Care at Home Transformation.
• Reality checking visits to Darent Valley Hospital and Queen Elizabeth UTCs, and to Care Transformation at Home.

The committee also noted the Quarter 4 2023/24 status report and agreed to continue the joint sub-group for the SEND action plan with the Children's Services & Education OSC. An update was received on the Ransomware Cyber-attack on Synnovis, with assurances that work is underway to ensure security and mutual aid to support patient services.