The Scrutiny Health & Social Care Sub-Committee met on Monday 22 January 2024 to discuss the Adult Social Care and Health Directorate's budget and transformation progress, as well as an update on a potential measles outbreak. The committee also reviewed its work programme for the upcoming year.

Measles Outbreak and Public Health

Rachel Flowers, Director of Public Health, provided an update on the current measles situation. While the main outbreak was in the West Midlands, cases in London were rising, with five confirmed cases in Croydon in the past year, and one in the last month. Vaccination rates for children under five were noted as particularly low. Ms Flowers assured the committee that the council was monitoring the situation and taking appropriate action. She also confirmed that targeted awareness campaigns were being delivered in cooperation with the UK Health Security Agency, and that risks had been regularly communicated within schools. The Sub-Committee requested that the Director of Public Health circulate the latest communication on measles to all Councillors.

Adult Social Care and Health Directorate Budget, Savings, and Transformation

Annette McPartland, Corporate Director for Adult Social Care & Health (ASCH), presented a report on the directorate's financial performance and transformation progress. The report highlighted that the directorate was meeting its savings objectives despite the challenges of inflation and increasing demand for services.

Key discussions included:

• Budget Increase: An increase in the net budget from £129.8m to £141m was explained as a result of moving a team and its associated budget from the Housing Directorate to ASCH, which was deemed more appropriate for supervision, accountability, and development opportunities.
• Asylum Seekers and Refugees: The impact of the government's intention to reduce the number of asylum seekers and refugees placed in hotels on ASCH was discussed. The council had established a multi-agency board to monitor the use of additional grant funding, with a noted risk regarding its renewal. Further information on the origin of this grant funding was requested.
• Provider Market Risks: Concerns were raised about the risk of providers exiting the market. It was explained that while Croydon had a large care market, risks associated with budgeting, inflation, and the National Living Wage were present. The commissioning team regularly engaged with providers through the Providers' Forum.
• Increasing Care Package Costs: The Sub-Committee questioned the increasing cost of care packages and contingency plans. The council uses the CareCubed system to ensure value for money, and a Market Sustainability Investment Fund supports work with the market to determine inflationary uplifts.
• Review of Care Packages: The process of reviewing care packages was acknowledged as demanding but essential to ensure individuals' needs were met as they changed.
• Housing and ASCH Integration: The significant influence of housing on ASCH was recognised, with efforts underway to strengthen the link between the two directorates, particularly concerning mental health and the provision of accessible housing.
• Resident Feedback and Complaints: The council's process for engaging with residents who disagreed with assessments or support levels was outlined, including a formal complaint process.
• Care Costs for Placements from Other Boroughs: It was clarified that the originating local authority is responsible for placement costs when individuals are placed in Croydon, though Croydon Council incurs other costs such as safeguarding.
• Local Government Association Peer Challenge: The Sub-Committee was informed that the upcoming LGA Peer Challenge Review would not have direct financial implications but might lead to resource reallocation if areas for improvement were identified.
• Digital Services and AI: The development of digital services, including a virtual ward, was discussed, with anticipated savings through prevention and early help. The use of artificial intelligence (AI) to support staff efficiency was also being explored, with an example given of Swindon Borough Council using AI to produce easy-read documents rapidly. Reassurance was given that AI would be used to support, not replace, practitioners' decision-making.
• Staff Shortages: The impact of staff shortages on core areas like care package reviews was acknowledged, particularly for occupational therapists and commissioning staff. Croydon has implemented an Assisted Supported Year in Employment programme for newly qualified social workers to improve retention.
• Agency Staff Costs: The use of higher-cost agency staff was acknowledged due to winter pressures, with assurances that this was short-term and funded through additional pressures funding. Work was ongoing to benchmark staffing costs and convert agency staff to permanent roles.
• Transformation Programme Resourcing: Staff shortages were identified as a concern for the transformation programme, with assurances that resources would be reallocated if necessary to support its progress.
• Younger Adults in Nursing Care: The Sub-Committee sought information on work to reduce the number of younger adults placed in nursing care, with explanations that not all nursing homes are exclusively for older persons and that placement in a care home is usually a last resort.
• Key Performance Indicators (KPIs): A new reporting framework from the Department of Health and NHS England, requiring more client-level data, was expected to improve data collection and comparison with other boroughs.
• Inflation Impact: The directorate works with governmental bodies and the LGA to manage inflation risks, particularly the impact of the National Living Wage. Annual star chambers are used to estimate demand and prepare for market changes.

The Sub-Committee concluded that while there was a good level of understanding and control over the current budget, some areas of the forthcoming year's budget, particularly the transformation programme, still had unknowns. These areas would be scheduled for a deeper dive later in the year. Actions agreed included requesting further information on additional pressures grant funding and circulating the LGA Peer Review report once available.

Update from Healthwatch Croydon

Gordon Kay, Co-optee for Healthwatch Croydon, presented two reports: one on the health and wellbeing experiences of asylum seekers and another on a mystery shop of Croydon's GP websites.

• Asylum Seekers' Experiences: Discussions focused on sharing best practice with GP practices and the registration process for residents without a permanent address. It was confirmed that GP practices generally cannot refuse registration, and residents facing difficulties should contact Healthwatch Croydon's signposting service. Data sharing agreements are in place between relevant stakeholders.
• GP Websites Mystery Shop: The report highlighted the importance of accessible information and the challenges some residents face in registering with GP practices.

Scrutiny Work Programme 2023-24

The Sub-Committee reviewed its work programme for the remainder of the year. Members discussed how to develop the programme to avoid replicating the work of other ASCH-related bodies and agreed to meet informally to select topics for the next meeting, noting that the LGA Peer Review challenge should be added to the agenda. Several items were added to the work programme, including accessing sexual health clinics, immunisation, prostate cancer check-ups, and menopause services. The Sub-Committee resolved to note its work programme.