The Healthier Communities and Older People Overview and Scrutiny Panel met on 24 January 2024 to discuss the council's budget and business plan for 2024-2028, as well as the safeguarding annual report and updates on how to keep people out of hospital and the Care Quality Commission (CQC). The panel agreed to note the safeguarding annual report and received updates on the budget, hospital admissions, and CQC assurance framework.

Safeguarding Annual Report

The panel received an update on the Safeguarding Annual Report from Aileen Buckton, Independent Chair of the Merton Safeguarding Adults Board (MSAB). The report highlighted four key priorities for the safeguarding strategy: prevention and early detection, building and strengthening connections, making safeguarding personal, and quality assurance. There is a focus on educating residents about where to report concerns and building relationships with local communities. A Community Adult Safeguarding Champions Network has been successfully launched. In response to questions, it was confirmed that the MSAB website lists the champions and their contact details. The number of concerns raised (850) was noted as comparable to the size of the Merton borough. Efforts are being made to ensure all communities in Merton are reached, including the Asian community, to ensure all necessary referrals are received. An Independent Domestic Violence Advocate (IDVA) role has been added to the Adult Safeguarding and First Response Team to assist with enquiries and support individuals affected by domestic abuse. Aileen Buckton agreed to provide a detailed note on GDPR and its application to safeguarding and confidentiality. The report also mentioned a national library of Safeguarding Adults Reviews (SARs) from which learning opportunities are taken.

Budget 2024/25 and MTFS 2024-28

The panel discussed the draft Budget and Business Plan for 2024-2028, which followed on from the initial scrutiny in November and included information on the government's provisional settlement and recent Cabinet proposals. Councillor Billy Christie, Cabinet Member for Finance and Corporate Services, introduced the report, noting that while the burden of funding local services has shifted to taxpayers, funds have been identified for further investment in certain areas.

The Executive Director for Adult Social Care elaborated on the proposed savings, which included:

• JMC Day Centre Redevelopment: Rebuilding the JMC day centre with 21 supported living spaces above. This is projected to save money by enabling individuals to move from residential care to supported living, leading to better outcomes.
• Increased Reablement Functions: Enhancing reablement services aims to prevent, reduce, and delay the need for adult social care, thereby reducing long-term care packages.
• Mental Health Brokerage: Bringing mental health brokerage services in-house to the Council's Brokerage Team to negotiate better prices for placements.
• Recommissioned Home Care Providers: A new set of homecare providers has been established, with the CM2000 system ensuring accurate charging based on actual hours delivered.

In response to questions, officers provided further details:

• Inflation was identified as a significant pressure on budgets.
• Financial assessments are used to maximise income by checking for eligible benefits.
• Adult Social Care accounts for 56% of the council's budget, a figure comparable to most local authorities, with social care representing a large portion of most council budgets.
• Merton Council's in-house brokerage team is considered skilled and dedicated, capable of finding the best placements and negotiating rates more effectively than the Mental Health Trust. This move also provides clearer oversight of the wider market.
• The 2% Adult Social Care (ASC) precept is considered vital.
• The Equality Impact Assessment (EQIA) for fees and charges will be informed by consultation.
• The redevelopment of the Riverside and JMC sites will provide supported living units.
• The council has seen an 8.9% increase in provider costs this year due to inflation, with approximately £20 million spent on nursing care.

A panel member requested further details on the capital expenditure of nearly £10 million for Supported Living, which officers confirmed would be supplied and presented to the Healthier Communities Panel when available. The Cabinet Member highlighted that despite the provisional government funding announcement, the council still faces a significant shortfall, receiving £20 million less than in 2010.

How to Keep People Out of Hospital

Mark Creelman provided an overview of the work being undertaken to prevent hospital admissions. Key areas include:

• Access: Investment in telephone systems, promotion of the NHS App, availability of online consultations at all practices, and the rollout of Universal Care Plans across health services. All practices are on track for prospective records access.
• Proactive Care: 869 care home beds are covered by 10 practices, with a lead practice assigned to each care home. This includes care planning, reviews for all residents, structured medication reviews, and individual case reviews for approximately 4,000 patients annually.
• Prevention: The Merton Health & Care Plan 2022-2024 focuses on Start Well, Live Well and Age Well. Initiatives include cancer screening, social prescribing, immunisations, mental health reviews, virtual wards, and hospital-at-home services.

In response to questions, Mark Creelman provided further information:

• Efforts are being made to ensure same-day access to appointments with GP populations.
• Feedback is actively sought to identify GP practices requiring additional training and support.
• Extended Access Hubs can access patient records.
• Breast Cancer screening is delivered by St George's NHS Foundation Trust, and Merton Council will relay discussions regarding mobile vans and The Wilson Hospital.
• Primary care complaints have been managed by the Integrated Care Board (ICB) since 1 April 2023.

The Chair thanked Mark Creelman for his attendance.

CQC Update

Phil Howell, Assistant Director of Commissioning, updated the panel on the new Care Quality Commission (CQC) assurance framework for adult social care, which came into effect on 1 April 2023. This framework places a duty on the CQC to assess local authorities' delivery of adult social care duties under Part 1 of the Care Act 2014. CQC assurance is being rolled out nationally, with five local authorities participating in pilot assessments in autumn 2023, the findings of which were published in November. Merton's Adult Social Care department has volunteered for an LGA Peer Review in June 2024 as preparation for assurance. A CQC inspection could occur within the next two years. Over the next three months, priorities include completing a self-assessment report, developing an action plan, populating the information return, and identifying any gaps with a plan to address them.

Work Programme

The panel agreed to the proposed work programme.