The Adult Social Care & Health Overview and Scrutiny Committee met on Wednesday 07 October 2026 to discuss the Bexley Wellbeing Partnership's Winter Preparedness and Resilience Plan for 2026/27 and the outcome of the Care Quality Commission (CQC) assessment of Bexley's Adult Social Care services. The committee received updates on winter planning, including strategies for managing increased demand, avoiding hospital admissions, and improving patient flow, as well as the findings of the CQC report, which rated Bexley's Adult Social Care as 'Requires Improvement'.

Bexley Wellbeing Partnership Winter Preparedness and Resilience Plan 2026/27

The committee reviewed the Bexley Wellbeing Partnership's Winter Preparedness and Resilience Plan for 2026/27. This plan outlines a comprehensive, whole-system approach to managing winter pressures across health and social care, focusing on three key objectives: ensuring appropriate Accident and Emergency (A&E) attendances, avoiding inappropriate hospital admissions, and improving patient flow and discharge. The plan builds upon existing strengths such as neighbourhood-based care, proactive population health management, integrated working, and the increased use of technology and virtual care models.

Key initiatives discussed include:

• A&E Attendances: Strategies to ensure appropriate A&E attendances involve promoting self-management, increasing access to primary care and pharmacies through the Pharmacy First service, and encouraging vaccination uptake. The plan also highlights the role of Urgent Treatment Centres (UTCs) and the Acute Respiratory Infection Hub, which provides additional same-day capacity for respiratory illnesses. The Better Access Bexley campaign aims to inform residents about alternative care pathways.
• Admissions Avoidance: To prevent avoidable hospital admissions, the plan focuses on enhanced community services, multidisciplinary working, and proactive management of deteriorating health conditions. This includes expanding Same Day Emergency Care (SDEC) pathways, the Urgent Community Response (UCR) service for rapid home-based assessment and intervention, and the role of Emergency Department Care Navigators to signpost residents to community support. Enhanced support for care homes, including multidisciplinary reviews and a pilot to reduce ambulance conveyances, is also a key focus. Virtual Wards are being maximised through step-up pathways to deliver care closer to home.
• Improving Patient Flow and Discharge: The Home First programme aims to improve discharge processes and reduce hospital length of stay. This involves integrated Hospital Discharge teams, increased capacity for discharge-to-assess (D2A) services, and brokerage support. The plan also seeks to create Virtual Ward step-down pathways and enhance palliative and end-of-life care within the community to avoid unnecessary hospital admissions.
• Mental Health Support: Efforts will continue to support individuals requiring specialist mental health care in the community. The Mental Health Crisis Café, which operates in the evenings, is being considered for extended hours over winter to prevent A&E attendances. A multi-disciplinary community-based mental health hub has increased capacity, and work is underway to prevent escalation to crisis services.
• Acute Trust Plans: Updates were provided on the winter plans for Queen Elizabeth Hospital (QEH) and Darent Valley Hospital. Both trusts are focusing on improving urgent and emergency care, patient flow, and discharge, with an emphasis on shifting care into community settings. QEH plans include reopening inpatient beds and expanding SDEC, while Darent Valley Hospital is managing a reduced bed base through pathway redesigns and community collaboration.
• Support for Unpaid Carers: The Bexley Carers Partnership has developed a draft Carers Action Plan for 2026-27, focusing on early identification, quality assessments, carer wellbeing, and awareness of available support. Initiatives are underway to improve carer involvement in hospital discharge processes.

The committee noted that the plan is underpinned by existing budget resources, with additional funding of £306,000 from NHS South East London Integrated Care Board for specific schemes, including communications, care home support, and discharge capacity. Risks related to workforce challenges, demand exceeding capacity, and potential peaks in demand were highlighted, with mitigation strategies in place.

Bexley CQC Outcome, Strengths, Areas for Development, Priority Action Plan and Next Steps

The committee received an update on the outcome of the Care Quality Commission (CQC) assessment of Bexley's Adult Social Care services. The final report, published in July 2026, resulted in an overall rating of 62, categorised as 'Requires Improvement', just one point below a 'Good' rating.

Key Strengths Identified:

The CQC report highlighted several strengths, including:

• A person-centred and strengths-based approach to assessment and care planning, with timely assessments and multiple access routes.
• Strong prevention services that contribute to improved confidence and independence.
• Effective provision of equipment and adaptations to support independent living.
• Mature and effective partnerships across health, social care, and the voluntary sector.
• Strong community-focused prevention and early intervention initiatives.
• A supportive workforce culture with access to professional development and visible leadership.

Key Areas for Development:

The CQC identified several areas requiring improvement:

• Consistency in people's satisfaction and experience of services, including communication about care planning and named social workers.
• Barriers and inconsistencies in accessing services and information, with a need for more accessible formats.
• Limited engagement with some seldom-heard communities and ongoing barriers for certain groups.
• Delays in completing care act reviews, although progress has been made.
• Insufficient local provision for specific needs, such as dementia support, respite, and supported accommodation, leading to reliance on out-of-borough placements.
• Safeguarding concerns, including timeliness of escalating concerns and inconsistent inter-agency communication.
• Opportunities to strengthen the personalisation offer, particularly in supporting individuals to manage direct payments.

Next Steps and Improvement Plan:

Bexley Adult Social Care has developed a Priority Action Plan to address these areas for development. This plan is being co-produced with staff, residents, partners, and providers. Key priority areas for improvement include:

• Enhancing the quality of people's experiences and satisfaction with care and support services through resident feedback and co-production.
• Reducing review backlogs and improving the timeliness of reviews.
• Strengthening direct payments and personalisation.
• Improving community engagement, equity, and access.
• Enhancing support for people with autism.
• Improving safeguarding practices and assurance, and safe systems and transitions.
• Addressing market sufficiency and accommodation needs, particularly for dementia, respite, and supported accommodation.
• Ensuring quality assurance of care provision and provider quality.

The council has submitted its Stage 1 response to the Department of Health and Social Care (DHSC) and is developing its Stage 2 response, which will include the detailed improvement Action Plan. Partners in Care and Health are providing a support and challenge role to assist with these submissions and the development of a tailored support package.

The committee was assured that progress has already been made in areas such as the timeliness of reviews and the establishment of a Direct Payments Support Service. Communications with staff, partners, and residents are underway to manage the outcome and outline the improvement journey.

Urology Services Redesign at Lewisham & Greenwich NHS Trust

The committee received a briefing on the proposed redesign of urology services at Lewisham & Greenwich NHS Trust (LGT). The plan involves relocating elective outpatient and diagnostic urology care from Queen Elizabeth Hospital (QEH) to a new Urology Investigation Unit (UIU) at University Hospital Lewisham (UHL) by December 2026. Emergency urology cover will remain at both sites.

The redesign aims to improve safety, patient access, and long-term sustainability by addressing workforce challenges and fragmented patient pathways. A joint Guy's Urology with LGT service is being developed with Guy's & St Thomas' NHS Foundation Trust (GSTT) to create a more resilient workforce and provide a more integrated patient journey.

For Bexley residents, emergency care at QEH will continue, and existing patients will be managed appropriately. However, some Bexley patients attending QEH for elective urology may face longer journeys to UHL. LGT will monitor the impact on deprived communities and transport-sensitive groups, and GPs retain patient choice options across South East London and with local Kent providers. The UIU project has secured £3.4 million in capital investment, with works targeted for completion by November 2026. Risks related to travel, equality, backlog management, and emergency pathway safety are being mitigated.

Primary Care Infrastructure Contributions from Local Developments

A briefing paper detailed four secured primary care infrastructure contributions through Section 106 planning obligations, totalling £2,123,936. These contributions are intended to mitigate the impact of housing growth on local primary care services and will support improvements to existing GP premises, including fit-out, reconfiguration, and increased clinical capacity. The secured funding is linked to specific local schemes in Belvedere, Slade Green, and Crayford. The London Healthy Urban Development Unit (HUDU) methodology was used to assess health impacts and calculate contributions, aligning with the local primary care estates strategy.

Work Programme

The committee reviewed its work programme for the upcoming year. Potential items for inclusion were discussed, including Frailty and Cancer Haematology proposals at the PRUH/Denmark Hill. The committee also considered standing items for its February and March meetings, which will cover the Council's budget and financial plans, Adult Social Care performance, and progress on outreach to underserved communities, as well as the Ageing Well (Frailty) priority within the Health and Wellbeing Strategy. The possibility of undertaking reality checking visits and establishing scrutiny project sub-groups was also discussed. The committee noted that the Adult Social Care and Public Health Directorate was reporting an overspend of £0.620m as of July 2026, primarily due to increased placement activity and inflationary pressures, partially offset by a staffing underspend.