People Scrutiny Committee

MINUTES of a meeting of the People Scrutiny Committee held at  on 16 September 2021.

PRESENT:                 Councillors Sam Adeniji, Charles Clark, Penny di Cara, Chris Dowling, Kathryn Field, Nuala Geary, Johanna Howell (Chair), Wendy Maples, Stephen Shing and John Ungar (Vice Chair)

LEAD MEMBERS      Councillor Bob Bowdler, Lead Member for Children and Families

                                    Councillor Carl Maynard, Lead Member for Adult Social Care and Health

                                    Councillor Bob Standley, Lead Member for Education and Inclusion,                                  Special Educational Needs and Disability  

ALSO PRESENT

Philip Baker, Assistant Chief Executive   Mark Stainton, Director of Adult Social Care   Alison Jeffrey, Director of Children’s Services   Ian Gutsell, Chief Finance Officer   Mark Whiffin, Head of Finance   Louise Carter, Assistant Director (Communication, Planning and   Performance)   Debbie Endersby, Head of Strategic Commissioning   Sophie Permain, Supply Development Manager   Michaela Richards, Head of Safer Communities   George Kouridis, Head of Service for Adult Safeguarding   Lindsay Adams, Strategic Commissioner – Domestic Sexual Abuse and   Violence against Women and Girls   Kaveri Sharma, Equality and Engagement Manager   Caz Kearton-Evans Strategic Commissioning Manager – Substance   Misuse   Graham Bartlett, Independent Chair of the East Sussex Safeguarding   Adults Board   Stuart McKeown, Interim Member Services Manager

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8. Minutes of the previous meeting 17 June 2021

8.1 The Committee RESOLVED to agree the minutes of the meeting held on 17 June 2021 as a correct record and agree the recommendations made at the meeting.

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9. Apologies for absence

9.1       Apologies for absence were received from Councillor Trevor Webb, Nicola Boulter (Parent Governor Representative) and Simon Parr (Catholic Diocese Representative).

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10. Disclosures of interests

10.1     There were no disclosures of interests.

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11. Urgent items

11.1     There were no urgent items.

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12. Reconciling Policy, Performance and Resources (RPPR)

12.1     The report was introduced by Philip Baker (Assistant Chief Executive).  He outlined that  this is the start of scrutiny’s engagement in the budget setting process for 2022/23 and beyond. The State of the County report considered by Cabinet in July set out the detailed financial planning context for rest of the year and beyond.  However, the financial and policy position remains one of uncertainty and there have been a number of developments since July which will be covered in a RPPR report to Cabinet in September 2021.   There have also been a number of significant Government announcements which include:

• There will be a three-year financial settlement following the spending review which is likely to be published on 27 October 2021.

• The Government is aiming for a balanced budget from the financial years 2023/24 through to 2025/26.

• The Government has announced plans for Health and Social Care reform which will be funded by a 1.25% levy on National Insurance contributions made by employers and employees. Details will be set out in a White paper which will be published later in the year. The impact on East Sussex could be significant in terms of the local care market and on local health partners.

12.2     The Committee discussed the report and a summary of the key points discussed is set out below.

• In response to a query regarding the one-off reserve contribution referred to in paragraph 1.5 of the covering report, Members were informed by Ian Gutsell (Chief Finance Officer) that due to the pandemic some of the pressures included in earlier financial planning had not occurred.  As a result an opportunity had arisen to explore into the autumn the use of £8.855m one-off funding for investment in areas that will help better manage future demand for services or support the delivery of priorities such as highways or climate change.  It was also clarified that the savings set out in the report are ‘legacy savings’ resulting from decisions taken in previous years and that the Medium Term Financial Plan for next year does not contain plans for new savings to be identified.

• The Committee asked about the steps being taken to address delays in children and young people receiving a diagnosis from Children and Adolescent Mental Health Services (CAMHS).   In response the Alison Jeffery (Director of Children Services) informed Members that the Department is in discussion with colleagues from the local NHS Trust about what can be done to streamline the referral pathway and deliver quicker responses.  Work is also being undertaken to raise awareness amongst the wider workforce of neural diversity in children. It is hoped this will result in more children and young people gaining access to support in a more timely manner, without necessarily requiring a formal diagnosis.  Furthermore, additional funding has been provided by central government to support children’s mental health.  The Department are therefore actively engaging with NHS partners to help ensure the best use of the funding.  
• With regard to the Government’s announcement of introducing a cap on care costs, it was clarified to Members that the national insurance uplift for employers and employees will come in to force in April 2022.   The change to what people pay, however, will not be introduced until October 2023.    It was also clarified that is anticipated that the cap will be applied to care costs and will not cover costs such as accommodation and that the department are waiting on further detail about, for example, what the additional funding from central government will be allocated to.

12.3     The Committee RESOLVED to establish an RPPR scrutiny review board to consider the developing Portfolio Plans and Medium Term Financial Plan and to submit Scrutiny’s final comments on them to Cabinet in January 2022.

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13. Work programme

13.1     The Committee discussed its Work Programme which is comprised of a number of ongoing scrutiny reviews, reference groups and planned reports.   In particular, Members noted the arrangements for an Away Day and the opportunity this would provide to the Committee to discuss its priorities for scrutiny activity in the coming months.

13.2     The Committee RESOLVED to note the contents of its work programme.

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14. Annual Review of Safer Communities

14.1     Michaela Richards, Joint Strategic Commissioner for Domestic and Sexual Violence Abuse Services, introduced the report and responded to a number of questions asked by the Committee.  A summary of the key issues discussed is set out below:

• Domestic abuse in the over 60s age group:  With regard to the over 60 age group, the Committee noted the reference in paragraph 1.5 of the covering report to a total of ‘only 26 referrals to the commissioned domestic abuse community service last year’.   Members asked for more detail about whether the number of referrals was at the expected level or was evidence of under-reporting of abuse in this age group.  In response, Members were informed that this group are under-represented nationally for a wide variety of reasons including: individuals not recognising their situation as abusive, reluctance to disrupt family life, and being less likely to know how to seek support.  Against this backdrop the Department is working to engage with and support this group in different ways.  This includes, for example, raising awareness of how people can access support as part of the Older People’s Day in October and undertaking a needs assessment of the service to improve refuge accommodation for older people. 
  
  
• Anti-Social Behaviour and Drug Trafficking rates: The Committee discussed the negative impact on communities of anti-social behaviour (ASB) and noted the sharp increase in reports of incidents (as referred to in paragraph 1.2 of the covering report).  The Committee also noted the reference in paragraph 1.3 of the covering report to the significant increase in the number of drug trafficking offences.  In both cases the Committee sought clarification as to the reasons behind the increases.  In response, the Director of Adult Social Care undertook to ask Sussex Police if it could provide further context regarding both sets of data which could then be shared with Members.

• Drug and Alcohol Treatment completion rates: The Committee sought clarification regarding the rate of successful completions for treatment for drug and alcohol misuse. In response, the Committee were informed that completion rates do not tend to be high across the nation as the recipients of support have a chronic long-term condition, which is managed with a substitute prescription. Sadly, many people are not able to complete the full course of treatment. In response to a further question, Members were informed that the definition of treatment completion is that the individual is no longer using illegal opiates and no longer needs prescription substitutes. The Committee were further informed that with regard to the Hastings area, additional funding had been provided via Project ADDER (Addiction, Diversion, Disruption, Enforcement and Recovery).  This is a Home Office initiative which engages with a number of agencies and charities to provide education and support to drug users and provides support for helping them end their dependency.
  
  

14.2     The Committee RESOLVED to note the report.

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15. Developing Care Markets Bedded Care Strategy

15.1     Debbie Endersby (Head of Strategic Commissioning) and Sophie Permain (Supply Development Manager) provided the Committee with a presentation which included a summary of the Care Quality Commission (CQC) regulated care services in East Sussex and an overview of current demands and service challenges.  Set out below is a summary of the key points discussed by the Committee:

• Block Booking.  In response to a question regarding ‘block booking’, the Department confirmed that it does ‘block contract book’ beds with a number of nursing homes in East Sussex.  The bookings are made as part of the Department’s ‘Discharge To Assess (D2A)/Home First’ pathway.   Where possible the D2A pathway aims to avoid unnecessary admissions to hospital, and where an admission is necessary, to ensure that people are discharged as soon as is safe and practical, back to their own homes or to a D2A bed to have their assessments and services arranged outside of hospital. The number of discharge to assess beds varies throughout the year, with approximately 90 beds in use at present.  

• Vaccination of care home workers: The Committee discussed the potential impact of vaccination legislation which requires all care home staff to be vaccinated against Covid-19 by November 2021.  More specifically, the Committee asked for clarification regarding what steps are being taken to minimise the impact on care home clients if significant numbers of staff lose their jobs because they have refused to be vaccinated.   In response Members were informed that in terms of directly provided care services the number of staff that have not been vaccinated currently stands at only two. It was therefore anticipated there would not be a challenge with providing continuity of service in this sector.  The Director of Adult Social Care also confirmed that there are staff who are exempt from being vaccinated and therefore they would continue in their roles.
  
  
• Overseas recruitment: The Committee discussed the proposed recruitment of care home staff from overseas and asked whether more could be done to increase rates of recruitment from the local population.  In response, Members were informed that the Department actively employs a range of methods in the local area to promote working in the sector.  This includes, for example, attendance at recruitment fairs.   However, there are a number of factors which mean recruitment remains a challenge for the adult social care sector.  These factors include competition from similarly paid roles in the leisure and hospitality industries and the nature of care work itself, which whilst rewarding is also a challenging and demanding job. 

· Homecare referrals: The Committee discussed the increase in the rate of homecare referrals and asked for clarification as to what factors were behind the trend.  In response Members were informed that over 25% of the population in East Sussex is over 65 years of age and therefore there has been and continues to be a general increase in demand for support with care.  In the short term the Covid-19 pandemic may have contributed to a rise in demand for Homecare as many clients wished to avoid using a care home.  The increase in the rate of homecare referrals is also being driven by an increased recognition at the national level of the benefits of helping clients to live independently and in their own homes for as long as possible. 

• Self-funding clients: In response to a query regarding the support provided by the Department to individuals and families who fund their own care, Members were informed that the Department offer advice and guidance to clients about all the options available to them.  Where requested this includes support from the Department’s brokerage team who will work with clients and individual care homes to help identify suitable options.

• Use of technology in homecare:  In response to a question about the extent of its use, the Committee were informed that technology is widely utilized to provide assistance with care.  For example, the Department use Technology Enabled Care Services (TECS) which incorporates a range of technological solutions and services for those in care, many of which are interlinked with other services such as Lifeline.  The Department is also about to undertake studies looking into the use of robotics to assist with moving and handling, a form of technology that has been successfully deployed in other local authorities.

15.2     The Committee RESOLVED to note the report and request an update report in six months.

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16. Safeguarding Adults Board Annual Report

16.1     Graham Bartlett, Independent Chair of the East Sussex Safeguarding Adults Board introduced the report and responded to a number of questions from the Committee. The key issues discussed included:

• Referrals from doctors: The Committee asked about the role of doctors in making referrals to the Safeguarding Adults Board (SAB), noting that this has previously been highlighted as an area for improvement. In response, Graham Bartlett informed the Committee that the East Sussex Clinical Commissioning Group (CCG) have recently appointed eight named GPs for safeguarding roles.  It is hoped this coordinated approach will have a wider impact on adult safeguarding across the county. George Kouridis (Head of Service Adult Safeguarding) also informed the Committee that safeguarding reports from other medical staff, such as community nurses, form a significant proportion of the referrals received.

• Modern slavery and human trafficking: The Committee asked for more detail about the modern slavery and human trafficking training course which was undertaken by SAB members and sought more information on how prevalent both issues are in East Sussex. In response Graham Bartlett informed the Committee that there is a general lack of awareness and under-reporting of modern slavery and human trafficking activity. As a result, one of the aims of the training course is to help individuals develop the skills to identify possible indicators of abuse. Mr Bartlett confirmed that the training was applied to many different settings and that it was not being offered due to a specific issue in East Sussex.

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• Conference on Adult B Safeguarding Adults Review (SAR): The Committee asked about the recommendation from the Adult B SAR to hold a conference, hosted jointly with Brighton & Hove SAR, to look into key areas of learning. Specifically, the Committee sought assurance that this conference had now taken place, noting that it was delayed due the pandemic, and asked for the key learnings taken from this. Graham Bartlett confirmed to the Committee that the conference had taken place and that it was very productive and informative. Members were informed that details of the learnings and any policy changes as a result of the conference will be set out in the next annual report to the Committee.
  
  
• Joint working with the East Sussex Safeguarding Children’s Partnership: The Committee asked for clarification about whether the East Sussex Safeguarding Children’s Partnership (ESSCP) and the SAB share learning from serious case reviews and other activities.  In response, the Committee were informed that the Chairs of the SAB and the ESSCP hold seats on both bodies and that a partnership protocol is in place.  The protocol aims to help ensure all work streams and learning are aligned towards best practice and the safeguarding of both adults and children.

16.2     The Committee RESOLVED – to note the report and to thank Graham Bartlett for his commitment and contributions as Independent Chair of the Safeguarding Adults Board.
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Councillor Johanna Howell (Chair)

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