Report to:	Governance Committee
Date of meeting:	22 March 2022
By:	Assistant Chief Executive
Title:	Scrutiny Activity Update
Purpose:	To provide an overview of scrutiny activity being undertaken by the People, Place and Health Overview Scrutiny Committees and an update on the work of the Audit Committee.

RECOMMENDATIONS: The committee is recommended to:

1) note the updates on recent scrutiny and Audit Committee activity and the current work programmes at appendices 1-4; and

2) agree to receive ongoing quarterly updates on scrutiny activity.

1          Background

1.1       This report provides a summary of scrutiny activity across the People, Place and Health Overview Scrutiny Committees. The report also includes an update on the work of the Audit Committee. The current work programmes for the committees are attached at appendices 1-4.

1.2       It is proposed to provide ongoing quarterly reports on scrutiny activity to the Governance Committee to support increased visibility to all Members of the wide range of work being undertaken by the scrutiny and Audit committees.

2          People Scrutiny Committee

Recent work

2.1       The Committee met on 18 November 2021 to consider reports on:

· Findings and recommendations of Adult Social Care and Health (ASCH) department commissioned research by Activmob Community Interest Company. The research was commissioned to deliver a recommendation of the previous Scrutiny Review of social care information and signposting that the ASC department should undertake additional engagement to gain a better insight into how well-informed people in East Sussex feel about social care support and funding arrangements. The research was adapted in response to COVID to understand client and staff experiences of the first lockdown; and then to understand residents’ and front-line staff members’ understanding about ASCH and how it works.

· The East Sussex Safeguarding Children Partnership Annual Report 2020/21.

· RPPR – to consider the latest report to Cabinet and identify further work or information needed in advance of the December RPPR Board.

· Work programme update – the Committee agreed a fully refreshed work programme following their October work planning awayday.

2.2       Two scrutiny Reference Groups have resumed work which began before the election:

· Loneliness and Resilience Reference Group (membership: Councillors Clark, Geary, Howell, Maples, Ungar (Chair) and Webb). The group is providing ongoing Member input to Public Health-led work on this area. At its meeting on 8 December 2021 the Group received a detailed update from ASC and Public Health officers and Collaborate Community Interest Company who have been commissioned to deliver the project which will develop a systems approach to tackling loneliness and social isolation in East Sussex. The update on progress with the project covered insights from partner and community engagement activities undertaken last autumn. The Reference Group Members asked questions on the research methodology and emerging findings, provided additional insights on the drivers of loneliness in their divisions and made suggestions of further groups and bodies the Council could work with to address loneliness. A further meeting on 21 March 2022 has been arranged to coincide with project work to synthesise the research findings and develop recommendations.

· Health and Social Care Integration Programme Reference Group (membership: Councillors Clark, di Cara, Geary, Howell, Ungar and Webb). This Group will meet in early April to receive an update on Health and Social Care Integration work in East Sussex and the recently-published Integration White Paper, coinciding with a report to Cabinet on the Health and Care Bill and latest developments with the Sussex Integrated Care System. The group provides additional Member oversight and scrutiny to update reports on health and care integration received by Health and Wellbeing Board and Cabinet.

2.3       The Committee held its RPPR Board on 13 December to review draft portfolio plans for the Children’s Services Department (CSD) and ASCH, relevant ongoing savings plans and the latest financial outlook as indicated at the Autumn Budget/Spending Review. The Board also received detailed updates from the Directors of Adult Social Care and Children’s Services on recent national policy reforms and upcoming reviews and developments which would, or were expected to, have significant impacts on both service areas. Comments to Cabinet focused on concerns that important detail was awaited from Government on how the ASC reforms to social care charging will be implemented in practice, as this is needed to undertake informed budget and service planning, particularly given the potential impact the reforms could have on ASC; and the Board’s concerns about the potential for savings to be made in the Early Help Service. The Board discussed and clarified various aspects of the national policy developments Directors highlighted, as well as plans outlined in the Departments’ portfolio plans. The Board welcomed both draft portfolio plans and the priorities and plans outlined within them.

2.4       A briefing presentation on ESCC’s work to tackle Domestic Abuse (DA) and Violence Against Women and Girls (VAWG) was held on 10 December. The presentation included a briefing on the draft pan-Sussex Strategy on Domestic Violence Accommodation and Support. The Committee welcomed the draft Strategy, particularly plans to ensure sanctuary schemes were available across the county and plans to increase support for children, particularly boys and young men. A formal note of comments from the meeting was submitted to the department and taken into account in development of the final strategy which was reported to the Lead Member for ASCH in January. The briefing presentation session also covered ESCC’s work to tackle VAWG and CSD’s work to support children in families with domestic abuse. The Committee asked questions on various aspects of the work outlined, welcomed the work taking place and requested that updates on work to implement the new DA Strategy and tackle VAWG be included in the next Annual Review of Safer Communities report to the Committee. Members also requested that learning for ESCC from the national review into the death of Arthur Labinjo-Hughes was shared with the Committee as part of the annual update on learning from case reviews provided in the East Sussex Safeguarding Children Partnership Annual Report update.

Future work

2.5       The committee’s current work programme (attached at appendix 1) underwent a thorough review through a work planning Away Day in October at which the Department Management Teams updated Members on current challenges and priorities for the services and suggested areas for potential scrutiny input. The Committee is now progressing the areas of work agreed which includes a range of committee items, potential scrutiny reviews, briefings and ongoing Reference Groups and will consider further updates to the work programme at its March meeting.

Scrutiny Reviews

2.6       The Committee’s programme of scrutiny review work is as follows:

School attendance	The Committee heard at their work planning awayday that overall school absence and persistent absence rates across East Sussex are high, when compared to national and statistical neighbours; and that East Sussex has a significant number of children and young people deemed too ill to attend school due to anxiety and poor mental health, and increasing levels of Emotionally-Based School Avoidance (EBSA). The Committee agreed at the November 2021 meeting to undertake scoping for a potential review of school attendance to understand more about the drivers of school absences, the impact of school absences on children and young people, the work the Department is undertaking in response, and whether there are areas where scrutiny could make recommendations for change or improvement. A scoping meeting took place on 10 March, with the outcome to be reported to the 24 March committee meeting.
ASC workforce	The Committee heard at their work planning awayday that the challenges seen nationally in recruitment and retention of the ASC workforce are reflected in East Sussex. Members noted that the previous Committee undertook a scrutiny review of ASC Workforce Challenges in 2019 but the context to these challenges had developed and they have been brought into sharp focus by the COVID-19 pandemic. The Committee agreed at the November 2021 meeting to undertake scoping to investigate whether there is potential for a further short review of ASC workforce challenges. A scoping meeting took place on 9 March, with the outcome to be reported to the 24 March committee meeting.
School exclusions	This topic had completed initial scoping and a terms of reference for a full review had been agreed prior to Covid. On advice from the department, it has been agreed to restart this review later this year when we expect schools will have greater capacity to engage.

3          Place Scrutiny Committee

Recent work

3.1       The committee met on 26 November 2021 to consider reports on:

· RPPR – to consider the latest report to Cabinet and identify further work or information needed in advance of the December RPPR Board.

· Scrutiny Review of Becoming a Carbon Neutral Council – 6 month update on implementation of the action plan.

· East Sussex Road Safety Programme – Outcomes of the pilot projects to reduce road accidents resulting in Killed and Seriously Injured people (KSIs) in East Sussex.

· An update on the Council’s Workstyles Programme which is supporting the move to a more hybrid way of working in the future.

3.2       The Committee held its RPPR Board on 16 December to review draft portfolio plans for Communities Economy and Transport (CET), Business Services Department (BSD) and Governance Services (GS), relevant ongoing savings and the latest financial outlook as indicated at the Budget/Spending Review. Comments to Cabinet focused on the endorsement of the draft portfolio plans; whether there was a case for additional investment in highways infrastructure for road and pavement improvements; and challenges presented by not knowing the impact of the Local Government Provisional Settlement on the medium term financial plan at that stage. The Board also noted the requirement contained in the Environment Bill to establish a food waste collection service and asked about the financial impact on ESCC as the waste disposal authority.

3.3       The Highways Contract Re-Procurement Reference Group has been re-established to provide ongoing scrutiny input to the Highway Services Re-Procurement Project and met on 15 December 2021 to discuss the next stages of the Project. Cllr Kirby-Green was elected as Chair of the Reference Group, with the other members being Councillors Beaver, Collier and Hollidge.  A session on the asset management approach took place on 10 March 2022 to familiarise the Reference Group with how highway works are prioritised and the intervention policies (this session was also open to all Place Scrutiny Committee members). The Reference Group plans to meet on three further occasions to discuss key stages of the project with the last session timed to take place before consideration of the award of the contract by Cabinet, expected to be in the autumn.

3.4       An initial meeting of the Local Transport Plan (LTP) 4 Reference Group took place on 1 February to examine the work involved in revising the LTP and to agree the terms of reference for the scrutiny work. The Reference Group agreed to wait until the expected guidance on revising LTPs is published before setting further meetings. The Group also agreed not to review the Emergency Active Travel Fund projects, but instead concentrate on looking at the Local Cycling and Walking Infrastructure Plan (LCWIP) as part of the revision of the LTP. It is envisaged that the Reference Group will hold three or four meetings during 2022. The membership of the Reference Group is: Councillors Collier, Beaver, Hilton, Hollidge, Holt, Lunn, Redstone (Chair), and Stephen Shing.

Future work

3.5       The Committee’s updated work programme agreed at the November Committee meeting is attached at appendix 2. There were no new additions to the work programme and the key future work priorities agreed by Members are:

• Economic Development: The Committee has asked for several reports on Economic Development which have been scheduled for the June 2022 meeting. This includes the Team East Sussex recovery plan, and a report on how projects are developed and selected, including the governance arrangements. An update report on the Broadband Project and the Gigabit scheme rollout will be considered at the 23 March 2022 meeting.
• Climate Change: As part of the update on the Scrutiny Review of Becoming a Carbon Neutral council the Committee was invited to take part in the review and update of the Council’s Climate Emergency Action Plan. It is highly likely that the Committee will want to have an input into this work and form a working group to do so. This will be discussed under the work programme item at the March committee meeting

Scrutiny Reviews

3.6       The Committee’s current planned scrutiny review is as below, with further topics likely to emerge from scheduled committee reports or Reference Group sessions which will provide initial information on topics the committee has expressed interest in:

Procurement

The review will focus on Social Value and buying local initiatives. A Scoping meeting was held in February and it was agreed to recommend proceeding with the review. A draft terms of reference for the review will be considered by the Committee at its March meeting. Membership is Cllr Collier, Cllr Hilton, Cllr Redstone.

4          Health Overview and Scrutiny Committee (HOSC)

Recent work

4.1       The HOSC met on 2 December 2021 to consider reports on:

• Cardiology and Ophthalmology services at East Sussex Healthcare NHS Trust (ESHT): The Committee agreed that proposals for reconfiguration of cardiology and ophthalmology services provided by ESHT both constitute a ‘substantial variation’ to services requiring formal consultation with HOSC. The HOSC will review the proposals via two separate review boards (set out below) that will report back to the Committee in June 2022 with reports and recommendations. The proposals have also been subject to public consultations, and they include both services being either partially or fully single sited in Bexhill, Hastings or Eastbourne. Consideration of the proposals is subject to the NHS timelines, with the final HOSC review of the NHS decisions currently expected at the September 2022 HOSC meeting.
• Cardiology services at Maidstone and Tunbridge Wells NHS Trust (MTW): The Committee agreed that the proposals to single site specialist cardiology beds and catheterisation labs at either Maidstone or Tunbridge Wells Hospital was not a substantial variation to services. The Committee agreed the number of patients in East Sussex affected by the proposals was too small to be considered substantial but will monitor developments with the proposals.
• NHS Winter plan: The committee considered a report on the NHS Winter Plan over 2021/22 winter period. There were a number of concerns raised over access to booster vaccination hubs, home vaccines, hospital handover delays and Emergency Department capacity, and whether the temporary closure of Crowborough Minor Injuries Unit was justified.
• Community Mental Health Services: Members considered a report on Community Mental Health Services, seeing it as a key pillar to improving mental health services in East Sussex and ensuring inpatient mental health services are sustainable. The Committee concluded they wished to know more about Emotional Wellbeing Services – newly developed primary mental health services based around Primary Care Networks -  and the overall funding of mental health.  
• Redesigning Inpatient Mental Health Services in East Sussex (a ‘substantial variation’ to health service provision requiring statutory consultation with HOSC): The Committee supported the NHS decision to relocate Inpatient Mental Health services from the Department of Psychiatry at the Eastbourne District General Hospital (DGH) to a new facility to be built in north east Bexhill was in the best interests of health services locally. HOSC will receive email updates on progress and plans a site visit before the facility opens in 2024.

4.2       The HOSC met again on 3 March 2022 to consider reports on:

• Child and Adolescent Mental Health Services (CAMHS): The committee requested a report in light of concerns about long waiting times and the capacity of the CAMHS service. Members received a presentation on current levels of referrals and waiting times, actions being taken to address the issues arising and the use of recent investment in the service. HOSC requested a further report in the autumn in order to assess whether the actions outlined are having a positive impact.
• Urgent care: HOSC received a report in response to the committee’s request for updates on a range of recent developments in the local urgent care system, including with the NHS 111 service, the closure of Eastbourne Walk in Centre, the redesign of the Hastings Walk in Centre as a Primary Care Led Hub and the temporary closure and subsequent re-opening of the Crowborough Minor Injuries Unit. The committee asked a range of questions and received assurances on issues arising from these developments.
• Hospital handovers: Members considered a report on the current level of delays in handover of patients between the ambulance service and local hospital emergency departments and actions being taken to address these. HOSC requested a further update in the autumn to assess progress.

Future Work

4.3       Key future work priorities for HOSC are set out in the attached work programme (appendix 3) and include:

• Conduct the following substantial variation to services reviews in the first half of 2022:

Cardiology	The review will consider whether the proposals to single site cardiology catheterisation labs and specialist cardiology to either Eastbourne DGH or Conquest Hospital are in the best interests of health services locally. Membership comprises Cllr Belsey, Robinson, Turner, di Cara and Marlow-Eastwood.
Ophthalmology	The review will consider whether reducing day case and outpatient ophthalmology from three sites to two is in the best interests of health services locally. Membership comprises Cllr Belsey, Robinson, Azad and Brett and Geraldine Des Moulins.

• Consider the proposals to move adult burn services from Queen Victoria Hospital in East Grinsted to a major trauma centre in the South East.  
• Scrutinise Primary Care Networks and the development of Emotional Wellbeing Services for residents requiring primary mental health interventions.

Other HOSC Issues

4.4       The Health and Care Bill may have an impact on health scrutiny arrangements, in particular the powers HOSC currently has to refer ‘substantial variations’ to the Secretary of State for review - the Bill proposes to confer the power to review a service change directly on to the Secretary of State instead. Further information is awaited.

4.5       The Bill is focussed on the creation of Integrated Care Systems (ICS) which will have a decision-making Integrated Care Board (ICB) that will replace CCG Governing Bodies and an Integrated Care Partnership (ICP), with wider membership including local authorities, which will hold the ICB to account, and produce a strategy the ICB must have due regard to.  It is not clear yet what impact these future arrangements will have on health scrutiny. Consideration may be needed as to whether there should be a more consistent framework for the establishment of joint health scrutiny committees. Joint HOSCs are currently established ad hoc where there is a substantial variation to services covering more than one local authority area, but because ICSs will cover more than one local authority area there may be more instances of service changes that affect more than one HOSC. The Committee will consider a report on the Bill/Act and on ICSs at a future meeting.

5          Audit Committee

Recent work

5.1       Audit Committee met on 19 November 2021 to discuss reports on:

• Treasury Management Stewardship Report 2020/21
• Internal Audit Progress Report - Quarter 2 2021/22
• Property Asset Disposal and Property update
• Audit Committee Work programme

The meeting was preceded by a training session on Treasury Management and the Committee also received training on Property Valuation before the meeting held in September 2021, which was linked to external audit work.

5.2       The Committee welcomed the introduction of Environmental and Social Governance (ESG) factors into the Treasury Management Strategy which means ESCC is investing in funds that take issues such as sustainability and climate change into account (in a similar way to the Pension Fund). The Committee noted the limited number of products currently available and that the market is still developing.

Future work

5.3       The Committee’s future work areas are set out in the work programme attached at appendix 4 and include formally considering the Internal Audit Strategy and Plan for 2022/23 at the meeting on 29 March 2021, having previously commented on the draft Strategy and Plan at an informal session in January.

5.4       The Committee also has an ongoing Working Group which is providing oversight of the Modernising Back Office Systems (MBOS) programme implementation.

6          Scrutiny engagement in Reconciling Policy, Performance and Resources (RPPR)

6.1       ESCC currently follows a good practice approach to scrutiny engagement in the organisation’s business and financial planning which involves scrutiny input from People and Place Scrutiny Committees throughout the annual RPPR cycle. This approach has largely worked well in the past, provides scrutiny Members with the opportunity to contribute at various stages and integrates scrutiny engagement in RPPR with scrutiny’s wider work in an ongoing cycle. However, there are opportunities to build on this for the future, particularly in relation to engaging scrutiny more fully with the ‘policy’ and ‘performance’ aspects of RPPR which can be more challenging to scrutinise. In consultation with the Scrutiny Chairs and Vice-Chairs some enhancements to the existing scrutiny RPPR arrangements have been identified. These are:

• A proposal that scrutiny committees consider relevant parts of the quarter 4 (end of year) monitoring report and the State of the County report annually at their July meetings to enhance scrutiny’s consideration of performance achievements and challenges over the preceding year, alongside earlier engagement with the forward-looking demographic, policy and financial analysis in the State of the County report; and
• A proposal that each scrutiny committee holds an annual work planning awayday in early September, to enable further consideration of issues arising from State of the County for the services within the committee’s remit and to ensure that key issues are incorporated into the committee’s ongoing work programme.

6.2       Place and People Scrutiny Committees will consider the above proposals at their March meetings and, subject to the committees’ agreement, will add the relevant items to their future work programmes.

6.3       Scrutiny committee meeting dates in the summer and autumn have also been adjusted to ensure scrutiny has the opportunity to discuss and comment on RPPR information provided to Cabinet in a timely way.

7          Conclusion and reasons for recommendations

7.1       This report provides an overview of recent scrutiny and Audit Committee work, and a look forward at planned activity, for information. It is proposed to provide ongoing quarterly reports on scrutiny activity to the Governance Committee to support increased visibility to all Members of the wide range of work being undertaken by scrutiny and Audit committees.

PHILIP BAKER
Assistant Chief Executive

Contact Officer: Claire Lee
Tel. No. 07523 930526
Email: Claire.lee@eastsussex.gov.uk