Report to:	Governance Committee
Date of meeting:	13 December 2022
By:	Assistant Chief Executive
Title:	Quarterly Scrutiny 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 scrutiny and Audit Committee activity and the current work programmes at appendices 1-4.

2) agree to receive update reports on a six monthly basis in future.

1          Background

1.1       These regular reports aim to provide the committee with a summary of scrutiny activity across the People, Place and Health Overview Scrutiny Committees and the work of the Audit Committee to support the visibility to all Members of the wide range of work being undertaken by the scrutiny and Audit committees.

1.2       These updates have been produced quarterly over the past year, during a period in which scrutiny committees have reviewed and updated their work programmes significantly and begun a range of new projects.  It is now proposed that the reports are prepared on a six monthly basis in future to allow scrutiny activity to develop further between updates. This approach has been supported by the Scrutiny and Audit Committee Chairs and Vice-Chairs Group.

1.3       This report outlines developments since the last update in September, focusing particularly on the committee meetings held at the end of September which were not covered by the previous report. The current work programmes for the committees are attached at appendices 1-4. An overview of planned scrutiny review and Reference Group activity over the coming months across the three scrutiny committees is attached at appendix 5.

1.4       A scrutiny leadership workshop has been arranged for Chairs and Vice-Chairs to consider effective strategic leadership of the scrutiny work programme, to be followed by questioning skills training open to all Members early in the new year.  

2          People Scrutiny Committee

2.1       The committee’s latest work programme (attached at appendix 1) captures the full range of activity underway or planned. Key elements are outlined below.

Committee meetings and awayday

2.2       In early September the committee held its annual work planning awayday which provided an opportunity to consider current and forthcoming challenges for the services within the committee’s remit and areas Members wished to prioritise for further scrutiny. This followed on from consideration of the State of the County report in July. Committee members discussed and asked Directors questions about implementation of the planned reforms to charging for Adult Social Care and new Care Quality Commission assurance inspections of Adult Social Care, drivers of attainment in East Sussex schools, plans for implementation of the Schools White Paper, and drivers of rising demand to support teenagers in social care. The committee agreed to establish a Reference Group on the Adult Social Care reforms to consider their implementation and impact on the Council. The committee also requested, and has now received, briefings on Public Health work to support food partnerships in the County and on plans for Family Hubs in Children’s Services. In addition, as part of the RPPR process, the committee considered potential areas for one-off investments identified by services and agreed comments to Cabinet in relation to these.

2.3       The committee met on 27 September 2022 to consider:

· The Annual Review of Safer Communities Performance, Priorities and Issues – the committee received an annual update on the work and performance of the East Sussex Safer Communities Partnership and asked questions on trends in reports of Anti-Social Behaviour (ASB), domestic abuse figures and comparatively high numbers of high-risk cases, changing social attitudes to ASB, training to change attitudes, availability of county lines data, and learning from the change in provider of refuges in 2021. The committee also requested an update on some data included in the report.

· East Sussex Safeguarding Adults Board Annual Report 2021-2022– the committee received an annual update on the work of the East Sussex Safeguarding Adults Board (SAB) and asked questions about the partnership protocol the SAB has with other safeguarding partnerships, reasons no outcome of complaints may be recorded, and efforts to support financial inclusion of older aged residents. The committee asked for an update on latest figures for safeguarding referrals from GPs and for confirmation a webinar on safeguarding referrals had been implemented for East Sussex Healthcare Trust staff.  

· Reconciling Policy, Performance and Resources (RPPR) update – the committee considered the RPPR update report to September Cabinet which provided an update on the policy and financial context for our planning for 2023/24 and beyond. The committee asked about: expected use of national funding announced alongside the new Plan for Patients, provisions to manage financial uncertainty facing ESCC, for clarity regarding the projected deficit in the Medium Term Financial Plan, and for more detail on use of the proposed one-off funding to support recruitment and retention. The committee also asked to receive a copy of ESCC’s Market Sustainability Plan when published. Members were also able to ensure that key areas of interest were reflected in the committee’s work programme.

· Work programme update – the committee considered feedback from scrutiny activity undertaken since the July committee, agreed updates to the work programme following the work planning awayday, and requested a report on ESCC’s work to deliver the Armed Forces Covenant.

· East Sussex Safeguarding Children Partnership Annual Report– the committee received a report from the Independent Chair on the work of the Partnership. The committee asked questions about appropriateness of resourcing for safeguarding work, child exploitation in work, supervision caseloads, safeguarding of Electively Home Educated (EHE) children, pressures facing Child and Adolescent Mental Health Services and assessment of child exploitation risk. The committee asked for further information on licenses granted to employ children and agreed to write to Government on concerns about changes to Government’s plans to legislate for councils to keep a register of EHE children.  

2.4       The committee met again recently in late November to consider reports on the below topics – further detail will be provided in the next update report once meeting minutes are available:

· An update on work to address challenges with recruitment and retention in the ASC workforce.

· An update on ESCC’s work on EHE and national policy developments in this area.

Reference Groups and Briefings

2.5       On 13 September, members of the committee received a briefing presentation from the Adult Social Care and Health (ASCH) department on community safety, the role of councils and councillors in community safety, the work of the Safer Communities Partnership, and the role and work of the Safer East Sussex Team. Following the briefing, further information on the Get Safe Online and In My Shoes projects was provided to committee members.

2.6       The committee has two ongoing Scrutiny Reference Groups which are continuing their work to provide Member input to areas of work being led by departments during the autumn:

· Loneliness and Resilience Reference Group (membership: Councillors Clark, Geary, Howell, Maples, Ungar (Chair) and Webb). The group has provided ongoing Member input to Public Health-led work to consider the impact of loneliness on East Sussex residents and identify opportunities for a systematic approach to mitigate its worst effects. Following input from the Reference Group earlier in the year, ESCC Officers and partners have considered the final project report and how to take forward its recommendations and have agreed next steps. A final meeting of the Reference Group took place on 29 November to consider the final recommendations and next steps, as well as what and how the Group would report back to the committee on this project.

· Health and Social Care Integration Programme (HASCIP)Reference Group (membership: Councillors Clark, di Cara, Geary (Chair), Ungar and Webb). This group meets as required to review the latest developments in local health and social care integration. A meeting of the group took place on 22 November to consider the draft Sussex Integrated Care Strategy ahead of the Strategy being considered by the Lead Member for Strategic Management and Economic Development and East Sussex Health and Wellbeing Board. The Group has also agreed they will continue to provide additional Member oversight and scrutiny to HASCIP update reports received by the Health and Wellbeing Board.

Scrutiny Reviews

2.7       The committee’s programme of scrutiny reviews is currently as follows:

Use of technology and digital in Adult Social Care	The committee has agreed to undertake a review of the ASCH Department’s work to encourage greater use of self-service and digital services,    such as online financial assessments and needs assessments, by those who are able to use them. The Review is particularly exploring what cultural and behavioural changes are needed to support the Department’s planned direction of travel in moving towards being ‘Digital by Default.’ The review has been taking place this autumn, with the Review Board meeting in September, October and November to consider a range of evidence including the perspective of current service managers, current take-up of online and self-service portals, learning from approaches taken by other authorities to encourage channel shift and greater use of Online Financial Assessments, learning from the approach of NHS partners locally and the Department’s work to employ behavioural change approaches to increase use of Online Financial Assessments. The Review is due to report to the committee in December. Review Board membership is Councillors di Cara (Chair), Geary and Maples.
Adult Social Care Equalities and Inclusion	The committee held a scoping meeting on 1 July to consider a potential review to examine progress in implementing the ASCH Equalities and Inclusion strategy. Members agreed that, while they were encouraged by the presentation demonstrating the level and detail of work underway to tackle equality issues, have inclusive services, and create a safe, fair and inclusive work environment for staff, there were issues that could benefit from closer examination by scrutiny, particularly work to define and engage with seldom heard groups and assess whether residents of all backgrounds know how to access and have confidence in ASC services. The committee agreed to proceed with a review which will begin during the winter and has agreed Terms of Reference. Review Board membership is Councillors Geary, Ungar (Chair) and Webb.
Prevention in Children’s Services	The committee held a scoping meeting on 11 July to consider a potential review to consider how preventative approaches and early intervention can play a role in improving the sustainability and effectiveness of Children’s Services. The Board received a presentation from the Department on the national policy context and evidence base surrounding preventative work in children’s services, the current local approach, and the benefits of prevention and early intervention for both service outcomes and effective use of resources. The Board also heard about work underway to strengthen preventative approaches, including plans to develop Family Hubs using one-off Government funding. The Board concluded, on the basis of the discussion with officers, that there were areas within the work the Department had in train to strengthen preventative/early intervention approaches that could benefit from closer examination and challenge by scrutiny. The committee agreed to proceed with a review which will begin during the winter and agreed Terms of Reference. Review Board membership is Councillors Adeniji, Howell (Chair), Field and John Hayling (Parent Governor Representative).
School attendance	The committee undertook scoping earlier in the year 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. The scoping board concluded that a review of this area would be beneficial but that, in light of current pressures on schools arising from COVID and the impact of ongoing COVID disruption on attendance rates, agreed to defer proceeding with this review until Spring 2023 when there is expected to be a clearer understanding of the long-term impact of COVID on school absences. In the interim, an update on school attendance data was reported to the November 2022 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. Following advice from the Department, it has been agreed to restart this review in the new year when the Review Board will be able to hear the outcomes of a project the Department is undertaking with ISOS consultancy on inclusion and use of Alternative Provision; and factor the outcomes of the project into updated Terms of Reference for the review.

3          Place Scrutiny Committee

3.1       The committee’s current work programme (attached at appendix 2) outlines the full range of activity underway or planned. Key elements are described below:

Committee meetings and awayday

3.2       In early September the committee held its annual work planning awayday which provided an opportunity to consider current and forthcoming challenges for the services within the committee’s remit and areas Members wished to prioritise for further scrutiny. This followed on from consideration of the State of the County report in July. Committee members discussed proposals for one-off investments put forward by departments as part of the RPPR process; the local and national policy context including the level of financial uncertainty; progress updates from the review board and reference groups; and additions to the committee’s work programme.

3.3       The committee met on 30 September 2022 to consider reports on:

· Economic Development – Members received a report from the Economic Development Team on how projects are developed and selected for the available funding streams. The report also included information on the governance of projects and measuring outcomes. Members asked questions on the development and monitoring of projects. It was clarified that scrutiny could request more information on particular projects at any time and that the governance processes used were open and transparent.  Members requested earlier scrutiny involvement in the development and monitoring process of projects, particularly where projects were encountering delays or difficulties. The committee may consider looking at the stages of the project lifecycle to identify the best place for scrutiny involvement.

· RPPR – as with People Scrutiny, Place Committee considered the RPPR update report to September Cabinet which provided an update on the policy and financial context for our planning for 2023/24 and beyond. The committee commented on the level of financial uncertainty, the challenges for the SEND Home to School transport provided by the Transport Hub in the Communities, Economy and Transport Department and asked for information on the progress of the highways patching work which is part of the Visibly Better Highways programme. Members were also able to ensure that key areas of interest were reflected in the committee’s work programme.

· Work programme update – the committee considered feedback from scrutiny activity undertaken since the July committee meeting, agreed the updated work programme following the work planning awayday, and agreed the addition of a presentation and report on the current work and challenges of the Council’s Rights of Way Team.

3.4       The committee met again recently in late November, when representatives from Southern Water attended to outline plans to tackle the discharge of sewage into water courses and the sea in East Sussex following recent incidents. Further detail will be provided in the next update report once meeting minutes are available.

Briefings and Reference Groups

3.5       The Climate Emergency Action Plan (CEAP) Working Group (membership: Councillors Hilton, Hollidge, Holt, Kirby-Green and Redstone (Chair)), established to work with officers on the update of the corporate CEAP, met on 21 June, 15 July, 8 September, 6 October and 20 October. The Group has now completed its work commenting on the draft updated Plan ahead of its consideration by Cabinet in January and County Council in February.

3.6       The Highways Contract Re-Procurement Reference Group (membership: Councillors Kirby-Green (Chair), Beaver, Collier and Hollidge) met on 26 September to consider the report to Cabinet on the award of the contract. The Reference Group endorsed the recommendations and agreed that future scrutiny of the contract’s implementation will be undertaken by the Place Committee. The Group’s conclusions were presented to Cabinet by the Chair.

3.7       On 2 September the Local Transport Plan (LTP) 4 Reference Group (membership: Councillors Beaver, Collier, Hilton, Hollidge, Holt, Lunn, Redstone (Chair) and Stephen Shing) received a briefing on the Transport for the South East (TfSE) Strategic Investment Plan. Future meetings will be scheduled to coincide with the key stages of the LTP revision project, with the next meeting scheduled for February 2023. There has been some delay in the work of Group due to a delay in Government issuing revised guidance for LTPs, which is now due later in the year. The Reference Group plans to start work by exploring key policy areas.

Scrutiny Reviews

3.8       The committee’s current active scrutiny reviews are as below:

Procurement	The review is focusing on Social Value and buying local initiatives. Membership is Cllr Collier (Chair), Cllr Hilton, Cllr Redstone. The review board met on 26 July to comment on the draft Social Value Policy and review the existing Social Value Charter and current policies and procedures. Further review board meetings were held during the autumn with the review now extending into the new year to consider further evidence and accommodate Member availability, with a view to reporting back to the Place Scrutiny Committee at its meeting in March 2023.
Highways Maintenance	Members have agreed to scope a potential review looking at highways maintenance. This topic had been discussed in some detail at both the Highways Contract Reference Group and at the March committee meeting. There is an interest in reviewing the maintenance polices that affect the condition and roads and pavements, and the previous scrutiny work in this area. This is likely to include the intervention levels for repairs, current issues, performance measures and the funding available for highways maintenance. A scoping meeting is planned to take place in early 2023 with the outcome to be reported back to the committee.
Climate Change	The committee discussed establishing a review board to review the Council’s countywide work on climate change, which could look at countywide actions and how the Council works with other organisations (e.g. District and Borough councils) on this issue. This would follow on from the work on the corporate Climate Emergency Action Plan. It was agreed to add this as a potential scrutiny review topic to the committee’s work programme and hold a scoping meeting at an appropriate point to develop a draft terms of reference for the review.

4          Health Overview and Scrutiny Committee (HOSC)

4.1       Key work priorities for HOSC are set out in the attached work programme (appendix 3) with highlights below:

Committee meetings

4.2       The HOSC met on 22 September 2022 to consider reports on:

• Child and Adolescent Mental Health Services (CAMHS) – the committee considered an update on the CAMHS service in East Sussex, including the progress being made to reduce assessment waiting times and the impact of additional investment in CAMHS on service provision and performance. The committee agreed to request a future report on the progress of the waiting times for CAMHS, including progress on the development of the neurodevelopmental pathway, figures for the numbers of young people waiting more than 52 weeks, and how long young people wait between assessment and the beginning of treatment.
• Hospital handovers – the committee considered the work being undertaken to reduce hospital handover times by the Ambulance Service, Adult Social Care and the various hospital trusts the serve the residents of East Sussex. The committee agreed to have a further update report after the winter period at the June 2023 meeting.
• South East Coast Ambulance Service NHS Trust (SECAmb) Improvement Plan - the committee considered a report providing an overview of SECAmb’s Care Quality Commission (CQC) report findings, following a rating of inadequate in the well-led domain, and the Trust’s Improvement Plan. Members agreed to request a further report on the progress of SECAmb exiting the Recovery Support Programme at its 29 June 2023 meeting and to have SECAmb monthly Board updates and any further CQC reports circulated to HOSC members via email in the meantime.
• HOSC future work programme – the committee considered its future work programme priorities and agreed to add update reports on CAMHS, Hospital Handovers and the SECAmb CQC inspection improvement plan.

4.3       Key future committee agenda items include:

• Reconfiguration of cardiology services at East Sussex Healthcare NHS Trust (ESHT) – the committee will consider the NHS decision on the reconfiguration of cardiology services at its December meeting. Further detail at section 4.5 below.

· Reconfiguration of ophthalmology services at ESHT – the committee will consider the NHS decision on the reconfiguration of Ophthalmology services, which includes focussing service provision at the Bexhill and Eastbourne DGH hospitals at its December meeting. Further detail at section 4.5 below.

• Primary Care access and next steps on integrating primary care. Consideration of a report providing an update on GP access including the eHubs pilot and the next steps on integrating primary care strategy. It will also include access to NHS Dentistry following a request from the East Sussex Health and Wellbeing Board (HWB).
• The performance and future plans of Primary Care Networks, which will include the development of Emotional Wellbeing Services for residents requiring primary mental health interventions.
• Proposals to move adult burn services from Queen Victoria Hospital in East Grinsted to a major trauma centre in the South East (timing dependent on NHS England).
• Proposals to re-procure the Sexual Assault Referral Centres in Sussex (timing dependent on NHS England).

Reference Groups and briefings

4.4       A small group of HOSC members, including the Chair, visited the Crowborough Minor Injuries Unit (MIU) on 8 November to discuss the service and use of the space at the MIU.

Scrutiny Reviews

4.5       HOSC has been focused on completing the following substantial variation to services reviews by the end of 2022:

Cardiology

The committee agreed that proposals for reconfiguration of cardiology services provided by ESHT constitute a ‘substantial variation’ to services requiring formal consultation with HOSC.   The HOSC submitted a report and recommendations for NHS Sussex to consider alongside its Decision Making Business Case (DMBC) and the public consultation outcomes. NHS Sussex will then return to HOSC setting out the reasons for its decision. The HOSC will consider whether the decision, which includes single siting cardiology catheter labs and specialist cardiology to either Eastbourne DGH or Conquest Hospital, is in the best interests of health services locally. NHS Sussex has subsequently confirmed that, following the completion of the options appraisal process for the site of the specialist interventional cardiac services (cardiology catheter labs), the recommended site has been identified as Eastbourne DGH and this will be specified in the DMBC. Consideration of the decision is subject to the NHS timelines – which were delayed pending a review of the capital envelope due to the impact of inflation – with the final HOSC review of the NHS decisions now taking place at the 15 December 2022 HOSC meeting, following NHS Sussex sign-off during October and November. Membership of the Review Board (now complete) comprised Cllr Belsey, Robinson (chair), Turner (Hastings Borough Council representative), di Cara and Marlow-Eastwood.

Ophthalmology

The committee agreed that proposals for reconfiguration of ophthalmology services provided by ESHT constitute a ‘substantial variation’ to services requiring formal consultation with HOSC.   The HOSC submitted a report and recommendations for NHS Sussex to consider alongside its DMBC and the public consultation outcomes. NHS Sussex will then return to HOSC setting out the reasons for its decision. The HOSC will consider whether the decision, which includes reducing day case and outpatient ophthalmology from three sites to two, is in the best interests of health services locally. Consideration of the decision is subject to the NHS timelines – which were delayed pending a review of the capital envelope due to the impact of inflation – with the final HOSC review of the NHS decisions now taking place at the 15 December 2022 HOSC meeting, following NHS Sussex sign-off during October and November. Membership of the Review Board (now complete) comprised Cllr Belsey (chair), Robinson, Azad and Brett (Lewes District Council representative) and Geraldine Des Moulins (VCSE Alliance).

4.6       HOSC will consider further topics for review in the new year, which will include any further substantial variations to services proposed by the local NHS.

Other Issues

4.7       A report or awayday will be arranged to consider the implications for the committee of the Health and Care Act 2022, including the replacement of East Sussex Clinical Commissioning Group (CCG) with the NHS Sussex Integrated Care Board (ICB), the creation of the Sussex Integrated Care System (ICS), and the effect of regulations that allow the Secretary of State to intervene in local service reconfigurations on HOSC’s powers to refer decisions to the Secretary of State. Guidance has been issued by the Department of Health and Social Care on how HOSCs and ICSs are expected to work together and this is currently being reviewed to understand any impacts on HOSC’s work.

5          Audit Committee

5.1       The committee’s future areas of focus are set out in the work programme attached at appendix 4.

Committee meetings

5.2       The Audit Committee met on 23 September 2022 to discuss reports on:

• Internal Audit Progress Report – Quarter 1 2022/23
• CIPFA Financial Management Code
• Strategic Risk Register – Quarter 1 2022/23 – The committee resolved to request a session for the Audit Committee to conduct a ‘deep dive’ into the Strategic Risk Management framework to explore the processes and governance using Risk 12 (Cyber Attack) as an example.
• Managing Back Office Systems (MBOS) Update
• Audit Committee Work programme

5.3       The committee met again recently in late November to consider reports including the quarterly Internal Audit report, annual update on Property Investment Strategy, and the 2021/22 Statement of Accounts.

Briefings and working groups

5.4       Two training sessions were provided to the committee on 23 September covering counter fraud work and risk management.

5.5       A ‘deep dive’ session to explore the Risk Management framework (as mentioned above) will be held on 31 March ahead of the Audit Committee meeting.

5.6       The Working Group which is providing oversight of the MBOS programme implementation met on 26 August and discussed the MBOS project entering into User Acceptance Testing and the impact of Payroll Parallel Run as a critical stage of the project. A further Working Group meeting was held on 22 November.

6          Conclusion and reasons for recommendations

6.1       This report provides an overview of recent scrutiny and Audit Committee work for the committee to note. It is also recommended that the committee agrees to receive future reports on a six monthly basis to enable scrutiny activity to develop further between updates.

PHILIP BAKER
Assistant Chief Executive

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