An opportunity to question the Cabinet Member for Adults & Health, Cllr Sarah James, on developments within her portfolio.
Minutes:
Cllr Sarah James, Cabinet Member for Adults & Health, opened this item with a brief introduction, reporting to the Panel that the budget had been passed at the Full Council meeting the previous evening. This had included:
· provisions to pay the London Living Wage to care staff and others;
· investment in autism and learning disability services at Waltheof Gardens;
· investment in the Linden Road scheme, providing accommodation for people with autism, learning difficulties and challenging behaviour, which would be coming on stream shortly;
· investment in mental health provision at Canning Crescent.
Cllr James then took questions from the Panel on issues within her portfolio.
Helena Kania asked what measures the Council had put in place to protect workers who come into contact with the public and at hubs such as at Waltheof Gardens from the coronavirus. Cllr James said that health advice was being distributed, including by text message from GP practices. The national general health advice is being followed which includes, for example, to self-isolate if displaying any symptoms of the virus. Asked about whether extra provision of hand gels and disinfecting stations would be provided at certain places, Beverley Tarka, Director of Adults and Health, said that Will Maimaris, Director of Public Health, is in close contact with Public Health England and that the whole issue of additional sanitisers had been discussed within the Council. However, at this stage, the conclusion was reached that this was not a proportionate response and could create additional anxiety within staff. The Council was following the Department of Health guidelines and referring staff to these guidelines on the advice of Public Health England. London ADASS (Association of Directors of Adult Social Services) is currently conducting a survey of all London Boroughs to establish what additional support is required for home care providers.
Cllr da Costa commented that the Council’s response was, in his view, a different interpretation of the Public Health England advice which he said was encouraging companies to ensure that people in offices clean and disinfect their hands.
Asked about how Same Day Emergency Care (SDEC) in hospitals might impact on Council services, given that some of these patients being sent home will require more social care, Cllr James said that this will required joined up care and would be addressed through the Borough Plan and partnership working. John Everson, Assistant Director for Adults, added that the Council is working closely on this with the CCGs, Acute Trusts and the A&E Delivery Boards. Any impact on discharge would need to be worked through with the Council as discharge wouldn’t be possible without certain Council facilities such as Single Point of Access, Reablement services or intermediate care beds. Work was ongoing on this issue but it was not an area that had been identified as a risk at this stage. Helena Kania expressed concern that statistics might not be collected on what happens to patients after SDEC and on whether they require further hospital treatment. John Everson responded that the Council does already measure the number of people who are discharged but return to hospital within 91 days but acknowledged that this is an important point and would take that away to consider.
Asked by Cllr Da Costa what risk assessment the Council had carried out regarding the government’s proposed new points-based immigration system and the potential loss of care workers, Cllr James noted that the Council’s plans to pay care workers the London Living Wage is expected to help with the recruitment and retention of staff. She acknowledged that there had already been concerns about the impact of Brexit on foreign workers in the care sector prior to these proposals so it would be necessary to ensure that those who need to apply for settled status are aware of this and do so. Some coordination across the NCL area may be necessary on how to deal with threats to the sustainability of the labour force and to make those views known to the government.
Referring to an article in the Guardian newspaper on 18th February 2020, which reported that over 22,000 residents in the NCL area had not received mail sent to them from Barnet and Chase Farm Hospitals following an error by a private contractor, Cllr da Costa asked what contact there had been between the Council and the NHS Trust to ensure that residents were updated on their medical status. Cllr James said that she was not previously aware of this incident but that she would look into this and provide a written response. (ACTION)
Referring to an article in the Ham & High newspaper on 20th February 2020, which reporting on an inadequate CQC rating for Alexandra Park care home, Cllr da Costa asked what communication between the Council and care home was ongoing. Beverley Tarka said that quality assurance colleagues were working closely with the CQC and the care home, will support the care home and their service improvement plan and are in the process of reviewing the Council’s six clients within the home.
Asked by Cllr Berryman why the capital costs to rebuild Osborne Grove nursing home had escalated from an estimated £7.9m in June 2018 to £35.9m in the budget papers in February 2020, Cllr James said that the original budget line in 2018 was a very rough estimate at best and was based on plans for a much smaller building. The opportunity to expand the site to 70 beds obviously comes with significant additional costs attached to it. It has been through a feasibility study and a process of consultation and co-design process and there had been a suggestion of adding supported housing units to the site as well which was the subject of further work and had pushed the costs up further. GLA funding may be available for this, which could mitigate some of the costs. Cllr Berryman responded that the June 2018 estimate in the Cabinet report had also been for a 70-bed home so this did not explain such a large rise in costs and asked for further details about the supported housing. Beverley Tarka clarified that the recent Cabinet paper was concerned only with the rebuild of the 70-bed care unit but that work was still ongoing work concerning the other site at the front which would be subject to another Cabinet decision. She also said that the more recent proposals for the care unit included a more specialised specification which took on board proposals from the co-design group for the various client groups. Cllr Connor said that the Adults & Health scrutiny panel would continue to monitor the capital spend on Osborne Grove.
Asked by Cllr White for an update on the Waltheof Gardens project, Cllr James said that this was in two parts, a centre for people with autism/learning difficulties and an autism hub to be run by people with autism. She had met with the designers earlier in the week and there had been a lot of input from carers with work on site expected to begin soon which would take around 10 weeks. Potential service users were already in the process of being identified and feedback from carers had been optimistic about the project and positive about the co-design process.
Asked by Cllr Connor whether a dementia hub would be provided in the east of the Borough to mirror the service provided by the Haynes Centre in the west of the Borough, Cllr James said that a review of dementia provision was ongoing which would look at whether more services are needed. She added that the Haynes Centre staff currently do a lot of work to upskill providers elsewhere in the Borough such as at the Grace Organisation and the Cypriot Centre.
Cllr Connor asked for clarification about the funding and delivery models to pay the London Living Wage which, according to the papers from full Council the previous day, had been described as cost neutral by 2024. Beverley Tarka said that, as well as paying the London Living Wage, the aim was also to get quality returns from providers and so the tendering process would identify a smaller number of providers that are able to meet those quality standards. The Council also aims to increase the use of Direct Payments which are known to be the most cost effective way of delivering social care, as well as giving service users more choice and control. However, only around 25% of payments are made through this route currently so there would be a strand of work to increase the number of Direct Payments workers. That team has a duty to review on a regular basis how money is being spent and whether it is meeting the needs of the care package. Finally, there would be a strand of work to increase the use of assistive technology, which can promote the independence of service users and reduce the cost of paid care. These measures, taken together, would help to mitigate the additional costs associated with paying the London Living Wage to care workers. Asked about the additional social isolation that could result from replacing some care work with assistive technology, Beverley Tarka said that paid care hours would not be taken away but rather that the assistive technology would improve the overall quality of the care package provided. However, the Council recognises social isolation as a problem and the Connected Communities programme aims to take action to address this.
Cllr Connor asked what was being done to establish what would happen financially next year given that the government had provided a one-off £4.9m additional payment for social care this year. Cllr James and Beverley Tarka acknowledged that there was no guarantee of receiving such funds in future years but that the Council monitors the situation through various sources such as London ADASS.