Agenda and minutes

Apologies were received as follows:

• Councillor Begum
• Councillor Ethapemi
• Councillor Moeen (substituted by Councillor Akram)
• Mr Simon Goulden

Members are invited to declare at this stage of the meeting, the nature and existence of any relevant disclosable pecuniary or personal interests in the items on this agenda and to specify the item(s) to which they relate.

Personal interests were declared as follows:

• Councillor Sheth – Lead Governor of Central and NWL NHS Foundation Trust
• Councillor Matin – employed by NHS
• Councillor Seelan – spouse employed by NHS
• Councillor Akram – family member is a service user of a daycare centre
• Councillor Collymore – health educator for Brent Mencap and patient voice member for CNWL and NHS NWL
• Councillor Fraser – adult carer

To hear any deputations received from members of the public in accordance with Standing Order 67.

There were no deputations received.

To approve the minutes of the previous meeting as a correct record:

4i. 9 March 2022

4ii. 14 March 2022

The minutes of the meeting on 14 March 2022 were approved as an accurate record of the meeting.

There were no matters arising.

For the Community and Wellbeing Scrutiny Committee to receive an outline of the community based specialist palliative care improvement programme.

Tom Shakespeare (Director – Brent Integrated Care Partnership (ICP)) introduced the item about end of life care in Brent. He advised that officers had undertaken service user engagement with events in the borough and were now at a point where there was good understanding of the issues people faced in relation to end of life care. There was now an opportunity to shape the model of care going forward, and as that started to develop there would be a need to engage again with communities as well as councillors more broadly on what those options would look like. As the model developed, officers would want to build on the work of the Brent Health Matters Programme, ensuring that the people using services were representative of local communities and listening and responding to the needs of patients. He acknowledged the concern in Brent around the closure of the Pembridge Unit which had presented a number of challenges, and advised the Committee that he had been assured that the resource that had always been tied within Pembridge had remained within the system and invested in end of life care in the borough. 

Jane Wheeler (Director – Local Care, NHS North West London) spoke about the common themes they heard when engaging residents, including the wish for speed, but also to engage with the voice of people that they did not usually hear from and reach communities who were not accessing services. There was a need to balance those two wants together, getting to an end point quickly, but respecting the need to do that in partnership with hyper local communities as well as communities that spanned North West London (NWL). There was now a weekly model of care meeting with an equal number of professionals and residents in the room, made up largely of relatives and carers of service users. The group was working to understand what ‘good’ would look like for the future, ensuring that everyone was using the same language to describe the same issues. It was difficult to quantify need, which meant the work was slow, but they expected to get a shared view of what was needed over the next couple of months. At all stages, the ICP were working in an open and transparent way in informal forums, at borough level, and across NWL to do that options work in collaboration with communities.

Janet Lewis (Director of Operations, Central London Community Healthcare (CLCH)) added information specifically in relation to the Pembridge Unit. The Committee were advised that the unit remained suspended, as CLCH had not been able to recruit consultant support for the unit. A bedded unit like Pembridge required intense consultant support and there had been several rounds of recruitment with limited success, including working with other providers to see if there was cover availability but that had not been possible. A recent recruitment exercise for a Community Consultant Specialist Palliative Care Lead with similar challenges had led officers to believe that they would not be  ...  view the full minutes text for item 6.

For the Community and Wellbeing Scrutiny Committee to receive an update on Adult Day Care Services.

Lynette Gbedze (Market Oversight Manager, Brent Council) explained that there were 13 day opportunity providers in Brent, 2 of which were in-house. The Council were working closely with providers and had done since the start of the pandemic, staying very engaged with them. During the pandemic, day services had paused, but engagement with providers continued through meetings and forums, and the public health team had provided support and local guidance on how to manage infection in local services. Operations had to change as building based services were no longer possible, and day services adopted a creative approach to deliver services with a hybrid offer. This included virtual activities as well as activity packs sent to people in their homes, and providers had assisted service users with practical issues such as shopping and essential needs. Tiffany Adonis-French (Head of Services Access information and Long Term Support, Brent Council) highlighted that the face of day opportunities had changed nationally as a result of the pandemic. The model of delivery was changing everywhere and there were signs of that in Brent too.

The Chair thanked officers for the introduction and invited comments and questions from those present, with the following issues raised:

The Committee asked how easy it would be for a Brent resident, who may not know such services existed, to reach out and get onto the system for day opportunities. They highlighted that the figures in the report detailing total number of service users was quite low in light of the population of Brent. Tiffany Adonis-French advised that the Council were always taking steps to encourage accessibility and visibility of Adult Social Care services in Brent, working closely with community stakeholders and colleagues across the Integrated Care Board (ICB). Most referrals were received through the Brent Customer Service Centre, which was the main point of access for residents in the community. The Adult Social Care team also worked closely with GPs across the borough to encourage them to include information on access to Adult Social Care services in their practices.

Committee members highlighted table 3.3 of the report, which detailed support need figures for learning disabilities / mental health and asked why the 2 were combined. They felt the presentation of data could be interpreted as saying that Brent only provided services for those with learning disabilities if they also had a mental health need. Tiffany Adonis-French confirmed that they were separate, and there was a cohort of residents with a learning disability and a cohort of residents with mental health needs that were supported separately. She also recognised there were a number of residents who had a dual diagnosis of a learning disability and mental health need. It was agreed that the Committee would be provided with the figures for each cohort separately for a truer reflection.

In relation to performance, the Committee queried how that was measured at a personal level. Lynette Gbedze advised the Committee that the Community and Prevention Team within Commissioning did quality assurance work, where  ...  view the full minutes text for item 7.

For the Community and Wellbeing Scrutiny Committee to receive an update on the Shared Lives Scheme and Tudor Gardens.

Martin Crick (Team Manager - Commissioning Contracting and Market Management, Brent Council) introduced the report, focusing on the section on the Shared Lives Scheme. The scheme was for service users over the age of 16 and aimed to match service user needs with registered carers. The match process considered age, gender, ethnicity, culture and support needs. The service user then lived with the carer and their family. Terryann Ebanks-Thelwell (Direct Services Service Manager, Community Assessment and Well-being, Brent Council) introduced the section on Tudor Gardens; a 24-hour supported living service for people with learning disabilities. The service was regulated by the Care Quality Commission and rated ‘good’. Accommodation was purpose built and consisted of 3 separate buildings with 5 self-contained flat lets in each building. The service was currently at full capacity, and all 3 buildings had a mixture of male and female residents between the ages of 32-74.

The Chair thanked officers for their introduction and invited comments and questions from those present, with the following issues raised:

The Committee highlighted the reference in the report to move from a CQC rating of ‘good’ to an ‘outstanding’ rating, and queried how that would be achieved and what the timeframes were for that. It was explained that Tudor Gardens had not received a positive CQC report in 2017 but had made huge improvements in 2018 and the inspectors had been very positive about the improvements made. The service was re-inspected in March 2022 and remained at a ‘good’ rating. A service improvement plan was in place looking at how that rating could increase to ‘outstanding’. In order to improve that rating there was a focus on a strength-based approach to promoting what people could do for themselves and there were a number of residents in college and work experience. The service promoted independence and partnership working so that people’s lives felt fulfilled. Officers had supported people applying to an NCIL bid to upgrade their homes, and when the service was next inspected officers would be able to show that the service was supporting people, in a person-centred way, to live their lives more independently. The timeframe for improvements was 12 months. Phil Porter (Strategic Director Community Wellbeing, Brent Council) added that the CQC had done a lot of research to understand what drove good performance and improvement and found that continuity of leadership made a big difference, meaning the sustained leadership of the team was important.

One of the challenges faced was recruitment, as while there was good retention of staff in Tudor Gardens, it was a challenge to find qualified staff with specialist expertise of people with learning disabilities.

The Chair thanked housing colleagues for their responses, and drew the item to a close. He invited members of the Committee to make recommendations, with the following RESOLVED:

i)              To visit Tudor Gardens to see the improvement being made.

For the Community and Wellbeing Scrutiny Committee to receive a report about how carers access services in Brent.

Councillor Nerva (Cabinet Member for Public Health and Adult Social Care, Brent Council) introduced the report, which provided an overview of the arrangements in place for carer support in Brent, which was key to ensuring people could be supported in home settings. He acknowledged that many present had declared that they were carers in some way. The report was presented in advance of formal procurement for carer services, and he confirmed there was opportunity for future involvement from scrutiny in the procurement process.

Tiffany Adonis-French (Head of Services Access information and Long Term Support, Brent Council) added to the introduction. The definitions used for ‘carer’ in the report and the numbers referred to were in relation to the Care Act definition and assessment process, but she acknowledged the vast number of informal care arrangements happening across Brent. Anyone could be a carer and often people did not recognise themselves as being a carer. Data from the 2011 census showed there were over 26,000 carers in Brent, of which the Council were supporting just over 650. She noted that there would be more up to date information from the 2021 census soon. As such, the Council were recognising the need for higher levels of engagement to give people the opportunity to come forward and be recognised and supported as a carer.

The types of services carers were currently engaging with were respite services, sit-in services and day opportunities, and a number of carers received support through direct payments. The Council was relaunching its Carer’s Strategy which would speak to 3-4 strategic objectives to benchmark against. This would include a Carer Strategy Delivery Board made up of local authority officers, community stakeholders, and a range of carers. A carer’s forum was also being set up as an opportunity for all adult carers to have a place to go with their particular issues and get assurances that their concerns were being listened to and addressed.

Lynette Gbedze (Market Oversight Manager, Brent Council) concluded the introduction, explaining that the Brent Gateway Support Services contract would be coming to an end during the year, and so a retendering process would happen. Officers were undertaking market engagement events and meeting with carers in the community, the Brent Carers Forum and Ashford Place to get feedback on what had worked well with their support services so far to inform the specification moving forward. Officers would like to come back to the Committee with that new specification for comment.

The Chair thanked officers for their introduction and invited comments and questions from those present, with the following issues raised:

The Committee asked where carers turned to if the behaviour of the person they cared for deteriorated and they did not know what to look for online. They were advised that Gateway had been used all around the borough for carers to access services anywhere in Brent, which is what the specification had asked for. Gateway had a base in Bridge Park and attended different day centres on various  ...  view the full minutes text for item 9.

The report updates Members on the Committee’s Work Programme for 2022/23.

The Committee approved the work programme.

Notice of items to be raised under this heading must be given in writing to the Head of Executive and Member Services or her representative before the meeting in accordance with Standing Order 60.

None.