Agenda and minutes

Apologies for absence had been received from Councillor Reeta Chamdal (Councillor Colleen Sullivan was present as her substitute) and Councillor Alan Chapman (Councillor Richard Mills was present as his substitute).

There were no declarations of interest in matters coming before this meeting.

It was noted that Councillor Labina Basit had not been present at the meeting on 19 July 2022. 

RESOLVED:  That, subject to the above amendment, the minutes of the meeting held on 19 July 2022 be agreed as a correct record.  

RESOLVED:  That all items of business be considered in public. 

Mr Andy Goodwin, the Council’s Interim Financial Planning Manager, noted that this was the first of two reports that would be considered over the course of the municipal year by this Committee.  This report set out the Council’s broader financial position, identifying the budget gap and the savings that would be needed to bridge that gap.  The report that would be considered by the Committee in January 2023 would focus on detailed budget proposals for 2023/24.  The 2023/24 budget would then be agreed by Council at its meeting on 23 February 2023.  Members asked that examples of initiatives undertaken by the Council to reduce costs be included in future reports. 

The country had been facing unprecedented inflationary pressures, with actual inflation expected to exceed the sums built into the Medium Term Financial Forecast (MTFF).  However, an underspend of £46k had been projected across General Fund budgets at Month 3 and a minor overspend of £37k had been reported in Health and Social Care, driven by an increased demand for adult social care services. 

There had been an increase in the Council Tax base and increases in Government grants, although this had been front loaded in 2022/23 as a result of the Spending Review announcements, and an increase in social care funding.  The 2021 Spending Review had been a multi year settlement, increasing and frontloading the social care grant, but this had been offset by the increase in demand for social care services. 

Increases in annual pay and supplier costs were the drivers behind a further uplift of £13.3m.  Members queried how much of the adult social care budget had been allocated for contracts with third party suppliers and asked that this information be included in the report in January 2023.  Mr Goodwin advised that officers from finance and procurement reviewed any increases in contract costs attributed to inflation to identify which elements of the contracts had increased, and by how much, to then be able to negotiate fairly with the contractors. 

Members were advised that the Council pooled its budget centrally (including social care grants) and then worked up a savings programme.  This de-risked grant funding.  Finance continued to work with officers to manage the back office expenditure to maintain frontline services. 

The Council had started to refresh its savings requirement over the budget strategy period, bearing in mind that inflation rates were just under 10%.  The growth in demand for services remained high and continued to be monitored.  The Council would review its savings requirement and look for efficiencies to protect the frontline services as far as was possible, whilst also meeting the requirement to produce a balanced budget each year. 

The Council had reassessed inflationary requirements associated with contracted expenditure for SEND transport and Members queried how this would impact on the service provision.  Mr Goodwin advised that the fuel costs associated with SEND transport would be reduced through the capital programme to increase the number of SEND places across the Borough.  This would potentially reduce the travelling  ...  view the full minutes text for item 26.

Ms Bukky Junaid, the Council’s Interim Head of Service Safeguarding Adults, advised that, in September 2019, the Hillingdon Safeguarding Partnership arrangements were launched in line with the statutory requirements set out in the Children and Social Work Act 2017 and Working Together to Safeguard Children 2018.  The local authority now shared equal responsibility with its statutory partners (the NHS Hillingdon Clinical Commissioning Group/North West London Integrated Care Board (NWL ICB) and Metropolitan Police) to safeguard children and young people.

The Care Act 2014 placed a statutory duty on each Safeguarding Adults Board to produce an Annual Report, outlining the work undertaken to achieve its strategic objectives, the work of each member to implement the Safeguarding Adults Boards’ strategy and detailing the findings of any Safeguarding Adult Reviews and subsequent required actions.  In promoting this joint approach, both boards were now scrutinised and held to account through the multiagency Executive Leadership Group.  The Group was chaired by the local authority's Chief Executive and attended by the senior representatives of the safeguarding partners. 

The Safeguarding Annual Report summarised the work undertaken by Hillingdon Safeguarding Partnership to support and safeguard Hillingdon's residents: adults with support and care needs; and vulnerable children and their families.  The report provided reassurance that the actions taken across the local partnership to prevent abuse, neglect and self-neglect had been effective in the year 2021-2022 and that the Council had discharged its statutory duties to ensure that it learnt from serious incidents and provided strategic leadership for safeguarding.

The Partnership had responded effectively to safeguard residents during a challenging year that began with public health restrictions still in place due to the pandemic.  The pandemic had impacted on all Hillingdon residents’ resilience and, in many cases, on their economic independence.  This had led to an increased dependence on the services available, including the availability of skilled workforce from both the social care and health perspective meaning that there had been significant challenges in maintaining the quality of care available.

The Partnership had maintained effective working arrangements and relationships that facilitated a nuanced and dynamic response to changing local, national and international contexts.  This had included the need to support and safeguard increasing numbers of asylum-seeking children, adults and families and those seeking refuge from conflict in Ukraine.

It was noted that the Partnership had focussed on fostering a culture of empowerment, independence and early intervention for residents in Hillingdon.  Members requested that practical examples of this work be provided to the Committee to illustrate the impact that this had had. 

Mr Alex Coman, the Council’s Director - Safeguarding, Quality Assurance and Partnerships, advised that the child and adult Multi Agency Safeguarding Hubs (MASH) had been established as a front door for care and included representatives from the police, health and care partners.  Daily reviews of presentations were undertaken by the MASH to identify any need for early intervention and wrap around support that spanned adults’ and children’s safeguarding.  It was important to meet the residents’ needs and prevent  ...  view the full minutes text for item 27.

Ms Tina Swain, Service Director for CAMHS and Eating Disorders – Goodall Division at Central and North West London NHS Foundation Trust (CNWL), advised that the team at Hillingdon Child and Adolescent Mental Health Services (CAMHS) provided community mental health services to children and young people up to the age of 18 with complex mental health difficulties (and their families) in a range of different ways, depending on their needs.  A multi-disciplinary team made up of psychologists, psychiatrists and therapists provided assessment and identified the needs of the child in the context of the family.  Treatment could include cognitive behavioural therapy (CBT), family therapy and individuals and group psychotherapy.  Medication was also used when appropriate and would often be prescribed by a specialist but supported by the young person’s GP. 

The Adolescent Community Treatment Service (ACTS) was a community team that provided support for young people aged between 13 and 18 years.  Young people were referred to ACTS by their local CAMHS team because they needed intensive support in the community during their period of mental health crisis.  Wrap around support was then provided for the young person (and their family) and effort was made to keep them in school, etc. 

The CAMHS Urgent Care Teams worked in conjunction with local hospitals and existing local CAMHS services to provide access for children and young people up to the age of 18 to a dedicated crisis and liaison service when they were experiencing an acute mental health or emotional crisis.  A risk assessment was being developed with the hospital team for young people that had presented at A&E. 

Ms Swain advised that there had been an increase in demand for CAMHS services during the COVID pandemic and referrals were now at their highest level ever, impacting on the ability to see children and young people quickly and resulting in a longer waiting list.  However, Ms Swain noted that there had been a reduction in the average time that it took for a young person to receive an assessment after having been referred to CAMHS.  Although Members were pleased that the average wait time for an assessment was down to 10 weeks (against a target of 18 weeks), 10 weeks was still too long for a child to wait to be assessed. 

Members queried how long it would take for these young people to receive treatment after they had been assessed.  Ms Swain stated that she was unable to provide an answer as it would depend on the treatment pathway that each child was following.  Services were designed and offered at a place level in North West London as well as at a system level in an effort to keep the gap between assessment and treatment as short as possible.  Action was also being undertaken to reduce this further and digital initiatives such as Healios had been put in place to support young people outside of traditional interventions.  Other initiatives included weekend clinics, out of hours clinics and Waiting Well (which  ...  view the full minutes text for item 28.

Consideration was given to possible review topics.  Mental health had become a dominant issue with adults and children continuing to experience difficulties in accessing assessment, support and treatment services.  It was agreed that further information be brought back to the Committee at its next meeting on 22 November 2022 about both of these areas so that Members could decide which topic to pursue.  Mental health was thought to be a relevant and sensible area to review but that caution would be needed to ensure that the scope of the review was focussed. 

It was suggested that social prescribing be included as a future single meeting review topic. 

RESOLVED:  That:

1.    further information in relation to adult mental health services and children’s mental health services as possible review topics be brought to the Committee’s next meeting; and

2.    the report be noted.

It was agreed that, subject to the agreement of the Cabinet Member for Health and Social Care, the 2022/23 Better Care Fund Section 75 Agreement Cabinet report be considered by the Committee at its meeting on 7 December 2022 prior to it being considered by Cabinet on 15 December 2022. 

A request was made that the Committee consider the Cabinet report on Approval to establish a new Dynamic Purchasing System (PS) for Transportation Services for Social Care and Children.  As this report would be considered by Cabinet at its meeting on 10 November 2022, it was agreed that the Committee discuss the implementation of the decision once it had been made.  

RESOLVED:  That:

1.    consideration be given to the 2022/23 Better Care Fund Section 75 Agreement Cabinet report at the Committee’s meeting on 7 December 2022;

2.    consideration be given to the implementation of the Cabinet decision on Approval to establish a new Dynamic Purchasing System (PS) for Transportation Services for Social Care and Children after it had been made on 10 November 2022; and

3.    the Cabinet Forward Plan be noted.

Consideration was given to the Committee’s Work Programme. 

RESOLVED:  That the Work Programme be noted.