Agenda and minutes

To note any apologies for absence from Members.

Apologies for absence were received from Councillor S Adams and Councillor L Wardlaw.

To provide an opportunity for Members and Officers to declare any disclosable pecuniary interests, other registerable interests, and non-registerable interests in any item on the agenda.

In the interests of openness and transparency, Councillor Gardiner declared that, in relation to Item 5, he was the Council’s representative on the Cheshire East Learning Disabilities Partnership Board.

To approve as a correct record the minutes of the previous meeting held on 23 September 2024.

RESOLVED:

That the minutes of the meeting held on 23 September 2024 be approved as a correct record and signed by the Chair.

In accordance with paragraph 2.24 of the Council’s Committee Procedure Rules and Appendix on Public Speaking, set out in the Constitution, a total period of 15 minutes is allocated for members of the public to put questions to the committee on any matter relating to this agenda. Each member of the public will be allowed up to two minutes each to speak, and the Chair will have discretion to vary this where they consider it appropriate.

Members of the public wishing to speak are required to provide notice of this at least three clear working days’ in advance of the meeting.

Petitions - To receive any petitions which have met the criteria - Petitions Scheme Criteria, and falls within the remit of the Committee. Petition organisers will be allowed up to three minutes to speak.

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The public speaking procedure was noted. There were no members of the public registered to speak.

To receive a briefing and presentation on the Cheshire East Learning Disabilities Partnership Board & Cheshire East Place Learning Disabilities Plan.

The Committee received an update and presentation on the Cheshire East Learning Disabilities Partnership Board & Cheshire East Place Learning Disabilities Plan (2024-2029) from Mark Hughes, Programme Lead Complex Needs, and Keith Evans, Head of Service: Learning Disabilities and Mental Health.

The Board’s aim was to make life better for Cheshire East residents with a learning disability and their carers, and was made up of partners from a range of organisation's including the local authority, NHS, voluntary sector, community groups, carers and self-advocates.

The Committee received presentations from two self-advocates, Claire Hodkinson and Andrea Dean, who provided the committee with information on what they liked to do, where they saw room for improvement and details on how the services had benefited them, with particular reference to the “staying up late” project which had enabled a self-advocate to attend a recent concert. Sarah Jacklin, Local Area Co- Ordinator, attended to speaking on behalf of Thomas Clapperton, self-advocate, who was unable to attend.

Councillor Gardiner, the Council’s representative on the Cheshire East Learning Disabilities Partnership Board, thanked the self-advocates and their carers for attending and presenting at the meeting, and stated that he wanted to ensure that the services delivered to Learning Disabilities clients were not affected by the Council’s financial difficulties. 

The Committee were updated that Cheshire East Council performed well in providing supported living accommodation, with over 700 units of supported living including Mental Health and physical and sensory impairment, of which 442 are for learning disabilities, and new, high-quality accommodation in the pipeline which would be delivered shortly. There was also work ongoing with the independent sector to start to decommission some of the older, lower quality accommodation, and recommission newer accommodation. A report on strategic investment and provision of supported housing would be brought to a future Adults and Health committee.

There were a number of voluntary and community organisations providing evening activities and the Time Out Group has secured Lottery funding to provide ‘Stay Up Late’ activities. Further work was required to ensure that self-advocates could take full advantage of it, with the biggest challenge being to ensure all providers provide these opportunities for the people they support.

The Committee thanked the self-advocates for attending the committee meeting and noted their comments.

RESOLVED:

That the updates be noted.

To recieve a report on the proposed best practice policy position for supported employment.

The Committee received a report which set out the rationale for investing in supported employment, and the best practice approaches as the Council looked to ensure a consistent approach to the delivery of supported employment within the borough, from Mark Lobban, Interim Director of Commissioning, and Colin Jacklin, Head of External Funding, Complex Worklessness & Inclusion.

The Committee were updated that in 2025 there would be additional external funding to support the team, and the three main focus areas were:

1. Ensuring that right model for supported employment was used;
2. Emphasising the cost savings which this model can produce; and
3. Acknowledging that there would be a further report to Adults and Health committee which would detail the funding schemes for the policy – the Shared Prosperity Fund, and the “Connect to Work” scheme from the Department of Work and Pensions in 2025 which would provide up to £4.5 million to Cheshire East Council over a three year period.

The Committee were updated that Cheshire East Council has an active relationship with potential employers and worked closely with them on a person to person bases to ensure that the correct individual could be supported in each supported employment role. It was noted that employers were supportive of the scheme and there had been a number of instances where roles in hard to fill sectors had been filled with an individual from the supported employment scheme, and Cheshire East Council would be using its supportive apprenticeship scheme to ensure that roles were available within the Council.

The Committee were updated that the Cheshire East Council works with each potential employee to ensure that taking on a paid role would not impact their finances negatively in terms of any benefit entitlements.

RESOLVED: (Unanimously)

That the Adults and Health Committee:

1. Note the content of the report and request a further paper comes back to Adults and Health Committee when there is a substantive decision to be made.

To consider a report which provides the current forecast outturn for the financial year 2024/25 based on income, expenditure and known commitments as at the end of August 2024.

The Committee received a report on the current forecast outturn for the financial year 2024/25 based on income, expenditure and known commitments as at the end of August 2024, which also identified actions being taken to address adverse variances to urgently address the financial sustainability, from Nikki Wood-Hill, Lead Finance Business Partner.

The Committee were updated that, despite making further savings, it was unlikely that the forecast outturn for Adults would reduce significantly from £20.7m. Interventions which had been made had brought the projections down from £28m to £20.7m and the figures were being recalculated on a weekly basis.

It was noted that activity had largely stabilised, and had been steady for a number of years. As a result of the work which “front door” services had undertaken, the number of people receiving a social service from Cheshire East Council had not increased in the way in which would have been predicted. However, it was noted that, since the covid-19 pandemic the service had seen increases to prices as a result of a national increase to wages, inflation, and a general demand for workforce.

The service was proactively investing in services such as Falls Prevention and in the primary care and voluntary sector, to enable people to stay at home for as long as possible and reduce the likelihood of people being hospitalised and requiring longer term care.

The Committee were updated that Cheshire East Council were being rigorous on price increases from providers and as a result were starting to receive notice of ending placements from providers, but were actively working to find new placements for those who had been given notice. Cheshire East Council could not meet price increases which providers were seeking and would not fund price increases where providers could not evidence as a transparent justification, or which didn’t run ahead of costs.

The Committee were updated that no additional requests for exceptional financial support had been made, and that the Chartered Institute of Public Finance and Accountancy (CIPFA), who had undertaken a review of Cheshire East Council as part of due diligence for the Ministry of Housing, Communities and Local Government (MHCLG), had provided feedback on the Adults element which was positive - everything they could think of Cheshire East Council were already doing, and they acknowledged that the issues it faced were largely national factors.

It was noted that Cheshire East Council could assist individuals with negotiations with providers for those who self-funded their care, and would offer advice on the most appropriate facility.

RESOLVED: (Unanimously)

That the Adults and Health Committee:

1. Review the factors leading to a forecast adverse Net Revenue financial pressure of £20.1m against a revised budget of £395.4m (5.1%). To scrutinise the contents of Annex 1, Section 2 and review progress on the delivery of the MTFS approved budget policy change items, the RAG ratings and latest forecasts, and to understand the actions to be taken to address any adverse variances from the approved budget.

2. Review the  ...  view the full minutes text for item 30.

To receive a report which sets out how the Council will resource the achievement of the Council Plan, and sets out progress and further development activity required before the final MTFS 2025-29 is presented for approval to the budget setting Council in February 2025.

The Committee received a report on the Medium-Term Financial Strategy (MTFS) which set out how the Council would resource the achievement of the Council Plan, from Nikki Wood-Hill, Lead Finance Business Partner.

The Finance Sub-committee approved the financial assumptions underpinning the current MTFS at their meeting in June 2024, with a further funding update received in September 2024. It was noted the report had been published prior to the Chancellor’s budget on 30 October 2024, and the impact of increase in wages and national insurance had not been factored in.

The Committee were updated that, in terms of the MTFS for Adults, Health and Integration, most of the savings would be delivered via the Transformation Plan, and the details if this would be provided at Adults and Health Committee in January 2025.

The Committee were updated that Cheshire East Council was looking into alternative options for the provision of Extra Care and school meals. Cheshire East Council had not entered into formal consultation about this and would not be able to do so until the current provision had been withdrawn. It was noted that if the service was to be withdrawn, then an interim solution would be looked in to for the two Extra Care facilities in Cheshire East, which would cover the period from January to April 2025, following which a permanent solution would be in place. A formal consultation regarding Extra Care would take place between January and April 2025. It was noted that if any individual had a social care assessment that stated they required a meal adult social care would find alternative ways of meeting their needs assessment.

RESOLVED:

That the Adults and Health Committee:

1. Note the progress to date on the development of the MTFS for 2025-29.

2. Note that officers will continue to challenge draft proposals and develop further proposals in consultation with Members prior to approval by Council.

3. Note that Committees will be presented with the opportunity to review the full set of financial proposals, designed to achieve a balanced budget, as part of their January cycle of meetings prior to recommendations being made to Council for approval.

To consider a report on the Cheshire and Merseyside Commitment to HIV Fast Track Cities Approach.

The Committee received a report requesting their support for Cheshire East to become part of the Cheshire and Merseyside work to end new HIV transmission in the sub-region by 2030, from Dr Matthew Atkinson, Public Health Consultant. In joining this sub-regional work, the Council would sign up to the HIV Fast Track Cities agenda, and therefore commit to the Paris and Sevilla declarations. All nine local authorities in Cheshire and Merseyside intended to make this pledge.

The Committee were updated that being part of the fast-track approach would bring an increased focus on HIV and would allow Cheshire East Council to benefit from expertise from international networks, and the Cheshire and Merseyside Public Health Collaborative.

It was noted that although HIV could also be contracted via intravenous drug use, this report did not cover that in detail, and Cheshire East Council would be working closely with partners in substance misuse services also.

It was noted that although stigma associated with HIV had decreased, there were still a number of groups of people who would be uncomfortable talking about the disease, and projects would be planned to specifically help those in groups who were not comfortable with discussing it, or did not deem themselves to be at risk. There would also be more work to protect women from contracting the disease. 

The report noted a significant number of those identified as having HIV were not diagnosed until a later stage of the disease. The concern regarding individuals presenting late with the disease was noted, and the Committee were informed that there could be a number of reasons for this; in localities where the risk of HIV was relatively low, the population may be less likely to consciously think of the risk, or have less access to testing. It was noted that, as HIV had been under more control, there had been a rise in sexually transmitted diseases other than HIV.

Education was noted as critical element to the approach. It was noted that most schools have Personal, Social, Health and Economic (PSHE) Education on their curriculum but it is not explicit what has to be taught and different schools will teach different aspects, however, a young person can access sexual health services and GPs confidentially.

It was noted that due to the remaining stigma regarding HIV, individuals may choose to get tested away from their local area. The Committee was notified that there were reciprocal health care arrangements in place in neighbouring Boroughs to encourage testing.

It was noted that Cheshire East Council had started a “needs assessment” which would inform the recommission of the Service in two years’ time.

RESOLVED: (Unanimously)

That the Adults and Health Committee:

1. Support the sign up to the HIV Fast Track Cities agenda, and therefore commit to the Paris and Sevilla declarations. All nine local authorities in Cheshire and Merseyside intend to make this pledge.

2. Put forward a Consultant in Public Health as a key representative from our local sexual health and HIV  ...  view the full minutes text for item 32.

To consider a report on the re-procurement of core systems for adult and children Services.

The Committee received a report on the Service’s requirement to continue with the existing case management, financial systems, and online provision for Adult and Children services, from Helen Charlesworth-May, Executive Director of Adults, Health and Integration. An exercise has started to re-procure a new contract as the current system contracts would expire at the end of March 2025.

The Committee were updated that, due to the requirement of the department to focus on its transformation programme, balancing the finances, and the wider improvements taking place with regards to generative AI and technology in the sector, it would not be a good time for the Service to be procuring a new system. The Executive Director of Adults, Health and Integration had commissioned IT colleagues to undertake an 18-month project to plan for the future of the Service’s IT requirements, and to help determine what would be required in four years’ time.

It was noted that the Service has a level of ongoing improvement with the system, and it worked with its own internal IT department and System C to find solutions to issues with the current software and to ensure that it continued to be fit for purpose. It was noted that the personal information which was used in the system was held on Cheshire East’s servers, and in the last three months there had been an exercise to test what would happen in case of a cyber security attack on the system, to best inform the security which was attached to the system.

RESOLVED: (Unanimously)

That the Adults and Health Committee:

1. Authorise the Executive Director of Adults, Health and Integration, in consultation with Children Services and Corporate Services, to award and enter into a contract to deliver core systems for case management, financial payments, online services.

To consider a report on the new drugs and alcohol plan for Cheshire East.

The Committee received a report seeking approval for the new drugs and alcohol plan for Cheshire East, from Nik Darwin, Acting Programme Lead, Thriving and Prevention/ Live Well for Longer, and Professor Rod Thomson, Interim Consultant in Public Health. The report aligned with the priority within the Cheshire East Corporate Plan of: “a council which empowers and cares about people’. It also aligned with the Government’s 10-year drug strategy: “From harm to hope” and with the Cheshire East Joint Local Health and Wellbeing Strategy 2023-2028.

The Committee were updated that the team were working with local drug project groups and that the commissioned services provided services around needle exchange and screening for blood borne viruses. It was noted that there were instances where people used substances as a means of self-medication and the service would be supportive to them and their issues, and older people who have had long-term alcohol problems, or were habitual users would require different treatment.

It was noted that there were over 14,000 people classed as “high risk” with regards to alcohol consumption across Cheshire East, and 3500 who were alcohol dependent.

The increase in cannabis users in local areas was raised by Members. It was noted that trying to persuade users not to use drugs was a difficult process, but users hearing from those who have dealt with their own issues could be effective and tailored to individual cases.

It was noted that the Service would need to work together with partners to make the best us of the resources available, and Cheshire East Council would work with providers to ensure that programmes were successfully delivered and to help address issues before they become major problems.

RESOLVED: (Unanimously)

That the Adults and Health Committee:

1. Approve the new drugs and alcohol plan – Reducing drug and alcohol harm in Cheshire East.

To receive a briefing report on the Care Quality Commission (CQC) process - self assessment.

The Committee received a report and briefing providing the self-assessment submitted to the Care Quality Commission (CQC) as the first stage of the local authority adult social care assurance process, from Jill Broomall, Director of Adults Social Care Operations.

It was noted that the Care Quality Commission would be with Cheshire East Council week commencing 20 January 2025 and officers were undertaking briefings for Members in preparation. 

Members requested that information from officers be made available to them, and were encouraged to complete their Safeguarding Training before January 2025.

RESOLVED:

That the update be noted.

To receive the minutes of the Cheshire East Health and Wellbeing Board – 24 September 2024.

RESOLVED:

That the minutes of the Cheshire East Health and Wellbeing Board held on 24 September 2024 be received and noted.

To consider the Work Programme and determine any required amendments.

The committee considered the Work Programme.

Members were asked to review the work programme and contact the Chair or Democratic Services with any suggestions of scrutiny items that they would like to put forward for the Committee.

The following was noted:

·         There would be a focus at the January 2025 committee on the budget, transformation plan and the Service Strategy. There would also be a paper on the Smoking Cessation Scheme.

·         There was a need to add a further update on the Care Quality Commission Assurance Process, but until the feedback timelines were known this could not be added to the Work Programme yet, but would be in due course.

·         There was further work to do on the transformation programme and the timelines for implementation; when these were known a timetable of reports would be produced for the committee.

·         An informal committee briefing would be arranged on finance papers in advance of the next committee.

·         Officers would look to identify any agenda items which could be deferred from the January 2025 Work Programme.

RESOLVED:

That the work programme be noted.