The Adult Social Care and Public Health Cabinet Committee met to discuss adult social care, public health performance, and future strategies. Key discussion points included the adoption of the Adult Social Care Prevention Framework 2025-2035, proposed changes to Wellbeing Services in the Community, and an extension of the contract for Wellbeing Services in the Community for Adults with Sensory Impairments. Members also reviewed performance dashboards and risk management in adult social care.

• Suicide Prevention Efforts and World Suicide Prevention Day
• Community Equipment Services Transition to Medequip
• Association of Directors of Adult Social Services (ADASS) Report and Funding Pressures
• Impact of Heatwaves on Adult Social Care Services
• Public Health Updates: Pandemic Planning, Infection Control, and More
• Tuberculosis, Measles and Chickenpox
• Adult Social Care Performance Dashboard: Quarter One
• Public Health Performance Dashboard: Quarter One
• Risk Management in Adult Social Care
• Parent and Infant Mental Health Service Funding
• Adult Social Care Prevention Framework 2025-2035
• Wellbeing Services in the Community: Key Decision
• Wellbeing Services for Adults with Sensory Impairments: Contract Extension
• Kent Community Equipment Service Contract Award
• Work Programme

Suicide Prevention Efforts and World Suicide Prevention Day

Councillor Diane Morton, Cabinet Member for Adult Social Care, highlighted that it was World Suicide Prevention Day and announced new suicide prevention grants awarded to charities and social enterprises across Kent. One example was therapy partners, who will be running a project called Hard Hat Minds in the construction industry, giving employees access to mentoring, group sessions, and advice. On 22 September, Kent will host the Baton of Hope, a national suicide prevention initiative.

Councillor Stuart Jeffery asked if additional money is being put into suicide prevention for employed people, and if further money is being put into other groups. It was confirmed that services look annually to see what the local school is going to be seeing, the choir, uplifting music.

Community Equipment Services Transition to Medequip

Councillor Diane Morton reported on the collapse of NRS, the previous community equipment provider, and the swift action taken to ensure service continuity. Medequip had taken on the contract, recruited 125 staff, secured a facility in Beersted¹, mobilised 57 vehicles, built up stock, handled 617 calls, and completed 308 deliveries by 1 September. Councillor Stuart Jeffery asked what warnings there were of the NRS collapse, and why KCC were not on the front foot and prepared for the event. Simon Mitchell, Assistant Director of Commissioning, responded that there was a cyber attack on the organisation a year previously, and the organisation approached councils a month or six weeks prior to the collapse looking for a support package. The national feeling was that what they were asking for didn't give the assurance that it would actually make them a secure and viable organisation moving forwards.

Association of Directors of Adult Social Services (ADASS) Report and Funding Pressures

Councillor Colin Sefton asked if the cabinet member was liaising with other cabinet members of other authorities to work jointly to put pressure on the government to get realistic about the funding. Councillor Diane Morton confirmed that she was working with colleagues across the country. Richard Smith, Corporate Director Adult Social Care and Health, added that the Association of Directors of Adult Social Services carries out surveys about the state of the market and the state of the finances, and this year it was seen as dire. He noted that demand is outstripping resources, with demand around 10% to 12% for older people and younger adults, and the funding formula around 4%.

Impact of Heatwaves on Adult Social Care Services

A member asked whether the leader's announcement that there is no climate emergency in Kent will affect the way that services are going to be able to respond to heatwaves. This followed Richard Smith's earlier comment that heatwaves increase demand on services. The chair ruled that the question was not relevant to the update.

Public Health Updates: Pandemic Planning, Infection Control, and More

Dr Ellen Schwartz, Deputy Director of Public Health, provided an update on public health developments, including:

• Ongoing support for the UK Health Security Agency² regarding notifiable diseases and outbreaks.
• Focus on infection prevention control, particularly in care homes and community settings.
• Pandemic planning exercises to prepare for future pandemics.
• Collaboration across KCC to support health and environment initiatives.
• Development of a Marmot Coastal Region Program.
• Publication of the pharmaceutical needs assessment later in the month.
• Expansion of a supervised toothbrushing program for three- to five-year-olds in deprived areas.
• Completion of a SEND health needs assessment.
• Development of key data resources by the Kent Public Health Observatory, including the joint strategic needs assessment.
• Improvements around pathways for opiate and crack substance misusers into treatment.
• Work on gambling as a new area for public health.
• Partnership with KMPT³ and other mental health providers.
• Improvements to sexual health services, including a new sexual health clinic in Dover⁴.
• Procurement of a new therapeutic for children and young people aged 4 to 19 years who need mild to medium emotional well-being support.
• Procurement of new community infant feeding services.
• Active procurement in smoking, lifestyle, and children's services.
• Development of a cyber sanctuary initiative to protect survivors of domestic abuse from cyber crime and digital stalking.

Tuberculosis, Measles and Chickenpox

A member raised concerns about diseases being brought into the country by people coming into the country. Dr Ellen Schwartz responded that the UK Health Security Agency is looking at the surveillance of disease progression internationally, and that a pandemic is most likely to be a novel agent, something that hasn't been around or has mutated into something because it has to meet a population that's not immune. Councillor Connie Nolan raised concerns about tuberculosis (TB), measles and chickenpox. Dr Ellen Schwartz responded that Kent and Medway are a low endemicity area for TB, but nationally there is an increase, and that they are working closely with partners to ensure that pathways are robust. She added that measles is probably the most infectious virus there is, and that vaccination rates are decreasing, and that they are working across the system to ensure that the Director of Public Health is assured that the system works effectively. She said that chickenpox is not such a critical disease, but that they are supporting vaccination scheme rollout around chickenpox, and that with vaccination you have to see the kind of order of urgency where measles is right at the top.

Adult Social Care Performance Dashboard: Quarter One

The committee reviewed the performance dashboard for adult social care for quarter one, which showed high and increasing levels of demand. Despite the pressures, adult social care delivered an increased number of care needs assessments and reviews, and Kent Enablement at Home and Kent Enablement Service supported more people. None of the key performance indicators are currently RAG rated red, four are RAG rated amber, and three are RAG rated green. A member asked about the cost of signposting people to outside agencies, and why 1.3% of people re-contact. A member asked about the difference between Kent Enablement at Home and the Kent Enablement Service. Mark Albiston, Director for Adult Social Care, explained that KES is around enablement for people with more mental health needs, autistic spectrum conditions, whereas Kent Enablement at Home is traditionally set up around supporting people around physical health conditions. A member asked if all the providers used all their funding, and if not, where did the money go. A member noted that the summary talked about an increased number of care needs assessments, but that the graph on page 25 did not show this. Mr Albiston responded that one of the changes that they made operationally was around how Adult Social Care Connect operates, and how they prevent the number of people that then require a formal care act assessment for long-term support as a result of that. A member asked what trends are emerging in service demand. It was explained that demand for adult social care primarily comes from three areas: a life-changing incident, people not being able to access preventative services in the communities, and through children and young people services.

Public Health Performance Dashboard: Quarter One

The committee reviewed the performance dashboard for public health for quarter one, noting that seven indicators were green, two were not available, and five were amber. Two of the amber KPIs are in health visiting services, but performance is still above other areas. There are amber targets for the One You Kent service, due to slightly less targeting during this time, and seasonal trends. The other two amber KPIs are within sexual health, and in the young person's substance misuse service, which has moved from red to amber. A member raised concerns about mumps and infertility. A member asked about stopped smoking services, how many people are still smoking in Kent, and whether there are targets around vaping. It was reported that 1,000 people successfully quit smoking, and that the Stop to Start grant has increased capacity. Dr Ellen Schwartz responded that they would come back with the current prevalence of smoking, and that they take smoking seriously. She added that vaping is complex, and that they are working with trading standards colleagues to make sure that no illegal products are imported into Kent and sold in corner shops. A member asked whether vaping should only be available on prescription. Dr Schwartz responded that she was sitting on the fence, or rather kind of to the no side of the fence on that one. A member asked whether vaping is the right way to go, given that it can cause liver damage within a year, where smoking can take decades. Dr Ellen Schwartz responded that vaping, if it's the right legal product, replaces nicotine minus the tobacco, and so the tobacco and all the toxins, the poisons really, about 4,000 different toxins in a cigarette, they don't get into the body.

Risk Management in Adult Social Care

The committee considered the risk management report for adult social care. A member commented that the first risk around sustainability is rated as about as high as you can get, and that they could not see anything within paragraph 2.5 that gives them confidence that actions are being taken. An officer responded that adult social care have made some difficult decisions about things that they need to stop doing to make us more sustainable, and that they need to be managing demand. She added that there is a person behind each of the numbers and each of the performance and the risk, and that they need to look at how they can reduce the current numbers of people that are needing expensive services. She said that they have invested in enablement services, and that if they put care packages and support packages in a point of crisis, they know that they're going to be unsustainable and very expensive. She added that they have rewired community services back into communities, and that they have a structure that's based on a health and care partnership footprint. A member said that they would love to see and hear more about not just the integration with health, but also to pick up housing, education and other key determinants. A member asked whether the risks are measured more often than once a year. Mark Scrivener, Head of Risk and Delivery Assurance, responded that they are having conversations at management teams collectively with individuals reviewing the risks as and when they have a policy set out that says minimum three months, but actually, they use common sense, and that one of his team was on the daily calls at times when the incident was unfolding around the NRS situation that was discussed earlier. He added that this isn't the only place that members look at this as well, and that Governance and Audit Committee, Cabinet, sometimes the risks get caught in scrutiny if you go for deep dives and things. A member requested that they could see the trend as well as just one snapshot figure.

Parent and Infant Mental Health Service Funding

The committee considered a request for approval for additional expenditure funded from the Department for Education Family Hubs grant and the public health grant to support venue costs for a new specialist parent-infant mental health service in Kent. The parent-infant mental health service will provide support for families having parent-infant relationship difficulties to have positive interactive relationships with their child. The service seeks to strengthen parent-infant relationships and prevent needs from escalating, helping parents become more responsive and sensitive to their baby's needs and support secure attachment. The current budget is £2,059,928, and the proposed financial budget, including the venue cost, is £2,459,928. Following approval, a compliant procurement process will take place in autumn.

Adult Social Care Prevention Framework 2025-2035

The committee considered the Adult Social Care Prevention Framework 2025 to 2035, a plan to support people in Kent to live healthy, independent, connected, and fulfilling lives. Councillor Diane Morton introduced the framework, stating that demand for care is rising, costs are increasing, and resources are tight, and that if we carry on as we are, the cost of supporting people over 65 in Kent will rise probably to 50% by 2035. Sarah Crouch, Consultant in Public Health, added that the framework builds on the adult social care making a difference everyday strategy, and is a long-term approach and commitment to prevention to support and enable people to live fulfilled, healthy, and independent lives. She noted that if we continue as we are, whilst assuming costs of care and support stay at current levels, which are unlikely, then the cost for supporting older people aged 65 plus alone will rise by 48% in the next 10 years. The framework has five approaches:

• Principle of prevention first
• Focused support
• Partnership working
• Inclusion and equity
• Measuring and evidencing impact A member expressed concern that the council has been forced to scale back or delay non-statutory but still vital preventative services because of the funding. Councillor Diane Morton responded that they have to stack up their finances to make sure their statutory services are protected, and that the prevention framework is definitely the way forward. Richard Smith added that they have a legal responsibility under the Care Act to provide services that prevent, reduce and delay the need for ongoing services. A member asked what is the reason for the 54.2% increase in the adult social care budget from 21 to 25, given that the demand hasn't increased by 50%, and how are those reasons addressed within the prevention framework. It was explained that the complexity of the individuals that they are supporting is requiring more care and support that is costing, and that they are hoping to support people earlier on so that they can divert their needs having such an increased amount of package of care at that point. It was also noted that what we paid for services in 2021 is also increasing, and that there are inflationary factors.

Wellbeing Services in the Community: Key Decision

The committee considered the Wellbeing Services in the Community Key Decision, focused on community navigation services funded by KCC and delivered through contractual arrangements with partners in the voluntary, community and social enterprise sector. Councillor Diane Morton stated that our communities are affected by successive governments not taking social care seriously enough, and that adult social care must deliver over £63 million in savings, almost 9% of its budget. She added that she had invited providers to the table for further discussions and how we can work better alongside each other. The proposals were developed informed by providers, and there was a public consultation between 26 November 24 and 27 January 25, with 1,376 responses. The alternative wellbeing services that are available include social prescribing, Adult Social Care Connect, and Kent Enablement Service. The proposed changes will focus the services on people assessed as needing a medium to higher level of support, and three months' notice will be given to the providers. A further mitigation that was identified following the consultation is to develop an awareness and prevention campaign to help people understand where they can go for information, advice and guidance at the right time.

Wellbeing Services for Adults with Sensory Impairments: Contract Extension

The committee considered a key decision on a contract extension for wellbeing services in the community for adults with sensory impairments. Councillor Diane Morton explained that these services give people advice, equipment, training and support to stay independent, and that more than 22,000 people used them last year. She added that they help reduce pressure on health and social care by supporting people early, and that they want to be able to extend this contract along with other wellbeing services so that they can look to put them all together. Simon Mitchell noted that one of the subcontractors' names has changed and that he will make sure that that is amended in the paper before it is finalised.

Kent Community Equipment Service Contract Award

The committee noted the decision to contract with Medequip for the Kent Community Equipment Service, following the collapse of the previous provider, NRS.

Work Programme

The committee noted the work programme. A member requested that all of the items are included at every meeting, and that the current schedule should be reviewed. It was explained that a lot of these reports will then will come to Adult Social Care Cabinet Committee then will go on to Cabinet and where relevant will go on to County Council, and so if we break out of that cycle it becomes confusing.