The Adult Social Care & Health Overview and Scrutiny Committee met to discuss proposed changes to inpatient haematology care at Princess Royal University Hospital, review adult social care performance and user feedback, and examine efforts to tackle health inequalities in North Bexley. Key decisions included the continuation of engagement on the haematology care proposals and a commitment to further investigate areas for improvement in adult social care services, particularly concerning carer support and communication.

Proposed Changes to Inpatient Haematology Care at Princess Royal University Hospital

The committee received an update on proposed changes to inpatient haematology care at the Princess Royal University Hospital (PRUH). King's College Hospital NHS Foundation Trust is proposing to consolidate all inpatient haematology cancer care at King's College Hospital in Denmark Hill, while enhancing day case provision at the PRUH. This change is driven by an increase in outpatient and day case treatments over the last 25 years, meaning fewer patients require inpatient stays. Specialist care, including treatments like CAR-T therapy, requires the broader infrastructure and 24/7 specialist support available at Denmark Hill.

The Trust stated that only a small number of Bexley residents currently receive inpatient care at the PRUH, with the majority already treated at Denmark Hill. The proposal aims to ensure patients receive the highest standard of specialist care, leading to better outcomes. The Chartwell unit at the PRUH would continue to operate as a day case and outpatient facility. Emergency admissions to the PRUH would still occur, with a decision made on transfer to Denmark Hill if specialist inpatient care is required.

Concerns were raised by Councillor Lisa Moore regarding whether this constituted a substantial variation of service requiring formal consultation, rather than engagement. The Trust explained that advice from NHS England deemed their engagement approach reasonable, citing the small number of patients affected, manageable travel distances, and the continued availability of emergency care at the PRUH. The engagement process is ongoing, and the Trust plans to incorporate feedback into a revised proposal, including quality and equality impact assessments. The committee was assured that the engagement process is more than just informal, with various methods offered to patients and families, including focus groups and telephone interviews.

Councillor Wendy Perfect noted that, from her experience, Denmark Hill is often easier to access for residents than the PRUH, despite the latter being closer geographically. Councillor Ball inquired about the data on patient demographics and the reasons for the high response rate from men in the survey, which the Trust acknowledged as an interesting point they could not immediately explain. The discussion also touched upon potential improvements in service quality at Denmark Hill, particularly regarding waiting times for chemotherapy, which can be influenced by the availability of specialist pharmacists and the need for blood tests.

The committee was informed that the engagement process has been ongoing since the autumn, with a more formal period of four to five weeks. The Trust indicated that they would likely not proceed to a full statutory public consultation unless significant new issues arise, as they believe the engagement feedback will allow them to modify the proposals sufficiently. The committee expressed gratitude for the presentation and requested to be kept informed, with the possibility of returning to the topic in the new municipal year.

Adult Social Care: Performance Levels and User Feedback and Satisfaction Levels

The committee reviewed a comprehensive report detailing the performance of adult social care services and user feedback, including results from the annual client survey and the Healthwatch Bexley report.

Councillor Wendy Perfect highlighted concerns regarding the high staff turnover in the formal care workforce, noting that this leads to inconsistent levels of care, particularly for individuals with dementia. She also spoke about the emotional toll on carers and the need for support in navigating complex systems. Officers acknowledged these challenges and outlined ongoing work to improve support for carers, including co-producing a guide and ensuring better awareness of available support.

Councillor Rags Sandhu raised concerns about Bexley's overall satisfaction levels for service users being below the England average. While acknowledging this, officers noted that Bexley's performance is comparable to the London average and that they are actively working to understand the drivers behind these figures and learn from best practices. The committee also discussed the capacity of the voluntary sector, with officers assuring members that Bexley is committed to supporting its voluntary sector partners through grants and contracts, enabling them to increase their capacity.

Regarding provision for individuals with autism and learning disabilities, Councillor Sandhu inquired about gender bias and the suitability of large versus small provision. Officers highlighted a focus on direct payments to promote greater independence and creativity, and the co-chairing of the Autism Partnership Board, which addresses issues like under-detection in girls and the allocation of funding for early intervention.

Councillor Peter Craske related to the frustrations of navigating social care systems, particularly concerning communication. The report indicated that communication is the biggest cause of complaints, and officers detailed ongoing training initiatives to improve staff communication skills, particularly in handling difficult conversations and managing expectations. It was noted that the number of formal complaints is relatively small, but the learning from them is taken seriously.

Councillor Nicola Taylor, who was part of the task and finish group gathering evidence, emphasised the individual nature of care and the importance of consistency. She highlighted three key areas for improvement: ensuring carers understand they have had a formal assessment, providing accessible information at the right time, and maintaining consistency in care staff to build trusting relationships.

The committee discussed the quality improvement plan, which includes actions to develop a carers' guide, provide more proactive support for carers, improve access to information, and expand opportunities for capturing lived experiences of care. Recommendations were made to pursue a carers' welcome information pack, consider processes from other local authorities for carer wellbeing, scale up peer support systems, and ensure a structured feedback loop for qualitative data.

Tackling Health Inequalities in North Bexley

The committee received an update on projects funded by the NHS South East London Integrated Care Board's Health Inequalities Fund, specifically focusing on North Bexley. The report detailed initiatives aimed at raising awareness of breast cancer screening and prostate cancer, alongside efforts to improve community engagement and trust in health services.

Councillor Lisa Moore questioned the sustainability of outreach efforts given the mention of limited resources and the allocation of three well-being coaches for 2026/27. Officers clarified that the Health Inequalities Fund is recurrent and that the new well-being coaches represent a more advanced, sustainable model of support. They explained that lessons learned from previous projects, such as the need for culturally sensitive communication and sustained outreach, have informed the current strategy.

Councillor Howard Jackson sought more detail on the lessons learned, particularly regarding cultural and language barriers, and the challenges of limited resources for sustained outreach. Officers explained that while cultural differences exist, misconceptions often stem from misinformation, similar to challenges seen with immunisation uptake. They highlighted the use of community champions and events at locations like the Sikh Gurdwara to disseminate accurate information and build trust.

Councillor Ball inquired about the nimbleness of the service in utilising social media and responding to media stories to promote cancer screening. Officers confirmed that the funding for the well-being coaches includes flexibility for such outreach activities, including the use of social media and community champions.

Councillor Nicola Taylor raised concerns about the slight decline in cervical screening rates and asked about plans to address this, as well as the possibility of incorporating PSA level awareness into prostate cancer programmes. Officers noted that cervical screening is a national programme with some challenges, but Bexley is working to improve uptake, particularly for individuals with learning disabilities and serious mental illness, through GP incentives and accessible information. They also confirmed that awareness campaigns for prostate cancer are ongoing.

Councillor Rags Sandhu shared positive feedback on a health engagement event at the Sikh Gurdwara, highlighting the success of blood pressure and diabetes checks. He also suggested that the new well-being coaches could be recruited from diverse backgrounds to address language and cultural barriers.

Adult Social Care Workforce Development Plan

The committee reviewed the Adult Social Care Workforce Development Plan, noting significant improvements in the recruitment of permanent staff. The report indicated that the proportion of permanent posts has increased from 57% to 69% between December 2023 and December 2025, with a 30% reduction in net vacancies.

Councillor Howard Jackson expressed concern about the high percentage of home care staff on zero-hour contracts, questioning whether flexible contracts would offer better protection. Officers confirmed they are working with homecare providers to explore alternative contractual models that offer more financial stability, which in turn can improve consistency of care. Councillor Jackson also raised questions about international recruitment, noting the challenges faced by providers in meeting regulations and the potential for a future reliance on domestic recruitment. Officers stated they are developing a local recruitment offer and exploring ways to support providers in navigating the complexities of international recruitment.

Councillor Bola Carew inquired about the status of zero-hour contracts, and it was clarified that while not yet outlawed, changes are expected through the Employment Rights Bill. The care at home market currently relies heavily on zero-hour contracts to manage fluctuating demand.

Regarding international recruitment, officers detailed the challenges with providers losing their sponsorship licenses and the displacement of workers. Bexley is working with the South East London Health and Care job hub to support these displaced workers and is exploring ways to facilitate their transfer to alternative providers under specific visa transfer routes to mitigate costs.

The committee also noted the ongoing work to develop apprenticeship schemes for social work and occupational therapy, aiming to grow our own staff.

Work Programme

The committee reviewed its work programme for the upcoming municipal year. Several items were noted for future consideration, including:

• Underserved Communities: Examining how small community groups provide services and receive support.
• Dementia Nursing Model & Community-based dementia care: Reviewing work to develop a procurement framework.
• Planned Digital Switchover: Reviewing plans and seeking assurances.
• Expanding Social Opportunities: Discussing plans to co-produce activities accessible via direct payments.
• Health and Wellbeing Strategy & Integrated Forward Plan: Progress against key priorities.

Councillor Janice Ward-Wilson, Chair of the committee, noted that while ward councillors used to be invited to care home visits, this has been less frequent due to the move towards unannounced visits to ensure a single point of contact for quality assurance teams. However, she agreed to consider widening invitations for future planned visits.

Councillor Nicola Taylor raised concerns about the declining proportion of planned reviews completed within three months (ASCH_28), which has fallen to 55% against a target of 70%. Officers acknowledged this as a priority and are developing proposals to address the backlog and improve sustained performance.

The committee also noted briefing papers on cancer screening inequalities with a learning disability focus, an update on direct payments, and the future of routine tier 2 paediatric audiology services, which is expected to retain a clinic at Queen Mary's Hospital in Sidcup.

The committee concluded by thanking members, officers, and partners for their contributions throughout the year.