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No. Item




Apologies for absence were received from were received from Councillor Yemi Osho; and from Althea Bart and Shumon Ali-Rahman, co-opted members.


Apologies for lateness were received from Councillors Khevyn Limbajee and Terry Wheeler.



Members are required to declare any pecuniary or non-pecuniary interests they or their spouse/partner may have in any matter which is to be considered at this meeting.  Interests are defined in the inside cover of this agenda.


Councillor Richard Sweden declared a non-pecuniary interest in relation to care provider Vibrance, with whom he had worked closely in the past.




The minutes of the meeting held on 10 June 2019 were approved as a correct record and signed by the Chair.



Members of the public are welcome to participate in scrutiny meetings.  You may speak for three minutes on a topic related to the Committee’s work, and fifteen minutes in total is allowed for public speaking, at the discretion of the Chair.  If you would like to speak, please contact Democratic Services (details above) by 12 noon on the day before the meeting.








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Maureen McEleney said that an update would be provided on reablement.


Forest Lodge Nursing Home – the Chair asked that the Committee be kept appraised on the future of Forest Lodge and the possibility of acquisition.  Michael Cleary said that officers would be viewing the property the following week. 


The Committee Action Tracker, Action Update and Forward Plan were noted.



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Consideration was given to a report of the Independent Chair, Safeguarding Adults Board, and the strategic partnerships team, setting out the achievements of the Waltham Forest Safeguarding Adults Board (WFSAB). The report focused on the impact the Board has made in keeping vulnerable adults safe in the borough, and illustrated the Board's priorities, ambitions and impact for 2017-2018.

Helen Taylor, Chair of the Board, said it had been a busy year for the Board and its sub-groups, despite some changes of personnel, and also in the way the police and CCG work now across boundaries.   There had been real progress in the priority areas of:

  • pressure care
  • making safeguarding personal
  • self-neglect
  • modern slavery
  • cuckooing.

Cuckooing is a priority London-wide for the network of Adult Safeguarding Chairs across the capital, and can be typically a housing or a criminal issue.

Partnership work in Waltham Forest is strong, and the Council funds much of the safeguarding infrastructure through other partnerships.

The Chair thanked Ms Taylor for the timely submission of the report, which led to discussion in which the following points were made.

Pressure ulcers or sores – Councillor Saumarez asked for more information as to how these are managed.  Officers said this depended on how well people were known to services.  Sores typically affect elderly and frail people, and occur more commonly in the community than in hospital.  It is also about individuals understanding their cause, treatment and prevention.  The Pressure Care Group focused on the issue in 2018-19: people are issued with a leaflet on discharge from hospital if they are at risk and there is a helpline, but more work needs to be done.

Types of abuse – Councillor Saumarez queried the layout of the bar-chart on page 36 showing types of abuse needed clarification, along with any correlation with Section 42 enquiries.  She also noted that mental health concerns appeared to have dropped.  Maureen McEleney said that 118 was quite high, and the reduction may not be statistically significant.   There are also instances of police Merlin ACN(Adult Come to Notice) reports being wrongly coded as they come in.      

Cuckooing – Councillor Mahmud expressed concern at how long it can take to resolve a case: she was aware of a number in her own ward in council housing, and it took many months for Housing and the police to take effective action.  She also wanted to know how people could be made aware that help was available.  Suzanne Elwick describe the referral pathway and said cases were discussed on a daily basis by MASH (the multi-agency safeguarding hub).  There is a poster to explain what cuckooing is and how to make a referral, and there is work in hand to raise awareness among practitioners. 


Cases are discussed at an ASBRAC (Anti-Social Behaviour Risk Assessment Conference) which provides a governance link to the Partnership.  There is also a London-wide body to monitor cuckooing, but not app boroughs are on board.


Councillor Mahmud said Members would like to see consistent  ...  view the full minutes text for item 14.



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Consideration was given to a report of the Scrutiny Officer, providing the opportunity for the Committee to speak to providers about market resilience and the risks associated with provider failure.


Conrad Eydmann introduced the report and said the Committee had undertaken a joint review with the Health Scrutiny Committee of commissioning, and resilience in response to external pressures, with a focus on what the Council could and could not do.  It was acknowledged that there would be instances where providers fail for reasons beyond the Council’s control, and that all manner of pressures exist across the public sector.


Therefore a number of providers had been invited to the meeting, as indicated in the attendance record above, to discuss with the Committee their challenges and aspirations.


The Chair noted that there had been a series of quite serious failures, including the loss of two large residential homes and the collapse of the community midwives service.


Sushil Kadia of Westminster Homecare Ltd said they provided domiciliary care from 25 sites, with 10 in Waltham Forest, where there were 2,000 visits per week.  They have survived due to their size and ability to train their workforce: he stressed that good services needed infrastructure.  Many providers close down because of poor service and their customers going elsewhere.


Mr Kadia said it was not simply a case of meeting the minimum standards set by the Care Quality Commission: providers needed to be plugged into the community.  Care workers need time to chat, form relationships and help prevent loneliness.  Early intervention prevents more serious problems later.


Secondly, providers must be paid proper rates: these amount to so much more than the hourly pay of the carer, and have to cover the cost of management, training and recruitment.  Agencies cannot function on the minimum wage: it must be the London Living Wage at least.  £9 per hour for the carer translates into £12-13 per hour for the provider. Meanwhile the Dynamic Purchasing system used by the Council has the effect of forcing pay and standards down.  Staff who would normally be dedicated and rewarded by care work are therefore easily attracted away to jobs in retail with regular pay and discounts, and manageable transport costs.


Bibi Aklimah Abdraheman of Marieco Care Ltd said that late payments to providers add pressure, and can undermine a market that is under pressure and must adapt to change, without compromising on service.  There should be greater partnership with other services: carers work alone and sometimes feel abandoned in an emergency, for example if they cannot get hold of a duty social worker.  She gave the example of staying with a client for four hours while she waited for an ambulance late in the evening, and was told it was her responsibility if the ambulance was cancelled.


Administration is also burdensome and time-consuming: more time was spent on recording and reports than caring.


Annabelle Augustin of Verrolyne Services Ltd said it was true that no-one else would take responsibility, which then falls  ...  view the full minutes text for item 15.




Consideration was given to a report of the Violence Against Women and Girls Team manager, detailing the background of the Iris Programme, and summarising the service delivery and implementation plans for Waltham Forest.  The programme followed a pilot study that showed a prevalence of domestic violence experienced by women attending general practice substantially higher than that recorded in the general population.


Daniel Phelps introduced the report, and said the IRIS project was a nationally recognised intervention, aimed at improving GPs’ ability to identify and respond to domestic violence.  The project funds direct support to GPs to enable this, including training, digital resources and direct work/advocacy across GP practices. This has been a high-profile need recognised by the Community Safety Board and will directly improve primary care services.

The programme is for female patients aged 16 and above experiencing current or former domestic abuse from a partner, ex- partner or adult family member. IRIS (Identification and Referral to Improve Safety) provides care pathways for all patients affected by domestic abuse as well as information and signposting for male victims and for perpetrators.

There is a range of key performance indicators covering an increase in referrals to MARAC (Multi Agency Risk Assessment Conference); a reduction in the risk of domestic violence; and prevention of escalation for those at a lower risk of domestic violence, all measured through the DASH risk model.


Councillor Saumarez thanked Amana Gordon, Director of Children’s Social Care and her team for their work in this area.  She was interested to know how funding would continue, and what feedback there had been from GPs.  Mr Phelps said a bid to MARAC had not been successful, so the next step is to make an investment case.  The programme was only in the early stage of engagement with GPs, and officers would be interested to know from Members which surgeries might be suitable to pilot.  Ultimately though, the case must by made to doctors by doctors.


Councillor Saumarez also expressed concern that the elderly did not appear to feature in the programme, and that with an ageing population there was a growing likelihood of abuse in care homes and home care, by ‘carers’ and family.  Mr Phelps agreed that there was a general need to raise awareness of abuse across the GP community, and he would consider the point about elder abuse further.   There was also a role for nurses and reception staff at surgeries in noticing possible signs of domestic abuse.  Ms McEleney added that this was also an element of the Dementia Strategy and guaranteeing people’s safety in what was often a complex dynamic.


The Chair said there was considerable knowledge to be gained from Hackney, where the Iris programme began and is well-embedded.  Mr Phelps agreed and said it was an evidence-based programme which must be evaluated and accredited in an Iris way.  All learning gained goes into the base.


Councillor Wheeler noted that telephone consultations with GPs were becoming increasingly common, and any visible signs of  ...  view the full minutes text for item 16.



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Consideration was given to a report of the Assistant Director, Commissioning Contract Management and Brokerage, setting out the reasons for seeking Cabinet’s approval to an extension of the current arrangements for home care, in order to allow officers adequate time to develop the future model, consult on it and implement the new model effectively.

Michael Cleary introduced the report and outlined the tender process and options to be considered.  A recommissioning exercise is underway to develop a new person-centred model that aligns to the strategic approach of the Council to maintain independence and reduce dependence on formal care interventions.  He also outlined the twelve-week TUPE process and the reasoning required to justify a restructure of the service, as well as the implications for staff pensions.

There are currently 43 providers on the Dynamic Purchasing system, with 20 waiting to join.  There may not be enough work for everyone, and Waltham Forest does not need over 60 providers.  Mr Cleary was surprised that the providers did not raise with the Committee the issue of parking permits, as many carers risk fines by using their cars in CPZs.

As well as the extension to the existing arrangements, officers were seeking the help of Members to provide a link with their constituents and find out their real needs and expectations.  The guiding principle must be that a situation should never arise where someone who is dependent on their care does not receive it.

Councillor James queried the figures, which seemed to suggest an average cost of £10.20 per hour, and how this sat with the figures quoted by the providers earlier in the meeting.

Councillor Wheeler also felt that pay rates were on the low side.  He said this was the opportunity to get things right, and the exercise should not be rushed.

The Chair said the Committee would like a further update before the end of the municipal year, and asked that Age UK and CarersFIRST be involved in consultations.  He felt there was a risk that the exercise might not achieve the client-centred outcomes the Committee wanted to see.  The continuity of care was important, especially if a client wanted to carry on with their existing arrangements.




The Committee made the following recommendations:


(a)  that the Committee supports the recommendations to Cabinet;


(b)  that Cabinet ensure that inflation is factored into the contract extension; and


(c)  that the Committee receive an update on the plans for home-based care in 2020, with stakeholders such as Age UK and CarersFIRST invited.




Councillor Limbajee said he shared the Committee’s sadness at the news the Linzi Roberts-Egan, Deputy Chief Executive, was leaving the Council.  He wished to put on record his thanks for the truly brilliant job she had done for Waltham Forest over the years.


On behalf of the Committee, the Chair said that all Members shared these sentiments.  Linzi was held in exceptionally high regard and would be sorely missed.  All Members and officers joined him in congratulating Linzi on her well-deserved promotion and wished her every success for the future.