This relates to market shaping, commissioning, workforce capacity and capability, integration, and partnership working.

Strengths

There is an established commissioning function, quality of care within the borough appears to be good. There are consistent and embedded partnership structures in place and an opportunity to celebrate some undersold strengths within the borough, for example homecare and supported living.

Considerations

There is a sense that some of the underlying challenges within the system are not surfaced at an early stage and there is a potential for increased risk in the system that could be addressed through an enhanced learning environment.

Quality Statement Four: Care Provision, Integration, and Continuity

There is substantial strength in the integrated commissioning model. This is a mature and established partnerships between leaders. There is a potential risk in the underpinning governance when either organisation to face significant challenge, however these are mitigated as far as possible through the section 75 governance agreements. The strength of relationships demonstrated within the review would suggest that this is not unsurmountable, but the Council may want to assure themselves that the current section 75 agreement has sufficient substance to support should there be an incident or a near miss. The Council may want to assure an equivalent level of robustness within its partnership arrangements for delivery of outsourced Care Act functions.

There is a good supply of domiciliary care, this is a strength for Bexley and should be celebrated. The ambition is to move this provision to an outcome-based model. This is a positive step towards supporting personalisation and improving quality of support, however this is one area in which the peer team heard that providers had concerns. This may be because the model is only partially delivered and there are concerns about sustainability and operational commissioning capacity to make this achievable.

To ensure success there is a need to undertake open and honest dialogue and have some frank and challenging debates to ensure that this initiative delivers the step-change needed to improve outcomes for individuals. The Council appears well placed to have these discussions as the commissioning team are established, respected and have mature relationships with partners.

Direct Payments

Bexley’s performance on direct payments is relatively low at 19% compared to a London average of 25%, suggesting that there is an over reliance on traditional models of care. In the case reviews, albeit a small number of cases, direct payments were actively considered and used. The peer team heard positive reports of the development of individual service funds for people with learning disabilities, with fifteen providers now signed up. This was particularly being championed within the transitions services and there were some innovative and personalised approaches described to maximise people’s choice and control over their lives by combining shared lives provision with direct payments. There are also opportunities to build on nationally established and recognised strengths-based models, such as Circles of Support for a wider cohort of people.

These initiatives are positive to note, and the peer team heard from staff working in other parts of the service that they would welcome the opportunity for this work to be extended so it is accessible for other people with care and support needs. Similarly, the peer team felt that supported living could have an improved profile within the discussions.

The Council benchmarks well in relation to care home admissions at 12.1 people per 100,000 compared to 12.6 for London and 14.6 for all England. The quality of care homes within Bexley is good with 86% of care homes rated good or outstanding and 100% of mental health residential home rated as good. The figure is slightly lower for care homes registered for people with learning disabilities with 71% of homes rated good and no homes with an outstanding rating. There are challenges in accessing complex dementia nursing care placements and support for people with complex behaviours which consequently results in out of Borough placements.

Quality Statement Five: Partnerships and Community

The relationship with the care market appears to be strong although providers reported that they would welcome more strategic engagement. The current quality assurance led forums appear to be focused on information sharing whereas previously this has been more of a collaborative approach. There are some underlying controversial factors which may be impacting on relationships such current unresolved provider inflation discussions, and the implementation of the outcomes-based domiciliary care contract. Whilst the Council has recently produced a market position statement it would benefit from continued discussion and communication in this area as providers reported that it was not always clear what the Council required.

There are some positive examples of joined up collaborative working with partners for example in response to a fire in 2023 and cross border work to develop shared respite provision.

Internally there appears to be a disconnect between operational staff and commissioning staff, which is likely to be a product of the pressures that the complex care teams are dealing with, the lack of a clearly articulated practice model and associated commissioning strategy. The Council may want to think about communication and engagement opportunities to increase awareness.

The Council also has strong established foundations with the community and voluntary sector. The OneBexley ethos is powerful and came through clearly throughout the work at a strategic level although there were some challenges at an operational level. There was a concern that the focus of the community and voluntary sector on assessment and review was impacting on capacity to provide community support as well as some of the quality of these reviews. The peer team heard in several forums of a focus on the positives rather than understanding and addressing real, or perceived challenges. There is a risk that the established and cohesive relationship creates a group think mentality however formal contracts, contract monitoring, and quality assurance processes are in place to mitigate this risk and to underpin the relationships.