Health and Wellbeing Board - Thursday 25 September 2025, 1:00pm - Wandsworth Council Webcasting

Health and Wellbeing Board
Thursday, 25th September 2025 at 1:00pm 

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  1. Webcast Finished

Hi, good afternoon.
I'm Councillor Graham Henderson and I'm each of the pathway of being bored. I welcome you all to this
eating
Members of the board are now call your names in alphabetical order
Please switch on your microphone to confirm your attendance and can you please turn it off once you have done so?
purely in alphabetical
alphabetical order. Abbie Carter. Present. Hello. Hi. Mark Creelman. Present. Hello.
Tony Remodley. Councillor George Crivoli. Present. Excellent, thank you.
Council, Judy Gasser.
Yes, good afternoon.
Sharon Catillo.
Good afternoon.
Diyama Oban.
Not present currently.
Ike Proctor.
Not present.
OK.
Wakar Shah.
Present.
Thanks.
And Kate Simek.
Present.
Excellent, thanks.
Good, excellent. We do have a few apologies.
Oh, yeah. How was that?
It was my fault. I skipped over you, Stephen. Stephen Hickey.
Present. Excellent, sorry.
You definitely have not been moved off the top of my being bored.
Can I, so please, ask you when you are speaking,
could you refer to the page number at the top of the agenda pack and the paragraph number
so that any members of the public who may be listening in on the meeting can follow
the discussion.
Please also indicate when you want to speak in the normal way by raising your hands.
Again, once invited to speak, if you can please turn on the microphone and since you have
finished turning it off.
We do also have the usual array of officers present
at this meeting who will introduce themselves
when they address the board.
So we do have apologies.
I think this list has probably grown

1 Apologies for absence

since I was given these notes.
But certainly on my note we have apologies
from Jeremy de Souza, Robert Guile, Nicola Jones, Ariane Jogia, Philip Murray,
Anna Papabici and Andrew Travers.
Any more?
Not?
Excellent.
Now, I'm off the floor on that news.
So, declarations of interest.

2 Declarations of Interests

of any declarations either pecuniary of a registrable
or an un -registrable interest,
please declare any interest quoting the item
and paper number in which you have interest
and describing the nature of your interest,
including whether or not you intend
to take part in that item.
So can I ask if there are any declarations of interest?

3 Minutes of the meeting held on 26th June 2025

Excellent. So we move on to the minutes of the last meeting on 26 June 2025, pages 5 -14
of the minutes of the previous meeting agreed and can be signed as a correct record.
Councillor Gasser.
I'm happy with them. Can I raise a matter of writing?
Well, just so, there was a paper about the challenges of the timeliness of initial health
assessments for looked after children, and it is still a challenge, and we still have
a lot of problems with these initial health assessments are not happening.
We need to move this forward.
I don't know if anybody in the room can advise me how we're going to move this forward.
Should I reach out to Mike Proctor, or who should, can somebody advise?
Maybe Kate can advise, because we have to improve on this.
we have to find ways of getting our children to health assessments.
I think you have your hand up.
So there are a number of actions that are already underway
but I would suggest probably perhaps if we take this offline
and link with me and I'll ensure that we're updating on the actions
but also updating the health and wellbeing board on the progress.
Lovely, thank you.
I'll take that off the line.
OK, thanks.
Thanks, Mark.
The first item is Wontworth Carers and Young Carers' Charter,

4 Wandsworth Carers and Young Carers Charter - One Year Report (Paper No. 25-312)

the one -year report, paper number 25 -312,
on pages 15 to 22.
So this is a report by the executive director
of Health Care and Social Care and Public Health.
And I gather Steve, Steve Shafelberg,
the senior commissioning manager,
will introduce the review report.
Thank you, Councillor.
Yeah, so my name's Steve Shafelberg.
I'm a senior commissioning manager in adult social care.
With me online is the report author Marie Neofittou.
I'll be throwing any really tough questions her way.
So just a reminder to everybody that back in June of last year,
we launched the Wandsworth Carers and Young Carers Charter.
And this was a charter which replaced a strategy and action plan.
It was all on one page.
It was really a co -produced effort with both adult carers and children's services did a
fantastic job of consulting with young carers.
Basically what we ended up, again, was a one -page document which sets out the priorities for
priorities, which I'll go over really quickly.
And then in carer's own words, there were I statements.
So carers told us what was important for them
in their caring role.
So those four priorities were working together,
health and well -being, young carers,
and a life alongside their caring responsibilities.
As part of the launch, we made a commitment
that each year we would bring an annual report to the Health and Wellbeing Board
to update members on how we've been doing, what activities have happened,
what progress we're making, and what challenges there are. So in the report on
page 21 there is an infographic where we try to capture some of the most
important points that our partners brought up.
Should have mentioned at the start that this was a real collaboration between this sector.
So it was something that was led by the carer, I always get the words mixed up, the carer's
partnership Wandsworth board, which is co -chaired by the council, the ICB, and the chief exec
from the Wandsworth carers centre.
So really nice collaboration between statutory services and the voluntary sector.
I won't go through all of the activities.
I'll take it that you've had a chance to read the infographic,
but I just wanted to highlight a couple of things.
One is the Children's Services Young Cares in Schools Project,
which is a nationally evidenced initiative
which supports schools to identify young carers
and it actually makes a massive difference
in terms of their academic performance
and their feeling that they're being heard
and being supported.
St. George's Hospital, they,
They have developed a carers tab,
which goes on their digital records now,
which instantly recognises patients
who have an unpaid carer,
and involves them in both the care and the discharge.
We've got St. George's Mental Health Trust,
who have trained over 200 staff on being carers champions.
Little bit closer to home, adults social care
has increased our CARES assessments by 24 % last year,
and we are about, next week, we're about to launch
a pilot of a generative AI CARES assessment tool,
which will hopefully mean that unpaid carers
will get information much quicker than having to
wait a couple of weeks for a CARES assessment.
And Wantsworth CARES Centre, our main flagship CARES project,
CARES contract now, as of last year, has over 6 ,000 members for the first time.
It's not without its challenges.
If you ask CARES what the top three things are for them,
they'll probably say short break, short breaks and respite.
We've recognised that, that's a theme which has come up
in the recent CQC inspection.
Adult social care is looking at developing a short break
and respite improvement plan, which will hopefully lead
to clinician more respite for unpaid carers of people
looking after residents with learning disabilities,
mental health disabilities, or frailty.
We are very conscious that this one year summer re -report
doesn't include consultation with unpaid carers
about how they feel we're meeting the I statements.
That's something that we really need to look at
and get the balance right between unpaid carers
feeling like they're under the microscope
because we do consult with unpaid carers a lot
on other issues, but also getting their views.
So we'll be taking this back to the partnership board.
We'll be looking at the ways that we engage with unpaid carers now, seeing if we can include
questions on the charter in the other engagement activities rather than having a separate engagement
activity.
If it turns out that we need a separate engagement activity, then we'll have a separate engagement
activity.
And the last challenge that I wanted to mention,
and hopefully maybe the Health and Well -Being Board
may have some suggestions on this,
is engaging with the wider sector.
So we've had good engagement from health,
we've had good engagement from parts of the council,
other, including leisure services,
I should really give a shout out to them
in terms of the access for all.
They have really been asking them the question, how can we improve the access for unpaid carers as well?
And they came up with some creative things during their strategy.
But how can we get the wider sector, voluntary sector,
businesses to be asking themselves that golden question, if I'm going to be changing the services,
If I'm going to be introducing new services, how can we make the lives of unpaid carers
better?
So I think that's all I'm going to say.
I welcome any comments, any questions, or any suggestions that anybody has.
Thank you.
Thanks, Steve.
I have George, you beat everyone to sticking your hand up,
even though I can't see you, so George,
if you'd like to fire away.
Okay, can I just say, I thought the initiatives
that you had on paid care, it was a really good initiative,
and I think obviously a lot of thought's been put into this.
I read somewhere that only 4 .7 million people in England are unpaid carers and they save
the National Health Service billions upon billions of pounds a year. So it's great to
see that there is this emphasis on giving supports unpaid carers. I particularly like
the idea that you said about supporting schools to identify where unpaid carers were because
we all know there's lots of sort of teenage children in effect maybe doing the rate levels
or something like that and they're looking after a parent or something like that and
they perhaps haven't been given the support in the past before.
I wanted to ask specifically about trying to identify people like that.
You've talked about the support for schools to identify unpaid carers.
I noticed the health foundation said that 60 % of carers were actually aged over 50.
I am quite sure a lot of these people who are unpaid carers and are maybe looking after
a relative or a loved one, they maybe don't even consider themselves to be an unpaid carer,
they are just doing what they see as being their responsibility to that member of the
family and they wouldn't necessarily be aware of the sort of support that we in Wandsworth
could give them. I just wanted to know what can we do to persuade these people that, listen,
you are an unpaid payer and there is a lot of support out there for you and once we are
disabled how can we do that?
Steve, it is quite a bit fair, I think George has very important points, would you like
to answer those points first?
Yeah, it's a great question.
And we know from a lot of consultation with people who are providing unpaid care that
they don't see themselves as, they don't label themselves as an unpaid care.
They're a wife looking after a husband.
They're a parent looking after a child.
They're a daughter looking after a father.
So, we have that discussion quite a bit in the Carer's Partnership Board.
Increasingly, we are using not the label of an unpaid carer, but asking people if they
are providing care for a family member or a friend who would not be able to cope, live
independently without that help.
That's what we have worked with the carer's centre to develop a making every contact count
module on unpaid care.
And we intentionally didn't call that
an unpaid carer module.
We called it a making every contact count
for people who are providing unpaid care.
As part of, just one other thing,
as part of some funding that we got in Southwest London
to look at accelerating initiatives
across Southwest London,
One of our neighbouring boroughs, Croydon,
has commissioned some insight research into how do we better
recognise unpaid carers.
And they've given us quite a bit of insight
into the types of people who are caring,
who might be more willing to and ready to recognise
themselves as an unpaid carer,
and ones who we would need not a social marketing campaign,
but a much more in -depth grassroots campaign to get them
to understand even if they don't call themselves an unpaid carer
that there is help out there.
And often that is we're seeing that increasingly in some of the,
some ethnic communities who are much more used to, I guess,
what we probably used to have in Western culture of looking
after your elders more than perhaps what we do now
in the Western world.
Thank you.
As part of the school's health -related and behavioural
questionnaire, we do have a question in there
that asks our children and young people
whether they've got caring responsibilities at home
for someone who's unable to care for themselves.
And in the 2022 survey, for example,
10 % of children in year five and six identified
that they did have such caring responsibilities.
I know we work jointly with our children's services
in terms of the use of the outcomes of the survey,
and also the schools get an individual report
which is tailored for their school
so that they can pick out any issues
that they need to address in terms of providing additional support.
So there are mechanisms in which we've now started to consistently embed at a population
level just trying to assess the level of caring responsibilities.
An additional point that I wanted to make in relation to caring and careless responsibilities
is as you'll see when we come on to the later agenda item on the age well report for our
and health and well -being strategy, we've got work streams such as the dementia one
that have got very specific activities happening around carers. I just wondered
as a result of your sort of more general engagement with carers we could pick out
some of the issues that relate to other work streams in the joint health and
well -being strategy and maybe just feedback back so that we've got kind of
cross -fertilisation and sharing the information and knowledge. Thanks Harshana,
it certainly makes a lot of sense. Any more points in relation to those which
Councillor George Croupp earlier raised before I moved on to new topics?
I would just like to add a following point that I echo everything that's been said already and that
organisations looking to move towards being proactive rather than reactive. So just to
give you an example about the numerous professional awareness sessions that are being undertaken
and delivered by Bonsive Carer Centre reaching over 90 professionals, which is mentioned
in the report, and staff being trained to be care aware across South West London. I
think it's about training professionals to be able to identify carers and then once they're
to identify carers and they're able to then signpost them and advise them where necessary.
Fine, could you identify yourself? I must have missed you sort of explaining who you are and
who you're representing. Oh apologies, Steve introduced me previously. My name is Marie Nefitu,
I'm the Commissioning Officer in Adult Social Care.
Thank you. Excellent.
Steve, do you want to answer that particular point?
Yeah, just one other thing to mention is,
since I think it's about two years,
our Equality Impact Needs Assessments require officers
to look at wider determinants of health
as well as protected characteristics.
And one of those wider determinants is unpaid care.
So officers need to consider the impact
of the proposals of their service changes
or introduction of new changes on unpaid carers as well.
As part of that, what we've done in adult social care
is we've worked with all of our providers
to encourage them to ask their members
whether they either have somebody
who is providing unpaid care to them
or if they are an unpaid carer for somebody else.
Again, all of these things start to add up
and it starts to get the conversation normalised about.
And it makes us more able to identify people
who are providing unpaid care.
Thanks.
I've heard indications of people.
Is it on these matters?
I think I've got Kate.
Yes, I've got my hands up.
Graham, Councillor Henderson.
Should I just comment?
So I'm Kate Slammet, Manager of St.
George's, part of the Epson, St.
Henry and St. George's executive team.
And just to say, Wendy Doyle, who's our head of patient
partnership and engagement, has been, sits on the
Richmond Wandsworth Patient Partnership Group and we're trying to do much more
in secondary care to be aware of carers, to identify them and to support people who are caring
and sometimes that will come to light when people come into hospital, so I realised that.
We sort of had a real focus on this in carers. We've now got a carers charter,
which we roll out across the wider organisation and we've got carers awareness training sessions
that we do with staff to make sure people are aware of the importance of carers, but
also how they might identify them when people come into hospital. So really welcome this
report today and the collaboration that's happening around it. I think it's obviously
really important. We identify young carers as well as all carers, and we're involving
them in care planning for their relative or the person that they're caring for when they're
and actually sharing information appropriately
to support them in the really important role that they do.
Okay, thanks.
If Abby, you also want to say anything?
Thank you, Steve, thanks for the report.
Just a question from me on the AI tool,
which you were planning on rolling out,
which sounded very exciting.
I'd just like to know two things.
One, what's it actually going to do?
But second, just kind of what steps you're taking
for those who are digitally excluded.
I think George said earlier,
he's something around 60 % older than 60.
That might be a lie now.
Quite a lot of people,
unpaid carers are older people,
who it might be reasonable to assume
are maybe not as digitally savvy as the younger ones.
So just wanted to understand kind of, yeah,
what the plans in place as well
to make sure that you're not missing out
on people who don't even know what AI is, to be honest.
Another good question.
So the AI platform is not intended
to replace the face -to -face conversations.
So we've got us saying that you digitalize the transactions
and you humanise the service.
So what we're hoping is that the AI platform
will be able to take some of the demand away so that our social workers can work with the
clients that really need the face -to -face contact from the very start.
In terms of digital inclusion, I call it, Paul here is doing a lot of work in terms
of trying to reduce the amount of digital exclusion
in older residents.
We have contracts with Age UK and a number of other groups.
In terms of what AI does, or what this is, as best we can,
we're trying to simulate a conversation
that an unpaid carer may have with a social worker.
So the carer's assessment is basically a conversation
which explores the impact of having a caring role
on somebody's health and well -being.
More times than not, it doesn't end up in a package of care,
but it ends up in signposting or advice
an encouragement to go to be a member of the Wandsworth Care Centre,
an encouragement to sign up for the universal care plan so that you can register that you're a carer,
so that an ambulance driver is going to know that, an encouragement to register with your GP,
a sign post to Citizens Advice Wandsworth to talk about benefits.
All of that shouldn't have to wait until
somebody can speak to a
social worker because there might be a delay there.
There's a waiting list.
It's not a massive waiting list,
but there is a waiting list.
So that's basically what we're trying to do.
You could say a lot of that could be covered
by chat GPT or copilot now.
It's unbelievable from the time that we wrote
the expression of interest 16 months ago,
which it all sounded very futuristic to what we have now,
and what co -pilot and chat GPT can do.
What one of the members of the team described it as,
we're clipping the wings of AI.
We're trying to make sure that it's not,
I'm learning all of these new phrases like AI
hallucinates quite a bit,
and we're trying to clip its wings
to make sure that the information that unpaid carers are getting from it is legitimate,
is things that have been vetted by us in the carers' centres.
My thanks if we can move on.
Judy.
I'm just going to follow up on the AI.
Since that's come up, I mean, we're all getting terribly excited about AI.
We're using different applications across the council.
Is somebody making sure they all join up and are compatible with each other?
because if you're talking to carers using AI,
I know you're going to provide some care through AI.
We are using magic notes for children.
You know, these things have to be able to talk to each other
so that there's one record for this family.
So I can't talk for all of the other
initiatives that are going on,
but I would suspect that they're all similar to ours
and that our development has been locked in step
with the corporate IT team, so yeah.
I'll carry on with my other observation.
First of all, this looks like a really, really good piece of work, all this work with the
carers.
It's great to see.
And as it happens, one of my daughters has been volunteering with Wandsworth Young Carers,
helping take the young people out on trips.
So nothing to do with me, but she's doing it.
And so I've heard from her how good they are.
But I am missing the carer's voice in this, and I know you said that.
We've got wonderful outputs.
You've done so much work, actually, what are the benefits for the children and the adults?
Are we doing the right thing?
So that's missing for me.
But then I just had a question.
So I see Enable do a lot of social prescribing, which is fantastic.
So in order for Enable to be seeing them, presumably a GP has referred them.
So could that GP not have referred them straight into carers and that sort of, it's an extra step, isn't it?
Maybe the GPs need to be more aware of the services?
Another really good point.
I guess social prescribing was established
because GEPs in their limited time
that they have to see their patients are often,
I think the estimate is between 25 and 30 % of the patients
that GEP is kind of looking at them and thinking,
you don't have a medical issue,
you have a wider determinant of health issue.
And they don't have the time that the social prescribers
have to engage and to have that dialogue
to understand where the person's coming from.
And then to not, so all of that builds trust
and then it hopefully leads to a more effective sign post
or referral.
I agree with you so, in the best of world
because we all know that folks listen to GPs
more than they listen to most health professionals.
And it would be great if when a GP can make a referral
or a signpost to the carers centre
or wherever that it happens right away.
And I'll take your point.
I've written it down about the carers voice
and when we come back to you in a year's time
you all see the voice of the carers.
Waka, thanks for your patience.
Thank you very much, Chair.
Steve and Marie, thank you for what I think
is an excellent report.
Steve, if I may, can I ask you,
well, make one observation and ask you one question.
GP records now have changed a little bit
where they now include, if it's known,
whether a patient is a carer or not.
It doesn't necessarily say whether they're unpaid or paid.
But generally they're unpaid.
And there is a source of further information
that perhaps in the future iterations of this report
you may want to leverage.
But my question is this.
I also work at the ICB as one of the clinical leads
for Wandsworth Place.
And as a result of that role,
I have had the opportunity to meet pretty much
every GP partner in Wandsworth over the years.
And we've talked a lot about how we can better support unpaid carers.
And it's something that's quite high up on our agenda.
And of course you mentioned sometimes we can support these carers by referring to social prescribers.
We have many of those now, which is fantastic.
But one source of anxiety that I've personally experienced with unpaid carers and also my fellow GPs across Wandsworth have observed,
And I know that because I've had these dialogues with them,
is the anxiety caused when some of these carers
have issues with their employers.
So they may be unpaid carers,
but some of them are in employment.
And sometimes there are difficulties in terms of
the working pattern imposed by the employer
may not accord with their caring responsibilities.
Sometimes these unpaid carers have to take unscheduled leave
for obvious reasons.
And so there is an issue that causes a lot of anxiety
for these carers when it comes to employment issues.
And I just wondered whether there was any scope.
It's a very difficult topic, but I wondered if there's any scope
for leverage here where we could develop some sort of resource
or some sort of tool to help these carers in the future navigate the difficulties
that you may have with employers.
So that was my question to you, Steve.
So if you answer my phone.
So there are some, that's one of the issues that we heard when we were putting the Carers
Charter together.
A lot of, whether it be performance in schools or whether it be work, it's a challenge.
There's the government introduced some new legislation, I believe, last year,
which entitles anybody to up to five days of carer leave.
That's unpaid leave, so that's for a lot of carers.
That's something, but it might not be manageable given their circumstances.
There's also nationally the Carers UK has a Carers in Employment initiative.
I think that that is certainly something that we should be looking more strongly at,
both for the council as probably the major employer within the borough,
but also something to encourage other employers to pick up as well.
Okay, thanks. Unless anyone has got an actual burning issue, if we can conclude. Can I just
say, I think that's been a very rich conversation, covering a very wide range of issues, so I
absolutely no intention whatsoever
to try to sum them up.
But what I will say is I think we're gonna be
very reliant upon Laura to get all the points down
in the minutes.
I mean I think all these are issues we certainly need
to look at in terms of addressing how we can improve
our approach to carers both paid and unpaid.
and the further developments of the carers charter.
But I would say that this is a very good start
and that was recognised by the CQC.
The CQC were very complimentary of what we have done
in relation to carers.
They did recognise that a number of carers,
particularly unpaid carers, indicated that there were
problems in relation to getting respite care.
But generally I think we are now starting
from a sound base, so I think any of the points
which people have made which are entirely pertinent
are ones which we can look at over the next year
and try to develop and adapt and in the years
can come up with an approach which hopefully
satisfies most if not all people.
So thank you.
So this is an item, first of all, to make the progress made by one of the Council partners
in delivering the commitments set out in the carers and carers charter.
And the second, this is the decision, commits to maintaining the annual reporting cycle,
ensuring that the charter remains a living document
and our progress is transparently monitored and shared.
Can we please agree with that?
Excellent, thanks a lot.
And our proposed to change the order of the agenda,
the reason being is we are very grateful to Waka,
Waka Shah because he makes up the quorum,
but I do know he has to leave around about two o 'clock.
So there is one other item on the agenda for decision.
So it's rather important we make that decision
before WAC it leaves.
And that is in relation to the pharmacy application guidance,
paper 25, three, six, on pages 65 to 76.

8 Pharmacy Application Guidance (Paper No. 25-316)

And that is a report by Shannon D .O .V.,
Director of Public Health.
So if Shannon can you please introduce the report, thanks.
Thank you, Chair.
The report will actually be presented by Vusi Adecki,
who's our Health and Well -Being Board Programme Manager,
and has been instrumental in developing this approach
for the Health and Well -Being Board.
Thank you, please.
Thank you, Shannon.
I just wanted to pull out a few key points from the report.
Just a few key things.
I'm sure you're all aware from our Pharmaceutical
call new needs assessment insights that health and well -being boards are considered an interested
party.
And as such, over the last year, there's been increasing applications coming into the shared
mailbox for a range of application types.
And in the report, you can see there's up to about six different types of applications
that the board are informed about.
And this flow chart is a provisional idea of managing the process.
I think we're taking some of the learning
that we've experienced in Richmond,
that there are changes to pharmacies,
and you can see from the flow chart,
there are two pathways.
So there's one in relation to applications to open
and consolidate pharmacies,
and also changes to service provision.
But one of the key challenges, as noted in the report,
is sometimes the board are notified
of these changes quite late,
and I think we don't have an established pathway
or protocol in place.
So I'm really inviting board members to kind of give their feedback
on the draught that we've pulled together.
You will note on, I think it's page 75,
on this, I know it's a bit hard to read the flow chart,
but there are some decisions where we would invite members
to contribute via a survey.
And so again, that would require participation
from all members in a timely way.
There are sort of time constraints
when responding to these types of applications.
So I guess I'm inviting the board to give feedback
in terms of this draught process.
One of the things that you will note in the flow chart
is there is a point that says communicate update
to health and well -being board.
And it will be useful to understand
what would board members prefer for every application that
comes into the board.
Would you like to be reviewing the applications?
And also just to say that the application form isn't just
one sheet there are quite a few attachments that go along with it so
what's the best way of managing that would be at would it be as they are
submitted to the board or would we want to bring this as an item to our
quarterly meetings so I'll pause for any questions
thank you it's a member support you want to be in the pharmacy applications and
How many do we actually get a year?
So as I mentioned, we've got 60 and in the last year we've probably had about 5 to 7 % of changes
and a lot of these changes are really around service provision timings
but it's really important as the board is listed as an interested party, it's important that we are aware of these changes
especially as residents are accessing service provision a lot more because of
the pharmacy first approach. So I find that's helpful. Any comments on what Uzi has said? Mark?
I think it's just what those all collectively kind of understanding that the Health and
Board absolutely is an interested party. The ICB has also been lobbying to the market entry
team that we need to be notified as well so that we can link up the various local stakeholders
etc. But actually the decision is a market entry decision which is a national process
so it is about feeding back on either the application, it's a consultation tool. The
I don't agree the decision.
It's there to recommend to the market entry board its opinion.
Thanks for the clarification.
Very helpful.
Any further comments, even?
It was just an anxiety, I suppose.
I mean, going back to our last meeting, we talked about the process more generally for
the board, and we talked about the need to focus on strategic issues and seminar -type
discussions rather than routine stuff.
And I'm slightly anxious.
This could be quite a big industry with quite a flow of stuff.
So I'm trying to sort of balance in my mind.
And I suppose what I'm really groping for is we need some sifting mechanism, perhaps,
as to which things are, frankly, fairly routine and we don't need to waste our time on, and
which ones might be a genuine issue that we need to address.
So I suppose I would like, I would be reassured
if there was some sort of pre -sifting
before it actually comes to us.
Otherwise, we'll just get lots of proposals
which we won't know that much about really.
And we'll spend a lot of time.
And to agree, Steven, if you see.
Yes, I can assure you, Steven, there is a vetted process.
So I think, I know it's hard to flick
between the two flowcharts,
But the ones that require a bit more engagement with the wider board members
But at the very least it does go through our chair and our director of public health
And again the ones that are deemed as the ones that should be communicated widely would be sifted down we are
Appreciative of works loads and things in capacity. So, thank you
Thanks
I just wanted to to add to that and just
to acknowledge the fact that actually this process
by design is intended to do exactly that,
but also acknowledging that our health and well -being board
only meets so many times in a year.
It allows actually for processes and decisions
to happen outside the health and well -being board
with appropriate input so that we don't miss any timelines
for ensuring that there has been some say,
whether that's just from the chair and the DPA
on behalf of the board, which will be communicated
or actually where we need further involvement
than as Woosi alluded to, we would then probably run
a survey if we wanted more detailed feedback
in between the health and wellbeing board meetings
so we can issue a timely response.
Thank you.
Are there any other comments behind me?
Yeah, I think my personal view on this,
clearly pharmacists are vitally important.
They have after far too many years
and given responsibility for a wide range of things
which are commonplace in Europe for some reason.
Pharmacists have given the powers to do this country,
so they are vitally important.
And in many cases, pharmacists are more likely
to know their local customers better
and necessarily their sort of GPs.
So, I mean, clearly this is important
and the pharmaceutical needs assessment is important.
And I think one thing that certain counsellors would,
and perhaps I would suggest even members of the board,
would be sort of clarity on how they can actually
sort of feed into the process.
I'm inclined to agree with Steve,
and he don't really want to be inundated with loads of paper.
We meet once a quarter, I think a quarterly report,
if necessary, you know,
it would suffice to flag up what changes have been,
what are the key points.
The pharmacy, you know, the pharmacy availability,
et cetera, across the borough is important.
So my advice perhaps or recommendation to the board
is we concentrate moving on as we have reports
as and when necessary, summarising any changes.
And perhaps some further guidance to members of the board
and also to councillors as to how they can sort of
comments in relation to the pharmacy availability, location, and need.
Stephen.
It was just a thought in terms of the counsellors.
I mean, would the relevant local counsellor or counsellors be routinely consulted as part
of this process?
Yeah, and I think that would be useful.
Yeah, Shannon.
Thank you.
I just wanted to make a comment that might be helpful
in terms of clarity, because there are two separate
questions around the general provision of pharmacies,
which will be addressed through the pharmaceutical
needs assessment that's being presented to the board
at the next meeting, and that's quite a separate issue
from the issues that we're usually informed about,
which are changes in operational operating hours
or provisions, which are usually beyond our control actually, their business decisions,
and those are more the kinds of things that we tend to get asked or informed about through
this process.
So in terms of the actual decision, does the health well being board agree the recommendations
are set out in paragraph one of the report?
So the first one is agree the approach to responding
to changes to pharmaceutical provision as set in the report
and the decision making flow charts in appendix three
as interested party when notified of the changes
to pharmaceutical provision.
I'm just sort of wondering off the top of my head,
I mean, if the board would prefer quarterly updates,
does that actually conflict with the recommendation using?
I was also gonna suggest what we do send out
in between meetings is our e -bulletin.
So we could also include that in between as well,
if that helps.
That should minimise the traffic of the extended papers.
Sorry, I'm very quickly looking at Appendix 3.
I mean, I've got a lot of review stuff in there.
I don't know.
Yeah, I'm very quick action to Appendix 3 is that we can accept that.
that's, I mean, it is talking about consultation.
Shannon, I mean, do you have any advice on this?
So which section, Chair?
Well, I mean, basically,
we're being asked to approve Appendix 3.
I think it's fairly clear that the board certainly
that don't want to be notified of every single application
and that, as and when necessary,
a quarterly report or a report to regular health
or well -being or eating with the physician.
I can't see anything very quickly in Appendix 3
which would necessarily conflict with that.
Yes, that's absolutely the case.
and I think even because we have been testing out this process already to date,
so I'd be looking to help them well -being board members to indicate if they feel that they've been overwhelmed with notifications,
but certainly the proposal is to consolidate that into a quarterly report
where we can just update overall on any of the changes that we've been notified in that period.
Okay, thanks.
On that basis, are you of board content
to approve the first recommendation?
And yeah, so the second item for decision
approve the decision making flow chart
as set out in Appendix 3.
Yeah, and my inclination is I think
I think you can probably do that as well.
Okay?
Okay.
So can we just formally for the record,
can we agree those two recommendations?
Yeah?
Okay, thank you very much indeed.
So moving sort of back to the original agenda,
the next item is the joint local health well -being strategy,

5 Joint Local Health and Wellbeing Strategy: Age Well Update (Paper No. 25-313)

the Age Well update paper, 25 .313, pages 23 to 34.
Another report from Shatman, thanks.
Thank you, Chair, and thank you, Board members.
I'm really pleased to present this progress update report
on Age Well, of our 19 Steps to Health and Well -Being.
I also wanted to note that I think it's a bit of a milestone
in terms of our strategy because this marks almost a year
since we launched the strategy,
and this is the culmination of all the reports
that we've had as updates on this strategy.
So marking sort of one year to reporting on progress
with our strategy.
I did just want to note an error,
which it doesn't take being sort of eagle -eyed,
I don't know how we missed it,
that in section four on falls, the introduction
is actually an update on our adult immunisation.
So please do bear with us.
Unfortunately, we were told that once the papers
have been published, they can't then be recalled.
But we'll absolutely make sure that we send an update
on that introduction.
It doesn't change the contents that are actually
in the section of the falls update.
So having said that, I know we're joined
by several officers, I think mostly the step leads,
who are here to give a very brief highlight
of the key points within their areas,
and then hopefully be able to take questions from the board.
Thank you.
Thanks.
Who would you suggest go first, Shannon?
So first we've got the fall section,
and we've got Brian Roberts,
and then that's deployed by dementia
and the standard for dementia.
We have, is it Anna who's the president,
and then finally.
Great, thank you for letting me talk about
falls in frailty today,
as opposed to childhood immunizations,
which I know very little about.
So obviously you've got the two pages of Aunfools and Fraute.
I'm just gonna jump to page two where there's coloured in things, so
coloured in charts.
For some people, otherwise it's so black and white for some.
Apologies for those people.
So the green on green chart at the top describes our numbers of falls.
And the dark green is the actual falls.
The light green are those people counted as falls in the national benchmarking
where they're admitted as a fall to a hospital
and then transferred to another hospital,
which is called the double count
in Chelsea Westminster, West Middlesex.
So I'm not including those, but I'm showing them here
so that actually if those people wanted to add them up
and look at fingertips,
you'd come to the same sort of numbers.
But actually it's really good news
in that our falls have gone down
compared to the last 12 months
compared to the preceding 12 months.
So we've seen 66 less falls.
The chart at the bottom, which is a benchmarking chart
across London, shows the number of falls incidents
by care home beds, so CQC registered care home beds
for those falls that come from CQC registered care homes.
And Wandsworth is below the London average.
Please don't ask me to explain what's happening
with Camden, who are somewhere else at the top.
But actually that's, it's really good news.
But these statistics hide some of the variation.
And so we've been working with
Urgent Community Response Services,
Falls Pickup Services, to try to work through,
and obviously commissioning teams,
to try to work through those care homes
that have seen a higher rate of falls,
or those care homes where an LES crew is called,
but the person is treated on site and not conveyed.
which actually feels like the right thing to do
is actually urging community response
or care and support teams
are providing an intervention to those places.
So actually, our rate of falls has decreased,
which is great news,
and there's been a lot of work happening around that.
There is some variation we need to deal with.
There's also looking at those people who fall
and then fall again,
and subsequent falls and can we think about
what that response is to break that loop.
And finally, just to highlight the massive amount of work
done in this borough around force prevention.
So that's back on slide one for us.
307 force prevention classes, over 6 ,000 attendances
across the borough in terms of force prevention.
So it does feel like all these things in tandem
have made a difference to our residents.
At that point, I'll stop talking and ask for any questions.
Any questions in relation to fools to broaden?
Stephen.
Could you say a little bit about what are the main causes, as it were?
Do you have an analysis of that?
If you could solve one problem, what would it be?
Top two.
So I really do think for this borough it is around,
so Care Homes makes up about 30 % of all falls.
I would say that actually working in Care Homes
to reduce that number and working with those Care Homes,
Urgent Community Response Services and Care Homes
support teams would reduce our falls pretty significantly
as well as supporting those more vulnerable people
in those places.
I think that's probably where I would want to see
that work done, partly because actually we have
quite a significant offer in terms of force prevention
in the community.
I think that feels like where the emphasis
would need to continue to be.
I'm Kate.
Thanks for this.
The only thing I was going to add is obviously what we want to do is to continue to reduce
conveyance to hospital where that isn't necessary and people could have a better intervention
in their home.
And I guess that's part of what we're looking in terms of our urgent community response.
But also we've got a, I'm trying to think what it's called now, but it's something we're
have just set up in South London whereby the ambulance stack is reviewed and people ready
to come in possible, you know, are there better alternatives that they can be directed to
rather than being conveyed into an A &E, which I think we all know is a last resort and this
should only happen if there's no better alternative. So Mark might remember the name of the hub
the hub that we've got. What is it Mark? I can't remember. It gets the ICC isn't it? Yes, yes,
the new bit of the ICC that sits at Croydon where we review ambulance stack but yeah,
but that's I think we need to keep measuring that element of this as well as we change
services and look to focus on reducing admissions into hospital as part of the 10 -year plan.
Thanks for the answer Mark.
I think it's also just, so Brian thanks for the report and it's good to hear that we are
doing really well but I think just in terms of frailty it is that focus on this is one
element of what will work for our older population. It would be good for us to make sure that
all the different bits—and I know the Frailty Forum are doing that—are working in tandem
with the Sergeant and Community Response, falls prevention, etc. There is something
about seeing the bigger picture around frailty as well as just the falls information.
Excellent.
Okay.
My question, Brian, given that a significant proportion of falls do occur in care homes
and given that the overwhelming majority of care homes in Wandsworth and those which we
use are essentially private.
How can we best work with them to try
to drive down those numbers?
So I think there's a number of steps,
some of which I've talked about in terms of
where our services interact with those services.
I think for me, and back to Kate's point about the stack
and reviewing the stack, I think that's great
I'd prefer the care homes to phone community services
as a priority rather than phoning an ambulance.
I think that because the longer someone has fallen
and is laying, the more chance they get conveyed to hospital.
So actually our two hour response service,
two hour response is very good.
And hopefully with the work around UCR
is creating more capacity to do this work.
So I think for me, we have the,
I think we have the constituent ingredients in place.
We have the urgent community response work.
We have the GPs and the cheque -ins and the MDTs happening
as part of enhanced health and care homes work.
We have the care and support team via CLCH.
I think the bit that would really help those providers
is actually allied and allied communication across them
to make community services the first point of call,
as well as understanding the training
and support that's given.
Yeah, I mean, I couldn't mention everything here,
but there is a digital element in here as well,
provided by the ICB and some of our care homes in Wandsworth
which obviously supports force prevention
and supports the ongoing wellness of the residents
of those care homes too.
So I think some of it is how we join up our provision.
Right, okay, let's see.
It was just a sort of further question, I suppose.
You talk about care homes.
Are residential homes, as I think from care homes,
part of this picture or significant?
And how are they part of any programme that you're doing or could do?
So by care homes, I'm referring to anyone who's secrecy registers care homes, so that's
what for nursing or residential care or people supporting learning disabilities or mental
health.
So that's all the care homes in Wandsworth that fit under that.
So that's the reporting we get from LES in terms of those.
So it's not just the nursing homes,
it's the residential non -nursing homes as well.
Non -nursing care homes, sorry.
Right, okay, well thanks for that, Brian.
I mean, it's just an important issue.
I read some horrendous statistics,
I forget exactly what percentage is,
of older people who have falls
and actually die within 12 months.
I can't remember what the percentages,
I remember thinking it was pretty horrendous.
So clearly if I can be involved,
we can continue with this work.
If people have finished in terms of talking on the FOORS,
could we move to the next element of the A12 report?
Sorry?
It's the man shows now, okay.
and I'm going to turn it over to Hannah Pearson.
Good afternoon, everyone.
Firstly, just to introduce myself,
my name's Hannah Pearson.
I'm one of the lead primary and community care
delivery managers in the Merten and Wansworth team
at the ICB.
So I'll just give a few highlights from the report
and then it will be great to have a discussion.
And there's certainly a lot of cross fertilisation
in connected areas with some of the areas
of discussion already in terms of carers and care homes,
falls and so on and so forth.
So I'm aware I'm here to talk about this,
but just to note from the start,
it's really all about the partnership work
that's happening across the system.
And since I've become a bit more in dementia
as a work stream, it's been really exciting
to see the range of work that's happening
across the sector really, primary community care,
acute social care, public health, voluntary sector,
the list goes on.
So this is sort of really a reflection
of all the work that's happening in the system.
In terms of our plan on dementia,
we've kind of got five themes
where there's specific areas of focus,
but that's not to say that's exhaustive
because there's other areas and other domains
where there's work occurring.
So just in terms of a really high level flavour,
there's a lot of work in terms of the prevention agenda,
think brain health, I think with public health colleagues,
what's good for the heart is good for the head,
and how we can kind of align dementia messages
and raising awareness as, you know,
along with suite of risk factors
and the recent Lancet review,
additional factors have been identified.
So that's sort of a key area.
In terms of diagnosis, Wandsworth is performing
really quite well.
So recent data, nearly 78 % diagnosis rate,
but obviously still recognising then there's a cohort
of people who are living with dementia
who don't yet have a diagnosis.
And that sort of borough -wide figure
does mask quite a lot of variation
in diagnosed rates across the borough.
So there's going to be a bit of targeted work,
looking at where there might be more inequalities
in that respect, and partnership work with community groups
and so on.
And I think the outside society and other partners
really focusing on that as a priority area.
So I think that's really important.
In certain terms of services and support,
we're really fortunate in Wandsworth
there's a wealth of services and information available.
Sometimes that can lead to complexity.
So one of the areas of focus is refreshing
and re -looking at a resource that's available
for people with dementia and their carers
and working with partners to sort of bring that up to speed
as that's sort of a bit of feedback that's been received.
So we're progressing with that.
Carers support, I think there's been sort of
a quite extensive conversation about that.
Obviously, close links there in terms of the work
and the specific needs in terms of people with dementia
and their carers that we want to support.
And in terms of care homes, as Bryce mentioned,
there's a lot of support for care homes in place,
and there's some specific initiatives relating to,
so there's kind of a whole work programme
in terms of enhanced health in care homes.
There are specific elements relating to dementia.
So for example, there's been some training initiatives,
there's been some digital developments as well.
I've put a couple of examples there.
So one I think really nice one is the magic table,
sort of a, I'm not sure, physical table,
but sort of a place where people,
dementia, carers and others in care homes
can get together, there's social interaction,
and it's led to really positive experiences
and good feedback, and we've heard that,
and this rotating around care homes
across Southwest London, but one recent bit of feedback
that I heard that was really nice to hear
was someone said that their wife
who'd engaged with the table,
so it really was really invigorating
for her, fantastic experience,
And then he decided to invest in that individual care home so that they could have a magic table on a permanent basis
And he just said you know it was just quite yeah quite life -changing really
So that's just you know just a little and snippet of what would be some of these things mean in
Yeah for individuals and but just to mention as well and in terms of other highlights that aren't sort of captured in the report
This is a really strong kind of volunteer
Cohort in in Wandsworth, which I think is is really positive. There's a lot of work in terms of inequalities
and I've put in terms of some really great example
of work that's happening.
We've mentioned, I think the ones with care
of centre quite a few times, but as an example,
their work, the work of the Alzheimer's Society,
and I think the ones with care of centre
bringing partners together as a dementia professionals,
information sharing, and from conversations I've had,
I think that a lot of people really value that
as sort of a forum where partners can come together
and progress the work, and then also some really exciting
and developing developments as an example
from St. George's perspective and others.
So I appreciate that's a whistle stop tool,
but I think there's some really positive work
that's happening in this space and in a range of areas
and would welcome any comments, thoughts,
or suggestions really, so thank you.
Oh, for that update, excellent, good.
Any comments on dementia at all?
I don't see any.
So thank you very much.
That isn't to say, obviously,
we don't take the injure very seriously.
Obviously, it's a growing problem
and we do need to tackle.
But I take it as a good sign that members of the board
didn't have any burning questions to ask you.
So thank you very much indeed.
Thank you so much.
I'm very happy to connect outside if there's anything.
Yeah sure.
Thank you very much.
Thanks.
So let's move on to the next report
in relation to social isolation,
which I think is Paul.
Yes, good afternoon.
Yeah, I'll refer you to pages 32 to 34
for the social isolation update.

6 Better Care Fund End of Year Report 2024-25 (Paper No. 25-314)

So this update particularly focuses on the age well step,
but we're very conscious that social isolation
cuts across the whole life course.
So we can absolutely consider how we can bring other steps
into the equation for future updates
to give a broader perspective of social isolation.
We already do work with other step areas.
In my work, so I should have introduced myself,
Paul Banks, Commissioning Manager in Adult Social Care.
And my particular portfolio does focus on reducing
social isolation, providing support services
to reduce falls.
We have services for dementia.
So my work area cuts across the age well perspective anyway.
Yes, so as a new step lead,
I've recently taken on the role of the step.
And I have particularly wanted to focus on being able
to try and understand and explore further
how we can identify support for more seldom -heard groups.
So we've put some statistics, should I say,
into the report to see how we are supporting people
from more seldom -heard groups.
This particular step is focusing on those most at risk,
So that's including unpaid carers, older people,
people with disabilities, and those living alone
or in areas of deprivation.
And we work closely with social prescribers,
council departments, and furniture sector organisations
to understand what activities are happening
across the system, across the borough.
And particularly accessing,
or those not accessing formal formal care.
So it's quite a challenge to try and unpick
all of the wonderful things that's happening
across the BOA for social isolation
and put it on a couple of slides.
But hopefully we've given a flavour
of the activity that's happened over the last year.
We're absolutely focused on ensuring
that we reach the most underserved populations.
So we do that by understanding
what population health needs are.
and we have a couple of services in adult social care,
a few services in adult social care
that actually undertake needs assessment
so that they can understand what their local populations
need and provide those particular services for them.
So that's our age well programmes.
I'll draw your attention, so we haven't got the ASCOF,
the Adult Social Care Outcomes Framework
results back for 2024, 25.
However, we are seeing great improvements
from the previous years.
So the Wandsworth is now the second,
or sorry, joint second in London forming
for people that are accessing adult social care services
and saying that they actually have enough social contact.
So that's really encouraging to have seen
progressing in the last couple of years.
I won't read through all of the various different activity.
I'm just going to say, well, I'll take it
that people have had an opportunity to read,
but just picking out some of those key points
and to my point about trying to make sure
that we reach more seldom heard communities.
46 % of adult social care,
prevention and well -being services,
service users are from black, Asian,
minority, ethnic communities.
Touching on to the point of carers,
well over 6 ,000, I've got 6 ,600 unpaid carers
are registered with the Wandsworth Carer Centre,
and over 1 ,300 of those unpaid carers
are accessing peer support groups,
which can point towards the fact that they are supporting
their, supporting them to reduce potential social isolation.
One main focus of the administration's manifesto
was to use food as a tool to reduce social isolation.
We have been able to establish over the last couple of years lunch club activity and we
use that in the broadest possible term, not just necessarily traditional lunch clubs and
we do have lunch club provision in the borough but it is essentially different ways of bringing
people together, sharing food and having social activity.
So in the last year we have had I think it was over 980 various different sessions at
lunch club provision.
Digital inclusion, we touched on that today as well.
We've had adult social care provision of over 600 service users in the last year.
And Wandsworth Community Transport supports over 1 ,800 members with over 6 ,500 shopping
trips.
So there's quite a lot of activity that is going on.
One of the focuses in the Care and Health Partnership is around the leisure strategy,
and there's been a lot of work going on in the leisure strategy.
So, ledger services now secure 10 -year contracts
for new providers.
They've established the sports
and physical activity networks, C -SPAN,
and that now has a chair and is operational,
an independent chair as well.
So, fairly different, a range of activities going on.
Just a couple more highlights just while I've got the floor.
Inactive adults, so through those ledger services,
We've seen over 2 ,600 inactive adults taking part in activity,
which is an increase from the previous year of 1700.
So we're showing that making great strides on the leisure services side of things.
1 ,400 attendances for force prevention physical activity sessions in adult social care provision.
And 283 residents engaged through the Wandsworth Care Alliance volunteering platform.
So matching local residents to volunteering opportunities.
So a vast array of initiatives which are ever growing
and just recently SPARQL, which is an intergenerational
service have opened up another scheme in Roehampton.
So lots of stuff going on.
Yes indeed, oh yes, very good to hear,
particularly the improvements which have been made
in the last couple of years.
But does anyone have any questions or points?
So, Abby.
Thank you.
This won't come as a surprise to Paul, I don't think,
because he kindly came to a health and wellbeing
engagement board and was bombarded with questions
about the fact that social isolation obviously
doesn't just affect older people.
And at the risk of being really annoying,
I do wonder if it's in the right place.
Is there a slight risk that by putting this in age well,
it's a focus, or we just think it's a thing
that particularly affects older people
and we just ignore all the other people
which it does really negatively affect.
And is there a risk that we therefore think
we're not, potentially things aren't being,
we're not intervening early enough.
I'm very conscious that I initially read this strategy
and was like, yeah, that all makes sense.
So I'm now doing the annoying thing
where I'm just wondering if it does.
But that was just kind of a, yeah, a recurring theme.
Obviously people I work with from socialisation majorly,
people with disabilities, but you've also cited carers.
And Steve, obviously you said in your presentation
for uncode carers that respite is one, two, and three
on their priority list.
And that was just kind of my question really.
I appreciate that resources are scant
and that you can't solve all the problems.
So it might be a case of picking something off
that you can focus on, which absolutely makes sense.
I just wanted to kind of raise that question though.
Yeah, maybe for you, Shannon.
But thanks, Paul, for coming to our meeting.
It was really helpful.
Yeah, thanks, Abby.
Good point.
A lot of these things are cross -cutting.
I think it's probably focusing on those elements
which are particularly relevant to certain of these
three categories of ages.
But Shannon.
Thank you, and I was anticipating that question
because actually I was going to raise my hand
to make a similar point to the Health and Well -Being Board.
I mean, it's great to receive this report
and note that if you're thinking about
our sort of prevention framework approach,
you've got approaches here at an individual community
and also environmental level, and that's really great.
But similar to Abby, I was going to ask the question around,
at the moment, we're treating the issue
around social isolation when it occurs?
And is there mileage in taking a more upstream approach
and thinking about how we can engage and work with residents
around preventing social isolation from happening
in the first place?
And obviously, that does need to happen across the life course.
Some of the things are thinking about decisions
in terms of how people prepare for their old age
in terms of where they're located and what their social and community links are, for
example, and thinking about some of those multi -generational approach opportunities
that are available so people can actually consider the issue around social isolation
and plan in such a way that they'll reduce the risk that that might happen to them when
they're in their older age.
So I think it is a really valid point and something that I know
has been considered within adult social care for many years before.
I think the reason why we placed this step within the age well was just
because the data that we had was basically from a particular cohort
which sat more within the age well.
But an absolutely valid point that we should be thinking about,
you know, the upstream prevention, and maybe it's about having a dialogue with our residents,
you know, as a whole to start thinking about this as being, you know, a real issue.
Thank you.
Yeah, and finally, you know, Shannon, any further points?
Stephen?
Thank you.
From a very wide -ranging point to a rather nerdy point, page 33, the statistics, I may
have misread this, but in the text bit above the table, it says in 2019, ones worth proportion
of adult social care use who had as much social contact as they would like was 40 .6 percent.
But then it goes on to say that the latest percentage was 11 .1%, which was the lowest
in London.
And I may have misunderstood what these numbers are saying, but on the face of it, this looks
like a dramatic fall in satisfaction, which worried me.
Yeah, no, it's essentially the other way around.
So it's the 2019, I think it was at the 11%, and then it jumps up to sort of 40 % in the
2023, 24.
and we don't have the data for then the most recent one.
Well that's very good news.
Yeah, it is.
Yes, it is.
And actually I was going to ask a question about that
because I do know that certainly the ASCOF measures
in this field and indeed the majority of the fields
have actually improved so considerably over the past three years or so.
Good. Or perhaps we can amend that.
But, yeah, I mean, I'll tell you the point Adm. E. and Shanna make
in the entire E. Eve and it, I mean, there must be quite a lot of learnings
from these work streams, which are obviously cross -cutting,
which apply to other ages as well.
I don't think we've probably got time
to have a discussion now as to how best
we can incorporate that into the health of our being strategy
but I think it is a very good point for us to consider
when we next come to discuss the strategy in this entirety
and certainly if anyone has any views,
please do feed them in.
Okay, well if people are content, first of all, can I thank the presenters?
Can I also thank all the people who have worked very hard on these work streams because they
are very, very important indeed.
We live in an ageing society.
There are considerable challenges in this field, so it's good to know that we are certainly
handling of overwhelming majority of those challenges very very well indeed
but clearly no room for complacency you know we believe as administration as a
council in terms of continuous improvement I think some comments that
have been made are areas we can very usefully focus on for the future.
But anyway, can I thank all the presenters?
The formal recommendation is,
does the health and well -being board agree
the recommendation to note the outputs
as set out in appendix one to the report?
So if we can agree that, thanks.
Can I just point out that no criticism or whack.
They pointed out they had to go off early.
But since Waka left, Dr. Waka left,
we have actually been operating as an informal meeting
because we're no longer quarantined.
So since he left the discussion,
which only involved noting,
if I might think pretty much the rest of the agenda
is only really for noting, obviously with comments.
but just to inform you that we are operating
as an informal health and wellbeing board,
as opposed to a formal one.
Okay, thank you.
Great.
So let's move on to the Medicare form end of year report 2425
and Brian, I think you're also leading on this.
Thank you.
I'll take the paper as read if that's okay.

7 Better Care Fund Quarter 1 Update 2025-26 (Paper No. 25-315)

Partly because I feel like I've talked enough already and I've still got another two reports to make my way through.
So having said, I'll take the paper as read, just a couple of things to pull out about the Better Care Fund End of Year Report.
Obviously this is the End of Year Report 24 -25.
We are catching up.
So today is the End of Year Report for 24 -25 and the quarter one, 25 -26.
The next health and well being board will have the quarter to report, which will almost be very much catching up.
So just to bear in mind for the year end, the money was spent to budget.
I'm also aware that in previous meetings, there have been an ask from the health and
well being board about the impact of the better care fund to which I just want to
Just highlight paragraph nine with the table below it,
showing the demand capacity for intermediate care
for discharge, showing that actually we supported
about 4 ,000 people and we expect you to support
about 4 ,000 people, but actually the time of us
to discharge, that time between when we knew
about someone in hospital, to discharge in them
under a discharge with us pathway was reduced in acute care.
We also supported rather more people actually
to remain in the community,
which is the small table below that.
And in addition, which isn't part of this table,
the mental health discharge and remand service
that was funded by the better care fund supported
timeless discharge from secondary mental health beds by just over a day.
So this day, day and a half doesn't feel like a lot, but actually over 4 ,000 people,
that's quite a lot over our population, especially as our population sort of,
over 65 grew by about 4 to 5%.
So what we're seeing is additional demand, but actually an increase in timeliness.
Just going back in the report slightly to the best care metrics, obviously we've talked about falls,
which reduced, as I talked about, in the ageing world step,
but also hit the ambition around falls.
We didn't achieve avoidable emissions, discharge of employees' residence, or
permanent admissions to residential care.
Discharge in all place residents, so it was exceptionally ambitious.
We do particularly well in this borough about that.
And actually when you, so and this captures those people that are placed,
and where they're placed directly from hospitals.
So if someone goes into a short stay care home or
an intermediate facility, that will count as not going home to the usual place residents.
even though weeks later they may go home.
So that's just to bear in mind.
And just avoidable emissions.
So again, I've just pointed out that the huge amount
of work keeping people safe in the community.
In terms of urgent community response services,
which obviously includes what Central London
Community Healthcare and the GP RAPA Response Service do,
we saw an increase of about 37 % of people,
But actually they didn't fit the cohort that's counted for avoidable emissions, unfortunately.
But we did actually manage to support an awful lot of people to remain at home.
And with that, I'll take any questions.
Thanks.
Any sort of questions to Brian on the UDL downturn from the Better Care Fund?
Anyone?
Are there any consequences where we didn't meet the targets?
I mean, do we lose money or does anybody do anything about it particularly?
So it's funny, I've been asked that a few times recently.
So there are no direct consequences through the BCF other than,
and I'll get on to that in the Quarter 1 report.
So support is available nationally
via the Better Care Fund team,
so which comes with scrutiny,
which may be helpful, but may not,
but also takes quite a lot of capacity to fulfil.
I think for me, the consequence always has to be
the fact that we want to get these things right,
we want to get them right first time.
That feels like the overarching consequence
rather than any stipulation around any penalties.
If I'm honest, I think it's penalty enough,
not achieving these things for the capacity that our health and care services have.
All right, thank you. Any other comments? Mark?
I sound a bit like a broken record and Brian, thanks for the BCF paper because I know how much
work goes into it. I suppose it's just going forward, just ensuring that the Better Care
Fund and everything else that we're doing across health and social care are completely aligned
because some of the targets within the BCF, some of our partners might not recognise the impact
that we're having and there's something about us joining them up. And Brian, I might land you in it
here, but the Better Care Fund is also under reform isn't it and we're anticipating some changes
and perhaps a kind of a bit of a kind of more focused scope
going forward.
I don't know if we've got the details
of what that will look like yet,
but it's just to say that I do think
the Better Care Fund is kind of under review
at a national level.
So two things, in terms of targets we recognise,
when I go into the quarter one,
so there was a move away from these distinct targets
that you're right, feel like they're isolated,
and onto targets, metrics such as the total number
of over 65s being admitted to hospital,
and obviously timeless discharge by the discharge radiate.
So those feel very much like they're incorporated
in our UEC plans.
They feel like they're proper big targets,
and obviously those ambitions were set,
through Merton and Wandsworth you receive
the urgent community, urgent and unscheduled care
delivery board as well as with St. George's,
so Paul Cloves there and Mike Proctor
and others helping with that.
So there is that bit.
In terms of the reform for the BCF,
so there are a lot of presentations that are coming out
which talk about intermediate care, discharged,
rehab and re -abdomen at the moment.
So that feels like pretty much where our BCF has pointed towards.
What we haven't yet seen, Mark, is the detail around that to understand what the actual ask going forward is.
Our BCF narrative really talks about neighbourhood health and care services and
the move towards that through the ones who have provider alliance and other vehicles.
So it feels like we'd already sort of acknowledged those going forward in our planning,
but obviously they're going to become much more mainstream as we move forward.
Thank you.
You know, further comments, I'll just sort of sum up.
I think that the last item for discussion is something that I am particularly interested
in, and the BCF has set up our government as quite a significant instrument to ensure
or greater integration.
And it certainly has been enormous progress made,
for example, particularly in relation to hospital discharges
and a range of other initiatives that Brian mentioned.
I think given the changes within the NHS
and the changes, potential changes coming forward,
which both Mark and Brian are interested in.
I mean, for me, the real challenge is using the money not just to satisfy demand in terms
of discharges or other places, but as a genuine vehicle to ensure greater integration.
And so what I was interested in sort of going forward is indeed how we can leverage the
the economic power that is embedded within the
British Health Fund to ensure that greater integration.
I think what's happened so far has been very, very good.
I think it's resulted in considerably more discussion,
liaison, practical working together,
and some degree of integration between the NHS
and local authorities and other organisations.
but I do think we have got some further way to go on that.
But thank you for that.
And if there are no further comments,
the action on this is simply to note the BCF spent
outputs activity for those schemes reported
in the paper for 2024 -25.
as per appendix one.
And second, to note the outcomes and impacts
of the PCF on hospital discharge
as demonstrated by the intermediate care demand
and capacity reporting.
So can we please agree with this?
Thanks.
Recognising that we are now in informal meeting,
but whatever the mechanisms are to endorse those,
I'm sure you will do so.
So if we can move on to the very next item,
which is also to do with better care fund,
there's a quarter one update.
And Brian, I think you're presenting.
Thank you.
Oh no, not him again.
So this is the quarter one.
It feels like we're whizzing by, doesn't it?
So hopefully by the end I can give you
whatever's gonna happen in 27, 28.
So this is the quarter one update.
So the plan came to a previous health and well -being board.
And this is the review of the quarter one progress
as per the national ask.
So some of that ask is,
are we meeting the national conditions?
So have we got a jointly agreed plan?
Are we, is our plan pointing towards the objectives
of the BCF to keep people independent in the home
and to support discharge.
Yeah, does it comply with the grant condition?
So are the schemes pointing in the right direction for that?
And including the minimum contribution
to adult social care.
And complying with oversight and support processes.
So Stephen, that's your point about consequences.
So there has to be a certain compliance around that
for the more challenged systems.
So in terms of the expenditure,
So we're 25 % through the year,
and we've spent just ahead of that.
And also I feel the need to say that
quite a lot of the services that are funded
by the Better Care Fund are funded under a block basis,
and so you'd expect some of that to be where we are.
And then they're all operational and running.
And then again, just, we've started some of this
conversation in the earlier section.
So under point 11, there's the three metrics.
So emergency emissions, total emergency emissions for people aged 65.
Average length of discharge delay, so that the point between when someone is ready to go and
when they actually do get discharged, and the long term emissions to people over 65 to residential and nursing homes.
So we are on track for average terms of discharge delay.
And obviously we're working towards trying to smooth discharge out of hospital still.
Our long term admissions is on track.
So we've seen a reduction in quarter one compared to where we expected to be based on non attainment in 24, 25.
And the one that we're not on track for is the emergency emissions to hospital for people aged 65 plus.
And just to say that this is, so if we were measuring
the number of people we saw at the same point last year plus population growth, we would be below that number.
But obviously we've got some ambitions in the system to reduce that number.
So some of that is around LAS conveyances,
so London Ambulance Service conveyances,
and increasing the see and treat.
And some of that is around how we're using
other forms of support from ED,
such as the Froudy Same Day Emergency Care,
the Froudy S -DEC, which started in July 2025,
and is seeing about 35 people a month.
So that so that the impact of that is not shown in the numbers yet, but
the scene July we've seen a
Decrease around some of those short stay emissions for over 65 and so we're expecting that to to continue
And and with that I I hand back to you
Thanks comments soon
It's really about the
The nature of these reports always troubles me.
The BCF is a very technical and arcane subject,
which we have to do.
And we do do it.
And Brian has to produce these reports.
And I know they have to come to this committee.
But I personally, I always struggle
for woods and trees here.
There's lots and lots of trees.
And I can't, well, I don't come away feeling I've
got the big picture in my mind.
And I'm not sure the BCF as such is actually the best vehicle for getting that big picture.
Because we start with the BCF and then try to work out from that, whereas rather than
starting with the big picture, then the BCF is a mechanism for addressing it.
So somewhere, I mean, clearly what this is all talking about, if I've understood it rightly,
is how we're getting on in terms of admissions, length of stay, and discharge, and in particular
than the consequences with social care and how does that interface work.
And I kind of feel it would be helpful if you could just present it in that way around
rather than here's all these particular targets and the last six months or whatever.
It's a different – it will be a different report.
And I realise that we have to produce these reports and they have to come to this committee.
So I'm not saying we should not do these reports or indeed to criticise these reports
because they're mandated.
But we don't quite ever have that overarching picture
of what is actually happening.
And I can't now remember,
because Kate did a very good presentation
on St. George's more generally to the OSCE
just last week I think it was.
And I now can't quite remember whether or not
some of those big picture issues were in there or not.
They may well have been.
But somehow I'd like to have a big picture
rather, or as well as if you like these rather micro ones.
That's a, that was my observation as it were,
Yes, that's the statement again. I mean, that's essentially what lay behind my comments at
the end in relation to the previous item. Yeah, you've got to produce all the statistics
to show that we're spending government money widely, so there will be a need for this type
of report. But I do think that going forward, you need to be much more imaginative in terms
how we can use economic leverage from the BCF
to actually transform the system to ensure far greater
integration.
And as you said, look at the big picture
and see where the BCF not only fits into it,
how we can actually assist that process.
But you mentioned Kate and her presentation at the OSCE.
Next person to speak is Kate.
Thank you. I mean, I do think this is quite a difficult report, but I know it's mandated
and it is what it is. So it's not the easiest thing to bring it all together. I do think
part of what we need to do at place and through the Alliance is really bring this to life
and think about how we utilise these funds in the best way to be able to demonstrate
some of those changes. I know that the 65 plus admissions have gone up, you're right
It's till the end of March 25th.
I think it'd be really interesting to see how things
like frail TS deck impacts upon that,
because that's the sort of thing we need to be doing more of.
And that has been really successful in terms
of turning back around about 50%, 50 % or 60 %
of frail people who end up getting pulled into that
capacity down in ED.
And all of those patients would have got admitted before,
because that was the pathway.
And once somebody is admitted who's frail, as we know,
they can end up staying quite a long time.
So I do think that will have an impact.
But stepping back, thinking about what we're trying to do here
and how do we sort of meet the needs of the BCF
whilst doing the right thing,
I think is something we'll need to take outside of here
and work through as part of our Alliance work.
Yes, Kate, I entirely agree with you.
Our 70 -store change is sort of coming on stream
over actually the next six, seven months,
but I mean ongoing.
It would actually be useful, Shannon and Brian,
if you give some thought to that,
particularly as to how we can involve partners, et cetera,
in looking at how we can have a much more strategic approach
to the development of the ECF.
Obviously, accepting the rules which are presented to us,
But whose sense there is fairly wide agreement here,
we have a very useful mechanism
which perhaps we're not necessarily utilising
in the very best way.
And that's not a criticism of what's been done to date
because as with most things,
it's a question of suckiness, seeing it,
see what works and learning how to adapt.
So really it's been an always out of excellent work done that I think there is a desire amongst
number of this to have a more strategic approach
Yeah, right
Thank Thank You council Hanson, so so so I agree I think so previously I
I presented the the better care fund to and
To the partnership group and other groups with a bit more detail around
and actually where we are and where the problems are.
And I guess there probably is, you know,
about what comes here from that.
I accept that the template needs to come here
and needs to be signed off, but that doesn't mean
you shouldn't get some of the other information around that.
So absolutely I can work with others to produce something
that gives that conceptual information
as well as the bits that we have to do.
I was kind of going to say, it's also, and I think everybody has acknowledged this, is
that this is a huge sort of administrative process and if we don't tick the boxes we
don't get them only. So we have to sort of do it. And as luck would have it, we almost
always have, so as Mark's referenced, next year, this year is already a change from last
year, so we have to adapt to that. And next year there's sort of the mood music is telling
us it's going to change again, but exactly how we don't really know yet. And I'm pretty
sure what we'll do is we'll get promised, we'll have six months, and then we'll have
to, if we're lucky, to make a plan.
So it does sit in that.
But you're right.
We do, as a system, have the opportunity
to actually talk a little bit more.
Because there is a lot of work that sits behind this,
in terms of evolving the plan as a system, as opposed to,
Brian doesn't sit at his desk and make it up.
He does go and talk to people.
Oh, he did.
Did you say perhaps a formal meeting?
So there is something about us bringing that more to life.
Because I know, I think all of us go,
oh, gosh, he's going to go on about it again, isn't he?
But we will try and make it more exciting, I promise.
Yeah, thanks, Lynn.
Yeah, I think we all acknowledge that
and we have to follow the rules in order to get the money.
And those rules can change quite frequently
and give us relatively little time to implement,
but nonetheless it's something we should think about
how we adopt a more strategic approach.
Having said that, can we agree the recommendations?
First, to note the year to date, PCFS end,
which is on the first quarter,
for those schemes reported on for 25 -26,
as per Appendix I, and secondly,
to note the outcomes and impacts of the PCF
on independence and mission avoidance
and hospital discharge as demonstrated
by the PCF metrics.
Can we please agree with that?
Thanks.
Moving on to the next item,
which is the Health and Wellbeing Board Work Programme.

9 Work Programme (Paper No. 25-317)

And Lynn, I think you're leading on this.
I know this is your favourite part of the meeting, isn't it?
So this is really just the upcoming attractions.
So as ever, I'm going to just highlight two things, which
is our intention to hold a seminar where we wanted
to focus on learning disability and health inequalities
in relation to that, which we've got in for the 13th of November.
So hopefully everybody will be willing to go to that and that will invite the wider participants.
So to members, if there's anybody that isn't on the invite or that you maybe don't know who's on the invite,
you just think should be on the invite list, please let Vusi know and we can extend it because it is a,
it's not a limited membership for that. And then to note, sorry?
I just wanted to note on that item before you move on whether there's a bit of a working
group that's coming together around the agenda and kind of feeding into the perspective.
Is this my moment in the sun?
I'm excited to be called an upcoming attraction.
Yeah, I can just quickly add, in context if that's okay, I'll be quick.
I just want to say thank you to Vusi for all the work she's done.
So essentially, in the attempt to kind of try and bring
the group to the people we talk about a lot,
rather than have them talk about them in their absence,
yeah, we thought it would be a good call
to have a seminar on this point.
And my suggestion would be that the group comes
to one of our sites, which is based in the garden,
for two reasons.
One is that this environment would probably
be quite daunting for a lot of the people that we work with,
and we wouldn't be doing them a service
to bring them into a big panelled room.
But the second is also so people from the board
kind of get to see what hopefully
autism and LD friendly environment looks like.
Spoiler alert, it does not look like an A &E waiting room
or a doctor surgery.
So it's just to be able to kind of see some of the work
that the charity that I run do,
but also will extend that out to other charities
in the hope that they will bring some
of their service use along.
And the idea really is to be able to look in a bit more depth to help the members of the board hear from
the professor's mouth about their experience in the healthcare sector and the things that are particularly important that we've,
through ones with counsel separately, including public health for example,
have been able to do some research on things like mental health, social isolation, physical activity.
So the idea would be that the members of the board can meet some of our students, have a bit of a tour.
If you're lucky, you might get some tomatoes or vegetables to take home with you or try.
You might get made to do Zumba as well, but that's a whole other thing.
And then have some workshops with our staff and students facilitating in small groups.
And then most importantly, but crucially, be able to think about what we in the room
can do more, better, less of, differently, et cetera.
I think there's real scope for more partnership working between voluntary services who obviously
see people on the ground and then health care and council.
Just very quickly kind of what the request is, yeah, please do come along.
I like Lynn's invitation to extend the invite.
Don't get too over excited though because we don't have like space for like a gazillion
people.
But yeah, we'd love to see members of the board and kind of obviously like relevant
other partners.
Just because we're working with people who do better if they know what's coming, my request
First is if you are going to come, tell us who you are, give us a picture and explain
what you do in terms of somebody with learning disability and autism would understand.
That might be hard for some of us who have got crazy job titles.
But it's like, you know, it's just explaining in layman's terms really because that will
really help and we'll present that to our service users and other charities, hopefully
service users so they are walking into a room where they can thrive, which is obviously
often not the case when they walk into a room
for healthcare professionals.
So that was just kind of my ask.
And hopefully we can have a really engaging, enjoyable,
meaningful afternoon where, yeah,
you'll, I appreciate we're often giving people
quite a small sample size,
because it's going to be handfuls rather than those people,
but we have done a fair amount of research,
which I hope means you'll be able to get
kind of a broad view of some of the bigger issues
that are faced by the cohort that we were with.
Thank you very, very much indeed.
I mean, I wasn't actually going to get into that much detail.
I was definitely going to say something
very much along those lines.
But before I conclude the comments, Judy.
Just don't tell this in my diary.
So when and where is it?
Because, I mean, I've got 13th on here,
but what time of day?
I'm not sure I'm going to be able to come on out.
I can't remember. Hang on. I'll tell you.
We'll see. Look it up quickly.
I'm going to reset the meeting later.
Well, because it says 13th in the paper, but what time and where?
Because I've got meetings all day. If there's time, I'll come along.
I think there were provisional holds in diaries, but I think where we had member changes, maybe your name wasn't added.
So I will forward it to you separately.
that lovely thinking.
Okay, thanks.
Well, just to say, you know, this is the type of initiative
I've always wanted to see to move the health and well
being bored away from just simply receiving
terminal, in that terminal, reports, et cetera.
And actually start to sort of speaking to the people
that as Abigail rightly says, we talk about
the organisations, we talk about the issues
that we talk about and to bring them much closer to the Health and Wellbeing Board.
So thank you for setting up that little working group and I certainly look forward to hearing
all and I'm sure that the majority of Health and Wellbeing Board members will as well.
In fact, all of them will.
So, that being the case, the recommendation is simply
to note the item, and perhaps we should add, you know,
good speed to Abby, them and everyone else
in terms of coming up with something which hopefully
will transform the health without being bought
into something much more proactive in terms of our dealings
with the wider community that we serve.
So is that approved?
Yeah, thank you very much indeed.
So the next item, one minute to three,
is the date of the next meeting,
which is due to be held on the 4th of December.

10 Date of Next Meeting

I've been told there are no other business
included in the agenda.
So unless anyone's got an absolutely urgent
any other business. I will close the meeting. This now concludes the meeting.
Thank you for attending and certainly thank you to any of the public who may be
listening. Thank you.