Health Overview and Scrutiny Committee - Tuesday 18 November 2025, 8:00pm - Wandsworth Council Webcasting

Health Overview and Scrutiny Committee
Tuesday, 18th November 2025 at 8:00pm 

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An agenda has not been published for this meeting.

for bearing with us as we get through quite a lot of papers.
So again, just being mindful that we still
have a fair amount to get through.
So yeah, taking that into consideration.
We now need to do the introductions,
because we are in a different meeting,
and this is a new webcast.
So I'm just going to go to the members of the committee,
if you could just introduce yourself.
first we've got councillor Apps
councillor Apps, Shefteran Queenstown Ward
councillor Crivelli
I'm councillor Crivelli, East Putney Ward
councillor Della Sejour
councillor Caroline St. Mary's Ward
councillor Fraser
good evening councillor Claire Fraser, South Ballum
councillor Gassane
good evening councillor Daniel Gassane, Westall Ward
Councillor McLeod.
Councillor McLeod, Battersea Park Ward.
Councillor Stock.
Kate Stock, Councillor Kate Stock, Falconbrook Ward.
Councillor Suttors.
Hi, Councillor Suttors, West Park New Ward.
And I'd like to welcome Stephen Hickey, Chair of Health Watch.
And Stephen will come in on items he's indicated.
I'd also like to welcome Philip Murray.
Welcome from St. George's Mental Health Trust,
who's with us for that first report.
And we've got Dr. Razvan Gutti from the Trust,
who's also attending online.
As with before, we've got officers attending here
and online as well.
So just to take the first item,
are the minutes of the 17th of September meeting approved.
Great.
And we also have Councillor Graham Henderson,
sorry about that, cabinet member for health and social care.
Good evening.
Are there any declarations of interest?
So we're going to take our first report from St George's Mental Health Trust.
Philip Murray is going to give us a nice short introduction to the report.
Thank you.
Oh, yes, that's better.
Right.
I'm conscious of what you said, Councillor Dobris, and good evening, everybody.
I'm Philip Murray.
I'm the...
I'm the...
I'm the...
I'm the Chief Finance Officer at Southwest London and St.
George's.
And on screen somewhere, I can see his initials.
We've got Dr. Razvan Guttu, who's
one of our clinical directors.
We did have a presentation I was going to talk to,
but mindful that you've said a short introduction
and then go to questions.
I'm assuming that you'd rather we didn't give a presentation.
If you could give an overview of the presentation,
that would be fantastic.
OK.
Yes, will do.
And I mean, if it pleases Council,
it might then be better if I do that
and then ask Dr. Goo to give a brief update
on what we're doing around length of stay,
but particularly planning for winter.
So I mean, I guess you've seen the report,
and it's been a challenging year last year,
and it's gonna be another challenging,
well, we're in a challenging year this year,
and I don't think anybody in the public sector
will think it will be any different moving into next year.
That said, I think it's important that we do recognise
some of the successes that we've had,
but also some of the challenges we've still to make.
And many of you will probably think,
members of the public and members in chamber,
that we're all about the hospitals,
it's all about the fabric.
But to give you the context,
you have the 85 ,000 referrals we had last year,
less than 2 % relate to inpatients.
The majority of our care happens in the community,
either through talking therapies
or community mental health teams.
Sorry, because I was thinking about my presentation,
I'm now thinking how I cut it short.
Well, we deliver the inpatient services from about 370 beds.
I think what you will also see within the report
as some of the successes.
So for example, looking at our health and equalities agenda,
which is clearly really important,
we've seen an increase in members of our black
and minority ethnic communities being seen
through talking therapies.
We've moved from 24 % to 28 % of those contacts.
We're still not good enough, but we are approaching
what would be representative of the underlying population.
And in addition, we know that unfortunately,
our black populations are over restrained
within our inpatient settings,
and since we've opened our new fabric,
we've seen those numbers reduced by about 40%,
and that's something I think is really important
that we recognise.
That said, it's still a long way to go,
and there's still far too many inequities
that we need to address.
Thinking then about what we're struggling with,
but the opportunities they give us.
As with the rest of the public sector,
we've got a new approach to health,
a new approach from the government,
merging NHS England and the Department of Health,
downsizing dramatically integrated care boards
and all the changes that brings.
And within that, we've still got to maintain focus
on what's right for our patients and indeed your residents.
So you'll hear from Razvan shortly
that what we're focusing on,
because we think it's the right thing to do for patients,
is looking at our length of stay of our inpatients
because we know we're an outlier.
Razvan will be able to tell you shortly how well we've done.
But we have reduced by about 20 days
in the last nine months our average length of stay.
Also, we know that we have been an outlier
on those patients that we were called
clinically ready for discharge,
so they've finished the element of their treatment
that will require them to be in an inpatient bed
and they should be moving somewhere else
in the health or care pathway.
We have been an outlier on that,
but working with all of the associated boroughs,
not just Wandsworth, we've seen a massive improvement
in that as well.
What does that mean for Wandsworth residents?
Well, last year, there were about 6 ,000 bed days
in non -trust beds that related to Wandsworth residents.
This year, although we're only partway through it,
I would forecast that it will be under 4 ,000.
So that means, one, we're treating Wandsworth residents
more locally, which of course is good,
and two, overall, we're spending less on higher cost
private beds, which means we can use that money
for other elements of care.
And I'll just say a couple of other things before,
if it pleases council, I invite Razvan to tell you
what we're actually doing in the here and now
and for winter, because that's what will affect
your residence.
You will have seen in the charts that last year,
referrals relating to Wandsworth residents
actually reduced into our community services
and the incidence of referrals into our
psychiatric liaison services.
That's the psychiatric services that are co -located
with Axton and Emergences, of course,
locally that's at St. George's.
This year, we've seen that reverse for Wandsworth residents
and all borough residents.
So there's about an extra 7 % increase in overall referrals
and about a 10 % increase in Wandsworth residents
being seen by our psychiatric liaison teams.
and overall mental health services nationally,
but specifically in this case for our trust,
are seeing a lot more demand.
So in that sense, it's pleasing the work we've done
to reduce our length of stay
because we're seeing more patients
actually through fewer beds,
and to reassure council and members of the public.
One of the key indicators
of whether we're getting those discharges right
are what we call emergency readmissions,
so patients coming back into hospital beds
within 30 days of being discharged,
we're not seeing those numbers go up.
So that gives us confidence that our discharges on balance
are probably reasonable.
In Minded of Time, that's a kind of overview.
I'm sure you'll have many questions and observations
in the detail of the report, but perhaps if I invite Razvan
to say what we're doing about winter
and the detail of our plans.
It'll be great, and that was a really great overview.
Thank you, Philip.
Razvan?
Hello, good evening. Thank you, Philip. Thank you, Councillor. So, I guess in response to
some of the challenges Philip talked about, we launched a few years ago the adult patient
journey programme, the APJ programme that brings together community acute and specialist services
in with the aim to improve the full mental health care pathway with a focus to ensure timely
high quality care and supporting people to return home or to appropriate settings as soon as they
are ready and ideally staying closer to their local communities. The adult patient journey
programme is delivering improvements across three key areas. One of them being crisis care, the other
one, Philip mentioned already, the inpatient length of stay, and we have programmes to improve
our community services as well. In terms of crisis care, the focus is on reducing the pressure on
EDs and providing faster and more effective support for people in crisis. And our aim is
to achieve a 10 % reduction in 12 -hour waits in A &E for our patients and at the same time
decrease the number of patients attending A &E in crisis.
The work includes a full redesign of our crisis pathway, improving access to urgent support
and also understanding the underlying drivers that lead individuals to seek help in emergency
settings.
For our inpatient care, as Filip already mentioned,
the main focus has been on reducing the length of stay.
And we are working towards a 26 % reduction
in the average length of stay
for our adult inpatient population.
But at the same time,
we focused on bringing down the levels of those patients
that Filip mentioned are clinically ready for discharge,
try to bring the percentage below the London median, which is at the moment around 8%.
In community, what we're doing, we're strengthening the personalised recovery
focus here by rolling dialogue plus care plans. We've implemented this for all our CPA patients
by September 2025, and we aim to do this for all the specialist CPA patients and non -CPA
adult patients within the next couple of years.
To give a bit more details on the work we've done on the length of stay or the outcomes we've seen
already, Philip already mentioned, but we're seeing quite strong progress in reducing the
prolonged hospital stays. We've seen a significant drop in the number of acute patients staying in
hospital between 60 and 180 days.
And at the same time, we've, we managed to reduce
the reliance of on external private beds.
In January 2025, we had 4 to 1 beds at Holyborn.
At the moment we have only 18.
Now, in terms of the positional length of stay, the approach we've taken, we've introduced
a new framework to tackle this particular issue.
And as Philip said, we set ourselves quite an ambitious target to reduce our length of
day to under 56 days by the end of the year. At the end of September, our three -month rolling
position sat at 59 days, down from a high of 73 days in December 2024. At the same time,
we've seen a significant reduction in the proportion of bad days lost to people who
are clinically ready for discharge. This fell from 16 .5 % to 8%. We also see an MR
a decrease in the number of patients placed out of area,
making sure that more people receive care
in the local inpatient services.
And again, we've seen an overall reduction
in the total adult acute bed days,
reflecting improved flow and more timely transitions
back into the community.
Now, in terms of our plans for winter,
in terms of winter preparedness,
we've launched a seasonal campaign
called Know Who to Turn To, and the aim is to help people understand how to quickly and
confidently access the right mental health support when they need it. The campaign highlights
five key routes, our mental health crisis line and the NHS 111 Press 2 for mental health,
for anyone experiencing a crisis and needing urgent help, NHS talking therapies offering
support for mild to moderate anxiety, depression and related issues. Our walk -in recovery cafes
that provide a safe and supportive space for anyone struggling or in a crisis. Our pharmacy
helpline for existing patients who need support with medication and advice or compliance.
And the NHS Every Mind Matters that provides self -care tools and well -being tips to help
people manage their mental health. A full campaign toolkit has been already shared with partners,
including Wandsworth Council's communication team, and all campaign materials are freely available
for colleagues and partners to download and promote across digital channels. And we do
encourage everyone to support this effort, and more details is available in the report that
was submitted to the committee. Thank you. Thank you very much. Can I start by taking
questions from committee members on the report? Councillor Crivelli.
Can I just ask you a question about on page nine of your report, page 13 of our papers,
you talked about improving mental health care in emergency departments and this is something that
we have mentioned before with St. George's. I think the last time we discussed it we were
talking about the fact that there are people who present themselves to A &E with acute mental
health needs, but there's also other people who present themselves to A &E who don't have
– they may well have mental health issues, but it's not something that A &E can readily
actually address in effect. You get people presenting themselves to A &E when there isn't
any acute mental health need that can be resolved by the A &E department. So I was
interested to read the point that you made that at Kingston Hospital you've
got this rapid assessment pilot that you've been using to support
patients arriving in emergency departments. You talk about the hospital
support worker will screen the patient and then see if you can prioritise the
most acutely unwell patients who need the clinical care. I thought this was a
really good initiative and I'd be interested to know the staff that are involved in this,
are they new staff that you've brought in specifically for the task of this or are they
staff who already work in ANE but they have been trained to identify this problem? If you could
just expand upon how this rapid assessment pilot is working I'd be very grateful. Would that be
Filippo, Razvan, are you able to comment on that?
Okay.
Yeah, thank you very much for the question.
I'm afraid the information in the pack is a bit outdated.
Yes, we did indeed have a pilot both in Kingston Hospital
and in St. George's Hospital.
They were, I guess, new members of staff
that were recruited for this particular task.
The idea behind it was that we would be able to provide
the way you described kind of quick screening and diversion
of some of the patients who attend A &E
with mental health problems outside EAD
towards other services like the Coral Crisis Assessment Hub
or home treatment teams.
We've done an evaluation of the pilots
both in Kingston and Georges.
and unfortunately we realised that what we thought in terms of outcomes was not delivered
by the model so those pilots have been stopped and the resource currently is being integrated
back in the crisis pathway. As you've seen from the report at the moment we are in the middle of
a full redesign of the crisis pathway.
That pilot, I guess gave us important information,
maybe on how not to do things,
or what might not be working.
But I guess the focus currently is to,
as I said, to redesign the whole crisis pathway.
A significant element of this
is going to be the home treatment teams,
because we want to be able to provide rapid support for patients needing mental health support in their own homes as much as possible.
I hope that answered the question unfortunately.
It does Andrew, I'm sorry to hear the pilot wasn't a success.
Shane, Councillor Stark.
Thank you, thanks very much for the report.
I've got two questions, one first about the opportunity for shared learning here and a
second question that I'll ask separately just slightly more in one of the areas where we're
finding there's more of a challenge.
Just on the first in terms of an opportunity for shared learning, really welcome in your
annual report your focus and identification of a key area that the trust is working on
tackling health inequalities and becoming actively anti -racist.
And I think the report makes clear the kind of number of initiatives
that you're running as a trust,
putting active anti -racism, co -production and continuous involvement
really at the heart of everything that the trust does.
And I think that's really to be welcomed.
And I think those are shared values that we have at the Council.
And I think your report touches on that you've got a growing reputation
for those values and that's having a positive impact
in terms of recruitment and retention.
So I just wondered if there was anything
that you could share this evening,
bearing in mind we have those shared values,
on what you really think is kind of having the biggest impact
and any shared learning that you might be able to share with us
that we could take away to really follow in your footsteps, I suppose,
if there is any opportunities to strengthen those values.
Thank you, Philip.
So, without knowing all the things that council colleagues
are doing, it's hard to know exactly what to say.
I think one of the things that's key is maintaining
the mantra that we are anti -racist and calling out
that we will not tolerate inappropriate behaviour,
including being so direct as to say,
if you don't feel comfortable with behaving differently,
perhaps you might want to look for an alternate employer.
We have been that direct.
I think the other thing we've proactively done
is to seek the advice of our staff members
from the global majority.
So we have a diversity and decision making panel
that works with executive colleagues
looking at upcoming policies,
looking at things that aren't working
as well as they ought to,
and proactively advising, members of that group
sit on all of our formal board committees,
finance committee, audit committee,
modernization committee, people committee, et cetera.
And equally, what we aim to do,
and I think largely we succeed,
is that interviews for senior members of staff
all have members from that group on as well
to ensure that our decision making is truly balanced.
I think what we're trying to do in addition,
because that's all about the experience of staff,
and obviously if we get the staff right,
then the patient experience improves,
is looking, trying to look more, using the data,
through an inequality lens at what we're providing.
Now obviously, Shannon's team has done a lot of work on that
and we'll hear in a second from them
some of the work they're doing to pick on the point
around non -serious mental illness,
but nonetheless things that we need to catch and do right.
And I think that's some of the other learning
we can do as well,
because there's a lot of wellness things
that we can do for staff and work with patients
earlier on in the pathway that hopefully will mean
that we'll get better outcomes for all of society.
Is that helpful?
Thank you, Philip.
Did you want to come back?
I've got a second question, but I'm happy to wait.
Do you want to just wait a sec?
Did Councillor Apps, did you have a question?
Or did I miss you that?
Thank you very much.
I was very interested in the focus
on reducing very long stays.
And obviously, you've identified the critical to that
is community support once the patient is discharged.
Hopefully, that prevents or at least
lessens the likelihood of repeat visits.
I was interested to know what the key partners are
to delivering that and what you need in terms of
council support, in terms of council services
to make that work effectively.
I also have a question on the pathways that you've got.
So you've got the non -urgent, the urgent and the emergency.
I was interested to know if you had any assessment,
and if actually data would be useful,
where people have sought non -urgent support
but not found it, how likely is it that their mental health
will degrade to a point where they go for urgent
or emergency care eventually,
or is there little link between those
in terms of that route of each individual.
I'm interested to know if you have any evidence
for that situation potentially escalating
beyond where it needed to,
if they weren't reached for non -urgent care, for example,
at a timely manner.
Thank you.
Philip.
If I try and talk about the work with partners
and maybe I'll ask Razvan if he's got any clinical evidence
on the pathways, I think probably the general comment
is that as a non -clinician that I would say
if we don't get the contacts right early on in the pathway,
we're more likely to see people escalating
in their mental ill health.
but hopefully Razvan can give us some evidence on that.
In terms of working across partners to try,
and as Razvan said, target patients that have been
in the hospital for greater than 60 days,
and at the time we started this initiative,
we had a number of patients that had been in hospital
over 400 days, many of them who didn't need to be there.
So I think the key is open dialogue
with all of our council partners,
and of course the issue is it's not just social care,
it's social care, housing, it could be education
for younger people and it could be the wider
health community as well, so I'm thinking like
free nursing care, continuing healthcare.
What we've put in place which I think is making
a difference is what we call made events.
We have now monthly multi -agency discharge events.
So actually they're not made events, they're made
because the year's event, apologies.
So that is making a difference, and through that,
we are, I think, actively bringing council colleagues
from all of the boroughs we face,
that's all five boroughs we don't face,
particularly Croydon, it's the sixth borough
of southwest London that south London
and Mausely face, and I think that is making a difference,
because I think through those monthly events,
there's a more open engagement, a more open dialogue,
and a recognition that if we work together
and plan discharges more proactively,
hopefully patients won't be stuck.
They'll always be an exceedingly complex patient
that's difficult to find the right housing
or the right onward location for,
but hopefully they should become few and far between.
I am just gonna try and move us on a little bit
because we have a few meeting items.
I'll just take questions from this side, Councillor Sutters.
Thank you. It's a short question, so don't worry.
I was just going to say, I think it takes a lot of confidence to leave a setting
if you've been there for a long time.
So I think it's incredibly important that there is a structure around that release
so that people do feel they've got somebody to talk to.
And also, how are you working with families?
I didn't read anything about that, but my own experience of mental health in families
is that they're a very important element of that and they need to understand what's going
on.
And finally, I think you're talking about elective treatment and I don't think all treatment
is elective.
I think sometimes people have to be admitted.
How do you deal with that?
So I'll try and pick up the subsets of questions there.
So each of our wards does have a nominated
discharge coordinator, so part of their role
will be to work across the agencies,
linking up the inpatient teams with our community teams,
social care, et cetera.
So there should be that individual in each ward
that would hopefully build up a relationship
with patients and understanding what their needs are.
We also encourage our wards to invite families
and carers into the ward rounds
and to be part of the discharge planning
where they feel able.
So hopefully again, it's not a total surprise
to patient or carers and relatives
when someone is on that pathway to discharge.
You're right, there are different types
of admission into our wards,
but ultimately we need to treat all patients the same
as they come to the end of their stay.
So whether they've started through a legal framework
that meant they were admitted under a section
or whether they were more what we call an informal patient,
so they weren't admitted under section,
I suppose the flight path to discharge
needs to be planned in the same way,
involving carers and relatives and the other agencies
in the same way so that each patient,
regardless of how they ended up in the bed,
has the same hopefully positive experience
as they move on out of it.
Because as you rightly say,
particularly for patients that had very long lengths of stay
it can be very stressful moving back again
into an alternate setting,
particularly if they've got used to that regular support.
Thank you.
Councillor Fraser and then Councillor Gassane.
Thank you, Chair.
And thank you both for your presentations this evening,
or your remarks this evening.
I'm just wondering and thinking about,
and it's a similar topic to some of the areas we discussed
in the previous item, on kind of where we go from here
and thinking about how progress on the plan be monitored
and then reported on moving forward
and if you've got thoughts on measuring impact
and KPIs on that moving forward.
Razvan, might you answer that one
because I know that's what you're thinking about,
the next steps and how we monitor outcomes, et cetera.
Yeah, definitely. As we mentioned in our remarks, we set ourselves quite ambitious targets that
we're consistently monitoring in terms of reducing the average length of stay. As we said, we aim to
reduce it by 26 % as compared to where it was in December 2004, and we're very much on track to do
that. Again, we set ourselves the target to reduce the reliance on external beds from 41 to 18 by
August this year, which we achieved, and we continue to progress work to try to reduce the
reliance on external beds down to zero. Again, we have KPIs targets around reducing the number of
patients attending ED, reducing the number of patients reaching 12 hours or 72 hours in ED.
These are KPIs that are, I guess, part of our reporting system.
It's something that we're monitoring on a monthly basis.
We're analysing, we're trying to understand where we are against the targets,
what can we do to improve if we're not on track to achieve them.
Thanks very much.
And then Councillor Kisei.
Thank you, Chair.
I've got a question about access times
to tier three CAM services.
In the appendix it mentions that the majority of breaches
for the eight week target were due to young people
waiting for ADHD titration.
I wanted clarification on whether those were young people
mainly waiting for titration to start
or whether they're in titration
and they're waiting for a review
and what that might say about how the whole sort of pathway
is currently set up.
Because if it is sort of pre -titration,
what is being done in that period, for example,
through schools and primary care to support those young people?
And if it's during titration, does that potentially
suggest that there's a bit of a mismatch between increasing
assessment capacity and the ability
to match that with treatment capacity further down the line?
and whether there's an over -reliance on medication
as the main offer, the first line of treatment,
although I understand that's largely dictated
by NICE guidelines.
So I think you've hit the proverbial nail on the head
in terms of the balance between assessment
and then treatment initiation and then titration
and ongoing monitoring.
So currently we have the situation where
demand outstrips capacity.
We're one of the few trusts in London
that still have an open waiting list.
Most have stopped them because of those volumes.
And I think it's fair to say that it's a delicate balance
between assessing people and then starting them
on the medication.
Under current NICE guidance, a specialist doctor
or a doctor has to do an annual review of that medication.
And that of course presents another capacity problem
because while a consultant's seeing someone
to cheque they're okay, they can't be seeing a new patient
and starting them off.
What we do know is that once people get through
the triage system, i .e. the referrals are all reviewed,
we get something like a 94 % conversion rate
to a positive diagnosis and then starting on
a drug -based regime, it is that high a conversion.
It's a national problem, as I know you're aware.
What we've seen in the last two weeks,
as again you're probably aware,
is the report from the National Working Group
looking at this.
I think what we're seeing,
and I haven't gone through it in detail obviously,
our child and adolescent, particularly conditions,
although ADHD and ASD is a problem for adults as well,
is that I think they're looking at trying to recognise it
as a less specialist treatment.
So hopefully that means it can be initiated
in other sections of the health framework,
and the monitoring also hopefully then can be
conducted in other elements.
But you're absolutely right,
that is the whole problem that we've got.
And I'm not gonna try and flannel you with an answer
because if I had it then everybody would have it
and that's what we need to get to.
I think the national report will hopefully lead us all
to think in different ways.
Because I think that's what we need to do,
we need to break the cycle of that historic model.
Thanks, I'm going to take two final questions,
Councillor Stock and then Councillor Crivelli.
Thank you, and thank you for that question on camps,
because that's what I also wanted to ask about,
because I think that is definitely something
that we're finding is a real challenge.
I know as councillors it's something we certainly hear
coming through in our casework
and from speaking to local families and children.
So I was just equally worried about the treatment wait times.
I think in 2021 our average wait for treatment was seven weeks.
I think in September the current wait time average
wait is over 20 weeks.
That's five months.
And I know the South West London Mental Health Strategy
really talks about prioritising improving mental health
for children and young people and timely access
and reducing wakes.
But at the moment from the information that's available
it doesn't seem like we've managed to time the turd on that.
I turned the tide on that.
And I know there's some statistics that suggest
that half of mental health disorders in adults
start before the age of 14.
So if we're talking in terms of early intervention,
how can we make sure that we really are prioritising
our investment, our money and our investment and our time
is following the words that are in our strategies
about ensuring that CAM's services
and meet the needs of children as quickly as possible.
Phillip?
So thank you.
So you're absolutely right.
And in fact, I think 75 % of mental illness
starts before the age of 24.
So if we can, you're absolutely right,
if we can reset the way we think about
treating our young people,
we are more likely to stop people having
serious mental illness as they move into adult,
which will help them and help society.
So that's absolutely right.
I think it is a shared endeavour.
I think the council has a shared endeavour with us
and the ICB also puts young people first.
So we're looking desperately to try and invest
in mental health.
I think it's also a government must do.
So mental health support teams,
previously known as Trailblazers, that is a must do.
There's more money coming into that next year.
We understand the allocations were only released today
so I can't give you any numbers,
but I believe that that is the case.
Again, I haven't got the panacea.
One of the questions that Councillor Kosein answered,
but I didn't quite answer,
but it hopefully helps reassure you,
is that because we recognise these waiting times
have gone out, our CAM services have put
a lot of infrastructure in to ensure
that people are waiting well.
regular cheque -ins so that if people are moving into crisis,
their care can be expedited in a different way
or we can provide different support to them
while they're waiting.
Obviously that doesn't give you assurance
but hopefully gives you reassurance
that we're not just sitting there
forgetting people until they come to the top of the list.
Thanks and final question from Councillor Covelli.
Can I ask a question you mentioned about recruitment
and retention in your report, and clearly from your report
you've had some significant success
in reducing your overall vacancy rate
and reducing your temporary workforce.
I was interested in what you intended to do
by way of the challenge of, say for example,
I know a number of the staff that you employ are
from overseas, and the Royal College of Nursing,
drew attention to the changes to visas for healthcare staff, in particular the
changes that were made to salary threshold rules, and they're obviously
concerned that it means it may well be more difficult for healthcare staff to
be employed in the health service overall. And I was interested in how you
intended to meet the targets that you've set about recruitment and retention. Are
you confident that you can do that while at the same time you're trying to
navigate the challenges of the new visa rules?
So I obviously won't profess to be totally confident because I think in some professions
there is a national struggle to recruit. What I would say is that in the last year we've
reduced both our vacancy rate and turnover rate both individually by 10 percentage points
and they're now both hovering around 10%.
At the same time, our sickness rates have gone down as well.
So we're doing something right.
Yes, you're of course correct that there are changes
to the visa rules.
Typically, I can't remember the salary limit,
you probably have it yourself,
but I can't remember the salary limit,
but what we find is that we don't struggle to recruit
locally for the lower paid staff.
And where we've been doing most of our recruitment,
well sorry, most, the little recruitment
that we've done from overseas has all been
with our medical staff through the accredit,
I think it's called the MTI, I'm looking at it.
And I'm sure it's called the MTI scheme
where we miss international recruitment for medics.
We haven't done lots of it, but we have done some.
So thus far, my HR colleagues aren't telling me
that the changing visa rules is stymieing us.
As we speak today, the largest area where we have vacancies
is actually psychologists, although that is also
starting to come down.
That's clinical psychologists, and we know obviously
that's a, in a way there's a challenge there,
getting people through their degree
into the clinical doctorate programme,
and then out again, although spaces on those programmes
have been doubled through NHS funding in recent years.
That probably is the area that we've been struggling with most of late
and I hear from my peers that they are, but as I say,
we're starting to see some green shoots.
So I think that what we're seeing is a bit of a snowball effect
as we're starting to see fewer vacancies, fewer, less sickness,
less temporary staffing.
That's creating an environment where staff are feeling more positive
and we all know that if staff feel more positive,
if they're more likely to recommend the place to work.
And you've seen from our report
that that is now a high quotient.
And I think that's encouraging other people to apply.
Thank you.
And can I just suggest, given the interesting CAMs
that we have a slightly more detailed update on CAMs
next time as part of the report.
I think that'd be really welcome.
And Stephen Hickey, can I ask you
to ask your two questions as one?
Yes, I think one of them, the main one was about discharge,
which I think has been covered quite well.
But the other one was about reference in the paper to hubs
in the community, reference in the papers
are hubs in the community.
And I just wondered,
we know in the health service more broadly,
there's a big focus now on building neighbourhoods.
Are these hubs, do you envisage them
becoming part of these neighbourhoods
or how are these programmes going to align?
So thank you, Stephen.
And I think as you said, it's emerging for us all.
If I said we had the ultimate answer,
I'm not sure you'd believe me.
Our vision, of course, is that our hubs,
our integrated recovery hubs,
won't have a one -to -one relationship with neighbourhoods
because of the different population sizes they serve,
but broadly would be aligned
with integrated neighbourhood teams.
I think we all then need to work to say,
how does that integration work?
but I think it is our aspiration that broadly
the teams would sit within what would be a neighbourhood
more than one I believe would be the answer
and then it's the interface that's key
but that's the key for all of us,
be us in health or care or housing,
get that interface right and it's better for everybody.
Thanks very much and thanks for the really useful questions
on the report, thank you Philip and Rasman online.
Can I take the report as noted?
Great.
So now we are going to move on to a fantastic report
on the Public Mental Health Action Plan.
We've got Ramya here who's worked really, really hard
on this to introduce the report and I know there's lots
of questions from committee members so I'll go to you.
Thank you, I'm Dr. Ramya Ravendran,
and consultant in public health,
and I'm here with Mike Wieg.
Good evening, Graham Markwor, Senior Public Health Lead.
So the Healthy Minds Public Mental Health Action Plan
is a whole council prevention focused approach
to improving the mental health
and wellbeing of our residents.
It recognises that mental health and wellbeing
are shaped not just by clinical care,
but by the everyday environments that we create,
including housing, education, employment,
and community life.
This plan is more than a health initiative,
it's a whole council commitment to prevention,
equity, and resilience.
It brings together departments, partners,
and communities under a shared vision,
which is to improve mental health and well -being
by addressing its root causes.
It's very much aligned with the values of the council,
thinking bigger, putting people first,
fostering connexions, and leading by example,
and embracing difference.
Healthy Mind sets out a framework for action
that is ambitious, inclusive, and grounded in evidence,
contributing to a healthier, fairer one's worth.
Thank you very much everyone for reviewing the draught
and we're looking forward to hearing your comments
and suggestions on how to develop it further.
Yeah and just to reiterate that point,
we're really privileged to get this report as a draught
as part of the kind of new scrutiny arrangement
so there is really an opportunity for the discussion
to shape this report with some of the comments.
So do I have any first questions or comments
on the report, Councillor Stock?
Thank you, Chair.
I would just like to echo those comments.
I really, really welcome this report
and this approach, that cross -Council approach,
and it's really great that you've got
cross -departmental buy -in,
and I truly hope that that continues
and that could be part of the work
that the Council continues to do
as it goes on its transformation journey,
in particular, because I think actually
being really person -centred
and no longer working in such silos,
I think will have real impacts for a council.
So I really welcome that approach
and the preventative agenda.
Just in terms of, I suppose,
some thoughts and reflections on the report.
I suppose in terms of, I probably had three,
just in terms of the healthy homes agenda.
I know certainly in my ward,
because it's facing a regeneration programme,
I have a particularly high level of families in temporary accommodation.
And I think what we sometimes find is that the decent home standard doesn't necessarily
always have to apply to those in temporary accommodation.
And I think that alongside with perhaps the reasons why families end up in temporary accommodation,
I think definitely my reflection would be that there seems to have kind of mental health
and wellbeing impact on those families because of the circumstances that led them to be in
temporary accommodation but also the circumstances they then find themselves in terms of the
quality of the housing, possibility of overcrowding, distance from family connexions or community
connexions.
So I do wonder whether under that section there is an opportunity for us to think more
about the work we're doing cross council in temporary accommodation and the support that
we provide to those families and being alive to that.
And then in the education and skills section
and the eat well section, I really welcome
the focus on what we'll do there.
But I did reflect that both of those sections
concentrate quite a lot on what we're doing
in terms of children rather than adults.
And I think we've got a lifelong learning service
that we can be really proud of that really
not only focuses on education but definitely reflects
on the fact that actually that is an opportunity
for residents to come together, connect, to learn, and that can have a positive impact
on wellbeing. So I think we should try not to lose that and really recognise that lifelong
learning have got a real role to play. And I've definitely seen it with some of our lifelong
learning winners in terms of parents who've been isolated following having children and
have used lifelong learning as a way of connecting and improving their own wellbeing and that
being a positive impact for their families.
And the same with Eat Well as well,
around how fine we can work in schools
to make sure that our children have access to healthy foods
and that develops healthy habits.
But how we also making sure that there's quality food
that's affordable for adults,
whether they're in families or not.
And I know we've got social supermarkets now
in Rayhampton and in Yvoncar in Battersea
in partnership with Racket's Cubed
and hopefully there'll be a third elsewhere in the borough.
but what more can we do thinking about a food strategy or our cost of living
commission recommendations to make sure that the good food is accessible for all whether you're
a child or you're an adult as well. Thank you. Thanks Councillor Stockton, some really interesting
points about some of that work, cross -departmental work. Did you want to come back on any of those?
Just to say thank you Councillor Stockton, all of the points you raised are absolutely valid
and the purpose of this evening is for us to
develop the draught further and continue those conversations
and we have those solid relationships
across directorates now and I'll certainly take
your points forward there.
I know from some of the case studies in there,
I'd just like to flag Chantelle's kitchen,
the work that I visited that and was blown away
by the impact that that's having.
and there were queues an hour before they opened.
And yeah, they were providing,
not just providing food through a food bank mechanism,
but also the skills in terms of
how to make nutritious recipes,
how to make the most of ingredients.
Those kind of things were being passed on.
And the cohesion, the community feel within that,
the room was alive with chatter and conversation,
and it was very clear that people were using it
on a number of different levels,
but absolutely take your point forward, thank you.
Thank you, Councillor Apps.
Thank you very much.
I'd like to express my appreciation
for this piece of work as well.
I think there's some really good ideas,
and there's a lot of things that we're doing
which are helping to improve residents' lives.
But just coming onto that,
we've got an opportunity with the new place and growth
strategies and directorate to look more closely
at how we can co -produce and genuinely co -produce
with residents.
I know that when I've been on training about co -production
and the fact is is that what most councils
describes co -production is actually consultation
rather than actually properly developing them.
So things like, we've got a heading here,
Where We Live Shapes How We Live,
but of course, how we shape where we live
also helps us to change how we live too.
And things that I've come across,
so when I was in the, it's not in my ward,
but when I was in the Doddington Estate,
I spoke to a gentleman who had a draughts club
and it was very difficult for them to host the draughts club
for their community because it was so expensive.
So things like looking at things like community budgets
so that communities can decide themselves
how they want to invest.
It's not for us to decide that a green space
is more important if actually some social community time
is actually gonna be the more critical thing
to longer -term mental health, for example.
But obviously that would be for each community,
including some of the communities where I live,
to decide for themselves.
I also note some of the key insights into our surroundings,
you know, picks up on the fact that off -licences
are more common in areas with higher levels of deprivation
and betting shops too.
I know we have looked at licencing
and how we can use licencing and commend the work
to make sure that we're starting to shape
our public sphere in that way,
but I'm sure there's more we can do on that.
We can be more ambitious in that area.
The only other thing I just wanted to comment on briefly
was about the housing.
The housing very much, and it makes sense, right?
We focus on the things that we control
and that we can change, and so it focuses very much
on social housing.
But of course there's a vast number of people
living in private rented in very difficult circumstances,
so, and far more people living in private rented.
So it's important to think about where we do have influence
to improve the situation where there's perhaps housing insecurity, where there's damp and
mould in private housing which is not yet covered by the legal changes, and also how
we can make sure that housing is fit to live in, how we can use the great work that we're
doing around landlord licencing to ensure that.
Those were my main comments.
Thank you.
Thank you.
Yeah, some really useful comments about community budgets, co -production and housing.
Is there anything that you kind of immediately,
oh, Shannon, sorry, wanna come back on?
Thank you.
And really helpful to acknowledge all those points
that you've mentioned,
particularly in relation to place
and recognising the various impacts
on people's mental wellbeing
in terms of the area they live in.
Two points I wanted to mention
in relation to this mental health action plan.
The first thing is we already have
a council prevention framework.
and we definitely the intention is that you know this action plan will be
delivered in conjunction with the council's prevention framework in terms
of thinking through things through decisions plans policies at three levels
at the individual level at the community level and then things that we can do
across the wider environment but what this plan does is provide us an
to put the mental well -being lens on that,
which is probably something
that was not explicit previously.
And then the second point that I wanted to mention
is this tool, which is the mental well -being
impact assessment that now provides an opportunity
for the council to explicitly consider
the mental well -being impacts of the council's decisions
and plans and policies and identify opportunities
to enhance any positive impacts and mitigate any potentially negative impacts,
but again with the specific lens of mental well -being and not just physical health.
I don't know if my colleagues wanted to add anything.
Thank you, Shannon. No, that was great.
I think Councillor Crivelli and then Councillor Gussain.
Can I ask a question about some of the features about what we're focusing on by way of mental health,
because in the report we touch upon briefly the issue about one of the statistics about
self -harm, but specifically we don't address the issue of suicide. It's not mentioned in
the report. In particular, we've discussed on occasion at Health Committee the suicide
rate for men, which is far higher than the suicide rate for women, in particular in the
male suicide group, principally focusing on the highest rates of suicide, which are middle -aged
men. And I do accept the fact that in your report you talk about isolation and wellbeing
overall because these are obviously factors which contribute towards the issue about male
suicide. But I was wondering if specifically as part of the preventative plan, are we going
have something that the focus is on tackling the issue of suicide.
Thanks, I was going to come to try and I know but absolutely okay.
Thank you, Councillor Crivelli, absolutely. I chair the ones with Suicide Prevention Group
and have done for nearly 10 years now. We have an active suicide prevention strategy in place
and are currently in the process of refreshing that
to include more of the latest evidence
and so we can absolutely, with confidence,
say that we are addressing the risk of suicide
across all age groups and specifically with men
who are higher at risk, but we're aware
of emerging groups as well.
So for example, people on the autistic spectrum disorder
are more likely to die by suicide.
There are emerging links around perimenopause and menopause
and also domestic abuse is coming more to the fore
and gambling.
So our refresh strategy will have a focus
certainly on men, middle -aged men,
but also on the more emerging needs that we're coming across
but thank you very much for that question.
It would be great to have an update come to this committee
when that report is ready.
I think that would be fantastic.
Thank you.
And I heard Councillor Gussane.
Thank you, Chair.
And I really welcome the ambition of the plan
and it's absolutely the right approach
to have sort of a joined up coordinated
multi -systemic approach to mental health.
But I'm struck, looking through
the paper and the report,
that pretty much, well, the vast majority of things
within the plan are things that the council was doing
already and has been doing for a long time.
And I just want a bit of clarification about what
the genuinely new substantially expanded element
of the plan is and how that makes things different
from how they would have happened,
and had this plan, healthy minds,
isn't being proposed as it is.
And that, I guess, just to give the confidence
that it's more than just sort of rebadge and exercise.
I think, Shannon, you mentioned
the mental health impact assessment tool,
and that does sound like something different,
but I'm wondering if there's more to it than that.
I was also just going to add that I think we've had a point about kind of what's new
but I guess the point around creating this and joining up and evaluating how all of the
different policies are working together and seeing how that's moving us forward in itself
is a positive thing but do kind of take your point and I'll go to officers.
Thank you Councillor, yeah that's a great question and but firstly I would like to say
that the evidence shows that in terms of health outcomes,
up to 70 % of those drivers are around social determinants,
are around lifestyle and around environment.
So that absolutely stands there as a call for us
to really bring together the work that we're doing.
And absolutely, it's happening right across the council
and we recognise that.
But we're working in a system,
and where I welcome the Mental Health Trust
and the ICB's strategy,
it was really important for us to say,
this is where we are in that system,
this is our place.
And so I think that's what this does.
And it also offers an opportunity.
And we have dedicated resource
to enable a coordination and a focusing,
So we can look at these outcomes and categorically say
that we are improving elements.
If you look on page 49 of the report,
that's what the residents said in terms of
what a thriving community looks like.
And my vision is that when we evaluate this,
we go back to that and we look at things like
how clean is our air, how many of our population
are in sustained employment.
and many more of those kind of ambitions
for a thriving society and use those
as the driver for our evaluation of outcomes.
Thank you, that was really, really helpful.
Did you wanna come, Nizar?
I think it's a really good question
and something that we have talked about before,
but just to reassure you that we've got
a year one action plan, but going forward,
we're gonna be building on this,
So at the moment, it highlights and puts a mental health lens
on what we're already doing and some new things
like the mental wellbeing impact assessments.
But going forward, we're gonna co -produce
with the communities and also wider partners
and the council new approaches.
And I think having this basis really supports
this wider determinants approach to mental health
and then can galvanise support
from newer and newer interventions going forward.
Thank you. And Stephen Hickey, did you want to come in with your question?
Thank you very much, Chair. I very much welcome the paper and in particular I'd like to welcome
the fact that housing actually comes first on this list because I think these wider determinants
housing is a really important one and one that we often don't talk about so much. My
question or my comment, if you like, on the sheets you've got on housing is it does very
much focus on the physical side of housing, either production or of accommodation, which
is obviously essential. But there's another whole dimension in relation to mental health,
which is about the services, if you like, and what we were talking about earlier about
discharge arrangements, for example, and the collaboration not just across the council
but with other services like mental health and physical health. So I suppose it's common,
It'd be really good if, as this develops,
as well as the physical side of housing,
a bit more about the actual services
which have to be collaborative go beyond the council,
but housing is absolutely central too.
And I think that's an issue that I think the Trust also feel
there's this great scope for greater work together.
Thank you.
I think that's a really, really interesting point
and hopefully noted as part of the next iteration
and I know that Councillor Graham Henderson
wanted to say a brief word on this report.
Yeah, thank you, Chair.
I think really an answer to Councillor Kussain's point
that these things have been done for a very long time.
What's actually in here is a very coordinated response
in which over the last three and a half years
we've broken down an organisation which worked in silos.
The prevention framework has been central to that.
That certainly is quite fundamentally new.
In tackling the socioeconomic causes of ill health and health inequalities, I could pick
out a whole number of different things here.
The report does actually largely reflect much of the manifesto the Labour administration
was elected on.
I do not, for example, recall the previous administration committing to building a thousand
homes.
Thank you.
Thank you.
Thank you.
We did it.
We did it.
Social.
Right.
And you said you didn't do it.
So no decisions required.
This report is for information.
Is the report noted?
Thanks for a really good discussion on that
and we're gonna get the next situation back
at a future committee.
So hopefully you can continue to talk about that
and thanks so much.
There's been amazing feedback across the board on this
so thank you for the work.
Okay, moving on, I'm trying to make sure that we do finish in time, we get through everything.
So we've got a brief report on CQC assessment. Claire, is Claire online? Yeah, Claire's online.
Claire, could you try and give quite a brief summary for this because I think Graham wants
to say a few words as well. Yeah, absolutely. Hi everyone, my name's Claire
Tu, I'm the Assistant Director for Assurance and Innovation. I did come in September with
verbal report on excellent results in our CQC assessment this summer. This is really just a
formal write -up of that verbal update I gave in September. It shares the highlights and the key
fundings and then we are going to do a follow -up in the new year to set out some of the actions
based on the recommendations from CQC. As you know, just in terms of a recap, we got a good
score and secrecy highlighted a preventative approach, a strengths -based approach, very
good joint working across the health and care system, clear co -production and the fact that
equality is diversity and inclusion work really well embedded. Thank you and happy to take
any questions. Graham, do you want to say a few words?
Given the time, it's been a very long day.
But while I spoke at the last Council meeting about the journey we have been on, I would
simply like to thank all Council officers and even the partners we have worked on in
delivering this very successful CQC assessment.
I think if you look from 2022,
for CQC assessments reinstated,
you look at the outcomes of,
as of the adult social care operating framework,
and you can see a progression of improvement year on year.
We are very much committed to continuing that
and indeed our intention is to bring an action plan
to move forward on this very important subject
to ensure that next time around we get even better meeting.
Thank you.
Thanks and just to say we've asked for that action plan
and next steps to come to the next committee as well
because I appreciate we have touched on this before.
Does anyone have any comments, questions,
anything further on CQC?
Sara.
I'd just like to say congratulations,
it is a good report.
Really well done, considerable improvement
on the situation before.
I was going to ask about what's next in your sites,
but as you've clearly laid out,
how you're gonna take that forward,
it seems unnecessary.
Thank you.
Thank you.
I'm just checking. Stephen, did you have any? No, you didn't
have questions on this. The report is for information and
action plan coming next year. Thank you again, Claire, for all
the hard work. For you and the team and Jeremy for all the hard
but for members that are new to this committee,
this is a regular of the report that we get
at different intervals.
Thank you, Nancy Carissa,
Statutory and Corporal Complaints Manager.
The report provides a brief overview of complaints
received and handled through our adult statutory process,
highlighting adult services commitment to transparency,
learning and continuous improvement.
This year we saw a healthy increase in formal complaints,
but overall numbers are low relative to the scale
of the number of people being supported positively.
There are no kind of unexpected themes or issues
that have cropped up.
And throughout the report, there's learning case studies
just to kind of really emphasise and highlight
the commitment to listening and learning from complaints.
And towards the end of the report,
I've put in the examples of positive feedback
to show that adults are regularly contacted by people
to say thank you to the really good services
that are being provided and happy to answer any questions.
Thanks very much, Nancy.
Any questions?
Everyone wants to go home.
Councillor Fraser.
Thank you.
And thank you for presenting that.
Just wondered from your perspective about if you
spotted any of the issues that have been identified
and through the process and how they're
to be addressed moving forward in the kind of interests
of continuous improvement.
Some of the specific issues.
Well just if there are any, yeah,
if there are anything that jumped out to you at all.
I think our general approach as well,
and Nancy is kind of what Claire's getting at.
The themes that jump out, they are the themes
that we expect to see every year.
It's things about delays,
They're some of the common themes.
And where that has been upheld, throughout the report,
there are examples of where services are putting measures
in place to improve it.
Quality of assessments comes up.
But again, it's not expected.
But there's annual audits.
We work with the professional standards team.
And through them, there's regular
when they identify issues.
There's training within the services.
And communication.
and communication is the theme that comes up year on year.
And even though it is a regular theme,
it doesn't mean it's not taken seriously.
There's continuous reflective practise with workers.
So it's a kind of scenario of continuous improvement.
Thank you.
Thank you.
Councillor Stock, did you have a question?
No, it's just as well as praising
the adult social care theme for the CQC assessment results
and the leadership there, just also,
I know in the report that the complaints team
also won a staff award within the organisation, so to note their success and their contribution
towards culture and learning across the council, because that is really important and the information
that they've been able to share to support service improve complaints handling, because
I know that is an issue that residents face. So congratulations and well done to note that
as well. Thank you, Chair, perhaps.
Yeah, thank you. And Stephen, I think you had a similar question around kind of lessons
learnt. Did you want to build on that?
Yes, it was just about whether you have a process in place for when lessons are learnt
and changes are made to follow up to cheque that those things have actually been implemented
and carried forward to downstream as it were so that, you know, six months or a year later
these things are actually being changed. Do you have such a process?
Yeah, we work with the principal social worker and professional standards team, so we'll
go to them each quarter and we go with the learning and the themes and we triangulate
it with the work that they're already doing and it's followed up through that. So, you
know, there may be a theme from that that we take forward through a workshop or training.
But yes, if there are specific pieces of learning, for example, somebody's going to go away and
create a new leaflet and information,
my team will then follow up within a certain amount of time
to ensure that that's been carried forward and completed.
Thanks everyone.
Is the report noted?
Lovely.
And then for our final report,
just a note about the work programme
that you'll see in the appendix.
As with the new system,
We are having opportunity for reports to come at an earlier stage and draught form and comment on those.
And as with that, there is an opportunity for the committee members to request things that aren't on the forward plan that they want to see.
So please don't hesitate to speak to me and Laura after the meeting if there's things that you want to see on the forward plan that aren't on there.
but we've got lots of good stuff coming up for that February meeting,
including more on CQC and the action plan,
more on the mental health report and the final report
on our VOG paper. But if there are any questions we can
also take them down. And I'm just reading the note from you
Stephen that you're collaborating with the Social Care Department on a
co -production charter and understand that that might come to
committee soon as well.
Is that right?
That sounds great.
It would be great to see that.
And we asked as well for a slightly more in -depth
report on CAMS.
Is that report noted?
Does anyone have any further comments?
Great, okay.
That concludes business for this evening.
Thank you for bearing with us as we got through quite a lot
and did it in a new format.
I hope you have a nice evening.
.