Health Overview and Scrutiny Committee - Tuesday 24 February 2026, 7:30pm - Wandsworth Council Webcasting

Health Overview and Scrutiny Committee
Tuesday, 24th February 2026 at 7:30pm 

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  1. Webcast Finished

Health Overview and Scrutiny Committee. My name is Councillor Lizzie Jbrays and I'm the
Chair of the Committee. I'm going to get the members of the Committee to introduce themselves
one by one and we also have a number of officers present but they'll introduce themselves as we go
through different papers. So I've got Councillor Crivelli first. I'm Councillor Crivelli. I'm the
I am the opposition spokesman on health.
Thank you.
Then I have a few apologies for the sickness bug going around.
I have a lot of health professionals in the room, so I am sure they will know that all
Apologies from Councillor Gassane, Councillor Anand,
Councillor Jeffries and Councillor Satters.
And I'd also really like to welcome Stephen Hickey,
Chair of Health Watch, and Stephen's going to comment
on those items that he submitted a question on.
And I'd like to just express a warm welcome to Kate
and to James for joining us from St. George's.
Thank you so much for taking time
out of your very busy operational days to come and join us this evening.
We really appreciate it.
And I'm gonna also, I missed out Councillor Graham Henderson,
who's cabinet member for health, to introduce himself.
President, thanks.
Thank you.
So we're gonna move on to the first item of the agenda this evening,
which is the minutes of the 18th of November.
are the minutes agreed?
Yeah, brilliant.

1 Minutes of the 2 Meetings held on 18th November 2025

And are there any other declarations of either pecuniary

2 Declarations of interests

or registrable or non -registrable interests
anyone needs to declare?
Brilliant.
So I'd now like to bring us to our first item
to welcome Kate Slimock, Managing Director,
and James Blythe, Interim Group CEO from St. George's,
and I believe Kate is gonna be introducing the report.
Thanks, Kate.

3 St George's Trust Report on an Update on the Trust's Performance and Other Key Issues (Paper No. 26-73)

Thanks, Councillor Dobres.
And the usual way, I'm just going to do a very brief introduction and then obviously open it up to questions.
We've obviously submitted a report and in that we've covered off a number of things.
One, just update on performance and how we're doing generally.
I think you see from our emergency UEC pathways, our four -hour performance continues to be good,
but we obviously continue to be quite challenged, as other organisations are, around ED flow and performance generally.
We are seeing an improving position with our waiting times.
We have eliminated our 65 -week waiters.
We're now focused on reducing our 52 -week waiters,
and we are seeing our patient tracking list coming down,
and that's something that's obviously a great deal
of focus on nationally and locally.
We continue to perform well in terms
of diagnostic performance,
so people get their diagnostics quickly,
and we are performing well around our cancer,
our faster diagnosis standards.
All of those are within the PAC or upper quartile, which we want to maintain.
We've also got a bit of a report in the PAC around our finances, which continue to be
really challenged.
However, we are going to be coming in on plan at the end of the year.
And then we've got lots of plans for next year about how we'll deliver quite significant
savings programme and transformation programme, which will link in with the 10 -year plan and
shifts, three shifts.
We've also touched on industrial action.
We've had junior doctor, resident doctor, sorry,
industrial action.
We've also had industrial action with our health care
assistance, but we hope that's the one and only time when we've
now found a way forward around back pay for our health care
assistance in terms of their pay award.
And then we've covered a reasonable amount on our CQC,
both the call service inspections, which
urgent emergency care in our surgery services and maternity services and also our well -led
inspection. And we've covered off and we can talk a bit more if that's helpful around some
of the work we're doing around the well -led, around making sure staff are aware of what's
in the report and engaging around some of the things that we're going to do differently
going forward. I'm happy to leave it at that if that's helpful and then obviously take
questions.
Great. I've got a question and I can see there's Councillor Marshall and I'll just take it
order and then did you have a question Councillor Cremelli? Okay cool so we'll go
Councillor Marshall first. Yes I'd like to talk about these these 300 stranded
beds seems really very significant I'm just wondering what the trend is on that
I don't remember it coming up before, I might have just missed it but you know how many
stranded beds were there six months ago for example is part one of that but
Looking to the future, what are the things that are causing the blocking those, what
are the bed blocking factors, placements, housing, packages, and really crucially, how
much of that is to do with the interface with Wandsworth Council and what could the Council
be doing to improve matters from our end?
So the 300 beds is across Gesch, which is Epson, St. Helier and St. George's, and certainly
not all Wandsworth patients.
I think generally the trend is down.
There's a whole range of reasons why people get to the point that they're ready for discharge
and have to wait for a variety of things, and that can be about hospital processes,
but it can also be about waiting for packages of care.
That's less of an issue for us, and we obviously
have quite good systems for moving people on quickly
who require a package of care.
Unless there's a high level of complexity
in terms of needing four times a day,
that tends to take a bit longer.
I think we do have some longer waits for people on pathway
three, waiting for nursing homes and to some extent care homes
as well.
And that can also be about families
being happy about where the patient's going.
So that bit of the pathway is more elongated.
I mean, we work really well with Wandsworth Council.
We have good relationships.
We've got a transfer of care team we've talked about before.
I think we're gonna look at how we can refine
the work that they do,
and to look at how we can be more efficient,
both internally and externally,
with things like we're working on describe,
not prescribe, things like therapists.
So they're describing the care that somebody needs
rather than prescribing it, which
isn't the role for us to do.
It's a role for our system partners to do with us.
So I think we're looking at a lot of internal process
about how we can speed things up, earlier identification
of people that need support in their pathway of care,
rather than raising that near the end of the time
when they're going to be medically fit
and ready to leave the organisation.
So it's a continual piece of work.
As I say, this is a number right across the organisation,
not just St. George's.
So I think probably in that way it's a little bit misleading, this report.
James, did you want to add to that?
Sorry, just a very illuminating answer, thank you very much.
But I realise the other thing I'm just curious about is, you know, of those 300 people,
is that sort of a very fast turnover, or if I came in a month later,
would any of the 300 still be there at the end of March, at the beginning of March,
or they sort of tend to be there for a week and then gone?
Well, I think it's variable.
A high proportion of them would have turned over,
but there would be a smaller proportion that stay.
Sometimes we have people that stay half a year,
even a whole year.
But that's very rare.
But we do have people.
So we really focus on people who stay for over 21 days.
But we do have a sort of reasonably high proportion
of people.
And there's a very high level of complexity
that we're seeing now.
So it's both mental health needs, dementia,
and it's actually quite hard to place people
with complex needs, and that often takes a lot longer.
And then you've got to get the family
aligned that they're happy about where their relative is
going as well.
But that is the smaller number within the 300,
say I'd say it's 20 % of the much longer stayers.
Yes, so just to add and just to share
sort of what we see across the whole group.
We know that where we have initiatives
across some of the hospitals that we cover,
that get the right therapy support in particular to people
as soon as they need it and at the right level of intensity
of that therapy support, that the impact
is that the long -term costs of care come down.
So I think the challenge for health and for local government more broadly is how much
can we operate on what we call a discharge to assess principle, which is basically we
get people out with the right support quickly because we know if we get them out straight
away they don't spend time in hospital not receiving the right therapy and rehabilitation
input, they're in their own homes, they don't decondition as a consequence and therefore
their care costs are in the long term lower
for the whole public purse.
The challenge is that when health and local government
budgets are so separate, that requires a sort of,
it requires a sort of act of faith, in a sense,
that actually if you put in that support upfront,
that actually you'll have lower long term costs.
And that's very difficult to do when budgets are so constrained
for both health and local government partners.
But I do think it's something that we've
got some initiatives already that
working towards that.
I think it's something where both health and local government should continue to challenge
themselves to say how much can they do that because actually it's better for the public
person.
Most importantly, it's better for local residents as well.
Thank you.
Councillor Cremelli.
Thank you for your report.
I was going to say I'm pleased to see the news that you've said about the reduction
in waiting times.
I just wanted to ask you about that because the government set a target seeing that 92
of all patients had to be seen within 18 weeks by 2029 and they set an interim
target of 65 percent by March of 2026. I appreciate you have you know made some
headway in that but do you think realistically you can meet the sort of
target that the government setting?
We're around 60 % and I think we're looking over the next number of months to push that
up to 65%.
There's a bit of a sort of dynamic with referral to treatment that if you're driving your long
waiters down it's harder to maintain the percentage because they work against each other and we've
really focused. We did have a 65 week issue within the organisation, which we have worked
really hard to bring that number right down and we're eliminating 65 week waiters. We're
now moving to 52 week waiters, which does have an impact on your percentage performance.
But we think realistically we can move that to 65 % over the next 12 months. We won't be
I appreciate you've put the financial update there and given us a very good background
about the challenges that you have.
We've seen that the total deficit is going to be $108 .8 million, and you've talked about
targeting savings of up to $90 .6 million.
The thing that I would like to know about the savings is how do you intend to achieve
savings of 90 .6 million, it seems like an incredible sum that you're talking about overall.
And secondly, can you guarantee us that if you achieve those savings, it's not going
to impact on services or patient care?
Yeah, always.
Or keep us away from you as well.
An unhealthy committee.
I mean, I think your cancer, Covelli or obviously, as ever, very astute.
That's an incredibly challenging savings target, and it has been incredibly challenging.
We've had to do some incredibly challenging things, although we have.
We know we've got quite a lot of productivity opportunity.
We have closed four theatres.
We closed theatres that were at Queen Mary's, and we've managed to absorb that activity
in all theatres.
We have to remember that we didn't have those features before COVID, and we're trying to
get back into more sort of normalised COVID period.
We have closed beds as well, but we know our length of stay is out of kilter and there's
opportunity there as well.
And there's a whole range of things that we've done.
We have also had quite sort of income support as well to help us get to that position.
We have also been probably more aligned that we'd want to be on non -recurrent solutions.
We have a very rigorous process around assessing all of our CIP programmes, cost improvement
programmes whereby they go through quality impact assessments that's clinically led
and overseen by our Chief Medical Officer and Chief Nursing Officer and
has to pass a number of tests to cheque that we're not impacting on
quality and safety and patient services fundamentally. So we do have quite a
rigorous process and all of those sort of schemes would have been run through
that process, but I think you're absolutely right,
it is very challenging, but we do have,
equally we do have productivity opportunities
that we keep needing to drive at.
Thank you, and I've just got a brief question
before we move on, and yeah, of course.
So thank you for the update in the report
about maternity services.
We do regularly hear, unfortunately, from residents
that there's a real fear, especially amongst pregnant women,
and sometimes around using St. George's maternity services.
And what reassurances, especially in light
of those improvement plans that you've talked about,
can you give women who may be pregnant
and willing to have a baby at St. George's at the moment?
And I assume that concern is because we,
of our CQC assessment rather than experience
that they're hearing from,
because we actually, we track really well
on patient experience and our outcomes are good.
So I think we do a lot of trying to reassure,
but we've made loads of progress
in terms of the CQC key actions.
And we were moved out of inadequate
to requires improvement, which is demonstration of that.
And we will continue to work on that.
We've also got some really good leadership coming in,
which is a really important part of building a team
and strengthening what we deliver.
And I think it's about working with our partners
and stakeholders around providing sort of reassurance
that St. George's is a safe place to come and have your baby.
Obviously, we are the high -risk birthing centre,
and we've got real expertise in that area.
So both through giving women a good experience when
they come to the organisation and have their baby with us,
because those messages do get out to other people.
But we're trying to do as much stakeholder management
and working with our maternity and neonatal voices partners
to give them the confidence as well
to be able to share information out in the public domain,
which sometimes is more meaningful
coming from non -clinical people.
So yeah, I'm very aware that it's been an issue
and we hope we'll be able to work that through
and get into a place where people
are feeling more confident.
Thank you, that's really, really helpful and reassuring.
Councillor Lee.
Hi there, good evening, apologies for my lateness
and sorry I missed your presentation,
I've read your report.
I wanted to ask about the freedom to speak up feedback.
That hasn't already been discussed.
So, yeah, there was a comment from CQC that they'd more staff
who contacted CQC after the inspection.
And one of the areas for improvement was, yeah,
improving the freedom to speak up policy or, yeah,
under leadership, so I just wanted to ask about
what sort of future plans you have to support
your leadership in making sure that everyone
who works for the trust feels able to speak up, please.
Yeah, so I'll take this.
Obviously we take very seriously the feedback
from the Care Quality Commission in terms of
the well -laid report in St. George's,
and we've been doing a huge amount of work,
both at St. George's but across the whole group.
And I think there's two distinct things.
The first is how we improve the quality of leadership
and management across the whole group,
and how we make sure that we're training leaders
that are really responsive to their staff.
The NHS is unique in that it puts people
into supervisory positions very early in their career,
in the vast majority of professions,
within two to three years of starting
some sort of clinical practise in most cases.
We have launched a leadership and management
development programme across the organisation now,
which is designed and delivered in -house,
And we've taken the first batch of leaders through it and we are using that now.
We're using the staff survey data this year to say where do we have particular challenges
because there are many areas within the whole group where we have fantastic leaders and
leadership.
Obviously with an organisation of 17 ,000 people there will be variation.
So actually what does the staff survey tell us about areas where we need to improve standards
and therefore are there then individuals and teams that we need to take through that leadership
and Development Programme to improve it.
Alongside that, we've really increased the oversight of significant concerns raised by
staff within the organisation.
So we have a dedicated group which has got a significant executive representation that
the Freedom to Speak Up Guardian comes to and talks about what she is hearing through
the two trusts.
So she says to us, you know, these are the concerns I'm hearing.
it's about this emergency department,
it's about this surgical service,
it's about this outpatient clinic.
And we use that to say, well actually,
were we aware of those concerns?
And if we were aware of those concerns,
are we confident that we're dealing with them?
And then they're really clearly tracked,
and we ask the Freedom to Speak Up Guardian
then to report into our people committee,
so one of our board -led committees,
about how that group is going
and whether there's sufficient responsiveness to concerns.
I would say that we are a large organisation,
and healthcare is a risky business and therefore there will always be, and it's right that
there always is, a culture where people feel the need to raise concerns.
I think it's about our staff becoming more confident that they can see and that we get
back to them and say, well actually we might not necessarily have agreed with everything
that you raised as a concern but you've been heard and we've taken this seriously.
And I think that through those mechanisms it's about how we do it as an exec but then
and also how we train our local leaders to say,
this is a core part of your job.
And that's what we've got the development programme
there to do.
And we'll continue to evidence that through
showing how we respond to this year's staff survey
when we publish it.
Thank you, and then over to Steve.
And I don't know if question two is somewhat answered,
but question one.
Yes, thank you.
I just wanted to firstly welcome the work you've been doing
in the emergency department, but ask for a bit more information
on two aspects of it.
I mean, one is lengthy corridor care.
You mentioned corridor care in the report,
but can you say a little bit about whether long waits
in corridors are still a major problem,
and are they getting better or worse,
or what the situation there is?
And so the proper link to that is the mental health cases,
where I know, again, work has been done to try to change
the processes.
But is that working and how is that going?
Thank you
Yes, really good questions so like so corridor care continues to be an issue
We count someone that's having corridor care when they've been on the corridor for 15 minutes or more
So the numbers look quite high people who have length so it does vary we have days where we have
Really don't have lengthy corridor care, but we have times across the system when the system's under enormous pressure
And I know Lynn's nodding because we had a period a couple of weeks in January
And it was really really challenging it's we tend to all go into a challenging period together all trusts at the same time
And often the whole of London at the same time and las at the same time and it's times like that one
We we work to sort of turn over make sure we're not leaving patients on the corridor for too long
It's not a standard issue, but it's an issue when we're under extreme pressure.
We have put in a lot of safeguard measures to ensure people are well cared for, have
allocated staffing to them, that they obviously still receive hot food.
We also have a cubicle that we can move people in and out of when they need assessment and
some privacy.
But it's not something that we obviously want to see continuing.
I know James is attending a corridor care summit this week
because there's gonna be real focus
on having zero corridor care,
and that includes boarding people
because we do board people up on to wards
who wait in a corridor on a ward to go into a room
to ease the pressure from ED,
which two years ago was the thing of the moment
and we're really pushed to do
and now seems not to be the thing of the moment.
So none of us want to be seeing patients on the corridor.
We do everything to avoid that happening,
but it is still happening.
But generally not for long periods of time.
Our 12 hour trolley waits are fairly static.
And generally it's not getting worse,
but there are periods when it's really challenging.
And I think as I said,
everywhere experience the same challenges.
Something just to mention,
because this sort of came, was largely answered earlier,
but we're also looking at how we can avoid people
coming in in the first place.
So we set up a frailty same -day emergency care service
about 11 months ago.
And we feel the next step is to expand that
and link to the frailty.
There's some real good frailty model work going on
across southwest London.
Lynn and I sit and Jeremy sit in many meetings about.
So we want to expand that.
But we have seen in just having that unit, which
is at the front end in ED, that about 56
of the frail elderly patients that go through that unit
to turn around and go straight back home with support.
All of those patients would have been admitted before,
so it's looking at how we can do things differently,
because we know that there's still too many people
coming into ED that we could avoid
by some of the work we're gonna do as a system and a place.
So I think it's, again, thinking about what else can we do
to prevent people coming in and crossing the threshold,
which is obviously much better for them
if we can turn them around to support them
in their own home environment.
In terms of the mental health issue,
so that continues, again, that fluctuates.
And when it's bad with us, it's challenging everywhere.
We are just, there are a couple of big pieces
of work going on there.
One, we're looking at having a mental health,
urgent emergency care type summit,
where we come together regularly
and look at what we can do differently
as a system to support people, to get them out much quicker,
or perhaps avoid them coming in the first place.
We're also working with South London and St. George's in regard to looking at whether we
have some capacity on the St. George's site where we bring people together that has more
of a mental health support and input from the trust to keep them away from ED but actually
help and support them to make sure they're having interventions while a placement is
found.
So that's something we're exploring because it continues to be quite a challenge.
Thanks very much and thank you both so much for taking time out of your operational roles
to come and join us.
And you're very welcome to join but you're also very welcome to also say sorry, I didn't
see.
You have a final question before we let them go?
Yes, I can.
Yeah, I think most of the topics I was contemplating, I was in a question that have actually been
asked.
But the question now about ANA and emergency care, one good and one perhaps not quite as
good. On the positive side, I was very interested to read that your same day emergency care
has actually reduced the demand for people needing to stay overnight and effectively
in enabling them to bypass the emergency department,
reducing obviously overcrowding, et cetera.
So if you could say a few words about that,
because I'm really quite interested in that innovative way
of trying to reduce pressures.
On the negative side, in the grey scheme of things,
this may sound quite parochial, but very important.
I'm afraid that a resident and a counsellor actually wrote to me concerning the state
of the toilets in A &E which have I think been a problem for quite some time.
And although you know you're waiting times in A &E you know they're sort of comparable
to many other hospitals, nonetheless people spend quite a bit of time there and therefore
the demand clearly for toilet facilities is likely to be so quite high. So I would
ask you to have a look at and address it because it is something which has
actually been mentioned to me on a number of occasions. Thanks. Yeah, of course, yes,
thank you. So we've really focused on expanding our same -day emergency care
services in medicine and we're looking to expand that further. I've talked about
frailty, which we didn't have a frailty same -day
emergency care service before.
And we know our frailty patients have quite long lengths
of stay and decondition, all the things that James
touched upon earlier.
So we also opened just over a year ago surgical
same -day emergency care service,
and we've expanded that recently.
So we started with four chairs rather than beds,
and we've then taken four more beds
and replace them with chairs.
And we've managed to turn people around on a surgical pathway
as well.
And the admission rate is still quite low.
So this is definitely the way forward.
There's still more opportunity.
There's still more pathways that we
know that we have opportunity to drive same -day emergency care.
London Ambulance can bring patients directly
into the same -day emergency care service.
And if they're suitable, turn them around
and get them out from there.
So again, they bypass the A &E department
and get the interventions they need much more quickly.
So it's definitely an area of focus
and an area of opportunity that we've maximised.
We're seeking to maximise.
We think we've got further to go on it.
In terms of the toilets, I'm sorry about the experience
of your counsellor.
I'll take that one away, because we do have toilet issues
around blockages, et cetera.
But this is about cleanliness and availability.
That we clearly need to be.
It's a very, very busy department, as you can imagine.
However we know that.
So we'll take that one back and just see what cheques
and balances are happening down there
to make sure the toilets have been kept clean
and available and working.
So I'll take that one back.
Thank you so much, both.
And yeah, you're welcome to stay,
but equally very welcome to leave and enjoy your evening.
Thank you so much, both.
Appreciate it.
So is the report noted for information by the committee?
Okay, brilliant.

4 Report by the Violence Against Women and Girls (VAWG) Task and Finish Group on the Findings and Recommendations of its Review (Paper No. 26-28)

Okay, so now we're moving on to the VOG task finisher report and recommendations.
Councils will be aware that we held a special joint meeting between Children's and Health
to discuss the report findings and recommendations in quite a lot of detail a week or so ago.
So we're not going to rehash all of the report and findings recommendations. We had a really great discussion
We had members of the Youth Council who were such an important part of the report
we had
members from our
Refuge and from our info service and take part in the meeting
and we had the chair of our
for community forum, my Shasuma attend.
So it was a really, really great discussion.
And we kind of highlighted that we've really drawn on the evidence and
recommendations and findings of about 350 people across Wandsworth.
Whether that be parents, parent champions, head teachers, schools,
survivors of domestic abuse, young people.
So that's what the report is really in its essence.
So I just wanted to use this meeting in particular to say a special thanks to the officers that
have been so helpful in drawing the report together.
So Kat Wyatt and Gabrielle in particular and also Andrew I think is on the line.
So I just wanted to say a huge thank you for all the work that's gone into this because
as part of the Democracy Review these kind of task and finisher groups came on top of
the original workload of all officers. So we really, really appreciate you kind of taking
the time and getting involved. And also thanks to Councillor Lee and Councillor de la Sejour
for being part of the review. So thanks so much, everyone. And I think we have a great
question from Stephen Hickey as well on the report. So please go ahead. Thank you. My
health services are sufficiently involved in this aspect of the work. And I was thinking
both ways of where mental health practitioners, professionals may spot risk. And conversely,
when risks emerge with the fact that the mental health dimension, whether the services are
provided, are accessible sufficiently quickly and responsibly to those needs. So it's really
about the involvement of mental health in this dimension.
I'll briefly come back and then I'll
bring Gabrielle in, who's on the line,
to kind of talk from an officer perspective.
In terms of what people told us, mental health definitely
came up in the kind of sometimes patchy provision
for people experiencing sexual violence, sexual harassment,
domestic abuse.
We know that the council does work really closely
with Springfield.
And something that came up quite a lot in schools
is that they feel that they could really do
with additional mental health support
to help them have some of these conversations,
that they feel like when some of it's coming up,
they don't always feel very equipped
to have some of those conversations.
So I think you're exactly right.
And a lot of it sometimes comes down
to the lack of funding and provision
with mental health support, especially from the trust.
But I know, and I think Gabrielle may speak to this,
we've done some work with various different providers
from the voluntary sectors to kind of come up with more holistic therapeutic offers for
women.
So Gabrielle, I don't know if you wanted to touch on some of that work that's happening.
Sure thank you.
It's a great question.
I think you know there's always more to do but I think I can just start by giving you
a little bit of an overview of how we do work with mental health services in brief.
I think to start off with we have mental health partners who join us for our risk management
for example, the domestic abuse MARIC, which is the high -risk multi -agency panel for domestic abuse cases, and victims who are in crisis also, when they attend the one -stop shop or when they engage with the IDVA service, they'll also be signposted to mental health services directly, as well as at the Council, if we're aware of a critical incident, we may also do that signposting to mental health services ourselves.
As Councillor Dobre has alluded to, there's also some work in the partnership through
the ICB funded IRIS -I programme, as well as council provisions that I can get into.
The IRIS -I is something that we have engaged with as the council, but it's funded by ICB
for I believe one more year, and it supports GP practises in being trained to identify
potential victims to support disclosures and referrals as well.
We also have an enhanced needs IDVA service and refuge accommodation.
So this is for at that sort of early intervention stage for victim survivors who may have complex needs,
including particular mental health challenges.
So that's a specialised service that we offer for victims at that point of, you know,
in crisis or just exiting crisis into refuge accommodation.
And we have a grant funded provision as well for group and
one to one counselling support for victim survivors of any form of VAW,
which is something that is new as of July this past year.
So I think it's something that we also have a lot of interest in doing
more on in the partnership. We actually at the last community safety partnership board meeting,
we decided to put mental health on the forward plan for this coming financial
year as an issue that we want to look at in terms of you know how we as a board
can look at a range of vulnerabilities including but not limited to vog and
how mental health services kind of intersects in that so I think I'll just
stop there and pass back to Councillor Dobre's. Thank you very much for giving
that really, really comprehensive,
both of you, Gabrielle, really, really helpful.
And I hope that that goes some way
to answering your question.
So yeah, given we had a really lengthy discussion
at that joint meeting, I'm gonna move us straight
to the recommendations out in paragraph one.
Does the committee approve of recommendations?
Yeah, brilliant.
Thanks so much, everyone.
So now it's been through the Children's Committee,
to the joint committee and here,
so they are officially approved,
which is absolutely fantastic,
and thanks to everyone again who took part in the review.

5 2024/25 Adult Social Care Outcomes Framework Indicators Annual Performance Report (Paper No. 26-74)

We're moving on now to the Adult Social Care
Outcomes Training Report, otherwise known as ASCOF,
and we've got a number of different offices,
but I think, Carl, you're gonna give us
the intro to the report.
I am, thank you.
Hi, my name's Carl Fenty, I'm the Adult Performance Manager,
I am really pleased to have this opportunity to introduce the 2024 -25 ASCOF Indicator Performance
Report.
The report provides an overview of the Council's performance, which is benchmarked against
the rest of London, excluding the City of London and nationally.
There are some changes to the ASCOF framework this year, which is part of the Government's
wider programme to improve data collections, but also to introduce some more meaningful
indicators monitoring health and social care.
There are four new indicators introduced this year.
Two of the indicators monitor the proportion of people living at home or with family, and
that is split into age groups of people aged 18, 64, and 65 and over.
But more interestingly, there are two cross -cutting health and social care indicators included
this year which is monitoring the performance of older people discharged from hospital into
re -abient services and then the effectiveness of re -abient within a 12 week period post
hospital discharge.
There are 12 indicators which are highlighted in Appendix 2 of the report which have been
classified as experimental statistics for this year only nationally and this is due
to the significant changes to the data collection processes but also because indicators are
now calculated centrally and the methodology for calculating
these indicators has significantly changed.
So it makes comparing performance over years
a bit more challenging this year.
So there are 20 reportable indicators
in the framework this year.
Seven of those come from the adult social care survey,
which is where we receive residence feedback
to create those indicators,
and 13 are collected through the data collection processes.
The overall performance this year, again, is very strong,
with 70 % of indicators performing
in the top two quartiles in London,
with two indicators in the lowest quartile in London,
but also the same proportion, 70 % of indicators,
are in the top two quartiles nationally,
with only one indicator in the lower quartile.
In terms of the survey, the adult social care survey indicators,
performance has improved in four of the seven indicators this year
and there are four indicators where the council's performing the top
top five London boroughs and most notably residents having as much social
contact as they would like is top in London and the unadjusted
quality of life outcome score is second in London. However there is one
indicator that isn't performing or isn't benchmarking as well as we would like, and that is the
adjusted quality of life indicator.
This indicator has improved slightly, but it's moved down in relative position due to
stronger improvements elsewhere.
This is a complex indicator and should be viewed alongside the other ASCOF indicator
1A.
We have done some more analysis since we wrote the report to try and understand our performance in this indicator.
And there were three key findings from that analysis.
The first is that older people living in the community are most affected in this indicator.
And that is due to high levels of physical dependency and mobility limitations in and out of the home.
The third finding is that although there is high dependency, respondents to the survey
are telling us that the Council is meeting those high dependency needs and the overall
quality of life is good.
We can see that through the ASCOF 1A quality of life indicator as the Council is performing
and second best in London.
So there are 13 non -social care related indicators.
Ten of those are in the top two quartiles nationally,
and four indicators are performing in the top five boroughs in London.
Most notably, all people receive support via a personal budget
to meet their needs, which is joint top nationally.
All care home providers are rated as good or outstanding by CQC, again joint top nationally.
And there's strong access to re -abment following hospital discharge, which I'll touch on a
bit more.
However, there are two indicators that aren't benchmarking as well as we would like.
One of those is the new indicator monitoring the performance of older people discharged
from hospital into re -abment and remaining in the community 12 weeks after discharge.
This is the first time health and social care data has been linked together at a
national level to create the cross -cutting indicator. It is a complex
health and social care indicator and it's reflecting that we are serving
residents with more complex needs with multiple diagnosed health conditions
which is making it harder for people to stay at home during that 12 -week period.
The council offers an accessible and inclusive re -abornment service with the
to maintain and improve independence as much as possible.
And this is evidenced through the other new indicator
that monitors the proportion of older people
discharged from hospital into re -abient services,
where the council is fourth highest in London
and 15th nationally.
We are also aware that councils who provide
more inclusive re -abient services
tend to do less well in this 12 -week post -discharge indicator.
But that said, we are still working with NHS partners
to better understand what we can do to improve performance in this indicator.
And there is also a lot of work going on nationally which I am part of for us to help understand
some of the data assurance around this indicator as well as it is a new crosscutting indicator.
The other indicator that is not performing as well as we would like is another new indicator
which is the percentage of older people who live at home or with their family.
However, over the last three years, the Council has been placing fewer people permanently
into care homes and it's always the aim of the Council to keep people at home for as
long as possible.
This is achieved through our inclusive re -aiment offer, providing personal budgets and direct
payments as well as home support.
So over time we are expecting this indicator to improve.
I'd like to conclude by saying despite a small number of indicators not performing as well
as we would like. The adult social care performance is still strong overall, especially in our
residents' feedback, and this was also confirmed during our recent CQC assurance where the
Council was given a good rating. Thank you. Are there any questions from the committee?
Councillor Cravani? Thanks to the data on the performance indicators.
Can I touch on the two that you pointed out that we've got issues with where the performance
is in the bottom quartile.
The one that you mentioned about the analysis,
the one where people are being readmitted to hospital
during the 12 week period,
you've said it can't be determined if the readmission
was directly linked to the condition
requiring re -enablement support.
In effect, what you're saying there is,
this person being readmitted to hospital, they may well have had another medical condition that developed or something like that.
And consequently, we can't say that that's anything to do with anything that Wandsworth has done.
And so, I mean, in effect, it's perhaps not that negative a statistic in the first place, is it?
Because until you dig down into it, you don't really know what the result of that is, do you? Am I correct in saying that?
Thank you. Yes, you are absolutely correct in saying that.
And I think that's some of the work that we are looking to do nationally in terms of really
guessing underneath what the data is saying because you are right in that people are going
back into hospital for unrelated issues to, they were discharged into re -aiment to improve
their independence.
The one where we've come in joint 68, the 2B percentage of people who receive long -term
support who live in their home family.
And that one appreciates a new indicator,
but we've come in the bottom quartile there.
What are we doing to try and address that and improve
the overall performance?
Sorry, let me try and take that.
So it is what we've said, as Carl mentioned,
that the number of people going into care homes has reduced in the last three years.
And we sit in a context, I think, which we can't ignore that post -COVID people's fragility
and complexity absolutely increased for all the reasons we've rehearsed a lot around perhaps
delaying getting support, perhaps the support not being available in a variety of settings
at that time. So I think that would be the first thing. And the second thing is the work
which again reflects in our citizens' feedback where we're saying we want to improve the
offer to people in terms of supported living, in terms of care in the community, and in
in terms of direct payments where they have much more choice and control over their things,
which we already do extremely well, but we'll keep on looking to do more in that space.
Thanks for coming back on that. The thing about you talked about the drop in overall
satisfaction of people who use the services, it dropped from 64 to 62 percent, and you
You said it's difficult to under -survey results.
There's a small number of residents
provide generic comments to support the responses
to all the survey questions.
If somebody is dissatisfied and they're saying,
oh, one's worth our rubbish, or whatever,
something like that, do you ever have the tendency
to go back to them and say, well,
what is it you think's wrong with us?
And to try and analyse that.
Thank you for the question.
So the survey is anonymous, and I think that is one
of the challenges with the survey in that we get very,
Limp, so we had 600 just over 600 responses and only about 19 comments
So it's really difficult to try and draw conclusions from that however
Yeah, if if we do pick up on people that have those complaints that they do go through our complaints process
And when we and we do deal with those as I say through the council's complaints process
Thank you. Thank you
Just wanted to add we are looking at
feedback from our residents throughout their journey with social care.
So, it all sorts of points in the process, including our quality assurance of our care
services, learning from our complaints process, but also feedback.
We've got different ways for people to quickly give feedback on our services.
So, all of that's used to gather feedback to improve our services.
Thanks for that.
And then, Councillor Marshall?
I'm coming back to this 2D1, 2D2 indicators.
I may be slightly repeating Councillor Crivene's question, but I was just intrigued by, it's
more a question of clarification really.
I asked the colleagues from St. George's earlier about these sort of 300 stranded beds.
What's the connexion between those 300 stranded beds and these reablement processes?
Are they tightly linked or a long way apart?
I think we can't draw any of those kind of conclusions, because what's happening is people
are going home with reablement, which is good, and we know most of our people go home as
opposed to into another setting.
But what happens is that they go to hospital for a reason that we don't know, or they sadly
pass on
It's not related to
necessarily to what's happened that was their original admission nor indeed to
the success of the reablement it can be completely unrelated and it also
In this this indicator looks specifically at the over 65 cohort and the people who are coming out of
hospital from our own experience are generally at the upper age edge with multiple conditions,
which means they could have gone in first time with condition one, gone out with reablement,
doing okay on that, managing it well, and then condition two goes awry. So it sits in the
complexity of our residents' conditions
rather than in overlong stays.
But as Kate said earlier, of course, that group of people
also do not benefit from staying in hospital too long.
Because they, it's a dreadful term, isn't it?
They decondition.
They just lose the ability to remain independent, which is why we feel so passionately about
the importance of our reablement service, to put them back on their feet and retain
their independence.
And just to say that there's also just some really great indicators as well as those ones
that we've drawn in as well that we should be really proud of.
And overall, coming back to what you drew on, Carl, about the CQC report, we've just
We've had our first rating of good and I know that officers are only keen to try and improve on that and strive for outstanding.
So I think it's fair to say that we've got a laser focus on those areas where we could be doing some improvement.
But we are also thriving in an awful lot of areas as well.
So thank you very much.
If there aren't any other questions, the report is just for information.
So is the report noted?
So that now concludes the meeting.
Thank you so much for everyone for bearing with us this committee cycle.
And this is our last meeting before the elections in May.
So good luck to everyone and thanks everyone for bearing with us.
Have a nice evening.