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Health Overview and Scrutiny Committee
Monday, 21st September 2026 at 7:30pm

 
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be one here, we will find out shortly.
Welcome to this evening's Health Oversight
and Scrutiny Committee.
It's great to have you all with us,
and we have a packed agenda to get through today
and lots of questions that we want to explore.
So welcome, my name is Councillor Jonathan Eileath,
I'm the chair, and the new chair indeed,
for this health committee, and welcome to all of our members
sitting on the committee, thank you very much for coming,
thank you very much for joining us.
It's been a pleasure speaking to you all ahead of this and I hope that we'll find some fruitful things tonight
And if we can we'll just go around and introduce ourselves if that would be okay perhaps the ward that we are from
and
And go forward
Councillor Glynn, would you like to start?
Yeah, hi, I'm Jasmine Glenn Councillor Glenn and I represent East Putney
Thank you very much
Councillor Graham we're doing some alphabetical orders.
Angela Graham, Councillor for Wamsworth Common, thank you.
Councillor Hampton.
Good evening, Melanie Hampton, Conservative Councillor for West Partney.
Councillor Simoes.
Good evening, Councillor Simoes for South Ballin.
Fantastic and I pronounced your name right, I'm delighted.
You did indeed, thank you.
Councillor Sweet.
William Sweet.
Hello, William Sweet,
Conservative Councillor for Nine Elms Ward.
And last but certainly not least, Councillor Worrall.
Thank you.
Councillor Worrall, Shaftesbury and Queenstown Ward.
Brilliant.
So also in attendance for everyone listening online
and more broadly in the room,
we have Councillor Daniel Gussain joining us
who is the cabinet member for this remit.
Perhaps you want to say hello?
Councillor Daniel Gussain,
a cabinet member for adult social care and public health,
and a counsellor for West Hill Ward.
So do we have any apologies of absence?
I don't believe so, but I just want to do the formal thing.
No?
Fantastic.
So we can move forward.
I want to very briefly say, and I've said it already,
I mean, this is the first OSC for health
of this new administration, this new term at Wandsworth Council.
And I just welcome to us all that we've
got several new members here, some
who have experience on this committee,
some who are new counsellors, some who are new on the committee.
And we're really here to do good work,
to provide scrutiny for health and for social care
here in Wandsworth.
And we are here to maximise that.
And I hope that over the coming months,
we can do that together.
It's really important that that is the approach
that we want to take.
And I think we can all around this set of benches
agree on that. Fantastic. Okay. We have had, as you will be aware, additional reports included.
Specifically there is an additional report on the outcomes of the spending review, which
was circulated late last week to the OSE members. And we also have had a deputation request
in respect of the reablement services report
for your consideration.
We are all aware of that, it looks like,
which is good, fantastic.
Next, I come to the end of the table,
and I'd just like to welcome Mr. Hickey,
Mr. Stephen Hickey, thank you very much for joining us.
I know it's not your first rodeo,
but you're very, very welcome.
And he's the chair of Health Watch,
and he's attending here today.
And where Mr. Hickey has questions,
and he has set them out in advance.
I will comment on those and indicate
that he has a question so that we can ask it as they arise.
We have a few other people attending.
Miss Kate Slemuk, you'll have to forgive my myopic vision.
Perhaps I should come to St. George's soon
for an appointment.
Welcome, thank you very much for joining.
Kate is the managing director.
I believe CEO, but I could be site CEO, yeah.
Thank you very much.
And she'll be giving the Trust Update Report shortly,
something which is a regular feature.
And then more broadly, we have lots of officers
around the room and virtually who are here to help
and here to observe and be a part of the process.
Welcome, thank you very much for arranging
and ordering so much of this.
and we will come to you and perhaps introduce
as and when your time comes, if that's okay.
Yeah?
All right.
So, forgive the rapid start.
I think it's important.
We begin thinking back to the last meeting,

1 Minutes - 24th February 2026

which is the 24th of February, 2026,
and I don't believe any of us sat on such a committee.
Nonetheless, as silly as it seems,
we have to approve and agree upon the minutes of that.
And I hope that we've all had a chance as members
to read through.
Certainly I have, and I have no qualms.
But I just want to cheque, are we all happy to agree
the minutes from?
Fantastic.
Yes?
Excellent.
Do I have to sign something now?
Fantastic.
Exactly.
And next, declarations of interest.
Are there any declarations of interest?
Pecuniary, registrable, non -registrable,
et cetera, et cetera?
No, fantastic, all right.
Fine.

2 Declarations of interests

So, we have one final thing that we do need to agree
before we get into the meat of the matter this evening.
And it's the reordering of the agenda.
So we received this additional report in relation to the outcomes of the spending review.
I propose that we reorder it, essentially, and consider this item following the adult
social care and public health 2026 -27 budget and Q1 budget.
And if people are happy with that, we will do that at that stage.
Is that all right?
Yeah.
Lots of nods.
Some gentle, some vigorous.
Fantastic.
Oh, sorry, Councillor.
Thank you, Chair. I just want to put on record our disappointment at the lateness of the paper coming to us.
Unfortunately, arriving on Friday afternoon or even on Saturday for some people hasn't given that much time for real scrutiny or discussion around the paper.
I was disappointed that this wasn't flagged up earlier. I agree. I'm happy for the reordering of the agenda, but just to put on record how unhappy we are in terms of the lateness of this process.
Okay, I appreciate you've noted your concern on that.
I mean, this is something that obviously
has affected all members,
and we all want adequate scrutiny.
It can only come out as fast as it can come out
in many respects, but yeah, that is noted.
Thank you for sharing.
Okay, fine, and that is all agreed.
No other further dissent on that.
Okay, so we now come to item number three

3 Questions to Cabinet Member

on our agenda. So this is questions to the cabinet member who is with us now,
Councillor Gossain. This is a bit of an experiment I will freely admit and what
we wanted to do was essentially to involve all members of this committee at
an early stage in the proceedings to get their involvement and so we were hoping
to take a question from from essentially each person if that's possible. This is
something that we may change for future committees, but we're kind of experimenting and we've
discussed this.
So in short, under section 10 of the overview and scrutiny committee procedure rules, this
section sits at this stage in the process before we've heard the reports, which might
feel a little odd, but that's how the standing orders exist.
And so from there we kindly received some questions from the labour side of this OSC
and thank you very much for sharing those in advance.
I know that you'll get better considered responses as a result.
Perhaps we can take a first question and perhaps the one on the voluntary sectors grant scheme.
Is that yourself, Councillor Glynn?
Yeah.
What is the cabinet member's assessment of the impact of cutting the voluntary sector grant scheme in relation to demand for the council's health and social care services?
The scheme allowed for meeting additional and emerging need.
So how much would it cost the council to absorb the additional need that may not be met through the voluntary sector now?
I think the starting point is that the voluntary sector is extremely important to us.
I think particularly as we're looking towards
greater focus on prevention,
we already have a number of voluntary care sector partners
that we support that do extremely important work
in that area, and we're committed to supporting
those organisations.
With regards to the wider grant fund,
that's not specifically an adult social care spend.
We can only control what we can in terms of spending,
and actually adult social care spending
will rise over the course of the period covered by the current spending review.
I think the key thing is that we're trying to create financial headroom.
So by making savings in terms of not spending so
much on less efficient care, managing demand earlier, making the council itself work more efficiently.
We can deliver a considerable savings which can then go towards more targeted support.
and therefore meeting the needs of our residents
in a much more effective way.
Thank you very much.
I hope that adequately answers your question.
We'll take it over perhaps to,
Councillor Sweet, you indicated you had a question.
Excuse me, Chair.
Are we allowed follow -up questions or not?
Because it's really unclear in terms of the rules
whether that's allowed or not.
So if they are brief, I think that's important.
We do want to give everyone a chance
to ask a question, and we also have questions later on
through the paper, so if you want to ask a question,
for example, to the cabinet member relating
to a later paper, you can do so then.
Does that make sense?
That does, thank you, as I said, the rules are,
and we're playing this by ear, I know,
as we go along, it was really confusing,
so thank you for the clarification on that.
My apologies for the confusion,
and thank you for the patience.
Okay, we'll take it over to Councillor Sweet, if I may.
Thank you, Chairman. There's considerable financial pressures on the Department's
budget at the moment, so I'd like to ask the Cabinet member what he's doing to bring
spending in line with the budget whilst protecting vulnerable groups of people.
Thank you. You're right, we are facing significant financial pressures, so we need to be extremely
disciplined about how we respond.
The answer isn't to reduce spending on social care
or public health.
It's to make sure that people receive the right support
at the right level and from the right organisation
while we tighten control over how the money is being spent.
So our programme will include earlier intervention
and prevention, stronger reablement, better use
of equipment and care technology,
regular review of care packages, and more consistent oversight
of high cost decisions, better commissioning and negotiation of providers, and making sure
that the NHS meets its costs, excuse me, meet the costs which properly fall to it.
And I also as a cabinet member ensure greater rigour in delivery, ensuring that savings have
named owners, milestones, and proper benefits tracking, and I'll be meeting regularly with
the executive director and the finance lead
in the directorate to ensure that that's done.
Thank you very much.
Councillor Worrell.
Just a clarification about what you've just said.
You said there'll be no reduction in spending
in health and social care, is that right?
Over the course of the period covered by the spending review
so up to 2030, there will be an increase
in the adult social care budget.
With regards to the public health budget,
there'll be a slight decrease,
but the core services are protected by the,
will be protected by the public health grant.
So just for clarification then,
so the programmes that are in place at the moment
right across social care,
you're guaranteeing that there will be no reduction
in funding for them?
I'm not talking about specific projects,
So I'm talking about the overall adult social care spend.
And ensuring that that's more targeted
and meets the needs of our residents more efficiently.
So we have our second question from the labour side as well.
It's just about neighbourhood health.
And I don't know, was that yours?
I'm sorry to put you on the spot again.
Don't worry.
Everybody knows I talk too much anyway in these things.
Yeah, could you please give me an update
on the current status on the move
to the neighbourhood health model,
and what might be the challenges for local authority
in the development of this model?
I think, naturally, understandably,
there's some anxieties, as there always is
when there's a reconfiguration of NHS services,
and we're all learning.
I think the key principle by neighbourhood health
is the right one, is that people gain access
to services locally, that local services are connected better and able to share information
better so that people don't have to say the same storey more than once.
The principle is the right one, and I think it's a principle of localism.
I think that's something, as a conservative, that I would support.
I think the key thing is that we don't see another layer of bureaucracy or another talking
that it delivers targeted outcomes
and that those are evidence based
and that we're able to track those
and that we know that this move, this transition
will deliver what it says it does.
In terms of the main challenges,
I think they're quite practical.
Things like how do different organisations
share information appropriately?
How do they connect with one another?
with one another and I think it's going to be difficult at this time of significant budgetary pressures for
organisations to
deliver change
But we had a meeting earlier on
Officers and I about this and we're all committed to making sure that this works and we'll update you at subsequent
overview and scrutiny committees
Thank you very much and councillor Hampton and councillor Graham, would you like to contribute a question?
Wonderful. We're being staggeringly polite. How marvellous.
My question is very much about the NHS and fair sharing, shall we say, of the budget.
So four years ago, I'm just going to give you an example. Four years ago, you would
have the NHS side, so me and my dyslexia, it's not the CCG anyway, it's the Integrated
health board would spend wages 250 ,000 pounds on discussing people with certain
conditions. Our side would spend 250 ,000 pounds on staffing. That's half a million
staffing cost a year arguing about things and I've always felt that that
was staggeringly inefficient. So I would really like to see development in that
area where these are costs that we could cut without encouraging any downfall in service
provision.
So I don't know what the cabinet member's thoughts are on that.
I think the key thing is to make sure that residents receive the care that they're entitled
to and making sure that the right body provides that care.
So in the case of the NHS meeting its costs, things like continued healthcare costs and
and NHS funded nursing care would fall under that umbrella.
Also, Section 117 aftercare, which is when people
have been detained under the Mental Health Act,
the free care via the NHS that they get afterwards,
making sure that the NHS meets its costs
in relation to that.
Reviewing high cost and jointly funded packages,
and escalating genuinely disputed or delayed decisions
where necessary because I think as you identify,
that's a significant drag on the budget.
So it's not about shifting costs around the system,
it's making sure that the right body meets
its statutory responsibilities.
And that in the same way that we shouldn't be,
the Adult Social Care Department
shouldn't be spending money on NHS priorities,
the NHS priorities, the NHS shouldn't be spending money
on adult social care, so it's being clear about
that delineation and making sure that the right body
pays for the right treatment.
Thanks very much.
Councillor Simos, do you have a question, I understand,
on digital delivery, is that right?
It's not on digital delivery, it's on heat associated deaths
if that's all right. Sure, go for it.
With an estimated 2 ,877 national heat associated deaths
this summer, May, and June, 2026,
but a lack of localised data for our borough
on heat -associated deaths.
How can the council work with health partners
to bridge this information gap
and permanently protect our most
medically vulnerable residents?
And what financial resource will be made available for this?
Thank you.
So I think there's a genuine difficulty
in providing reliable, thorough figures
on heat -related deaths, because heat isn't
generally recorded as a primary cause of death.
There are usually other comorbidities,
cardiovascular disease, other comorbidities
that may contribute to the death.
So there's an understandable reason why that data
isn't as available, perhaps, as it should be.
The council's response has been based
on risk and vulnerability, and it provided updated
guidance and public health communications through the summer, promoted advice through
libraries, distributed cool packs to people experiencing homelessness, staff and volunteer
training was provided.
There was an extreme heat resilience exercise within the council, as well as a climate risk
map which was developed to identify vulnerable communities.
In terms of financial resources, existing departmental budgets will be devoted to this.
and it's yeah as we approach next summer it's something that would be high on the
agenda with within the Directorate and yeah we'll have a strategy based on what
we've learned this last summer.
Councillor Graham.
Thank you Chair. My question is kind of two in one. Although you kind of unsnipped cabinet member,
How will the proposed changes to the reablement service help more residents regain their independence
and reduce the need for long -term care?
And how will, and this is the second part of the question, and how will the Council ensure
that commissioned providers have sufficient capacity and maintain the quality of the existing service, which is very important?
Okay, thank you.
Thank you.
We've got a paper on this later on.
Reablement is a very critical service that the Council has provided through its in -house
kite service, but also through Commission providers.
I think there's up to eight providers, isn't there, Mr. de Souza?
All of which have a CQC rating of good
and provide comparable service.
It's a really critical service in terms of
getting people to a level of independence
as quickly as possible through intensive six week packages
so that they're able to, they're less reliable,
oh sorry, they're less reliant on local healthcare services
and thereby reducing costs.
So it's a key plank of our approach
to managing the budget challenges.
Was there a second part to the question?
Councillor Graham.
Oh, just to add, basically,
you've actually kind of answered it.
Actually, you've kind of answered it.
It's the reassurance that the capacity,
the commissioned services have got the capacity
and the quality of service,
which was with the previous KITE offices?
Well, the quality of service is, yeah,
as I say, it's of the same standard as the KITE service.
But I believe officers have looked into that capacity
and they would not have proceeded with the transition
to a fully commissioned service without investigating that
and that's been looked into.
Thank you, cabinet member.
that.
We will come and do a deeper dive on that particular issue as we know in time.
Sorry, I missed your earlier question and there's I think one more on digital delivery,
is this right?
There is one, but I actually had a follow -up question for Councillor Kosei in relation
to the heat question that I was trying to get your attention for.
Yeah, sorry, we were just, we had begun with somebody else.
I actually signalled to you before you actually started.
Ask away now.
It's just in relation to the effect on services
during the heat epidemic.
Now, it's just a suggestion more than anything else.
I know voluntary sector services come under a lot of pressure
in terms of delivering against KPIs during this period.
Things get cancelled, appointments get
cancelled, groups, et cetera.
I'm just wondering, as a suggestion in the future,
if you'd allow some flexibility around the KPIs
for those foreign -trick organisations to take into account extreme weather conditions in
this way.
It's an interesting point and I'd be happy to consider it and perhaps to arrange a time
to talk specifically about that.
Thank you.
Would you like to ask the digital delivery or would you like to, we can move forward
as well.
No, I think the digital delivery one is an important one.
Yeah, go ahead.
Thank you.
With the increased move to the delivery of digital -based information and care, what support
will be provided for those who may have low digital skills or may be on low or no income?
Digital delivery might have the unintended consequence of actually increasing health
inequalities for certain population groups.
I think it's a reasonable question.
I mean, my view is that it's digital where it helps, but it's not digital only.
So technology has some great advantages.
It can make services easier to access,
help people to remain independent.
But we can't assume, as you rightly say,
that everybody's got the skills, the confidence,
or the equipment in order to access it.
So in terms of the support that we'll provide as a council,
telephone and face -to -face support, printed information.
There'll be information in libraries,
using our relationships with community
and voluntary sector partners to ensure
that they're brought in on this,
and that they work with their cohorts.
And yeah, assisted digital support will remain important.
We acknowledge that it will take some people
a lot of time and effort to transition to this,
but there are very significant advantages,
but nobody will be left behind by it.
So yeah, as I say, not digital only,
but digital where it helps.
Fantastic. We will have just one more question at this stage from myself, but obviously we
have discussed how there are opportunities later on down the line. Many of these things
will be covered again in some of the reports that we have. And very quickly, I want to
get on my my hobby horse, which is to say I see lots of people who lose their lives
to infection and there are declining rates of vaccination in in populations in Wandsworth
in particular, but also in organisations in Wandsworth,
health organisations, care organisations.
We have a public health role here as Wandsworth Council.
What are we doing to change that trend?
And this will cost lives this winter.
It is a serious business.
The Council has an important role, an assurance role,
and a health promotion role with regards to vaccinations.
It has existing relationships with its NHS partners
in relation to its health preparedness strategy.
It can be quite complex for a number of different partners
to work with many players involved,
but it's something that the council takes very seriously.
And obviously as we're coming up to that time of year,
it has to be a focus, one of my focuses as cabinet member,
and I'll be speaking to officers in public health
to ensure that we do all that we can
to fulfil our role in that area.
Thank you, I appreciate it.
So we'll come to the end of our questions to the cabinet member section and we will
move on in the interest of time.
Just a broader reminder for all of the members here, it's sometimes forgotten with the new
constitution that is in place.
There is the facility to ask cabinet members at any time any questions that we don't ask
tonight that you might have and this can be done via email and there's a certain kind
of due date I think but don't ask me on that.
The point is this, you have the option to contact
Councillor Gossain outside of this meeting beyond
if things are still pending in your mind, okay?
Right, now, sorry.
So just a clarification, as you said,
we're still learning this process as we go along.
Yeah, yeah, in your time.
If questions are sent in from either side
in relation to this and an answer is given,
is that answer actually printed and made available to us?
because it's really useful sometimes to hear the questions from around the table that are
actually being asked.
And I wouldn't want to lose the learning from, say, Councillor, Mrs. Graham, sending
something through that might be useful for us all.
It's a good question.
I have to admit, I don't have the answer for you.
The answer will be set in stone somewhere.
It's part of the changes that came into place.
And it's all ultimately in aid of increasing scrutiny.
It's about this.
It's giving everyone the opportunity at any time to answer questions.
that's one of the things we've added scrutiny capacities
within this council.
So, but we can certainly seek out
that answer together, perhaps.
Fantastic.
I will move it on then, if that's okay.
So we now have, and would like to welcome, really,
fantastic, right on cue.
This is regarding the St. George's Trust report,
which is an update on their performance

4 St George's Trust Report on an Update on the Trust's Performance and Other Key Issues (Paper No. 26-203)

and other key issues.
I'd like to welcome Miss Kate Slemick,
who's the managing director from St. George's Trust.
And we'd love you to introduce the report, if you may.
I can barely see you at the end of the table,
but I'm looking forward to it.
Go ahead.
Really nice to meet you, Councillor Eileth,
and you're very welcome to come to St. George's
when convenient for you.
So I'm Kate Cemek, I'm the site CEO,
Chief Executive Officer of St. George's,
and I'm with CJ Francis,
who's the site Chief Medical Officer of St. George's.
So as we provide a report,
obviously it's slightly new format here,
But I'm happy to just go through the key areas
and then take questions about anything in the report
or anything else that people want to ask us about.
So that's fine.
That's good.
We're going to go through.
So starting with a performance update,
we always have key areas of performance
we're measured on in terms of our emergency care
and emergency department.
We generally perform well around the four hour standard.
We're really focused on reducing corridor care.
That's a big area of focus for all trusts
and certainly St. George's as well,
are both corridor care, which we measure
anyone who's on the corridor for more than 45 minutes
in the emergency department,
or anybody who is on the corridor in a ward
in the morning at 8 a .m.
We have seen those numbers going down
over the last few weeks,
and we want to keep that momentum going.
I'm gonna touch on winter planning later,
because that's gonna be a big focus of our attention.
I'll also touch later on discharge planning and focus
and neighbourhood and place work that we're doing
in collaboration with the council
and also with other local health partners
and the voluntary sector.
In terms of elective recovery,
we are performing reasonably well around our RTT,
referral to treatment standard.
We are now seeing 64 .6 patients within 18 weeks.
We want to keep that heading in the right direction.
And less than 1 % of our patients are over 52 weeks
who are on the waiting list.
One of our big challenges is keeping our waiting list
at the right level, so not letting it grow.
We do sometimes see a bit of growth in the summer period
and people taking holidays, et cetera.
And one of the big challenges, you know,
St. George's, like all of our systems,
are quite financially challenged.
We're not in a position to be able to put
a lot of additional funding in towards
having extra lists and theatres running.
So we've really got to be as efficient
and productive as possible within the capacity
we have available.
But we've started the year well, and we're hoping to maintain that momentum an area
We are a bit more challenged which we haven't traditionally been so challenges around diagnostic weights. That's largely driven by non -obstetic
non -obstetric ultrasound
We have had real recruitment and retention issues largely because we are one of the only trusts that don't play pay a recruitment and retention
bonus we have had to
rescind on that
because we are falling behind in terms of our ability
to recruit and retain staff.
So we have had a shortage of staff.
We're now building that back up again.
It's gonna take a little while to catch up on that backlog,
but we're really focused on doing that.
We have some challenges in a couple of other modalities,
namely gastroenterology and echoes, cardiac echoes.
Both of those are coming back on track quite quickly.
It's non -adventurous ultrasound.
This is our real challenge.
And our cancer performance is reasonably good
and in the pack as well.
We are meeting our faster diagnosis standard.
We fall below this 85 % 62 day standard,
but we are within the thresholds that we have set
with the Cancer Alliance to deliver this year at the moment.
But that's our big challenge,
and that's mainly driven by thoracic cancer,
access to theatres, and also maintaining good performance
in breast and dermatology and skin,
which we've retained good performance over the summer,
which is good.
So that's performance,
and happy to take any questions on that.
We've already talked about heat wave and heat planning.
That's been a big issue for us at St. George's
over the summer,
the extreme heats that we are having to get more used to,
and we've got ageing buildings
that are not really set up for that,
and we also have a limit to how much we can load the system
with air conditioners because of the loading
of the system, loading of our electricity system.
So it's a real balance to keeping the buildings cool
and making sure that not everything sort of blows,
as it were.
So we saw very high attendances in the summer months linked
to heat.
But as a number of colleagues rightly said,
it's not necessarily about the heat.
Heat can lead to illness, but we don't necessarily
record the heat as the originating problem.
But you definitely see patients coming in
with strokes and heart conditions during heat waves.
So we used artificial intelligence
to help us identify and contact more than 2 ,000
vulnerable patients on outpatient waiting lists,
so not bringing them in in the heat
and negotiating with them what was better for them.
And we obviously have heat wave plans that we work through,
but we're looking at an estate's strategy going forward
about how we manage summer after summer of heat waves,
which we are expecting.
You will have seen, I think, that we are working with South
of St. George's around a mental health, we call it emergency
department, it's a form of facility run by a mental health
trust on our site for people who come into the organisation
and currently sometimes get quite stuck in our emergency
department for long periods waiting for capacity outside of
the hospital.
So it's looking at giving them a much better experience while
they're in the hospital with the mental health interventions
that they need at that time and supporting their exit
out of the organisation to the right place
at the right time.
This is very early days.
We've been given some capital funding
to sort of explore that, and we're working
very much shoulder to shoulder with Southwest London
and St. George's in respect to that facility
and how it will operate and how it will work.
We recently got our CQC adult inpatient survey results,
and generally the performance was strong
for the inpatient survey.
You can see in the report how we scored
around respect and dignity and kindness and compassion,
which are areas, of course, we really want to be good at
in terms of delivering healthcare to local populations.
However, there are some areas where we need to think about
how we operate differently, certainly at night.
I think patients find it noisy at night,
sometimes too bright at night.
So we're gonna think about how we can manage
that differently.
And also, discharge planning, which is, as ever,
a challenge about making sure there are early enough
conversations that people are feeling involved
in their discharge plans.
So that's something we're constantly working on as well.
And then finally, preparing for winter.
It feels like we're always preparing for winter, but this time of year comes around very quickly.
So we've got a very detailed winter plan.
Very happy to share it with you.
That's helpful.
Where we're looking at how we work.
We work very collectively with our local partners.
We've got very strong alliance in Wandsworth and our council colleagues sit on that as
well.
looking at how we can support working differently over the winter period, reducing length of stay,
and keeping people out of hospital when they don't need to come in.
We've had quite a lot of investment put into frailty in the borough,
and we're working really effectively within Wandsworth about how we deploy that resource,
particularly into community services, to support people remaining in the community for as long as possible,
and having geriatricians leaning out into the community and overseeing some of that virtual ward capacity
that we're expanding.
So that's going to be a real focus of attention for us,
because as we know, if we keep people in hospital for too
long, they become more dependent.
And the cost of that can often land on social care
and also health in terms of CHC.
So it's really an area to operate differently
in the future.
So lots of work going.
Our winter plan's still to be formally signed off
within the trust and externally.
It's still going through the processes.
But we're very experienced in developing winter plans.
And I think we need to challenge ourselves each year
of more we can do to support patients through winter periods and
communicate together and get people out of hospital as soon as possible when they're safe to leave.
So happy to leave it at that and to take any questions that anybody has.
Thank you very much, Ms. Lemick.
If we can bring it to the OSC members, and are there any questions that people have?
Councillor Hampton, do jump in.
Thank you very much and we're all very well aware of the huge pressures and strains upon
you.
I just want to go back to the diagnostic point where you are in red.
I know that a number of other trusts, I happen to know my father's 93, he's always with the
hospitals, Great Western Hospital Foundation and the Royal Berkshire NHS Foundation utilise
their diagnostics at the weekend.
And that saves money because it's utilising
what is already there.
And it's really good for patients
because they're not waiting so long.
So that is my first question.
I'm sorry I've got two.
I might as well hit you with them both at once.
The other one is the emergency care.
For two years, I was the chairman of governors
for South Central Ambulance Service.
And I know that there is a huge problem with people coming into urgent care who shouldn't really be there.
So my question for you is how you're working with primary care,
with the doctors, to prevent that, because I think anybody will tell you who attends
at St. George's NHS is that there are the people in urgent care who really shouldn't be there.
So thank you very much.
No, thank you very much. Good question. So in terms of diagnostic services, we do run
many of those over the weekend. We run a community diagnostic centre, Aquemaries, which is very
active and also some of those services are open at the weekend, and some of the services
at St. George's are as well. So we do, obviously weekend working is not, it comes at a cost,
so one has to look at how much you can do over the weekend, but we do provide weekend
services and some diagnostic services.
In terms of urgent care, yes, you make a really good point.
There are many people that turn up to hospitals
that could actually be seen by their GP.
What we do have is an urgent treatment centre
and GPs work within our urgent treatment centre.
We're also quite proactive at St. George's
of redirecting people into GP slots
that are available in the community.
And we work really well with our Wandsworth GPs
to have those slots available.
And in fact, this winter, we've got some investment going into slot availability to give us greater
capacity to book people into.
Some people, obviously, when they arrive at the hospital, don't want to go to their GP.
They've chosen to come to the hospital.
So we can't always turn people around.
But where possible, we do send people to a GP where there's slots available in their
local area, or indeed to pharmacy as well, where we have sort of good access to pharmacy
services as well in the weekend. Can I just quickly ask, do you think that is, what sort
of numbers are we talking about? 5%, 10%, 15 % of people that you recognise really should
be seen elsewhere? I wouldn't want to give a number. Thank you very much and if we can
and keep also kind of questions kind of fairly concise
as we progress.
Councillor Simos, go ahead.
Thank you, and thank you very much for your update.
In relation to preparation for the winter,
what are the main system pressure points currently,
and how are these being addressed?
Thank you.
So the way we approach winter is system working
is really, really important.
We have over the last few years built up more same -day emergency care access
where people can be seen and see some expert clinicians quickly and turned
around and sent back home rather than admitting them and we've seen that grow
significantly both in medicine and in surgery. We've got a really active
surgery same -day emergency care unit as well. We work very closely across that
health, I guess care boundaries I call it,
where with our community services provider,
which is CLCH for Merton and Wandsworth,
and we're looking at how we can expand,
they're expanding more of what they can provide,
so we work very closely with them,
again turning people back around
and back out into the community where possible.
And then again, it's also looking at
how can we be very efficient ourselves
about getting things done when people are in hospital,
and then working with system colleagues
to get them out as quickly as possible
when they're medically fit to be discharged,
knowing that the longer people spend in hospital,
they're either at risk of getting an infection
or indeed being deconditioned
when they're elderly particularly.
So I think there's lots of things we're doing
to try and look at those care boundaries,
both at the back end but also the front end
and reduce our length of stay
and avoid admissions where not needed.
Councillor Wourow. Thank you Chairman. What is the Trust doing to improve hand -offs and
the relationship with Wandsworth Council Services? I think we've got really good relationships
with Wandsworth Council. I work very closely with Jeremy and Lynn and all of the team.
when we sit around alliance tables together,
where we meet monthly and look at our service provision
and how can we improve them.
We've got a whole set of areas
that we're working on together.
So we really don't want to get into handing off,
we want to look at how we work together
and blur those boundaries.
I think more and more poor funding over time
will be a good thing.
We know that there's a strategy to reduce,
to actually transfer a lot of the funding
that goes into secondary care,
because we're keeping people into secondary care out of the hospital.
And that's very much what we're focused on about how do we work collectively to ensure people get the right care in the right place at the right time.
And that's at the heart of neighbourhood working.
Is there anything you want to add to this?
I'm not doing all the talking.
Or what did you say?
Excellent, yeah.
Councillor Worrell.
Thank you, Chair.
My apologies if I misheard you earlier.
But you indicated that you had a recruitment and retention issue within the hospital.
Am I correct?
Denographers.
Oh, only for that area.
Yes, for non -obsetra ultrasound.
OK, great.
Denographers are very hard to recruit groups of staff and nearly all trusts in London have
put in a recruitment and retention bonus and we were one of the few trusts that weren't
offering that.
Sorry, I should have made that, I didn't make that clear.
Apologies.
That's fine.
That helps me with the question I was about to ask.
Okay, then.
Previously CQC identified issues in your maternity services,
and I know they gave you a programme of remedial action.
CQC have also indicated, I believe,
at the beginning of the year that there is an issue,
that some work still needs to be done, let's put it that way,
around medicine management and also, I think, is it safety?
Yes, safety assessments.
I'm just wondering what work, how far are you along with actually implementing those
CQC recommendations and in terms of the maternity services, have the issues now been resolved?
And I ask that because I was actually on the Board of Governors at the time when that came
through so I know, I understood the problems, some of the problems that you had.
Thank you for that question.
So I wouldn't say all the problems are resolved.
It's quite a complex piece of work and there's quite a lot of work that needed to have been done
We've made considerable progress and that considerable progress has been made partly through the work that existing staff have done
But we've also brought in some new leadership that has helped quite considerably with
Focusing the work and and prioritising it taking those two particular issues that you've talked about from a medicine's management perspective
Quite a lot of improvement work has been done with our pharmacy team. We now have
quite regular dialogue between pharmacy and maternity
that then comes to our divisional,
what's called our Divisional Incident Review Group
that looks at any medicine incidents.
We look at our, we've got some mandatory assessments
that get done, audits that get done
to look at how well we're managing medicines.
There's been a lot of improvement there.
Some of the areas where we're still struggling with
are areas that require our IT systems to improve
to make it much easier for our midwives and nursing staff
to oversee the medications for patients,
but that's actually not limited to just maternity.
We have ways of mitigating that,
but those are mitigations,
and it's gonna take us some more time
to get our IT systems to be where they are
to completely ameliorate that.
From an assessment perspective,
one of the key challenges was around
what's called a maternity early warning score,
so that's a slightly different scoring system
to what is used for adults or children.
And again, we used to do it on paper.
we moved our whole maternity service across
to an electronic patient record.
As with any big move to a new system,
there's teething challenges and challenges
with things not quite working the way you expect it to work.
And I won't bore you with the details,
but the bottom line was the maternity early warning score
was not calculating scores properly
when midwives and doctors put the scores in.
It took us a little bit longer than we expected,
but earlier this year we've now implemented that fix.
they're now able to calculate the score effectively.
So that particular aspect is now resolved.
We're still struggling a little bit
with the electronic patient record
and a lot of the assessments that are recorded on that.
So we feel comfortable the assessments are being done,
but if you look at the recording of it
and being able to pull it out later
to give us assurance around it,
that's proving to be a lot more challenging.
But that's still something we're working on
and Kate's been leading the work with our new head of IT
on working on the IT systems and trying to make those
much more capable than they are at the moment.
Could I then ask at the next update,
if you could give us some updates about the area of work,
that'd be really useful, thank you.
Yeah, no, absolutely,
because we've made enormous amount of progress
in terms of all the should dos, must dos.
We're expecting, we're sort of rather hopeful
in the next few months we will get a re -inspection
because there's been a lot of progress made
as we did in the emergency department,
which obviously improved.
So, and as CJ rightly says,
We've got really excellent midwifery leadership now in place, which has made a big difference.
We're going to have just two more questions in this section if that's okay.
Councillor Graham was next, then I think we'll come to you, Councillor Simos.
Thanks, Chair. Thank you very much for your report and your verbal report.
I'm very much welcome that you're having meeting with senior officers of the Adult Social Services
But I'm concerned that we don't have the details.
It doesn't lack detail, but it lacks
the details of what we possibly would like to see.
Because we have people coming to us as regards
to complaints or whatever.
And I just would like to draw your attention
to the corridor care.
I mean, what conditions are they, you know?
Is it bed blocking, you know?
And how long do they stay in?
And how, you know, what are the, how are they discharged?
So that's kind of one question.
But the one on diagnostics, I have residents who come to me saying,
who have been to the doctor, and they're
going to put me through the, as I just said, I've got cancer.
Like, you know, goitre or prostate or something
like that.
And so the doctors are knowing that they're
going to get an MRI scan or a CCT scan or whatever it is.
And it's just that there's more detail
Well, as a Councillor on this committee, I would very much like to see if that is possible,
Chair, in the future. Because there are many questions that we could actually help you
with. To flesh it out in answers. You know, it's not them and us, it's us. And we're
there.
Yeah, it's a good question.
And it's the client. That's the client.
Perhaps we can hear from you, Ms. Lemmeth.
It's flashing green. Okay.
I'm really happy to... So this was the way we have worked before.
Conscious were working with many different people around the table and a different chair.
So really happy to work together to get the report and the information.
Obviously we've got tonnes of information.
and they don't want to drown you in it,
but equally, if this isn't enough,
then we can go away and provide a form of report
that meets your needs.
Really happy to do that.
Fantastic, I think that is, yeah, we'll take that forward.
And so we'll also move on.
And we have a bit more rope than I imagined,
so we'll take two more questions,
and I know Councillor Simos and Councillor Glynn
both had one.
Councillor Simos, if you go first.
Thank you.
In relation to the CQC survey results,
I'm noting the many positives.
What progress has been made in implementing
the recommendations, particularly in ensuring
vulnerable residents experience a safe
and well supported discharge from hospital?
Thank you.
So we received the survey last week,
so it's very new to us in terms of this feedback.
That being said, we're already doing lots of work around discharge planning.
How do we improve that?
We do that collectively with the council, but we also do it on our own because there
are lots of improvements we can make ourselves.
So with all the actions, both the nighttime action or nighttime feedback and discharge
planning, we're going to take that away and look at how we can improve all of those areas
and do things a bit differently that hopefully will lead to a better survey outcome next
time.
I just have a question on the mental health emergency department which I think is great
news.
And I guess one of the things with mental health is people in crisis might not necessarily
be able to identify the fact they are in a mental health crisis.
They might not present themselves to a mental health emergency department in order to access
the help that they need.
So I was wondering how will community groups and other services be involved in the design
of this to make sure that everyone who needs to access this department is being reached?
Yeah, I think it's a really good question.
And it's an issue that exists now because we obviously people when they're in mental
health crisis will often come to the hospital and to the emergency department and then sometimes
a bit delayed in getting the mental health and care that they need.
I think this has to be a collective effort and to look at what other provision there
is around crisis preventions, the preventative side of things,
where people go when they are anxious and worried
or have real mental health crisis,
and helping work with local communities
as well as users of the service to what
will help them to access the right service
at the right time.
So we're very much in sort of development mode,
because it's still quite a new concept,
but we'll absolutely pick that up.
I will very, very quickly follow up on that.
Quick question, hopefully a quick answer as well.
On the mental health emergency centres,
what kind of assurances and detail
can you give on physical health expertise in them
to ensure there's no diagnostic overshadowing?
So it absolutely has to be a collective effort.
I think at the moment, we have people in physical health,
people surrounded by people with physical health expertise
and not enough mental health expertise.
But we need to make sure when we open this unit,
We also have physical input into the unit and it obviously it will be acts or diagnostics and everything else will be very easily accessible
Which is some of the reasoning for having it on the on the hospital site. Thank you for the reassurance, so I'll bring in mr
Steven hickey at this stage. Thank you very much for joining us. That's enough questions for members
You have a question submitted perhaps you'd like to share it. Well. I think my question actually thank you
I was actually asked by one of the counsellors,
so we can probably pass on that.
And you're satisfied, so?
Follow up to the other one.
Fantastic.
Very good to hear it.
OK.
Fine.
So I mean, ultimately, this is a question
and a report for scrutiny.
It's for information only.
So we just need to cheque, is the report noted?
Yeah, fantastic.
OK.
Well, thank you very much for coming, basically.

5 Reablement Services - Supporting Residents to Live Healthier, More Independent Lives (Paper No. 26-204)

Thank you.
And we will see you soon.
Nice to meet you.
Yeah, absolutely.
or so. Thank you. Thanks very much. We move on to agenda item 5. This is
reablement services supporting residents to live healthier more independent lives
paper number 26204. So we have a deputation request and there's a
we need to decide whether we're happy to have a deputation from, I believe it's a Miss Eunice O 'Dame from Unison.
Sorry, are we happy? Yeah, all in accordance, fantastic. Okay.
And it's really regarding this re -ablement service.
So Miss O 'Dame, are you with us?
Oh, fantastic. See you shortly. Sorry, I thought she was leaving the building.
You're very welcome
Mr. Dean thank you very much for joining us you have
Five minutes to outline your points to the to the committee, and then we'll we'll ask some questions if that's okay
Thank you
My name is miss Eunice O 'Dell army
I am speaking on behalf of Wandsworth unison
regarding the proposal to close the kite reablement service and move to a fully
commissioned model of reablement provision. Chair, thank you for the
opportunity to speak. I am here because residents' independence
and the experience of long -serving workforce both matter. I'm not
justified, lawful, equitable, and low risk to residents and staff.
The supplementary report records Unison's concerns regarding workforce impact, employment
protections, equality considerations, provider capacity, service continuity, and resident
outcomes.
Unisom recognises significant financial pressures facing local government and the difficult
decisions councils are increasingly required to make.
We understand the need to secure value for money and ensure long -term sustainability
of adult social care services.
The Council's spending review states that it aims to maintain quality adult social care
support independence, strengthen prevention, enhance
reablement, and ensure residents receive the right support
in the right settings at a sustainable cost.
Unison supports these objectives.
However, before a long -established public
service is closed and 27 posts are removed,
we believe the committee should satisfy itself
that the proposal is justified, lawful, equitable and low risk.
On justification, we ask, is the proposal justified?
Members have been advised that keeping independence through enablement, which I will show in the
kite, enablement services and commissioned providers achieves comparable outcomes and
good CQC ratings.
If this is the case, members may reasonably ask what evidence demonstrates that closing
kite will improve outcomes for residents rather than primarily delivering financial savings.
Reablement is a prevention service designed to help people regain confidence, maximise
independence and reduce future reliance on health and social care support. If
members cannot identify a measurable improvement that residents will receive
from this proposal beyond financial savings, members may
wish to consider whether the case for closure has been fully demonstrated.
Members may also wish to satisfy themselves that any comparison between in -house and commission
provisions is genuinely like for like and that all relevant costs have been consistently
considered.
With regards to lawful, is the proposal lawful, the proposal affects 27 post.
Whilst the work itself continues through Commission provisions, members may therefore wish to
understand what legal advice has been obtained regarding 2P and whether all relevant employment
protections have been fully explored and evidenced.
The work currently undertaken by KITE is not disappearing.
Members may therefore reasonably ask whether the transfer of work has been assigned against
the requirements of the potential service provision change and whether all options to
preserve workforce continuity and retain expertise have been explored.
If we look at equality, we ask is the proposal equitable?
The report notes that the full equality impact and needs analysis has not been published
because individuals could potentially be identified.
Whilst we understand the need to protect confidentiality, members have a responsibility to satisfy themselves
that the disproportionate impact…
That's five minutes, so just take another 30 seconds to finish up, please.
I have asked for additional time.
can I be granted that time to finish please?
Yeah, do you have to take a little more?
Thank you.
Whilst we understand the need to protect confidentiality,
members have a responsibility to satisfy themselves
that any disproportionate impacts have been identified,
assessed and appropriately mitigated.
Members may wish to seek assurance regarding the gender,
ethnicity and age profile of the affected workforce,
including whether older workers, low -paid workers, women or black workers may be disproportionately affected by the proposal.
Equality is not simply a procedural requirement. It is a question of fairness.
On the matter of risk and continuity, is the proposal low risk?
The Council's own assessment recognises the value of retaining in -house expertise,
organisational knowledge and established relationships.
It is important to remember that behind the figures contained within the report are real
people.
Approximately 27 employees may be affected by this proposal.
Many have devoted decades of service to Wandsworth residents.
These are experience, please allow me to finish.
I won't take too much of your time.
I will finish shortly.
I have asked for extended time.
We did say five minutes.
I appreciate it and I've given you some extra time.
I'm glad to do so.
Thank you.
No, finish here.
I'll just conclude this.
If there remains any uncertainty on any of those matters, we have respectfully asked
That further assurance is sought before Cabinet reaches its final decision.
Thank you.
Thank you very much for the contribution.
We appreciate it a great deal.
And thank you for coming here this evening.
And it's important what you're saying.
We'll now come to questions from the members, if that's okay, to Ms O 'Dame.
Does anyone have any questions they would like to ask?
Yes, absolutely.
Thank you for your presentation.
You are cut short.
Is there anything else that you would like to tell me that you didn't actually mention to say in your letter?
Yes, I would happily just, if I may, just conclude on the lawfulness.
So basically on risk and continuity, I wanted to say that is the proposal low risk.
The council's own SMS assessment
recognise the value of retaining in -house expertise,
organisational knowledge and established relationship.
It is important to remember that behind the figures
contained within the report are real people.
Many have devoted decades of service to ones of residents.
Their knowledge has been built through years of experience,
professional relationships and an understanding
of local services.
members may therefore wish to consider not only the cost of retaining the workforce,
but also the value of the expertise, continuity, and resilience in providing such services.
That's it. Thank you.
Thank you very much, and I would encourage everyone to act in the spirit of the thing.
I appreciate very much what you're saying there.
Would anyone else like to add any questions?
Yes, Councillor Graham.
Following on, cut short.
I'm interested to know, as regards
to the area of lawfulness, what are you
trying to express by the concerns of lawlessness?
Because it's very important to hear your voice.
Well, we would like to know what advice was provided
in terms of the legality around the 2P of staff as opposed to looking at straightforward
redundancy, why those staff can't be absorbed into the provider service without 2P.
Thanks.
Thanks very much.
Well, I think then we will bring this section to a close.
Thank you very much for coming and speaking this evening.
We are very grateful for your time.
Yeah, thank you.
Thank you for having us.
Thank you.
Pleasure.
So we'll now move forward and the committee is now to consider paper number 23 -297.
So this is a report by the executive director of adult social care and public health relates
to key decision to be considered on the 12th of October by cabinet.
And we have Mrs. Lynn Wild, assistant director health care integration to introduce the report
and she's here in person.
Lynn.
Thank you, Chair.
I'd like to introduce the report by setting out the purpose of the proposal,
recognising the contribution of our KITE staff and acknowledging the concerns that the staff and trade unions have stated.
We have carefully considered the issues raised in the deputations request,
including service continuity, the workforce experience, the equality impacts, our provider capacity, resilience and lawfulness,
in terms of the in -house provision. And we've weighed that up against the financial savings that we would achieve, and I'll articulate that.
So, reablement is, as we all know, really central to helping our residents regain confidence,
rebuild independence, and avoid or delay the need for long -term adult social care need.
In the context of our financial challenges, this is a vital service.
Across Wandsworth, reablement achieves strong outcomes.
Most people leave the service more independent than when they started, and many do not need any long -term adult social care support after their short -term intervention.
And I think that speaks to the quality of the service.
The proposal concerns KITE, which as you know, as we've said, is an in -house provision.
It's a small provision.
It currently is 19 FTEs and it's 27 people.
Kites have provided high quality care
and support to our residents over many years,
as we've heard tonight.
And the proposal is in no way a reflection
on the quality of their work,
all of their dedication, all of their service.
I want to place on record our sincere thanks for the service they've given to the residents
and to the Council. The reason for bringing the report to Cabinet
is that the current client model is not financially sustainable.
The hourly cost of the service is significantly higher than commissioned reablement provision,
which is broadly equivalent. It's important to be clear that this isn't because the staff are
inefficient or because of the quality of their work. The higher cost is largely a consequence
of the small scale of the of the in -house model, the way in which the service is staffed and
organised and the council terms and conditions that rightly apply to all of the employed staff.
The previous work with staff has not been able to close this gap.
The challenges, therefore, are structural and contractual rather than anything about
the performance of the staff group.
The report did consider alternative options, including the benefit of retaining the in -house
knowledge and experience.
However, the move to a fully commissioned reablement model is the only option that delivers
a sustainable position while maintaining reablement support for our residents.
It's not an easy proposal to put before you, and we recognise the significant impact on loyal and long -serving staff.
And we know that it will be a worrying and uncertain time for them and their families.
If the proposal is agreed, staff will be supported throughout the consultation process.
This includes discussion with staff and trade unions about employment protections, including
whether 2P applies, access to wellbeing support, opportunities for skills development, help
to explore redeployment within the Council, and practical support for any staff who may
wish to apply for roles with local care providers.
We know that a number of local providers
are actively recruiting, and that KITE staff
have the skills and experience that would be valued.
However, we also recognise that doesn't remove the anxiety
that staff will feel during this process.
It's important for me to reassure committee
about the effectiveness of the model.
Wandsworth already has around 30 framework providers who deliver home care and reablement
services.
And currently we use 19 of them when KITE is not able to take on care at a particular
time.
And I think the sheer volume of provision tells us that there will be sufficient capacity
in the service.
These providers are not new.
We're not commissioning them afresh.
They already work in the borough.
They know our local provision.
They have relationships with our professional staff.
And therefore, we have no concerns
about the quality or their ability
to take on the additional hours.
For residents, we would avoid any kind of disruption
where possible.
So if a resident started a short -term service with CUT, we'd expect them to finish it.
And for another resident starting a short -term service, maybe with one of our commissioned providers.
And we will continue to ensure that this is managed as safely as possible.
The equality's impact are a very big issue and are keyly important.
For residents, the impact is very limited because we already have this model in place right now in Wandsworth.
But for staff, the impact is considerably more significant.
The workforce, as Ms Odeh said, includes a high proportion of older workers, women and staff from black and minority ethnic communities.
We will therefore need to approach the consultation with care to listen to our staff and our trade
union and to understand the individual circumstances before final decisions are made.
There are four further points which I want to, which may assist the Committee in considering
the report. First, I've made this clarity, but I want to make it again that there are
actually 19 FTEs, but it's 27 people,
because the majority of our CHIAT staff
do not work a full 36 hour week.
Secondly, the unit cost as set out in the report
is based on the hours of direct care delivered during 25, 26.
It's important to note that the unit cost will fluctuate
depending on the staff's capacity at any given time, which is affected by things like sickness, holidays, training days, capacity may be reduced.
Thirdly, that the financial saving has been calculated by comparing the Kite budget with the expected cost of commission services, which we're already in contract with.
And finally, if redundancies are required, the estimated costs have been calculated and included in the financial consideration.
I know that this is a difficult proposal as it affects valued colleagues who have given excellent service,
but I think it's vital that we do put the needs of our residents first and foremost
and that we are able to sustainably continue with our reablement service.
Thank you.
Thank you very much.
And Councillor Simas, do you want to kick us off with questions?
Yes, please.
Go ahead.
Thank you.
And thank you for talking us through those points.
My question is what quality assurance frameworks will be used to monitor
that the quality of service provision
is maintained and improved?
And then just briefly to add to that, if that's all right.
With the proposed changes, how will patients
be protected through the transition?
And I understand the anticipated timeframe
for that would be February to April 2027.
Thank you.
So the quality monitoring that we undertaken, and Ms. Soni may want to help me with this
one.
So we have a quality assurance team in the Council who look at all of our providers that
we're in contract with and who undertake a quality assurance process.
We have a sort of workbook that providers complete.
There were visits undertaken to the providers, as well as a process where social workers,
residents, families can raise provider concerns. So where there were any safety issues or missed
calls or late calls or inadequate care, all of those are directed to our quality assurance
team who take that into account, who investigate, and who report on that. So that is what we
do now and that will continue in terms of maintaining and improving our quality.
Residents are bringing us, excuse me, to residents quickly. So as I explained, it's a short -term
service. So we see that most of the residents will compete with the current team. So we
provision when we do these transfers between service in reablements one of the easiest
mobilizations because each
package can can end without necessarily a
transition for our residents
So hopefully I've answered that but I'd like Rachel Missoni to just add
Thank you, I'm Rachel Sony director of commissioning just to add to what Miss Moll is saying
So all of our re -ablement providers are registered good by CQC and we also have a standard specification
where we hold providers to account for working to an agreed quality standard and really robust
processes for everything that our teams monitor the providers as Mrs. Wilde said.
Thank you.
Thank you very much both.
Councillor Graham, you had a question?
Thanks, Chair. My family have had kite in its own language in other parts of the country,
and it is a wonderful caring right from the very beginning to whatever, and I believe
that our officers have been very dedicated. But it's very interesting as regards to the
four points you were making.
And I'd need more clarity, perhaps,
with the commissioning officer.
Was it Kite has 19 or 27?
If you could put more meat on the bone,
and in comparison to the commissioning,
the different commissions, I'd love
to have more information so I can see a clearer picture.
Thank you.
So it's a clarity in the report that KITE has 27 people working in it.
That includes office staff who do the rostering and monitor the calls and the manager and
the care workers.
So that's 27 head counts.
But in FTEs it's 19.
So that's, yes, sorry, yes, full -time equivalent.
So it's quite a small provision.
I'm not sure if we've got exact numbers on our providers,
but it's worth saying that KITE only delivers about 20 % of the total
reablement hours that are delivered in the borough at any at any time that it's
30 hours a week I didn't quite get the timing of full time equivalent 36 hours
a week yes but they do work across seven days in shift patterns thank you
Councillor Warrell, you had a question.
Sorry, Chair. I think the only thing to add would be, I think from what Ms. Swarbr was saying, is we've got 30 providers who are approved to deliver care to our specification and we use 19 of them regularly.
I think the number 19 came up more than once, so that probably needed a bit of clarity.
So we have a whole range of providers that we can draw on who have hundreds of employees working for them.
That's really helpful.
Okay, thank you.
Thanks for the clarity. Excellent.
We'll pass over to Councillor Woll now.
Thank you, Chair. I was actually going to ask a completely different question, but Councillor Graham's question actually triggered something else.
And that's in relation to 2P. Building upon Councillor Graham's question, are you going to commission it out as one lot?
Or are you actually breaking it up and commissioning out different bits and pieces?
Because if you are commissioning out in one lot, then 2P does apply, from my understanding,
and having been through 2P situations in the past around mergers.
If you're breaking it up, then obviously I worry about the quality aspect that my fellow
counsel brought up is if one agency takes this little bit and that little bit, then
actually you're losing the continuity of the whole service and the collective skill.
In this paper, it doesn't really explain that.
and I know we've had discussions before around that,
and I've still come away confused around that,
and the union has brought it up
as a legitimate question this evening.
It'd be useful to have some final clarity
as to what is actually, what are we doing
in terms of commissioning this out?
What does it actually look like?
Yeah, thanks for that question,
and it is a legitimate question,
and something that obviously we've looked at,
taken legal advice, and because re -abomance
is a short -term service, we already have a range
of approved providers who already deliver re -abomance
in the borough, the reablement provision will be dispersed across all of our providers.
So there's not an intention to commission a lot where we have a grouping of service
that therefore staff can transfer to.
So the initial legal advice is that Chupy is unlikely to apply because there is not
an organised grouping of staff in which employment can transfer to because of the range of providers
that we have delivering reablement.
So it's not a direct commission service
in order to transfer employment to.
Go ahead and follow up.
Yeah.
Thank you.
I'm now even more confused by your answer
because it sounds like what you're saying,
that is that you are closing down the service completely.
And then what you're saying is that the money that's
available from that closing down,
you're asking other organisations to bid for to increase their capacities.
Is that right? Because your explanation doesn't make sense then in terms of what I understood from a previous meeting in relation to that.
Can I try, Councillor Warren? So the reality is that we're not commissioning anything new.
It's already in place.
Today, some of our other providers
would have delivered reablement service in the kite zone.
So our intention is not really to do something new.
It's only to extend what already exists
with multiple providers delivering.
It doesn't mean one person gets multiple providers.
It means a person gets provider number one.
and another person might get provider number two.
So in terms of that sort of continuity, it remains in place.
I think what Ms. Soni was explaining is the operation of law in terms of 2P,
which is that because it's short -term, it's dispersed,
and she had some other words that have escaped me, but that it wouldn't apply.
So I think the legal advice takes the direction of whether there is an organised grouping
of staff and fragmentation of employment. It's not possible to say that one person's
employment is going to this place and therefore cheap is unlikely to apply. How we support
staff, talk to staff and support them through the process is absolutely important for the
Council and we take that really seriously. So we need to support staff through that process,
and whether they might want to seek employment in the council or with commission providers.
But yeah, that's the kind of how the QP law is set out, and we've taken that guidance.
Thank you.
We will have any other questions? One more question, and then we'll come to Mr. Hickey,
if that's okay, go ahead.
Thank you, Chairman, and I think that last answer
is really important, and these are individuals
with losing their jobs, potentially,
so I'm glad there's support being given.
My question is about something in the paper
about the cost differential to the council
between the existing service and outsourced services,
which seem to me very wide, astonishingly wide,
and I wonder if you can give some clarity on why it is so much more expensive to deliver
the service in -house.
So I think that it sits in a number of factors. The first is that the scale of the service
service is small. So the back office, if you like, the people who enable and support and
make the service happen is relatively large compared to the people delivering frontline
service. The second thing would be that because of the terms and conditions that the staff
enjoy in their council employment and the way in which their contracts of employment are written,
it gives relative difficulty to create flexibility.
And it is an intractable situation. We have tried really hard to close the gap,
but it's rather the contractual arrangements rather than any resistance or issue about our staff.
It's just that the council struggles to deliver the service at a better cost.
Thank you very much, Mrs. Wilde.
Does anyone else want to come in on that?
I can do, Chair.
Just in terms of commissioned provision,
obviously the purchasing power,
the scale of commissioned provision
from our commission providers does mean
that they can deliver that at a greater economy of scale.
But that doesn't, the evidence shows
that that doesn't impact quality.
Overall, our providers are able to meet the outcomes required
through our reablement specification.
Brilliant, thank you.
We'll come now to Mr. Hickey.
Welcome again and you have a question. Thank you my question was actually going
to be on the same lines. I was struck by the reduction, the significant reduction
in cost and yet the quality remaining equally high. I've heard the
answers. I suggest it might be worth putting some additional monitoring
certainly in the first year or so because it is squaring a bit of a circle
here cutting the cost quite significantly but actually maintain the
quality, and we've had some assurance about that, which is very welcome, but maybe something
to keep a very sharp eye on in the next implementation period.
Chair, I think we could certainly commit to that, yeah, additional monitoring, and if
Health Watch, you know, would like to look at that in the first year, should the decision
be taken, that that's how we proceed.
The key to ensure that existing monitoring is robust, as you say, and I'm sure it is
something to think ahead for.
Thank you very much.
We'll move forward.
This is a paper for scrutiny.
Do any of the OSC members have any comments on the report, anything that they'd like?
No?
Okay.
Fantastic.
Sorry.
Councillor Warrell?
Just a question.
I'll let you finish first.
Sorry, is it a question to?
No, it's not.
What would you like to?
So, I was just clarifying, are you closing the discussion now and moving to recommendations?
Yes, we are going to move forward now, if that's okay.
As much as it's in the interest of time, we have also still quite a lot of things in the
agenda.
This will be considered at the 12th of October cabinet for approval.
So now we will move forward to the adult social care and public health 2026 budget and Q1

6 Adult Social Care and Public Health 2026/27 Budget and Quarter 1 Budget Monitoring (Paper No. 26-205)

budget monitoring paper.
Councillor Worrall, do you have a question?
Yes, I do.
The paper is to approve the reconfiguration and move to the commission service.
Are we just asked to note this or are we actually voting on this in any way?
I'm just a bit confused.
So it's for scrutiny.
So as I said earlier, it's just for any members to comment.
And if you want to, feel free to.
But no, we're not is the answer to that.
Yeah.
OK.
Can I comment then?
You want to comment?
Go ahead.
Whilst we recognise the direction
of travel of this paper, those of us on this side,
we're not involved in the initial discussions previously.
and seeing the paper now, if this was put to a vote,
we would have abstained on the paper
because there's still a number of unanswered questions
in this, raised by the unions,
and also raised around the table today
that we are not fully satisfied with
or don't fully understand the answers.
So as a result, as I said,
whilst we understand the direction of travel in this
and are very sympathetic to the officers
and must commend them on the amounts of work
that's actually been done on this.
We find it very difficult to support this at this stage
because there's still a number of unanswered questions.
Thank you very much for your comment.
We appreciate that and I'm sure that will be noted.
I think I'll add in a comment as well,
which is of course that this paper is in much the same form
as it was under the previous administration.
So I'd like that also to be noted.
And then with that, I think we will move forward
in the interest of time to our sixth item on the agenda, which is the Q1 budget monitoring
and the 2026 -2027 budget.
This is a report by the Executive Director, Adult Social Care and Public Health, and we
have Ms. Evans joining us, Director of Business Resources, who's here in person.
And of course, if other people want to be brought in, relevant officers who feel they
can contribute, they are most welcome.
So yes, would you like to get us underway?
Yes, sure, thank you, thank you, Chair.
Good evening, everyone.
This report sets out the Adult Social Care and Public Health Revenue Position at Quarter 1 for 26 -27 financial year.
It forecasts an overspend of just under 3 .5 million against a net budget of 122 .4 million.
The Directorate has been experiencing a number of challenges, as have many councils nationally.
The main pressures are demand -led and concentrated in our care services, particularly in support
for older people and adults with learning disabilities.
And the pressures reflect increasing demand, but not just increasing demand in terms of
volume, also increasing complexity of need.
And we've also experienced significant market pressures, resulting in higher care package
and placement costs.
And the report does go on to outline the management and transformation action underway to manage
demand, support people to remain independent, strengthen care package reviews and financial
controls.
Also to maximise appropriate health funding and accelerate any delivery of efficiencies
and mitigations.
And the committee are asked to note the forecast position and the key risks and action being
taken and but myself and colleagues are here and very happy to take any
questions. Fantastic. Councillor Hampton straight in. Okay yeah straight in.
You'll have to forgive me about this. I first joined this committee in 2014 and
I'm going to be absolutely brutal. I have heard for years and years and years that
that the pressures are such we can't save any money, we can't save any money.
Mr. De Souza and I know that we can and we have done in the past.
My question is instead of the mantra of we can't and there's nothing we can reduce it,
I would like to see a passion for what can we do better and how can we save money doing that better,
because I genuinely believe we can.
And I'm sorry, I feel that this is very negative,
but I want it on the record that I have raised
that in the first quarter, the first quarter,
the overspend is 3 .477 million.
I do not believe that that is acceptable.
So perhaps you could expand.
Thank you. Thank you, Councillor Hampton.
So I agree, we have delivered efficiencies in the past.
The report sets out over the period 23 -24, 3 -25 -26, the Directorate did deliver 3 .5 million savings within our services.
But very much so, I mean hopefully maybe it didn't come out enough in the report, but
we are focused on increasing efficiencies as we move forward and that is the aim of
the transformation programme.
So much of the work within our transformation programme is around looking at how we can help
our residents and people to remain independent for longer through various interventions.
So we able them in one of them, equipment, technology enabled care,
falls prevention, stronger community based support.
We're also improving hospital discharge pathways, reviewing care packages,
so they remain aligned to current needs and making better use of home care, residential,
nursing and supported living capacity.
We're also looking internally to look at how we're meeting eligible needs.
And as you're aware, it's a statutory service and we do need to continue to meet those eligible
needs.
But we have introduced various kind of challenge mechanisms within the directorate.
So before a package is put in place, for example, we now have, it's called a practise circle,
where colleagues come together, look at the proposed way of meeting a person's needs,
and looking at alternative methods for doing that,
with a view to that being, you know,
meeting that person's need, but at a lower cost.
I have asked for this magical transformation programme,
and could I ask that particularly for us on adult care,
and that we actually see that transformation programme,
because I have got many points and I will not take up too much more time, but I would like to see that transformation programme.
We've got a series of seconders and thirds on that.
Thank you very much. We'll move over. Was it Councillor Simoes, you had a question? Is that right?
No, apologies. Have I?
Do we have time for one? Yes. Yes.
It was just a very quick one on the back of the previous question.
And that was to ask how can we ensure we are not increasing efficiencies to the detriment
of the quality of care to our most vulnerable residents.
Thank you.
Sorry, I'll turn it on.
And I think it is set out in the report as well, but we need to be clear that residents
eligible care needs will continue to be met in accordance with the council statutory duties.
So I think anything we do, that is first and foremost that we will need to continue to do that.
So any financial controls don't necessarily mean we won't restrict access to eligible care,
but it will mean ensuring that that support is safe, proportionate, effective,
and based on current assess need?
Can I come in there?
Now I don't think making efficiency savings
and quality of care are mutually exclusive.
The point of making these efficiency savings
is that we can create financial headroom in the budget
so that we can provide better quality, properly targeted
social care for our residents.
At the moment we're under severe budget pressures.
Unless we create that financial headroom, we will see a rapidly deteriorating service.
So it is precisely about providing high quality care to our residents.
Thank you.
We'll just take it around the room now.
Councillor Sweet, your question.
Thank you.
So like Councillor Hampton, I've got a lot of concerns about the transformation programme.
programme. And I wonder whether that might be something we could, as Councillor Hampton
has suggested, scrutinise in more detail in a future meeting. But for now, my question
is about the savings that are included in this paper from the transformation programme.
And I wonder if you can just tell us, are all of those savings actually deliverable
with plans to deliver them, or have some of them just been estimated and we're yet to
out how we actually make them a reality.
Thank you.
The savings programme has been built up.
It's over the medium -term financial plan, financial strategy, so from 26, 27 going forward
to 30, 31.
We've done work with a delivery partner to work up those savings proposals.
So we've done diagnostic work, so looking at our data and really focusing in on the
areas where we think that the changes can be made.
Reablement is one example of that, so there's a clear plan around that in terms of increasing
not just the volume of reablement, but also the effectiveness.
So someone has a reablement intervention, comes out of that reablement episode, they
did require 10 hours of care, they will now require 8 hours of care from that intervention.
So that is the piece, they're the pieces of work.
So they are worked up to that extent.
And the whole of the transformation programme has got a number of projects like that.
and I think certainly we would be able to bring that back to a future meeting.
I'd just like to ask a follow -up. Thank you for that answer.
You mentioned a delivery partner. Does that mean an external provider?
Yes, an external company working with us.
Can you tell us who that is and how much we're paying for it?
I can say who it is, the delivery partner in Newton, I don't have the costs associated
with that.
I think I'm right in saying that Newton are basically paid upon delivery, is that correct?
Thanks very much.
We will move on.
Councillor Worrall is next.
Thank you, Chair.
Actually, Councillor Hampton might be surprised.
I actually agree with her on something, and that's relation to the transformation programme
being seen by a number of people, because it's been thrown around quite a lot, and especially
new people don't actually have access or have seen it.
So thank you for bringing that up.
Part of this paper is based around aspects around the Care Act.
At the moment we've got the KC Commission taking place and the big conversation of care underway.
And then we've also got the neighbourhood health model being developed, both of which in the paper,
both of which are expected to bring savings somewhere along the line possibly.
And then you refer in paragraph six of the paper to issues about making sure that
the NHS takes their responsibility and doesn't pass on to local authorities.
We know from the Coughlin case actually that subsection one,
section four, and subsection five do bring issues of interagency fighting and
people getting caught in the middle.
So I suppose my concern is two questions, is what assumptions are you making in terms of planning for
the future and future pressures and costs from the KC Commission and
from the neighbourhood model in terms of savings?
And then how can you guarantee as you further enforce the Care Act and
these various subsections that actually people don't fall through the middle and
actually don't spend days, weeks, or months getting caught up between the two sides.
which unfortunately happens now and will continue in the future, I think.
Shall I? I'll start and maybe some colleagues, I'll bring in some colleagues on that.
In terms of your point around the, I think the point was around cost shifting between health and local authorities.
And I think our approach is focused on ensuring that funding responsibilities are applied
correctly and consistently rather than just transferring costs between the organisations.
We continue to work closely with our NHS partners through established collaborative arrangements.
I think we heard about some of those earlier today.
to identify the most appropriate funding route for each individual,
which will include continuing health care and ensuring that residents who are able to access that can actually access it,
NHS funded nursing care and jointly funded packages where residents have eligible health needs.
I guess the purpose of the work that we describe in the report is to ensure that the Council
funds only those elements of support that fall within the statutory responsibilities
of the Care Act, whilst NHS funds those needs for which it's responsible.
We recognise that disputes over funding responsibilities can be disruptive, which is why we do have
of re -descolation processes and ongoing partnership
discussions to resolve those issues constructively
and maintain a focus on achieving that best
outcome for the resident.
I thought that I might add something there
in relation to how we work together
with our NHS partners.
So the issue about where people's needs exceed what social care can legally do is not just
a matter of financial protection, which is clearly important, but it's also about residence
rights. Because, as you know, adult social care is charged to our residents based on
the points of need. So it's really important that we with our partners get that right.
And I have to say we've been working both locally with our partners, but at a Southwest
London level where Jeremy and his colleagues, sorry Mr. De Souza and his colleagues, have
been working with senior people in Southwest London, ICB, to create ways that we work more
effectively. So we most recently signed off a way of working through continuing
health care to avoid some of the things that that members have have referred to
where our residents sit with this uncertainty for a very long time. So
we've we I think have just signed off the process of escalation and an agreed
process which I believe will help us to deliver this more effectively. It also
So it is important to say that we have had lots of opportunities where we have been successful
in working in partnership with the NHS to ensure fully funded NHS care where it's needed.
And we have delivered considerable savings to the council as a result of some of those
interventions.
Thank you.
I think one of the other areas you asked about was neighbourhood health and the case commission.
Would you be able, Ms. Wilde, to say anything about neighbourhood health?
In terms of neighbourhood health, clearly that's a key mechanism for us to work differently
with the NHS.
And I think one of the things which Ms. Schlemick talked about earlier was the investment that
we have from the ICB, the Integrated Care Board.
I'm trying not to say acronyms, it's really hard.
The Integrated Care Board, in terms of an investment of new funding in the amounts of,
I think 1 .6 million, which we will be investing in services
across the partnership.
And as we see that, that will help
us to speed up services to create those efficiencies
that we've been speaking.
And at the moment, that's quite, in the scale of all
that we spend, both health and social care, in Wandsworth,
1 .6 million is minimal.
But it's a really important test bed
of how we work together as partners to deliver services that give better outcomes for our residents.
And I'm quite excited by the opportunity that that brings,
and I'm hoping that apart from the great outcomes for our residents,
it will also save both us and the NHS money in the longer term.
I think it's worth noting the neighbourhood health model and also the Casey Commission
both are very likely to come up on the agenda very, very soon.
So we will have an opportunity to further interrogate those.
Should we have a couple more questions and then perhaps Mr. Hickey.
Councillor Graham, please go.
Thank you, Chair.
Reading this paper, I must say, not that I found it difficult, but I tried to join up
connexion.
and it's terribly fragmented as regards to page 34,
absolutely support the Casey Commission.
I heard her speak on tele as regards to social care and our,
you know, our transformation is coming in line
with this coming forward and we can do that as a parallel.
But noting the page, it's all very good to have all these bullet points.
But I can't see, we're all doing the care, but I would love to see care in the actual
wording as regards to what we are about.
Because it all ties in with the neighbourhood health care and wellness as we are discussing.
I mean, I think of the older carers and the older people who want to remain healthy, but
they do need that package.
And I think that comes with the doctors, the surgery, and other departments as well in
tandem with us.
So thank you very much.
Perhaps, Ms. Evans, you'd like to respond?
Yeah, thank you.
Thank you for that.
I'm sorry it felt disjointed.
We have quite a…
yeah yeah yeah yeah yeah and that that particular appendix on page 34 was just
trying to give a flavour of some of the things that we we are doing the
practical things we're doing as part of the transformation programme so it kind of
tried to set set that out and but clearly meeting eligible care needs is
is absolutely first and foremost.
Ms. Parker would definitely agree.
Thank you.
One final question, I'll come to you, Mr. Hickey,
after if that's okay.
It really chimes with actually what
Councillor Hampton has said at the beginning of this,
so we topped and tailed it a little.
This department, over many years,
balanced its budgets, it knew how to do it,
it was good at it, actually.
And then obviously some significant challenges
over the last five years, we all know what those are,
I won't labour them.
How will your team build in a culture
of financial sustainability in perpetuity?
It is such an important point, and I put it to you.
How will that happen?
Thank you.
Thank you.
And yeah, I mean, as we've said, there
have been specific challenges over the last few years
that have kind of driven this financial position.
But I think that the transformation programme and the transformation work, and I appreciate
we want more detail to come back here in the future, which we can definitely look at doing
that.
But that transformation work the Directorate is doing aims to ensure that financial sustainability
and improve the outcomes for residents by providing the right support at the right time.
So it's about getting the right intervention and getting the right care in place for our residents.
So the focus is on helping people remain independent for longer through all the interventions that I talked about earlier.
And with the aim of reducing or delaying the need for long term care, which is where most of our costs are.
So it is about those early interventions and prevention mechanisms.
and that really will be around the difference.
There's a lot around commissioning as well, and Ms.
Sony spoke earlier about that, but I think there is something about getting our commissioning practise as innovative and effective as possible.
To ensure that the services are available to meet the right level of need at the right time as well.
and they are all strands within our transformation programme.
Brilliant. Thank you.
It's such an important point.
And Mr. Hickey, you have a couple of questions.
Yes, one I think has been raised, which is about the risk in all this,
of cost shifting and getting into a very negative sort of relationship with the NHS,
which could be a real danger, and I think that's been raised.
My more broader question is, clearly the pressures are huge.
Clearly change is going to be needed
to address these challenges.
Is it part of the transformation programme
to embed ongoing monitoring of what the impact
of the changes are in practise on clients and patients?
I mean, clearly the objectives are very positive,
but the reality on the ground doesn't always match
the original objectives.
So I would hope that as you develop
the transformation programme,
you actually explicitly have an angle
about how that's going to be monitored,
how the impact on patients and residents
will be measured and monitored as changes implemented.
Thank you.
Ms. Evans, yeah.
Yeah, thank you, thank you, Mr. Hecke, for that.
So yes, I'll say the impact of all our savings proposals
will be monitored through a range of established mechanisms and where appropriate that will
include a quality impact assessment as part of it.
Any change to an individual care package will be subject to an appropriate assessment and
review process to ensure that eligible needs continue to be met in accordance with the
Council's statutory duty.
The Directorate will also monitor service performance and outcomes, complaints and feedback
from residents, carers and providers so that we can capture that as we move through.
We have the annual survey of residents, so all that will feed into it.
Where proposals affect particular groups or services of quality and other relevant impact assessments will be completed.
And the transformation programme overall is intended to approve effectiveness, sustainability and support,
including helping people to maintain their independence, as I've said already.
And I think as well, you were saying, we are through the transformation programme addressing
a number of pressures and challenges, but it's not ones within isolation that are experiencing
those challenges as well.
Thank you.
Thank you.
Thanks very much.
Well, thank you all.
This is a paper for scrutiny, so we have an opportunity to comment if anyone else would
like to.
Anything that anyone would like to say?
No.
We'll move on then to agenda item 7, outcomes of the spending review.

7 Work Programme (Paper No. 26-206)

8 Deputation Request on Reablement Services, Paper No. 26-204 (Paper No. 26-228)

And this is the additional report that has been circulated in the supplementary agenda
published Friday.

9 Outcomes of the Spending Review (Paper No. 26-226)

And again, it's Ms. Evans speaking.
So I please do present the report.
Thank you.
Thank you.
So this report sets out the adult social care and public health elements of the Council's
spending review ahead of cabinet's consideration of the full review and medium -term financial
strategy in October.
It focuses on proposals within this committee's remit, however, some of the spending review
categories include cross -cutting elements that fall within the remit of other scrutiny
committees and will therefore also be considered through those committees.
So I'm just thinking of some of the tables that are set out in Appendix A to the paper.
Adult social care and public health services continue to face the significant demand and
cost pressures with the majority of adult social care activity underpinned by statutory
duties as we've spoken about a lot already today.
The proposals therefore seek to maintain safe, quality, and lawful services while supporting residents to remain independent for longer,
and ensuring available resources are used as effectively as possible.
I talked a little bit about these already, but the main themes are around prevention,
and reablement, neighbourhood working,
closer integration with health services,
and greater use of technology.
The report also considers improvements
to adult social care service redesign,
commissioning and care purchasing arrangements,
alongside fair and consistent approaches
to charging income recovery
and NHS funding responsibilities.
And I'll stop there.
That's just a quick overview of the paper, but myself and colleagues are very happy to take any questions.
We're grateful.
Any questions from any OSC members?
Councillor Warrell, kick us off.
I've actually got quite a few questions, which will probably take us half the night, so I will try and reduce those number of questions.
I just want to reiterate my comments at the beginning.
Councillor Graham has been working on the financial review since Peter Graham.
Sorry, my apologies.
Not you.
So, and it was, we were due to have a presentation in the first full council and it never happened.
And we had a presentation with a spending review very, very recently.
A paper like this obviously has been in the works for quite a while.
I presume Councillor Gassane saw this paper before it was actually issued.
I received it.
This supplementary paper.
Sorry.
This supplementary paper.
Okay.
As everybody else.
I find that quite disrespectful to you and to other people that actually you're asking
us to comment on this.
And I would hope that the team on the other side would understand where we're coming from.
So this is really, there's a lot of serious discussion, serious finances in here.
To give it to the members around this table at such short notice and then expect a full and
detailed discussion I think is actually quite disrespectful to the people around the table.
So I just want to put that down because I think this deserves more time than actually
giving this to us a couple of days beforehand.
And I appreciate, thank you, Councillor Kossain, for confirming that you hadn't seen this paper before.
That's very useful.
In terms of the paper itself, I just want to turn to, as a starting point, page 13,
the adult social care table.
And I want to go ask two questions.
In terms of the original budget, when I looked at the cabinet papers from earlier this year,
the budget lines were different to what's actually recorded on here.
So have you actually inflated numbers in this one?
This is a reprojection from what was actually agreed in, I think it was February, the February paper that came through.
And then in terms of the inflation here, these are huge numbers that you're actually putting down here.
What do these numbers actually contain?
I mean, because if you ask any person around the table that says 13 .4 to 20, what does that, it can mean anything to anybody.
So some clarification on those two as a starting point would be useful.
Thanks, Councillor Warrell.
I don't have that reconciliation to the budget papers with me here today, but I can look
at that and certainly get that for you.
In terms of the inflation estimates, they are around inflation on our contracted providers
and all our spot purchases, so it does reflect that.
But we have seen inflation increase over recent years, and that is the estimate.
But it is done in a very detailed way, contract by contract and placement by placement.
Can I just clarify that then?
Are you saying that the 13 .4 is a combination of all the contracts coming together, or is
the inflationary rate because the officer budget responsibility gives it between 2 and
3 percent.
The Bank of England goes a bit higher.
But I'm trying to understand what makes up 13 .4, 20 .0.
And I think people watching this would all like to understand how that's actually calculated.
What's the makeup of that?
Yeah, it is the monetary amount, and it is from the contracts and the spot placement.
but I could get the detailed makeup for you and share that.
Thank you.
I mean, you highlight a really important point,
which is that these inflationary pressures
are very, very high and the demand pressures besides them.
We'll come to, does anyone else have a question?
Anything else that they would like to ask?
I will, oh no, Councillor Graham, go ahead.
Thank you, Chair.
I'm curious about telecare.
If you could tell me more about it and how do we go forward with that?
Yeah, I may ask Miss Hasler to come in on the telecare, who's the assistant director
for that area.
Thank you for the question.
Just to clarify, do you mean – speak up – do you mean what's the future for telecare
or for the charging, because it specifically refers to both.
So we've been, this year, been in the process of upgrading
all the telecare alarms, because you might be aware
that the analogue telephone lines get switched off
in January, 2027.
So the focus this year has been making sure
that all the existing traditional telecare systems
get upgraded, so they all had to be switched to a digital alarm,
so that they continue to work when the analogue lines get
switched off.
So that's been the focus this year.
And then we've been working on modernising the technology so that residents can benefit from different kinds of technology
So where we used to provide it a false alarm something like a pendant that you might see
We try and provide different things like we might use
What?
Use a voice alarm we might use
Something that somebody might not recognise as an alarm because often people take them off because they don't like them
We might use sensors in the home to keep somebody safe
Like, for example, we might use door sensors to make sure we can monitor whether somebody
gets up in the night, whether somebody with dementia might leave the house, things like
that to support people to stay independent at home.
So it's a range of different things.
And then one of the considerations in the report is around how we charge for those services
going forward.
As we are promoting independence, we want more people to have those alarms rather than
have a home care package.
So, for example, we might work with a provider to say we can reduce the care call by using
using a device instead of a person coming in and prompting
for, for example, often we might make a call just for somebody
to be prompted to make sure they eat and they drink.
And we might be able to do that over device, over video,
or over something else.
So there's a whole range of different things.
Again, we might bring something back if you're interested,
more information.
Go for one.
I can actually remember it coming in where the light will
go on or the door will, suddenly there'll be an alert and it is absolutely fantastic.
It used to be, where is the centre?
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9 Outcomes of the Spending Review (Paper No. 26-226)

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7 Work Programme (Paper No. 26-206)

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