Health Committee - Thursday 9 November 2023, 7:30pm - Wandsworth Council Webcasting
Health Committee
Thursday, 9th November 2023 at 7:30pm
Speaking:
Agenda item :
Start of webcast
Share this agenda point
Disclaimer: This transcript was automatically generated, so it may contain errors. Please view the webcast to confirm whether the content is accurate.
hi everyone welcome to this meeting. My name's Councillor, Kate Forbes, and I'm Chair of the Health Committee. I am now going to call out the names of members of a committee in alphabetical order. Please switch on your microphone to confirm your attendance and once you've confirmed your attendance, please remember to switch off your microphone as malware at the moment, we've only had apologies for absence from Councillor Samhla Varatharajah, so in alphabetical order, Councillor Cavalli,
present Councillor De La Seydou, present
Councillor Dora's
I Councillor Gosselin present Councillor Marshall present
Councillor Rigby,
hi and Councillor Warrell, present and also in attendance is the Cabinet Member for Health, Councillor Henderson, present fact.
so moving on I'd also like to welcome Stephen Hickey, Chair of Healthwatch, whose present this evening, and I'll ask Stephen Hickey to comment on any items that he's already indicated that he wishes to ask a question on once we get to the item and Stephen will also be presenting the Healthwatch annual report which is on the agenda later on this evening for consideration, so thank you and welcome Stephen.
I'd also like to welcome Phillip Murray and Prius Samuel,
from Springfield who were attending in person for the Trust report on key areas, and we have a number of officers present, both in person and virtually this evening, who will introduce themselves when they address the committee, so, moving on to item 1 are the minutes of the previous meeting held on the 20th of September 2023 agreed as a correct record
agreed.
ITEM 2 declarations of interests are there any declarations of either pecuniary of a registrable or non registrable interests, please declare any interests quoting the item and paper number in which you have interests and describing the nature of your interests, including whether or not you will be taking part in the item.
nothing.
it's already quite swift this evening, moving on to Item 3, then I'd like to welcome Phillip Murray Prius Samuel from the trust and ask them to introduce the report before we go over to any questions.
thank you, Councillor and good evening, ladies and gentlemen, and firstly, apologise to the Council, I am on-call with my phone rings, I'll hand over to my colleague.
so first of all, I am Philip Murray as you'll see on the Deputy Chief Executive and Director of Finance at south-west London, George's or the local mental health trust I'm also the place lead that faces Wandsworth borough.
Prieto introduced himself.
I'm Prius Samuel integrated partnerships manager overseeing Wandsworth at south-west London and St George's mental health trust thank you so, as Councillor Forbes has said, you've all, had the paper had a chance to read it, if I may I just make maybe three points and then hand over to the floor for questions so first of all obviously you can see from the paper that,
we've focused on equality, diversion, diversity and inclusion, and we're clearly undertaking an awful lot of work in this area, but I think it goes without saying that we recognise there is an awful lot still to do. We're still not seeing the same experiences and outcomes for our staff and patients from black and minority minority ethnic communities, as we do from those other elements of society, so it's really important that we don't rest on our laurels. We keep pushing forward and we work with you and other key stakeholders to ensure that we keep this agenda moving forward until we see some of those equities. Sorry, some of those outcomes be more equitable
so the other key things wanted to mention we mentioned in passing in the report something called peak ref PCF which is the patient and carer's Race Equality Framework, which is a new framework issued by NHS England, and it's obviously as a mandated framework and its aim is to support organisations in becoming anti racist but deliberately structured to do that through co production and involvement of carers and patients so it's really important.
we have started working on that already, we've already undertaken an internal self-assessment, we've set up implementation groups, working with carers and patients, obviously, and other local stakeholders, and we've pushed ourselves forward as an early adopter of that framework.
because we feel one is obviously fundamentally important, but two, it fits very well with our values of co production and and working with with our key stakeholders and also our named direction of travel to become a genuinely anti-racist organisation.
the other thing I thought I would mention is the right care right person. So again we've that is covered in the report, but I thought it might be helpful to give a brief update, because you'll be aware that that has recently gone live following Sir Mark's letter of earlier on in the year, and people will clearly be anxious about how that's impacting on both staff and patients so clearly early days, and it would be wrong to say there is any trend, but there are green shoots, so I think what we're seeing in south London at the moment are positive signs. It seems to be working well, it's being engaged with well by the police force and we're starting to see some positive outcomes. So to give you one little example, last week we had 123 calls in into the
24 hour support hub, so that's a hub set-up manned by mental health specialist for police and others to seek advice.
of those calls at the time of the call, there were 50 patients that were at that point, not under a section of the mental Health Act, and it's really positive to have had that 31 of those 50 were directed to other areas for healthcare support such that they were never subject to a section of the mental Health Act. They would divide, diverted away from that police intervention, and that's obviously brilliant for those patients they got into the right place earlier, but also one of the key things about Right Care Right person, of course, is ensuring that the right individuals are supporting the patients and that, of course, meant that the police in those occasions weren't inappropriately having to support the patients. So I think it's a really good initial story that shows that it is, it's got the propensity to work as we all thought it would, but we're starting to see that happen and they were really just a couple of points I wanted to make to maybe introduce reduce the pool, but I know you'll have plenty of questions on other areas
thanks and I am going to open up the questions, but just.
using much as prerogative but they want to, I do want to dip into Right Care Right person right first myself, if I may committee.
it is interested in your update and I thanks for that, thanks for including it in here, and I know your your working on various engagement, events for Councillors and for the community to be able to engage a little bit better on what you're doing and what you're seeing going forward.
it is really interesting that you're saying you're seeing some positive outcomes in green shoots, because that is not my understanding of.
I guess diplomatic way of putting it is concern across the summer and across recent months of how this was going to impact mental health services.
and interesting that you're saying that people are actually being directed to other areas of healthcare, so they're not being detained under the mental Health Act, but what I guess, what's your evaluation, and obviously this is still very, very early days, what's your evaluation of the pressures that are going to come on these over where people are being diverted into other areas of healthcare?
there were also, there was also anecdotal evidence over the summer, not necessarily here in south London, but in other parts of London showing the map were already not responding to any mental health calls and there were concerns from across mental health stakeholders that this was something that was going to be seen.
it was going to be too, I guess, even in the most severe cases, even in crisis cases, that police wouldn't be acting where they should, is this anything that rings true locally, and I guess how will this that going forward and, looking further ahead, how are you thinking that this is going to impact your own services, how is it going to?
have you have you done any work on what it will look like in terms of readmissions like increasing A&E backlog, and then I guess that impact goes back to my initial question, on where people are being directed to other areas of healthcare, what will be the six-month time, what will be the impacts in 12 months' time, what will be the impact, and I guess is there anything that you think the committee should be aware of tonight on how this will impact our community services as well? Sorry, if that was a lot than a jumble, we won't go
so I think probably the for thank you for the question, I think probably the first thing to say is, as you'd expect, it's too early to really give you any accurate predictions.
I feel that what I'm hearing and I'm not. The trust lead in this area are chief operating officer journalists, but we're not at the moment hearing that it's creating additional pressure. So thinking about your specific question about A and E, actually, by diverting some of those section 1 3 6 patients to other places, it will in all likelihood reduce the numbers of those patients going through A and E. What we have set up across London through this cool line is it is a health placed base of safety hub. If you will so, that if the police ring up, they should be able to say old. There's an empty health place based of safety here and direct them to the best place, be that someone's in a wheelchair, that's got disability access or or whatever that might be that's appropriate, or indeed if there's physical health issues that need to be checked out to A and E. But I think we can reasonably say that a proportion of those 31 I said that didn't end up.
going through the section 1 3 6 some of those would have definitely gone to A&E beforehand, so I would expect that we'd see less pressure there in terms of where the patient ultimately ends up. I think it's hard to say until we've got a trend, because one might reasonably presume that some of those patients would have ended up in that old and ultimately the same place, but taken longer to get there and therefore had a worse experience, because they would have been sat in A and E, and we all know that because of the pressures there, how long it might have taken them to be assessed and then moved on to the to the better place. So hopefully we won't see huge increased pressures, but what we will see, I think, is a different timing of those
existing pressures moving through the system,
in terms of how it looks for our organisation, some of the work that we would have to do anyway for patients that have gone absent without leave et cetera and not returned back from their leave, we have to do those actions regardless of whether the police are involved the issue then is, as you rightly suggest if, when we feel we need the police input will they provide that in a timely fashion.
this stage we haven't and it is early doors. We haven't seen evidence that they are not doing that. I think you'll write that in the summer, just after Sir Mark's letter, there were occasionally instances where some officers would say Well, that's not what Sir Mark said and they would try and just hand a patient or a patient over and disappear, but I think after there was engagement, certainly mix. My anecdotal knowledge is that that behaviour stopped and there was constructive dialogue, and I think probably what we can reflect on is that the letter was probably a sign of frustration, that things weren't happening and a way of moving things forward which we can see they have and hopefully that will benefit patients. You'll right. We do need over time to assess the impacts and make sure that us and social care, which are probably the two areas that are most likely to be impacted, that it's not unmanageable and not destabilising those services, but unless social service colleagues are going to say anything different, I've not heard that that's the experience in these early stages.
thanks for that and and it would be helpful, I think, for the Committee for next time you'll hear which will be a while away anyway, and if we can have an update on API, then, because I think that will be really helpful, so open it up to the rest of the committee and sorry that that was a bit of a waffle Councillor Warrell first,
thank you, Chair, and, as my question is actually following on from what you've actually raised, and it's about change to the system that's being required. Any change to the system requires a re pivoting of some of the services and away and a reorientation of way of working, and I'm just wondering what is the initial cost to the system and this new way of working is sustainable in the long run, because we do know that often resources get poured into a change and then there's resources and fall away as other pressures come build-up within the system. So I suppose I'm asking you to look into a crystal ball and in many ways, but actually is this new way of working, sustainable in the long run and what needs to be done, I suppose from both the NHS and from the local authority side and the community to make it sustainable
I may also first of all I'm not going to pretend I know exactly how much it's cost to implement, for example, the over 300 telephone line that has been implemented in parallel with another support service 1 1 1 Press 2 for mental health, which is the mental health addition to the existing one, one, one health line, so there would have been some economies of scale there, I'm sure I think.
when I reflect on it and some of the the issues that we I've seen when we've tried to set these things up in the past, it's it's getting the sufficient clinical professionals available on these support lines such that when someone rings up they get good and timely advice in real time such that they can make the right decisions on the ground and obviously that's the fundamental point of this right care right person, it's getting the right decisions that initially so we do it right first time.
so I feel probably my instinct is that the initial bit that we need to do is one change. The culture that means everybody uses those help lines so that we don't have patients turning up at A&E or health place at basis of safety without having gone through that Harborne that support line so that patients aren't shall we say, erroneously transported or sectioned. That's a key thing to sustainability and embedding those behaviors, because we all know that when the pressure when it's not being focused upon it's easy for people to revert to previous behaviors, the other is ensuring that the roles and the jobs are such that people are interested in doing them because again we know it's not necessary the remuneration it's it's the job itself, the reward you get from it
and we, we know, or people know, that out on our call centre, jobs can not always be the most fulfilling, but hopefully we construct a job so that there is a career structure and they fit in maybe to other people's clinical work patterns, so they're not 100% coal, coal officers. I think that's key, the other side of it, of course, is the bit that Councillor Ford was getting at, is what do we need to put in place subsequent? The impacts are sustainable and are genuinely not going to try and answer that, because I think it's too early at the moment. I genuinely hope that, as I said earlier, that what we see is our patients going to the right place faster, but not in greater volume, and thus it's it's more about Q theory. Have we got enough people to take the patients in sequence rather than increasing volumes, and that might have a cost because of the needing need to change, maybe shift patterns and things but
will need to I guess reflect upon
how we see things emerging and then see whether actions taken.
I genuinely can't second guess what the impact might be on social care, colleagues, I guess other officers would be best placed to answer that and, to be honest.
any supplementary, and I think I just have to follow up and it actually links, and it links back actually to earlier in your rural report.
we know, obviously, the instances of of detention are hugely hugely, there's this huge disparities in terms of race and ethnic ethnicity.
Lincoln into your work and your aunt's racism policies, how do you see, I guess, what what are you doing work stream wise?
on your anti racism policy in regards to Right Care Right person.
we do know, especially where there, where there's police involvement and at the more serious end, when people are a mental health crisis and police, are being called that there is greater.
we'd be discrepancy in care and if we are looking at at the use of restraint which again are areas that are covered in your report in different ways, it would be just interesting to know how your how you are developing your auntie or your anti racism proposals in in light of what's happening with Right Care Right person and maybe this is something for to come back.
the Committee next time on and due to to evaluate what has happened and if, in the light of how, if, in light of the data, wherever there is more, that needs to be done in your eyes to abide by our own policies.
so I think I'd probably be honest in saying we haven't got a specific work stream that is looking at anti racism in respect to Right Care Right person, what we would desire to do is that our staff that are interfacing with that.
can follow our policies and our open, iniquitous approach such that when they're dealing with the police, they're influencing an anti-racist outcome, one would hope that, through the Hub which were the police will be talking to those clinical practitioners that they will therefore get support and advice based on the presentation of the patient, not any of the characteristics of that patient, and therefore one would hope that through that approach we would see a more equitable outcome.
between different elements of society, so I mean I haven't got the ethnicity breakdown of those 123 calls and what happened to them, but it might be an interesting thing, as you say, in due course, to look at that to see if we are seeing a more balanced,
approach of outcome probably is the better word I did not be helpful, is something to include in the update Benassi LP next time.
any other questions from anyone else, Councillor Gossington, then Councillor Cruella.
thank you, Chair, you mentioned that we're still not seeing equitable outcomes in terms of disparities between racial groups and yet, rightly, something that should cause us all concern.
but there is a much in terms of data in the report, and my first question, I guess, is why that is and whether we could be furnished with more data regarding those disparities.
one of the advantages of these committees is, we all come with different professional backgrounds, and I'm clinical psychologist and I take an interest in data and
research and statistics, and quite a lot of assertions made in the report, but without necessarily being backed up by statistical data at a level of statistical rigour.
so as a clinical psychologist, for example, I am interested in mental health conditions and psychological disorders, but so I'm dealing with the real world phenomenon, but I'm also dealing with theoretical constructs, so it's how you define these things which is really important in terms of research, because if you need to know what you're dealing with and how to define it in order to conduct meaningful research and we have a number of terms in the report regarding systemic racism and anti racism and that those are all sorts of valid concepts but it's not quite clear how those are being defined.
and if we're not quite clear about how those concepts are being defined, we're not quite sure whether we're measuring exactly what we're setting out to measure and the data might be there, but from from our point of view, I think it'd be really interesting and important to see that data so is it possible to provide us with more data in that respect.
and tell us a bit more about statistical approach and the methodological approach that's adopted when researching social disparities and so on.
so thank you, and obviously, of course, the date is hugely important and the report was structured to try and help Council Members understand what actions we were taking in response to some of the questions that were asked last time and indeed the recent report from our director of public health. So yes, there is a lot of data out there, we collect a lot and you'll appreciate from your background that some of that is available on NHS England websites and other wider websites. We absolutely know and I'm not going to start quoting figures, but when you look at the peak ref stuff from NHS England, one of their bits of data is that when you look at the incidents of interface with mental health,
whilst 13% of white British people make that interfacing connection, only six people from a black background or black adult background make that connection, so if one assumes there is a relatively homogenous incidence of mental ill health, and you'd say there's a massive disparity in the interface with our services or the services generally, we know some of that, of course it is breaking down some of the cultural issues and stigma that involves mental health which of course we've
talked at length about with you.
two meetings ago, when we came when we talked about our Springfield Village, and the whole point of that is to break down stigma.
and I know you're thinking I'm talking around the numbers are not giving you an answer.
but I think the honest answer is that if that's what the committee would like, we could obviously bring a paper back as Councillor Forbes suggested an update on Right Care Right person, but perhaps within that some statistics on as you're suggesting.
obviously, being clear how we've calculated some of those things, or maybe it would be helpful as an individual because of your interest to arrange a meeting to do that.
I think, as you will appreciate it, also giving it time so that you can see the results of any interventions, but equally sometimes it's challenging to seek individual cause and effect, so you can imagine Councillor Fox's had already mentioned A and E when we're trying to influence patient flow generally through the system we might try three or four interventions and of course at that point we've got a collective intervention and probably a single statistic ii patients in A&E or the amount of time they are in A&E or something by which to measure it and therefore it's a bit of a challenge for me I think.
we could go through what we're saying is anti racism, but I would like I'd like it to be clear, really what dials we're trying to change through that intervention, and then you could say, Well, did you move that dog, yes or no, and did you move it by enough to warrant the input and the effort you put in, so I think I'm not going to try and give you answers statistics. I think we all know that it isn't an equities engagement and it isn't iniquitous outcome. We know in terms of our staff, you're more likely to be taken through a disciplinary process if you're from a black or minority ethnic background, we know from
with our patients that if you're a young black male, you're much more likely to be sectioned than if you're not.
and we need to, as you say, monitor all of those kind of statistics and see whether we're making a difference, I mean you've seen in the Re it in many reports before about restrained, I think.
you mentioned, as someone mentioned it already, and looking at the instance of restrained, because again that's going to be imbalanced, as lots of these other things are, and so you're right that the statistics will help we can produce that quite happy to meet you individually or to do something for you because of your interest or bring it into the update that you've asked for already Councillor Ford next time, thanks for that, I think I'd welcome as I'm sure the rest of the committee words
I it's been included in the update and to have that data, and are you happy with that Councillor Gosselin, certainly, as well as data on outcomes, I think also maybe a bit more information on how constructs are defined, so things like there's a mention of systemic racism,
what exactly do you mean by that and how is that operationalised, how is that translated into sort of methodology?
so if that makes sense.
I think so, and I think when we say systemic racism, I think what we're doing is recognising the inherently within what we do as an organisation and therefore the people doing those things for organisation there is racism, and we therefore need to ensure that that is removed through the interventions.
what we then need to do is to work out, how do you track that now some of it is through those statistics you've mentioned others of it will be through patient feedback, so I their experience of being on the end of our treatment did it feel appropriate and was it a good or good experience recognising of course that when you're very or sometimes nothing feels a good experience but,
that's what it is when you're unwell, so it does make sense, I think it's again rather than thinking about what do we mean by systemic racism, boots about how do we think we're influencing, and how do we measure that influence which which you'll appreciate your background can sometimes be a little bit subjective and that's why we need to carefully pick the metrics that we're trying to through which we're trying to measure it.
absolutely.
go much long because other people want to ask questions, but that would be my worry without that statistical rigour there is a danger of archaeological, biased and subjective bias influencing how we interpret outcomes, so thanks.
Councillor Cavalli, I wanted to ask a question in the paper you have talked about being an anti-racist soldier or organisation and
I should imagine that St George's mental health trust was actually quite a diverse employer, taking your your staff from wide sections of the community, with all sorts of backgrounds, certainly that's my experience of, or over anyway.
I know that you've you've got a number of initiatives, you've talked about that during the the paper and I was wondering if it if, at some stage in a future paper you could give us examples perhaps maybe case studies of things where you've had to tackle issues around racism how those issues were resolved, a whether or not the preventative things that you'd done were effective or what the outcomes were, I appreciate, I wouldn't ask you to do that off the top of your head this evening.
but it would be, I think, interesting for us as a committee to see what sort of initiatives it was that you had tried from a preventative point of view and then perhaps move some case studies about issues that you did actually have to resolve.
thank you, and I'm sure we can do that, you're you're absolutely right, we do have a very diverse workforce.
I'm not going to try and break it down by all the subsets, but I can't do that yeah, roughly 52% of our workforce from black and minority ethnic backgrounds, and about 30% of that same workforce is are in senior leadership roles, so about a third of our workforce which is not that much out of kilter with your own demographics in Wandsworth of course.
when we're talking about anti racism, what we're reflecting on his people feeling safe, psychologically, to challenge behaviours that they see in the moment and addressing them, and of course that is really challenging thing to do one you may not.
understand what you're seeing and hearing, because some of it will be how it's received by an individual, and you may not be able to interpret what you're seeing as as racism, but other things that it's then do I feel comfortable raising that in the moment and for many of us it's easier to raise post-hoc as it were, but then the moment's gone, the person that felt as though they were being treated unfairly, has not seen the support they've not seen that other people have recognised the position they've been put in
and that's a massive challenge, isn't it to change that approach and to get people confident with challenging each other and having those mature conversations in the moment, but absolutely I'm sure we can identify some given some time because we're relatively in infancy foothills of our work in this area but it's something that we were keen to push on with and we know it's really important.
a supplementary Councillor World.
completely different question on a different area of the paper, you'll be happy to know I just wanna take it to page 23 of this report.
which is dealing with access and flow. So I, the questions I have is part way through the paper you refer to the revised plan and the 100 day challenge, and you say this is a key area of improvement. I suppose more of an explanation, what that really means and what does that really look like, and I appreciate you might not have some of the details. I'm very happy for that to be sent for sent on afterwards, but a bit of an explanation would be useful and then further down, you say that you welcome, working with local authority, colleagues in and create partnerships with at the housing directorate. Once again, that's a statement, but what does it really look like in practice, and what do you actually alluding to in that, and that would be really helpful for us because we've tried to make sure that we don't work in silos and think in silos and work more broadly and linked the different areas together and to me that's a very interesting statement, but I don't really know what it means,
thank you, so if I take them in reverse order so.
what we see often, and I haven't got the number in my head, I think it's 28 patients sat in our beds today that what I would describe a medically fit for discharge so they do. They no longer need to be in a mental health facility and obviously there's blockers to the discharge, often the complexity of their underlying condition and the need for housing or a specialist health or social care placement, or something else in a package, but it's normally patients that that need some of that support. We know through the extra discharge money that's come into the better Care Fund, that there's extra money, that's come out through central government to support the overall flow, and we know that some of that money was to be targeted at mental health, whereas the early early money was particularly targeted at physical health and more often was
so I think what we're getting at there is that we welcome, working with council colleagues and we're already starting to work with Lyn Wild, to look at how the existing better care fund is used. Are those historic uses still the right uses when we look at the issues that are patients and your care? Users are suffering and the changes in needs to keep the patient journey moving through to the people in inappropriate setting. So what we're alluding to really is we recognise there is more work to do. There's lots of historic decisions being made
through the for the right reasons at the time that I think we need to reflect on to make sure that we're spending our collective taxpayers' money to get the best outcome for the patient, so that's all we were alluding to we do know that specialist housing is a particular blocker for mental health patients not just in our trust across the capital and that might mean it's a wider piece of work, but that's why we particularly namecheck the area of housing because maybe there's something we could collectively do around commissioning something they're all thinking about how we commission supported housing
in terms of the flow where we said we've recast.
our projections.
what we, what we see in mental health, and it's well reported, is post COVID and and exacerbated, I am sure, by cost of living and other think crises and things like that is an increase in demand for mental health services generally.
for secondary mental health services. That's no less, so that's those most ill people and what we're also seeing is the complexity, so some people say the word acuity, but there's two phrases really for me, complexity, so other sub issues, co-morbidities would be the word that clinical colleagues would use, so there's a mental health issue, there's a physical health issue, there's a social issue, et cetera, so the complexities of these cases are going up and of course that means that they're harder and harder to treat they stay longer, but also those same individuals need more support post discharge
so the 100 day challenge, it's one of the many tools that particularly physical health hospitals have been using, so it's it's. I can't describe it adequately, so I will need to get back to you with the exact detail, but it's a, it's literally a 100 day roadmap to reviewing how you do things the way you review patients such that. Hopefully you come out at the end with a an improved pathway, and the idea of that, of course, is that you discharge patients at the right time in their pathway rather than having, as I say, we've got today, 28 patients that are really in the wrong place.
when we know that can often be detrimental to their ongoing recovery to stay in the wrong place. So there's a there's a number of interventions. We're doing the 100 day challenges one, there's another one called Red Green, so that's how you get patients from kind of the red risk rating up to the green risk rating and then onward to discharge. So what we've been doing is working with NHS England and looking at best practice models that are, as I say, typically being developed in physical health and adapting and adopting those so that we can hopefully do the best for our patients and going back to the original point. Ensuring that people aren't languishing in A&E that we've got beds available to bring them through quickly when their mental health need is identified, but absolutely we can share the background information on some of these particular work streams that have been developed around the country
yeah, I think that would be helpful to share anything further and I just got one point to pick up on the same on the same area of access and flow, especially in the the initial paragraph at 5.00.2 on page 22.
and I guess it's a quicker one, and maybe this is something to respond with separately, if you don't have the figures.
at the top of your head, obviously, you talk about adult acute bed occupancy remaining extremely high and having negotiated for use of an 18 bed unit.
obviously this is something this isn't unique to to your trust I was, I was interested in the cost to the trust of procuring these additional beds and having to having to spend money on private beds as well, where needed, because occupancy rates are so high.
I don't know about something that you have or can provide to us, because obviously that's a concern community, wise, that the trust is is is being.
is being stuck with the cost far higher cost per unit in terms of beds, especially private beds, because because of just how stubbornly high these rates are.
yes.
so of course we can share exactly say exactly how much we're spending in total on beds. I wouldn't want to obviously publicly share exactly the rates that we're paying with any individual provider because some of those will be negotiated and they might consider those to be slightly commercial in confidence. What I would say is the range of prices. It obviously depends on the nature of the placement. So a working age adult bed, which is a normal mental health bed, would be cheaper than a psychiatric intensive care unit bed, and then, even within that, of course, a patient that has slightly higher needs an average might need additional nursing support or healthcare assistant support. So what we would call additional observations, which, in a sense, is or is a form of restriction, because if someone's being extra observed, they're not free to roam around the ward without observation, so what you typically see are bed day rates at the lower end. If you're buying really really high volume of beds, people might give you a discount and you might be talking somewhere down at 650 pounds a bed day, and at the other end, not for high end placements because it is very different, but for just a normal bed, probably something up nearer 800 pounds a day for a pickup bed, so it is not an insubstantial cost to the taxpayer. So the obvious question of course is was, or why don't you put on one, why don't you just build more wards, of course,
so one, of course, you need the fabric, so you might need to physically build a ward, the other issue of providing more wards has been able to safely staff and then that's not just nurses, it's doctors, it's psychologists, it's therapists.
so at the moment we have a 15% vacancy rate that's in our world board papers, that's better than it's been for a long time, but 15% is is still a lot of vacancies, and we all know, I think, that there are insufficient specialist doctors and nurses, and all of the other therapists out there to fill every vacancy in the country. So one of the things that we need to consider is one. Could you safely run the ward? The other is reflecting if we had the the best and the most appropriate community based services, would those patients need to be in hospital, so our actual strategy in the medium to long term and we've already started. I think I mentioned this on the first time I came to to talk to you that we've been gradually working through our borrowers under the trans community transformation scheme once with Merton over the last two borrowers, so they are the ones we're working on at the moment, and the whole aim of those, of course, is to enable patients to be treated in the community for longer, and then to get them out of hospital quicker. So the phrase you often hear us uses treated in that,
in the least, restrictive setting, and obviously the least restrictive setting is in their own home where they can come and go as they please, with the support of their own known infrastructure, pay their relatives and carers, etc around them, so our actual strategy is to invest in community infrastructure.
to enable ourselves to support patients in the community and not need extra beds. What we're doing in the short term, because obviously that isn't a silver bullet that works overnight is to invest in extra beds and, as you've rightly said, Councillor Forbes, lots of trusts are doing this. What we're also doing is working with our wider system. Colleagues to see, do we need to buy more beds during the winter when obviously demand typically goes up, particularly in physical health, so we don't have mental health patients blocking A&E is or physical health beds, so they're in mental health areas and of course, if we all do that together, we will get a better value for money for the taxpayer. So that's what we were all looking at at the moment and in fairness we have done this for the last couple of winters collectively purchased
s more private beds, but that's why we're not laying on more in-house beds because one we don't we don't certainly have fabric that we could mobilise and two, I'm not convinced we could adequately staffed and we'd end up going to agency staff, which would probably it probably would be cheaper than the private sector, but that in itself is a problem because we know that our patients don't get the best experience when they're working in Surrey being treated in wards, fully staffed by agency. You need that Local regular staff to get the best outcomes
approximately any other questions from Committee members.
now can I go over to Stephen Hickey because I know you've got some questions, haven't you well, Charles Gunter, very much asked the questions that you asked about about acute, I mean, if always being a bit cynical, I entirely agree and support the principle that you've just identified about the is it much better to get people out of hospital into the into the community and all that and that's not not really to be disputed.
but, having said that, that has been the strategy not just in mental health, but in physical health as well, for many years, and lots of initiatives have been done, but the figures, the graph you've got about the acute is pretty scary of any any organisation, any sort of walk of life which are breaking until 98% is frankly just walking or,
if anything, anything can go wrong, you're in real crisis mode, so I do I understand.
the answers you just give them, but it does concern me that we were the roux my question I suppose is, is there a reluctance to face up to the possibility that actually more acute beds might actually be necessary, because all the other levers may just not have up to addressing the scale of the problem we have is really the same question that you ask but,
Helen, let's have a, let's have another stab.
I will try and finish my answer a little bit in response to your question Stephen, so I think you're right to pick up the bed occupancy rate that is higher than the other royal colleges and see QC would recommend and when you look at the benchmark I with how we compare to other trusts relatively we have improved over the last couple of years but we're still in the upper quartile, so why is the worst quartile in terms of our bed occupancy rates, but we have relatively improved
I think.
I would, I would say that we're not blind to the fact that more beds might be needed, in fact, we are looking at that as a trust whether or not looking at the modelling looking at the potential impacts of the interventions do we actually need to consider somehow funding and creating an additional ward.
I think what we need to do, of course, is to start seeing the impacts of the transformation, so it's a balanced decision rather than potentially say knee jerk and saying, we need two wards and then finding that's now stuck infrastructure, which of course he is there forever in a way, so it's it's a, it's about taking our time, but I think that's why, in the short term, Stephen, we are buying extra beds so that we're not disadvantaging the patients and say I suppose, burying our head in the sand but giving ourselves time to see whether those other interventions or the sorry the level of impact from those other interventions so that when we then, in a more controlled way, reflect on the longer term need for beds. It's the right decision, which may well be that we need an extra ward, for example,
did you have a second question, Stephen yeah, some different finger going back to?
equality and so on, we know that NHS England has just.
announced, then you patient and carer race equality framework has come out, I think, just in the last week or so, so it's not, so I didn't really want to push it too hard, but I wonder if you will at some point be able to say what impact of that new framework is likely to have on the work that you're already doing and you've documented in this paper about race equality going forward.
I'll take that on. Thank you, Stephen. So, for committee members who are not aware of NHS. England has launched its first ever anti-racism framework for all NHS mental health trusts and mental health service providers to embed across England, and we're working as a trust with the ECB as an early adopter of the PCF framework, and this is definitely reflected in the trust, values and belief in terms of us and collaborative work. So, in addition to start in the implementation phase of the patient and carer race equalities framework, the Trust has established a at early stages, a task and finish group which includes both staff patient carers, and we have already completed part one of the self-assessment and action planning stages and of J we've also joined
both national and London, Pycroft networks, to be able to identify good practice and share argued practice with with other organisations and for those networks as well, argo is as a trust to fully implement the three parts of Pycroft by all, certainly you know to 24 25.
thanks anything further Stephen.
in that case, no decision is required on this report and it is for information only is report noted.
thanks so much, both for joining as ever, you're welcome to stay, but you're on call that we know because came in during this meeting and you didn't have to dash out, so we understand, if you now wish to leave the meeting and thanks again for joining us it was another good discussion.
thank you for not moving on to item 4.
on re-procuring the independent domestic abuse advocacy commissioned service for victims of domestic abuse.
Karen over to you, thank you, Chair Kieran, Varchoel head of stronger and safer communities, if I can just ask Miranda to introduce herself.
good evening everyone when his Miranda habit and the vulnerabilities managing community safety. Thank you. So at the last committee in September we presented a report around splitting our domestic abuse commission services in terms of the rescue of the refuge accommodation provision we had and our independent domestic violence advocacy service, and that went on to the Executive Committee who agreed that, and now we're at the stages of going through and planning on tendering of the advert service. So this report sets out our procurement plan for the new commission services we're hoping to have them commencing from November 2024, the committee report sets out some of the work that we've already started to do, for example, it sets out the market warming event that took place in September,
so what we're asking the Committee to we're recommending to the committee today is to approve the approach and obviously provide comment, as well suggested, a reminder, the contract will be for a duration of three years commencing 1st of November 2024, with the appetite up with the option of extending for a further two years. It's a cross borough provision between Wandsworth and Richmond. We're happy to take any questions chair thanks, sorry, I am opening up the questions from Committee members, I've got Councillor Dora's Councillor Cavalli and Councillor Gosselin and Councillor Hall Councillor Douglas,
always good to see lots of people interested in domestic weeks.
so yeah, thank you for the paper, it's really comprehensive, particularly appreciated, seeing the note about national guidance on black and ethnic minority survivors in the equality impact assessment, it says that one's worth is made up of 38% of victims of domestic abuse are black Asian or ethnic minority survivors and that hasn't changed over the last three years.
and, given what is said in paragraph, I think 21, I believe, about the fact that
those survivors get better outcomes in services that are specifically designed to meet their needs, what is being done to design the procurement process and commissioning process outside of the market warming events, to make sure that services that can meet those survivors' needs have an equal chance with some of the larger providers,
yeah, gang thunder.
thank you for the question.
yeah, so outside of the market warming which we are doing and we're actively engaging with specialist and buying for services, we've also written into so at the moment working with procurement to create the service specification, and we're really putting a heavy focus in that on the national guidance and recognising the needs assessment that we've just undertaken and making sure that it reflects that, so we're kind of weaving it into the material that's gonna be put out and,
relevant as well, I think, is that we're putting a greater focus on the quality.
for this, so there's why some of the questions aren't finalised yet just because we're in the planning and writing stages, but the questions will be angled at what can you as a provided do in terms of making sure that we're approaching this from an intersectional point of view making sure that we're anti-racist and kind of taking all of that into account?
Councillor Tom Price.
Councillor Cavalli,
yeah, I wanted to ask about the figures on the table that are on page 28, the figures at table 3 talking about a domestic abuse incidences we've got Wandsworth, it's good or 8.7% increase, I note, as others have also got an increases well, but if you can feel that somewhere like Southwark which has got an 8.4,
percentage decrease, or are you able to put a little bit more background to these figures so that we can understand by once with has had this increase in why others have got a decreases?
thank you for the question and it's hard to say is there is the honest answer with it with domestic abuse.
statistics, well, it's always treading quite a hard line of the statistic is most of the time won't reflect the actual extent of domestic abuse, because it's a hidden crime and then when when domestic abuse incidents and reporting is increasing, that's a good thing because people are going to the police and seeking help on the one hand, but then because the domestic abuse is happening is taking place in the first instance so domestic abuse statistics are quite hard.
think to navigate it's just useful for us to understand what provision we need to be providing as a local authority, to try to respond to the incidents that we do know about and what we can do to.
really increased reporting and then make sure that there is a comprehensive
s level of services available to provide the support.
also just to add to that there could be an element of confidence as well in victims to report so, for example, with our services for domestic abuse, part of what we build into the contract is the provider to go out to raise awareness about the service, be it around the a domestic violence Multi Agency Risk Assessment Case conference providing training across the partnership so that people are able to refer in whether it's going out to the community as well, so sometimes it's a reflection of how much work we would do to raise awareness, build that confidence, to encourage victims to come forward.
thanks for any supplementary.
Councillor Gosselin,
thank you.
you present a rationale for splitting the refuge and advocacy services because delivering them under one contract hasn't been optimum, I'm wondering whether there has been any example of any other boroughs where there's those particular components have been separated and it has worked, and where does that happened whereas it happened and why do you think that way of doing things is more successful?
so I think, just directly from my previous experience, having commissioned domestic abuse services in a number of other borrowers, the approach that I took there was around splitting the contract into different lots and that provided an opportunity to gain for the market and providers to consider whether they'd like to either go for Lots 1 to 4 etc or do it.
or just go for one particular one, so you get a better mix of it and also there is different expertise that you can focus on, so with the aid for service it's mainly around frontline services, casework support risk management, direct victims support whereas a refuge provision is more around accommodation support and then again you have the advice coming in so potentially I think splitting the contract provides greater opportunities and mix of providers and we just spoke earlier about the kind of service provision for different communities, so by splitting it it does provide that better, I suppose choice but also a better sort of market as well market environment.
I would just give a kind of come in and answer the question as well on that, often when you have one large contract, you get a very one size fits all approach for victim, so it might be that one will provide us out to do one speciality but actually like especially,
Black and minority victims experienced very specific honour-based abuse, for example because of their religion or cultural background, so it is really important to kind of like have lots of different providers, it might not be the easiest thing for the council to, but it gets better outcomes for residents.
the free market works.
any supplementary Councillor Gotha.
no.
Councillor World.
thank you, I just want to pick up on the SI on the commissioning of this in terms of practicalities, on page 31, the national, this reference to the national considerations about the balance and feedback about from some communities about a provision by and for people from their own communities versus the issue of an organisation that has local knowledge plus what you're saying in terms of cost and and quality, so there's a lot of, I suppose there is a lot of factors in the equation my concern, I suppose in the commissioning of this process, as how do you square that circle that that's actually being outlined here
because big organisations and national organisations, and I weren't known, then why actually have very good bid writers they can come in, they can sweep through give you the question and give you the information that you want to hear on paper, and I suppose how do you ensure that there is a balance that local smaller organisations who might have the local knowledge and might have some of the experience but don't have some of the other bigger issues in terms of cost effectiveness of a national organisation can provide don't get pushed out of in terms of this process, having seen this several times being, on the other end of commissioning
and in the voluntary sector a national organisation will sweep through and actually then undo years of good work for local, local providers can actually provide and, as I said, there is clear requests from the staff that you gave yourself in this paper for very, very sophisticated and very vague in terms of a skills base that's needed, sir said the question is how do you square that circle?
setting I'll hand over to Miranda about the actual steps that will be taken in terms of that process, but we've mentioned that we've carried out to have sorry we've carried out a thorough needs assessment, so we're coming from a space of being very, very clear around what the provision should cater for and what our needs are on the borough. I think certainly the paper also introduced something around consortiums as well having those mixed bids coming together, I think also experts or people who have worked in this field. Miranda myself were very familiar with a lot of the providers that are that are out there. Small, regional, national, et cetera, and there's a lot to do around how we warm up and go out to the market and do that engagement.
and then obviously not, you know the actual process itself in terms of rounder sort of alluded to some of the questions that we would ask some of the testing, we would do that whole process around evaluating the tender, which is why it's quite good. It's around the quality and appreciate what he's saying around fantastic bids, but it's not all just gonna be paper-based. There is obviously a whole other process around who we bring in an interview in et cetera, et cetera, so would make sure that we sort of round all of that up, which is why it's so important that the specification, the tender that goes out, is absolutely clear. What we in Wandsworth would like, in terms of outcomes for our services as well, Rhondda
thank you, and it's a really good point, so with the evaluation we're looking at 90%, quality 10% social value, and it's a fixed price, so when you're talking about people coming in and kind of and being able to undercut essentially because they're a bigger organisation we don't have that fear with this particular case.
as as I mentioned earlier, as well. It's all part of the writing of the invitation to tender and the spag looking at the quality and how we can really get in the wording and get people to partner up and and be working in in partnership with each other in the first Market warming event that we did. We had a really good turnout and we had 11 agencies there, a mix of big organisations and smaller by them for organisations, and we made sure that it was in person so that we could kind of make, make people have those conversations and enforce those relationships where they might not already have had them, so people can get talking about all we know, could we partner up, and that was a decision that we took rather than doing it online. We'll be doing the same for the next market warming, which will be once we've got the speck in its first draft and will be it's very much a two way, conversation between us as the Commissioner and the services. What can we do to make it more accessible for them, how can we make it easier, what barriers are we potentially putting in the place in place that we aren't seeing that are preventing smaller organisations and been forced from bidding,
can I just add something to that. I'll obviously became sits in my my division and although there are obviously other papers on today that relate to became exercises would have different weightings in different allocations. You know we are in a prescribed environment with procurement, especially with the thresholds that we're talking about here, so there are fixed parameters for which we can work with him, but there are also some additional flexibilities. The use of the word quality in and price can be confusing.
because quite often the best way to get quality is in the specification you heard from my peers the use of the word specification quite a lot. That is where quality should be delivered, because once you move into the operation of the contract, the only thing that you can use is the specification specification is key for no matter not just for this paper, but for all other papers that you had not just today, but any procurement exercise going forward, understanding what it is you need, and that's why quite often you will see different waiting splits because it is much easier to bounce and a provider who is great at flaring up a bid if they don't actually articulate how they're going to implement the specific points that you need where you've got
challenge because there was different cohorts of individuals and he may want things operating in a different manner. That is where you might need to be less prescriptive and give greater opportunities for that flexibility, diversity fee, so where you might have to have a higher focus on non price, you'll notice I use the word price and non price, not quality versus non quality, because if we're understanding what it is that we want, you build the quality into its specification. That is how you can be ensure that you can effectively contract, manage going forward, but clearly need to understand the market and you need to engage and be able to get as many people who possibly can so where you got different cohorts of people. In this case, we have been talking about it that engagement with providers
early on upfront in advance, so you can scope that out, let them know what it is that you want, that is how you get people to write in, we're not asking for someone who's got an Oxford degree to be able to articulate it in a particular manner, we have to want common plain language that allows them to articulate how they're going to deliver to best meet the needs of all of the service users not just in this exercise but in all procurement exercises.
thanks for that, Councillor Wall, just a supplementary back in terms of what's been said.
I am very conscious at our last Committee meeting, we had a delegation from people who were using the service and their advocates around the issue of transition, and their voice is being heard in terms of the the process of contracts being given out, my question is to in this paper and will be the same question in the and another paper is how is the voice of the user of the service user or the person who is receiving the service heard and involved in the selection process?
so we have a survivors forum that takes place Monday, run by the Commission service, actually, and that's underpins all of the work that we do, and it ensures that the voice of the victim and survivor is throughout everything we do, not just the commissioning, so they are at the heart of everything that we're doing sorry,
and I think some survivors as it stands wouldn't be involved in the decision-making process for the commissioning.
but part of what we're writing in against the service spec.
is how the provider would ensure a smooth transition, that's right up there at the moment in its draft format, as one of the first things that we're asking for comment on is how that that how it would be ensured there is a smooth transition from the current provider to the knee.
thanks the UK for now, Councillor Councillor Dobson, did you have another question yeah I've just gonna say, given the interest from the Committee on this, could we ask for an update to come back at the next stage about the procurement outcomes and what's going on with it?
yeah, I think that seems fair.
Karen what you like, will that be possible and will obviously last Committee as well, we had the the first step in this process.
it is something both at that committee and this evening that there is a lot of interest in, would you be able just to set out a timeframe now, so everyone's aware, and so we can think of when we next get the update it committed.
sorry, we just check, I think, in the previous committee report we set out the timeframes between now and us, obviously commissioning the service certainly happy to come back and provide an update. I'm just conscious that in terms of violence against women and girls, there's a broader piece of what we're doing. There's broader investment, so we'd really like to come back to committee to actually provide a very full report around all our work around where we are due to come back. I think, early part of next year around our refresh of the VAWG strategy, so potentially we could tie in alongside that if that's acceptable, but obviously we are keeping our Lead. Members involved all the way through in terms of progress of this Commission. Councillor Anderson, Councillor debris herself as a champion, so I'm just wondering to be effective whether we, when we come back for the refreshed walks strategy
think that scheduled for is that that's gonna be slightly later, I think you want something in January, maybe do you mind if we take that away and have a look at the committee reports, because I think for the VAWG strategy we're thinking about February March wherever the Committee falls, but if it's too late we can come back slightly earlier because I appreciate that we're looking to have the service up and running.
in November yeah, that seems for let's see if it will be the February Committee meeting, but let's take that away and it can we can cut clarify via e-mail that we'll get up, it seems a sensible place to provide an update, there's also thanks for that.
are there any further questions, Councillor Gosselin, thank you, I would like to ask a couple of questions about pages 43 and 44.
it is mentioned that there are differences in terms of being able to capture data locally versus nationally, I'm wondering.
what those differences were and why it's more difficult to get that data locally, and secondly, looking at the figures, the data for once, with very encouragingly the incidences of FGM are at 0, but how much is that due to how much of that is due to there being genuinely no cases or is that does that reflect difficulty in terms of identifying cases,
I would say it could it could be either it could be that there is none, and the data is accurate or it could be that there are hidden cases because it is, it is a hidden crime, but although we can be doing as a partnership is awareness raising and making sure that health professionals, which I'm sure they are and teachers are comfortable in having those conversations and checking and challenging where they suspect there might be cases of F G M, so we
doing a big piece of work again, it's all part of the kind of broader Vogue work that we're doing at the moment is improving our response to honour-based abuse, of which F G M can factors into it, and there's an honour-based working group that we're thinking about getting going so that we can really focus in on some of these issues and try and unpick.
Anne Kennedy, targeted awareness raising and training around them, but there's a lot of training around F G M which schools and health professionals will have yet it's hard to say, and I'm sorry.
thank you was a bit more difficult to capture data locally versus national waste so reliant on national data.
because none is recorded locally, I mean if, if there were cases, they will be recorded.
but as far as we know, as far as health professionals know, there are none locally.
thanks if at all.
does the committee support the recommendations in paragraph 2?
it's unanimous, therefore, supported by the Committee.
moving on to the next item item 5 procurement of integrated sexual health services Richard overdue, right hello, I'm Richard Walton, head of commissioning for public health, wellbeing and service development and online, we have my colleague Les Seba, who is the senior Commissioning Manager with specific responsibility for sexual health services,
I won't go through the paper in any great detail, I'll assume you've read it, but what I will do is perhaps provide just a little bit of the context so firstly, in the broadest terms, local authorities have a duty to commission reproductive sexual health and services for,
treatment and testing of sexually transmitted infections.
in terms of contracting, we contract with are responsible for commissioning the services that are based in our own areas, but in terms of paying for services, these services are statutorily open access so Wandsworth residents may use a service anywhere in the country and resident from anywhere in the country may use a service based in Wandsworth and those are paid for on a tariff basis on the whole by the numbers of of of people attending so that it is a dual system, so this is although this paper is about commissioning our local service, it does need to be seen in the conduct of much broader
range of provision.
now the main point I would highlight is quite how big a transformation that has been over the past few years.
the way in which, in particular, testing for SCI as has been undertaken so that looking at
the first attendances for SCI consultations are recorded.
that which will mostly be for for for testing between 20 9,009 20, the year before the pandemic and 22 23 the most recent complete financial year, there was an increase of approximately 40% in the number of SCI.
testing a new SCI testing for once with residents, but at the same time there was a decrease of approximately 46% in the number of clinic attendances of once with residents for SCI testing.
and that is because
now we have approximately 70% of FDI testing is delivered through the pan-London sexual healthy service and I mean, and that has really it came into being in 2018 but absolutely took off at the start of the pandemic.
and overall I think that's that that is a really really good piece of news because we have achieved there has been a longstanding public health target to get or have higher rates of SDLT testing, we've achieved a 40% increase in a three-year period within existing budgets so that that that in itself is good news but there's a bot and the parties that,
with a service that her or with a system that is heavily reliant on tariff based payments, and you have seen a drop off a huge level in clinic attendances, it does put clinics at risk, and we do need a clinic based service to, because for quite a range of clinical activities you actually do need.
physical face-to-face consultation and also that, whilst for a lot of people a test in a test result is all they need, there are significant groups of people who do need much more than that and do need the much more in-person service that are a clinic can deliver, so we have so that in going through this commissioning process we are,
concerned to ensure that we are setting a stable base for our physical clinic based services, it still has to be financially realistic because we are doing a lot more online, we're doing less in clinics.
what we all look.
what we would seek to achieve, or what we're doing to achieve that, is that we have moved in terms of our local commissioning, as most other boroughs are doing away from a pure tariff base to a block contract, which provides an assurance that there is sufficient income for providers to keep a solid clinic based service going.
you'll see that the there has been a fairly extensive process of consultation in developing our specification for key elements of this specification are that the main hub base, which will deliver levels 1 to 3, those of the bulk of
including specialist sexual health services, will be in Wandsworth and that is agreed with the other boroughs.
and that there will be a range of specialist clinics for different population groups and that the service will also provide clinical support to our sexual health promotion and outreach service, so it will do some remote clinical delivery targeting more at risk and vulnerable groups thanks.
I would be happy to take any questions thanks for the introduction and can I open it up to questions from committee members? Councillor Warrell, I've got quite a few questions, I'll ask one one and then step aside and and then come back to the latest stage, so I suppose the first comment I would have is I understand where you're coming from in terms of this, just some feedback, one of the big issues from the community and having done market testing myself is the frustration in actually getting clinical appointments. So whilst there has been this decrease as as in a increase in online testing and there are problems with the online testing and screening process, is that what we hear from the community time and time again is the problem area of educating appointments in clinic? It's itself
and recently I did a market testing exercise where we did a phone around and said and basically presented with having having been taught being contact, tracing and saying we had symptoms and being told there was a week's waiting list for treatment in terms of it was suspected. Es t I to me that it's those the stories that we hear from time to time against a some consideration within the contracting arrangements that whilst there is good news that there is a on that from that side as well, I suppose well I just want to pick this first thing I'm gonna pick up is, I suppose, when I look at what part this paper and in its the market testing arrangement, and I understand that there are a lot of providers out there
one is the 2 p aspect within that.
and I'm just wondering whether the two are one of the things that puts.
because of his issue of actually having to 2 p staff across now, I appreciate there is a staff shortage as well so that there could be absorption, but the cost of 2 p is quite prohibitive and I'm just wondering whether calculation has been done around the potential 2 p costs that were involved because quite often they stick within the TUPE rules and then redundancies combination down the down the line. So I'm just wondering what the thought process and whether some work has been done around what the TUPE implications would be within this within. This should provide a change and be absorbed by another another area.
I think, for the detail of 2 p, I would ask if Les, if you are able to come in and update exactly where we are with that, I know that it it is one of the things we've been working on high there, yes La Ceiba senior Commissioning Manager, Gretchen and Wellbeing so we are currently in the process of getting the Tupi information from the incumbent provider just as part of our procurement processes, so the calculations you ask for isn't something we hold at the moment but it's something we are working on as part of the process.
Councillor Walsh,
as there are supplementary questions, but actually probably not appropriate in an open forum like this, so.
do you feel free to e-mail directly Councillor Warrell to make sure that those questions are answered?
and yet, if you look properly myself and Councillor Henderson would be helpful, Councillor Marshall.
yes, I.
as a headline to my question, is what what are we doing to understand the dynamics of the problem, but just to expand a little bit on that?
I mean, I was incredibly struck by the high share Wandsworth was paying for this and wondered, could it really be possible that SDRs were twice as prevalent in Wandsworth as they are in Richmond, but a quick dig into the data shows that indeed they are there are dramatic differences in Estee eyes between the virus,
I'm assuming that the proportion the 75% that we're paying is pretty much right to the number of people who shell up.
they are.
but you've and you've highlighted the tremendous changes both in channels.
and other other things, and clearly there are some very big demographic, economic racial differences, and I imagine all of these are changing also very fast.
and I'm seeing a lot of evidence in this in this excellent paper that a very multifaceted approach is being taken to this is not just about waiting and waiting for people to come through the door or log on their community outreach and to all sorts of other initiatives going on, but I'm just very interested to get more background I'm sure it's going on but I'd be just really fascinated to hear the background as to what's being done to understand the underlying causes the underlying trends with astonishing differences.
if I come back to that and I think my colleague Mr. Giteau, maybe maybe it seemed to come, they do, but I think.
one of the things I would say is that obviously, as I explained earlier,
the share of costs relate to this particular service, there are other services available so that Richmond residents, although they are a party to this contract, are actually more likely to turn attend, Kingston or West Middlesex hospital, so that the so there is a difference, but it's not quite as big as you would get if you looked at the shares of this and,
now, in terms of understanding, this is part of that, the consultation or the the the engagement we have done in preparing for this tendering exercise does run alongside a piece of work that we are doing with our public health colleagues, which is developing sexual health needs assessment which will be coming forward shortly and I don't know Mr Couto wants to add anything on that.
thank you so, in direct response to the question that you asked around the factors, you're absolutely right. All those demographic factors actually that you have mentioned contribute to some of how how we see sexual health issues and the outcomes for the residents and without going into too much detail around those behind the procurement of our service actually sit and long term strategy. We've got a sexual health strategy that ran from 2019 to up until next year actually, and through that strategy supported by a needs assessment, we identified that there were five priority areas for us, in one's worth of which the integrated sexual health service is a part of one of the services in the borough to address those issues, but is not the only service, because we also do commission primary care, sexual health services through GPs and pharmacies for our residents and we've got a whole raft of work that's going on with children and young people, including our work on reproductive sexual health, education within the schools and the curriculum that has been mandated by the government to be rolled out to that. So I suppose, in summary, I would be happy to refer to the work that we presented to the Health and Wellbeing Board in September of last year, where we provided an update on the strategy in terms of the progress that we've made towards meeting the needs that we've identified for local residents.
thanks any supplementary Councillor Marshall.
I I have one follow-up question which
it is sort of going for the beer.
one kilometre high view to the 10 metre high view, which is very struck by the well mention of psychosexual counselling services and just wondered what the ambition there was.
thank you, I don't have the specific answer to hand, I think we did circulated draft service specification which would outline that, and I don't know whether commissioning colleagues do have the and I think that may be one that Leia is able to come in on.
yes, so psychosexual services are offered as part of our existing contract, and for us it's important that they are maintained in the new contract, so as a as a new contract is implemented then.
we and it were in line with the sexual health needs as assessments that Mr Cato just referred to as well, we will be reviewing service use if there is a change and provided, and obviously through the monitoring of the first year, it's going to be of importance to see whether there's going to be a change at all in services we are also,
are going to include in the new service a requirement for the new provider to have a nominated lead for developing relationships with primary care partners, so, as Mr Cato and mentioned, we obviously have a a raft of services that are already available, primary carer is really key partner within that and and so we are emphasising the need for a nominated lead in their new service to hold that relationship.
in addition to us, obviously working in partnership with them around that and on many referrals obviously come through the GPs into the service when it comes to psychosexual counselling, and so that's something which I'm sure will be picked up as part of that partnership work, so I can't really give you a concrete answer as to what our ambitions are for just now because I think we have to wait and see what happens with the reprocurement, how things work, how things develop with this plan for improved partnership,
but I imagine we will certainly see a or a change, and we will be addressing that as a priority, moving forwards through the lifetime of the first few years of the contract.
thanks for that.
Councillor World,
thank you just the comments, I find it quite interesting that you doing the sexual health needs assessment of you doing the procurement.
working in north-east London and working on this sexual health refresh, I know that they're doing that first before they go think of reprocurement processes with bots and the other clinics, so because issues might come up there that might influence a future procurement issue, so it's just an observation I don't expect a response but just an observation that it seems a bit back to front in relation that their particular approach.
my mug my question, as is more around within the papers, on page 59.
in paragraph 8, you mentioned a number of specialist clinics, which I appreciate and I think and the speck looks good. I suppose the question I do have is one of the issues that is often missing is and a specialist clinic he says for sex workers. Now there are a number of sex workers that actually work in the in the in the tribal area, and I'm just wondering how provision would be provided for them in terms of a specialist clinic, because often the presenting needs are quite complex and in terms of the the working arrangements, and the other question is for trans people. Now I know that there are provisions about working with the Tavistock in clinic queue, but that's more about gender reassignment more than sexual health needs, so I'm just wondering why those two particular areas were not included as a possible specialist area. Was they not on the the demand? That would be my first question and my second question
is also on page 78, and in India you mentioned PrEP referrals now I'm just wondering, within the specification, what would be the link around PrEP referrals from within the community community organisations that you have commissioned and also the all HPP programme, which is which you are contributed towards, how those would also interact together.
I can take those Richard if that's okay.
yes, please.
great so rights at festivals, so the the list.
the list wasn't exhaustive in the
in the report that we put together and we don't currently have specialist clinics, and we haven't in the past few years of the existing service had specialist clinics for sex workers or people from the trans community, but they are certainly groups that plausibly, if the need presents itself, we would certainly offer clinics to those, along with any other groups that come up as part of the needs assessment or as part of re. You know, our constant review of of service need and service access as time goes on. You may be aware that we recently procured a sex worker service, the the first in south-west London, and that's under our community offer for the south-west London sexual health and HIV prevention service for high risk groups. So that's been going around a year now, our provider were successful in recruiting somebody and at an ex sex worker from the community to add advice and support around that that service offer, and so we've got really fantastic insight into the delivery of that service offer, and we are looking forward to this new procurement working with that service, it's still in its infancy, obviously it's only been going a year, so we are, we're really looking forward to seeing how the services can work together and of course, if out of that is
it is identified that we do need to do a specialist clinic potentially out in the community.
for sex workers, and that's absolutely something which will be offered, and it's totally something that is on our agenda, we we are waiting to see what happens with that to date whenever we've discussed it, and it has been discussed numerous times with the existing provider we always.
given the impression that there, or rather the service was always given the impression from service workers
sorry from sex workers accessing service that that they would rather have a more discreet opportunities to access services, rather than a bespoke clinic. That may change now that we've got this specialist sex worker support service in the community. So and the great thing I can provide a little bit of run Fred I don't have the specific data, but I would be happy to share it with you offline, but I am aware that we did a needs assessment for sex workers prior to procuring it, to identify whether there was a local need which of course there was, but the new service has actually identified that there are far more sex workers than originally thought in the local area. So we're really excited about that that we are. We've got this opportunity to hopefully provide a better level of support for those people who need it
in response to your question about a trans people, from people from transmitting we, our community based service, the suffer Sandon service I already mentioned. They offer specific support for people from the trans community and again through engagement with people. We will be looking to see whether we can set up something bespoke if it is required needed locally. We will certainly be listening to that and offering what we can, the the key emphasis on some of the more community-based work which we are hoping to see the new service deliver will have to be delivered, and it's mandated within the service specification that it will be delivered in partnership with our self-isolating community outreach offer
of which Wandsworth is the key contributor as well, which you may remember from when we brought that paper to committee a year and a half to two years ago.
thanks for that, Councillor Warren and a supplementary, there was obviously the question around the head around prep 0 sorry as well, yes, but before he wants the just to also feedback actually the Scopus paper is very good, I am very impressed with the thought that's gone into it and and the issues behind it I suppose what I'm bringing up his technical challenges to parts of it, but in terms of the thinking behind it it is well scoped out.
thank you for that, we appreciate it and I'd appreciate all of your your questions as well, I can see that Mr Katya is keen to come in, I would just say a quick point about the prep question that already the community-based service and the all HPP have links directly into the service for referrals for PrEP and that will continue the PrEP specification, the national one it has is being embedded into the service specification so PrEP will continue to be a key priority of the service delivery and of course referrals to that service offer as part of that now handover.
thank you, Councillor Councillor Warrell. I just wanted to reassure the committee that, although we don't always carry out a significant needs assessment before a procurement, I wanted to reassure you that we've got several mechanisms in place for ensuring that we're aware of how the outcomes are changing in relation to the need. As I referred to the paper that we presented to the Health and Wellbeing Board last September, part of that was actually looking at our progress in terms of the outcomes for sexual health and seeing to what extent they had changed and how the services that we've put in place have contributed to some of the positive outcomes and trends that we're seeing in services through the public health board, which I chair will routinely look at all the outcomes from the public health outcomes framework to see whether there are any significant changes that we should be concerned about that warrant, further work and a deeper dive, and finally, we also have, in addition to obviously the contract monitoring and the looking at the CPZ, which happens routinely is a public health quality assurance process.
where all the public health services commissioned by the Council report into in terms of all the pillars of clinical governance, so we look at staffing, we look at finance, we look at the performance and so on, and all that happens on a quarterly basis so even though we haven't carried out a large needs assessment I can reassure the committee that we are in touch with all the intelligence that tells us what the outcomes are for residents and how they are changing.
thanks for that.
and any other questions from the Committee.
I just have a very quick go on on arrangements for the new contract paragraph 12 it does say the proportionate share of the total contract costs between the three Borough as much as each borough share of activity, as you've discussed, and will be subject to annual review in line with any changes in proportionate activity shares when the only reviews happen.
if there are changes, would you be able to update the committee on that where necessary, I am sure we can that's helpful, thank you.
if no further questions,
I know that Stephen you've got a question for the Healthwatch Hazara, yes, it was about the, it was about the the contractual arrangements, which is on page 60.
and it was this question that we was actually HRA, it emerged actually in the previous paper about the balance between the weightings for price and quality, and the question that we had was on anxiety was around the relative weightings, particularly bearing in mind the previous paper has got has had 90% for quality and this is 45%.
I think the principles actually were answered, but I suppose it does prompt the question as to why in some contracts there is a fixed price, as it were, which then leaves the rest about quality and about social value, but in other ones Egypt is one prices are ISM it is a material consideration, so I'm slightly puzzled as to why the why the difference between these two approaches as it's a strategy point rather than specific I'll I'll take but if there's any specific op I'll pass over to Dr Wolves in order to do it.
but you'll note the value of this contract versus the value of the other one, this contract also is very much.
demand led, so there's no without a key element of usage, rather than having a fixed price envelope where there's an ability to have a fixed price envelope, then clearly the benefit from going on to look in at price differentials is less where the value is in question, the price differential is less but also way you've got something which is very prescribed.
and you know exactly what it is within the different service types, and you potentially will have different lots, and the scope in this particular paper showed where they've identified certain different areas and different ways of treating things you can be very keen and that specification can be very defined to make sure that you evaluate what's needed to be made and therefore the benefits that you would gain from having a very subjective overview and that's always going to be the challenge no matter what procurement exercise that you do when anything is in relation to something that is not based around the specification, it's not passed fail and it may mean you actually have an inferior contract wins, because more is skews towards a subjective overview rather than the definitive elements of a prescribed approach.
in the specification. That's why there is no fixed mandate. If you look at our procurement strategy overall, it and now it enables the commissioners to be able to have a starting point and then move significantly away from them, based on those parameters and understanding about what is it, that they believe that they can understand properly and fully and can prescribe to enable a bidder to articulate and take. The other points have been mentioned today about making sure that you do it in plain English, so that creates the opportunity for individuals to be able to bid appropriately, but that is how you will look at it. So we don't come at it from a fixed element and say it must be 70% price 30% non price of 50 50 or 1,009 20
you look at it objectively, you look what it is that you seek and to try to do, can you definitively put it into a specification where you can you get limited additional value out of them, potentially pay more for not much extra and then when you're doing that that gives less money to spend elsewhere?
on other products, on other services.
and other benefits to residents, and that's the fine balancing act that you want to do so if you can gain real additional benefit from allowing providers to articulate what they can do above and beyond, then clearly in those examples having a higher proportion a way to something that is non prices beneficial for all where commissioners believe that they can ultimately define all of that and get what's needed and prescribed why pay more for no additional value?
Stephen, did you want to come back in?
and in that case, does the committee support the recommendations, as in paragraph 2?
so the agreed unanimously, and therefore supported by the Committee.
in that case, we will move on to Item 6, the Council's progress paper on the prevention framework, embedding prevention and a health in all policies, approach to reduce health inequalities and promote good health. And I think Nikki is over to you good evening and thank you very much. So. The purpose of this report is to provide an outline of the progress we've made in using the prevention framework to prevent ill health and promote wellbeing as part of everyday practice in the work of the Council and embedded in the policies and the Pyrenean framework itself. Has it's been using his system delivery tool and it's about having prevention, the three levels, the individual level, the community level and the environment? It's a 21 to 25 strategy. So in terms of thinking about it, we won't have done everything in the first year, but what we're presenting today are some examples of what we've embedded, so you will find on pages 88 to 93, so I won't go into all of them, a number with a number of examples.
there are a number of principles that the prevention framework uses that are also listed and they include some of the stuff we have been talking about today, looking at the evidence, working with partners and taking equity in terms of data and just really thinking about how are we going to evidence that the prevention framework is working in terms of reducing health inequalities and through embedding prevention? The overarching indicator is the healthy life expectancy indicator. However, we are aware that it would be really helpful to think about other metrics, so we are considering other metrics to use. They would be more process, type indicators and will start looking at anything where we can pick up trends so we can begin to show how it is
being embedded in terms of the impact, but, as you can see from the paper today, you can begin to see where it's been embedded in policies where it's been embedded at an individual level and where it has also been embedded across some of the meetings and the partnerships we're having internally and externally. For example, it's also been the Wandsworth. Health and Care Partnership has, as one of its things, to report on how people who were presenting anything are highlighting how it's meeting the prevention framework. That's the last thing I wanted to wanted to say was just two that I think those are all things I wanted to highlight. Actually, thank you very much. I'll take questions thanks for that and and thanks for setting out the progress in the rule change in direction that there's been, I guess, in the last 12 to 18 months, and it's really helpful to to have those examples, can I open it up to questions Councillor Rigby, first thank you, and thanks for all your work in this.
I think it's so important that it should this framework should be showing up everywhere.
and so my question is, how is it showing up in decision making across the Council, for example, when transport policies are put forward, although all going through the lens of this framework, to look at how each measure is going to help drive this frame, the prevention framework forward is it showing up in housing in children's?
it's in the same way that the equality assessment is a filter for which we put every decision through.
this framework has the potential to extend the lives of every person in Wandsworth and therefore it's a very powerful document and
yeah, I'd like to see it showing up everywhere and I just wondered how it was, thank you, thank you, I let my director go first on that and then I will add to it because I knew Shannon has very clear views on how we can do that. Thank you. Following the approval of the framework and adoption by the Council, the team did a lot of work including myself, working with Lead Member,
working with the Cabinet Members, some of you may recall, we had a workshop where we tried to think of ways in which we could ensure that the prevention framework was systemically embedded in the work of all the Council does and all the processes, and I think because we've got comments here from each of the directors the executive directors across the council actually referencing how they've used it, I think that starts to give some kind of testament of the fact that it has started to to be embedded within decisions that are the responsibility of other committees.
but I am also pleased to report that, when a progress update was presented to the Health and Wellbeing Board, for example, I think it was earlier in the summer. The health and wellbeing boards did make the decision to adopt the prevention framework as a lens through which all the paperwork that is submitted into the Health and Wellbeing Board, whether beat by NHS partners or others, would be looked at in the lens of whether it has addressed the framework. So those are the two examples that I can think of. I don't know whether my colleague would like to add them yes, so I think you make a very, very salient point Councillor and because it's
the developmental tool. So we are hoping, as you say, by hopefully before 2025, but at least by 2025. It's totally systemised. I don't like that word, but it's part of how everybody's die in a systematic way is actually consistently applying it. So we have what we would using the NHS jargon call earlier, doctors who've picked it up and have been able to run with it, but there are some other divisions in directorates where we have to do a bit more work. Transport is one of them because they are bigger. There's so many different layers, so I think we will begin to see it more as we continue to do the work with them, so that that that's what I'd say to that, the other thing that we could say is there, there was some talk about actually always asking for statements if it's going to things like other committees, and that's something we probably just have to continue in terms of the influencing the other committees to decide. Actually we want that we also want that line to come,
and yeah. Thank you, Councillor Richter yeah just s a sore for transport because we've got the walking and cycling strategy which has health at its heart. It would be a good way to put either this inside the walking and cycling strategy or get the walk in just some way to marry up the two documents because they're sitting independently at the moment. Thank you, yeah, thank you. Good suggestion. Is that something that we can take away? Yes, thank you definitely perfect. Councillor Warrell
just to say thank you to the public health team for to recognise the amount of work that has been put into this and putting us together to no mean achievement, so she'd come up with a strategy that we're trying to drive through the through the council and to recognise behind the scenes the amount of time and effort and research that it takes for something together like this, so you know just a recognition of that I suppose,
in support of Councillor Rigby's
question is as local Councillors, what can we do to help support drive this through the Council and in in its and the policies I know intimated that in some of your answer?
but actually
part of our role here is to improve the quality of life of of our local residents, and we do all we can we have access to some levers of influence.
but I suppose we sometimes don't know what the ask is of us to help support something like this says some guidance for some ideas. I'm not saying you have to come up with them now would be really useful for us to take forward in ni different areas of work in our committees and and the different areas so we are actually involved with. Thank you very happy to do that. I also think it's a good time to mention that my colleague and public Health senior need who's been doing quite a lot of the work and heavy lifting is online. Jo Joanne Taylor billion, whoever, and I am sure that this is at this point. He would want to probably say something about absolutely will be developed to kids and we're very happy to continue thinking about how we can develop something that will be easy for Members to use. So Joanne, would you like to add anything if the Chair is happy for me to do that? Thank you, Joanne.
thank you, Nicky I I'd like to.
thankfully the Councillors who have saw this as an opportunity for all the other committees to consider or to extend life. I think that is hitting the nail on the head in terms of why we're also calling it a health and our policies approach and we we welcome that and that's why we've done a toolkit we've done a one-page summary of the prevention framework because it is a bit conceptual at the beginning but I think slowly people are starting to understand what it means, so I've taken some time to do some case studies, so we were providing different tools that we could share with you and if you hear of case stories that we can document, we can also add that to our our library of what is working, how it's working and give people some ideas on how they can apply it to their work.
thanks Councillor Ed, Councillor Gosling.
thank you.
yeah, just there's an interesting contrast of language on pages 1,009 91, I think, paragraph 23 when describing the potential impact of the regeneration plans for the ultimate status and or other estates, the document says that the regeneration will ensure that new housing community facilities and open spaces will achieve the best possible outcome for residents and the wider community. Now it's a supreme level of confidence given that the strategy hasn't been implemented yet and hasn't been evaluated and what's interesting is in paragraph 26 when describing the offer to expand free off peak access.
to council leisure centres to asylum seekers. The document says that should, which I think most would say, is probably a more reasonable use of language that should contribute to improved physical and mental health outcomes. So why is this supreme confidence about the potential benefits of the regeneration and not about expanding free off peak access to leisure centres? It suggests that
I have to realise that multiple authors have contributed to this report, so you will have disparities in language like that, but paragraph 23 just strays ever so slightly into a sort of political statement there, and I don't think this document is really the place for political propaganda it's really about demonstrating the
the potential benefits and when there is evidence to suggest it.
the positive outcomes of the policy, but I'm curious about that choice of language, there has been a councillor indicative and could have done better in terms of describing the the potential benefits of the regeneration plans, just wanted to make that point.
I am happy to respond in I'll hand over to Shannon, I suppose the first thing to say is and when we call it a strategy it's as as we've explained, it's got a number of things in there, so it's not just a strategy that's a plan and that's the end of it it's also the conceptual realisation of it and the delivery of it, so I do think and you're asking and you mentioned about the evaluation of it.
it's even if you put a logic framework to evaluate this, you will be the evaluation is a bit different, it's going to be more qualitative, because at the end of the day, if we are waiting to say we will do anything and unless we look at healthy life expectancy well then we will not be doing things in the service of our residents in terms of keeping an eye on the trend of it. So that's the answer to the first bit the bit you mentioned about the political language, I'll be very honest when we've read it and passed it round, that's not been commented on, so no, it's not been picked up before we didn't write it, but reading it. We read it through public health lenses, when you think about single regeneration zones, health action zones, all of the things that over the last 25 years have been trying to do regeneration that language resonated with me, as opposed to looking at it through any other lenses, so that that's what we could say about that and then I think what the the reality of all of this is
the the the the various divisions are coming from different starting points, so some people probably hadn't considered health inequalities and prevention in the way we've presented this, so their language will be 0, we will be considering it and what we will be asking them to is to present the second year a third year and some would have considered it.
mickelson, public health or some other places, and they've probably struggled a bit and this has given them a framework, but that again is my perspective, my interpretation referred to you for the explanation, but the phrasing is that we will consider it we will ensure the best possible outcomes and I think that's a bit presumptuous, I mean I very much hope that's the case, but I think at this stage before the policy has been implemented I don't think that's the right language.
thanks for that, any other questions from the Committee.
and yet different chenin different, so on page 95 in relation to the equality impact, equality impact and needs analysis says that all new policy strategies and commissioned services will be included in that analysis, I'm wondering whether the increases in council rents in council tax and service charges are also considered within the equality impact and needs analysis.
I'll have to take that one away, because it depends on the answer would be, one would presume so, but I would have to go and look at the e-mail what data they have before I, for whatever the services before I say yes or no to that, but I missed the beginning of your your question, but I think you said something about enters rent, but I didn't help. Would you say page 95 page 95, so yet it talks about the equality impact assessment and how that's been updated to incorporate all of these new policies? So I'm wondering whether that relates to everything that this administration is doing
now that is a jet data. That is not a statement that has come from the prevention framework, that is on every committee paper and as part of what we as a committee always consider, so I think there's a wider question and I noticed some work being done looking at our earners, so I think that question would be a good one, but I can feed back into the group that are looking at earners, but that's a general question at that that the equality impact assessment is on every committee paper. Every report today would have had that, so I think it's a fair question, but not one. I can give you the the answer to
thanks for that, and I think Councillor Henderson wanted to come in on this report as well, yes, thank you, thank you Chair first recurrently I immense thanks to the public health team.
d everyone else who has been involved in the at across or
departments and everyone who has been involved, this is actually an immense piece of work, in terms of where we were 18 months ago to where we are now, this is really quite a significant transformation in approach across the council approach as opposed to departments working in complete silos, and I think this is probably what Louis Uist so groundbreaking and suddenly potentially significant saw pieces of work but as Nick A quite correctly said, this is just simply a report of what we've done in the first year.
we have considerably more to do, and certainly the ambitions set out by Councillor Rigby and Councillor O'Rourke are absolutely cracked, we do actually need to embed health in all policies, much fervour some departments, I think, have certainly taken the bull by the horns others I think are much slower, I should also say in answer to county council borrower's questions about what councillors can do, I think we can all do a considerable amount to promote this particular framework, certainly I'm very grateful to my cabinet colleagues who have certainly taken the issue to the
erectus, but I think every who sits on any of the scrutiny committees should actually look at these policies and raise questions concerning their impact on health, I think in terms of some of the language used in the paper,
Councillor Lucas is correct, it was compiled, these numerous people did actually contribute to it and said I understand he is each of the directorates comments actually written by the director suddenly approved either director and I think I said is quite correct in terms of people not perhaps being entirely of a with how we actually approached things in public health terms it is, however, a case that the housing, aside from income housing is the main determinants of health inequalities and the quality of housing in Wandsworth.
it is extremely important we are trying to improve it.
so suddenly, I have confidence of the schemes in place which are more appropriate for the Housing Committee to discuss, nonetheless, will make a very considerable contribution to reducing health inequalities across this borough thanks.
thanks for that, and can I ask, does the committee support the recommendations in paragraph 2?
agreed unanimously.
let's move on to Item 7 annual complaints report. Adult social care I think we go into Nancy online is all right
yes, Hello Hello, thank you, Chair, and Nancy Carissa. Andy statutory and corporate complaints manager. This is the annual statutory adult social care complaints report. It sets out the detail of complaints, performance and the subject matter of adult statutory complaints. The report presents a very positive picture and it's really focused on learning from complaints with case studies provided throughout the report. Last year there was an 18% reduction in complaints, which is in part, related to the reduction in complaints for the East locality service. These locality service was the biggest locality team in terms of numbers of residents receiving services, as well as the locality, responding to the highest level of complexity and covering significant areas of deprivation in Tooting and Battersea post COVID. The team received a very significant increase in referrals for assessment and safeguarding concerns, and this resulted in significant pressure on the service leading to greater waiting time for residents. However, improvements were made to processes in adult social care were able to recruit successfully to vacant posts, to support all the services, to better manage the increased workload and address the backlog bleeding, to improve performance. Since then, adults have restructured the locality service from two teams, west north and south, which supports greater collaborative and integrated working with NHS primary care.
but also provides more aligned manager and practitioner resources to meet demand, moving onto timescales you'll see there's been an improvement of timeliness against the local 25 day target whilst the statutory process does allow six months to resolve a complaint, 56% were responded to within the 25 days any complaints that took longer than 25 days are agreed upfront with the complainant and the reasons for this is usually because the complaints are particularly complex and more times needed for the investigation.
positively less complaints have escalated to the Ombudsman this year, only four compared to 10 last year, and I'd like to draw your attention to the end of the report, which provides examples of compliments and they celebrate the good practice taking place across the adult social care teams and I'll be happy to answer any questions thanks very much for that. Can I go to the committee the questions
no, no questions.
well, thank you, I now unsurprised here, thank you.
there's no decision required or this paper is for information, can I check is the report noted.
great thanks so much, and thank Nancy thank you for mixing moving on to Item A the annual report of Healthwatch Wandsworth, I'm gonna move over to Stephen Hickey to introduce the report and then we'll take some further thank you very much Chair and I hope that precedent of no questions will carry on.
the meeting
Sarah Cook, who is the Healthwatch manager, who is available online, and if there are any difficult questions I will defer to her.
the hope of the report is fairly self-explanatory, I think I'll make three points really just by way of introduction.
firstly, obviously it is looking backwards and I flags up a lot of activity that took place last year, some of which is continuing to the current year, so I've mentioned work on hospital discharge and carers in particular work on perinatal.
perinatal mental health, I work on primary care cost of living, these are all important issues, but they're not everything we did, but the particular highlights of last year second point I'd make is that this was the first year since the COVID interruption where we were able to do a an interim view.
visits which we did in this particular case in the Gwyneth Morgan.
Day Centre and
without that reports being produced and the number of fairly specific recommendations which I think they are now being carried forward, but that is an important step forward because you weren't able to do interim view for a number of years and that we're hoping this year in fact quite shortly to do some work at Springfield which builds on what we were talking about earlier in the meeting and the third thing to say is that this was a year where once again the NHS did us a reorganisation with the integrated care system so as an organisation we needed to adjust to that and we did that at 2.00 levels, the south-west London level, where we now have a capacity for Healthwatch Walker were working across south-west London all the six boroughs of south-west London.
which is really important because increasingly, discussions are taking place at that level and we haven't got the ability of the capacity.
borough by borough to operate really strongly at that level that is important, but obviously in Wandsworth where there's been continuity but also change in terms of structures and engagement with particular organisations and people, that's been really important, we do put quite a lot of effort into attending meetings with commissioners and providers and so on because part of our role as well as doing specific pieces of work is to be,
yeah a constant reminder of the importance of engagement with patients and users and clients and residents, and we need to show our face consistently.
there are just three points made by way of introduction and very happy to take any questions, thanks very much for that statement and thanks for all the work that you all do and for real-time here in every meeting, I know it is really appreciated by the committee as are moving on to the committee does anyone have any questions for Stephen?
while Norway is continuing, I know that Councillor Henderson wanted to come in, though so I'll I'll let him come in at this point.
they are throwing stuff.
I just think you need to worry too much Stephen yeah, an extremely interesting report, and what I like about the work Healthwatch, you focus upon areas which
other people don't necessarily look at perinatal impact on mental health or vice of us, I think, is a significant UN indeed.
any comments really ease and to thank Healthwatch and in particular the volunteers who work with Healthwatch.
I know many of them
incredibly knowledge, or who committed a sudden, extend the reach of Healthwatch and actually amplify financial value we put into the organisation, so I sincerely hope, even I'm sure you will pass on my thanks to the staff and all the volunteers and even to yourself thank you.
thank you very much, uncertainty will do that, can I just make one point that where at that time of the year where we will shortly be having to produce our plans for next year, this comes round ridiculously fast each time, but it is an opportunity for anyone with an interest in this vast topic to flag up any particular issues or concerns or topics that they should think would be helpful.
for Healthwatch to pick up next year,
I just put it out in case any inspiration strikes to anyone run in Councillors clearly, but also actually officers as well. Thank you very much for the offer and I think if, if people do want to take the OK
and if they're all points to discuss, it may be worth having sort of a separate meeting, whether in person and offline, that sort of thing to to further discussion that is just to discuss things and I think that's as an authorising that would be appreciated by the committee Councillor Warrell,
muses more just picking up on what Councillor Henderson said. I think this is a lesson for us in the Healthwatch report, insofar that it makes very complex information, easily accessible, easy to read and actually a pleasure to read rather than trawling through pages and pages of tables and and things like that, so a big thank you for the further quality of the report has produced and something for us to take away about how we sometimes, as a council, produce reports for the public that can sometimes been inaccessible. So thank you
definitely a good point to raise.
and we have all that in mind, the reports for information is the report noted thanks very much and thanks again, Steven for everything that you do
moving on to Item 9 once the Corporate Plan actions and key performance indicators, I'd also like to extend a welcome to Clare and Rachel joining us this evening,
would you like to lead off and then what I'll do as well on the KPI is is go through it page by page, to see if there's any individual questions. Yes, I'm happy to cough hi, my name is Claire too. I'm the associate director for assurance and innovation. I'll keep it very brief in terms of intro, there are really two parts to this paper. The first is the update on our actions versus the corporate plan actions with regard to the remit of this committee, and the second part is KPI report against
Key copies for this committee and we are very happy to take any questions.
so first off are there any questions on the corporate plans, so I'm looking at pages up until page 1 6 8.
KPI is done any questions on page 1 6 9
Page 1 70
Page 1 7 1
and that's it, there's no questions at all at this point, I think Councillor Henderson wanted to come in on this paper, is that right?
I thought so you don't have to if you don't want,
at least this area is acutely here to answer any questions which people may pose since they didn't pose any questions, I don't think I've got anything to answer, particularly thank you.
thanks all in that case the reports for information is the report noted the reports noted and that now concludes the meeting thanks very much for attending this evening and we finished well earlier than last time anyway, so thanks very much
- SWLSTG Report-cover, opens in new tab
- SWL and St George's Mental Trust Report, opens in new tab
- Domestic Abuse Commissioning, opens in new tab
- Appendix 1 - EINA, opens in new tab
- Sexual Health Services, opens in new tab
- Appendix 1-EINA, opens in new tab
- Preventation Framework, opens in new tab
- Annual Complaints-cover, opens in new tab
- Appendix 1 - Annual Complaints Report, opens in new tab
- Healthwatch Annual Report-Cover, opens in new tab
- Appendix 1 - Healthwatch Annual Report, opens in new tab
- Corporate Plan, opens in new tab