Health and Wellbeing Board - Thursday 3 October 2024, 1:00pm - Wandsworth Council Webcasting

Health and Wellbeing Board
Thursday, 3rd October 2024 at 1:00pm 

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  1. Webcast Finished

Thank you. Welcome to this meeting of the Health and Wellbeing Board. Good afternoon.
My name is Councillor Graham Henderson. I'm the chair of the Health and Wellbeing Board.
Members of the board, I will now call your names in alphabetical order. Please switch
on your microphone to confirm your attendance.
Once you have confirmed your attendance,
please remember to switch off your microphone.
Abby Plater.
Afternoon, everybody.
Present.
Thank you.
Mark Creelman.
Present.
Excellent.
Robert Guile.
Welcome, Robert, to this, I think, your first meeting
representing the Central London Community Health Care.
replacing Jimmy D 'Oudo. So welcome to you Robert and thanks to Jimmy for her
contributions to the Health and Wellbeing Board in the past.
Stephen Hickey is on his way. Shannon Couture. Good afternoon, Chair.
Good afternoon. Ariane Jogia. I'll come back to you and I'll let you
Nicola Jones. Philip Murray.
President chair online. Excellent thanks.
Tihami O 'Orbam who is the new care representative.
Welcome. President, thank you for having me here.
Thank you very much. Well you're most welcome.
Mike Proctor. I think also virtually.
Thank you very much.
And Ariane, could you just simply confirm you are present, even if it is obviously the
rest of us?
Present, thank you.
Excellent, thank you very much.
Yeah, when you are speaking, it would be certainly helpful to everyone if you can refer to the
page number at the top of the agenda and the paragraph number so the members of
the public can follow the discussion. Please also indicate an unusual way by
raising your hand. Once I have invited you to speak please turn on your
microphone and please try to remember to switch it off after speaking. We do also
have a number of officers present at this meeting who will introduce
themselves when they address the board relevant to the particular topic.
So we can start on the agenda.
Apologies for absence.
Have been received by Councillor George Criveni, Jeremy de Souza, Mike Jackson, Anna Popovici,
Dr Wacka Shah and Kate Slomeck.
Are there any additions to that?
And Mike Proctor.
Okay, so if we can note those.
Declaration of Interest.

2 Declarations of Interests

Are there any declarations of either pecuniary, other registrable or non -registrable interest?
Please declare any interest quoting the item and paper number in which you have interest
and describing the nature of your interest, including whether or not you will be taking
part in this item.
So can I ask, does anyone have any interest they wish to declare?
Excellent.

3 Minutes of the meeting held on 29th February 2024

So we can move on to the minutes of the previous meeting held on the 29th of February 2024.
It seems a very long time ago, since which time we've had two elections.
These are to be agreed and signed as a correct record.
Any comments on the accuracy of the minutes?
Are people content that the minutes are an accurate record?
In which case I will sign on behalf of the board.
The third.
Thank you very much.
Excellent, good.
So, moving on to the first substantive item,

4 Emerging Needs Pathway (Paper No. 24-249)

which is the Emerging Needs Pathway Paper 24249, pages 13 to 18.
This is a report by the Executive Director of Children's Services.
And I gather Deborah Johnson, who is the Assistant Director of Ascend and Inclusion,
will introduce the report virtually.
Deborah, I can't see you.
I have eyes in the back of my head, but hopefully you're there.
I am here, yes.
Excellent.
Would you like me to start? Okay. The paper that I've got in that you have in front of
you I hope is very informative and has all of the detail in front of you that you need.
From the paper there are three real key recommendations as to why this is coming to the health and
well -being board. The first is to currently note the experience of families that are going
through the ASD diagnostic pathway. So that's obviously included in the report.
The second is to notify and ask for notification of the proposal for a new model
for the emerging needs pathway. And the third is to hold all partners to account for their
areas of responsibility and to monitor the outcomes of the new pathway. So to explain
And slightly further the background of this, the emerging needs pathway is the pathway
for children under eight years of age who are referred into the local authority and
the health authority for a diagnosis of autism. At this moment in time, the original pathway
was pulled together in 2019 and due to substantial change in both the health authority where
we've moved from the NHS to an ICB model,
and also following the 2019 local area
send of stead inspection,
where the local authority has also undergone
substantial change in terms of the development
of the sending inclusion service,
which was actually not in place in 2019.
What has happened is the two organisations
now are very, very different.
They're structured very differently.
services are delivered very differently and substantially because of the current challenges
with the emerging needs pathway for children and their families, the proposal is now to
completely overhaul the system. So what we've had to do is we've had to re -examine with
our health colleagues. So it's been the local authority and the health authority have looked
together re -examining the current system, what the challenges are and that's from the point of
referral when it comes in, the pre and post diagnostic support services and the waiting
list for diagnosis. So all of this has been examined between the two organisations together.
So section four of the paper outlines what the current aims and what the current impact and what
current issues are with the current system which I hope the way that it's set out is quite
self -explanatory and then it moves on in the paper to section 8 to say that what we're aiming to
produce now are two parallel pathways where the pre and post diagnostic support and intervention
for families would be provided by the LA in conjunction with the second pathway where the
actual diagnostic wait list would then sit with the ICB and St George's Hospital. This
then actually puts the key areas of responsibility back where they should be. Section 12 then
goes on to actually identify, or sorry, Section 8 goes on to identify what the LA proposal
is for their pathway for the pre and post diagnostic support. And Section 12 then lists
what the ICB and St George's Hospital aim to achieve with their pathway but to clarify both
will run in parallel so we will work together but it just really aligns the responsibility to where
it should lie and then the last section in section 14 just outlines for you what particular challenges
there may be in the terms of delivering the pathway and actually organizing the pathway.
The key aim for changing the pathway is to reduce wait times for parents which are substantially long at the moment and are in the paper,
but also to make sure the pre and post diagnostic support is provided to children and their families from the local authority in a timely manner.
And this all to a larger extent aligns with the new send an AP improvement plan, which will be coming in into 2025, 2026.
We think now it will be delayed till 2026 because of the change of government.
But this then actually aligns our pathway to where the areas of responsibility lie.
So that's to a larger extent the reason for bringing the paper to the committee.
So I'm very, very happy to take any questions that may have arisen from the paper.
Thank you, Deborah.
So can I ask the board if they have any questions or comments?
Mark?
Thanks, Chair, and just thank you, Deborah, for presenting it.
I just wanted to emphasize that this paper was agreed by both of us, so we were involved
in the construction of the paper, but perhaps as being the joint author going forward might
be the way forward.
And just to say that some of the waiting list issues
are national issues.
What we are seeing is an increasing demand for services.
And we have workforce challenges across the board really,
which means that often services aren't meeting the capacity
that they plan to meet.
Debra mentioned that it's a joined up piece of work,
the solution needs to be joined up as well,
so that from pre -diagnosis through to diagnosis
and post support. Absolutely we need to make sure that we are aligning everything that
we do even though we've separated the pathway. And there's just a couple of others. I just
wanted to acknowledge the issue, waiting times of this length and this magnitude are not
acceptable we need to be seen to be doing something about that. We are working with
St. George's now around increasing their usual business as usual service capacity. And I'm
I'm happy to say that I've just identified resource to work on the backlog.
So we should start to see improvements over the next few months.
But it's going to take us a while to get the amount of backlog cleared.
There are some challenges and we shouldn't shy away from those challenges.
We all know that in public services, finances are challenging.
So actually additional funding into these services might mean that we have to look at
other services that we commission and move money around.
And from a health perspective, I think one of the things
particularly around SEND is that we see waiting
lists across a number of areas. And what we want to do is we've kicked off a piece
of work to look at all our waiting lists for children and young people with
SEND and to have that action planned so that we can show ourselves
and partners that we are doing something about it. One last thing
and then I promise I'll be quiet, two last things.
We're gonna work with the Mental Health Trust as well.
We've spoken to them about supporting us in the system
around this, and then finally the communication
with parents, which is really, really key.
So we have a comms going out, telling parents
that we need to redefine the pathways
and the diagnosis pathways, but I think there is also
something just about our ongoing communication
so that we're being transparent with parents as well.
Thanks a lot, Mark.
That was very comprehensive and very, very helpful indeed.
And I think what I'll do is I'll go around the board
taking comments, et cetera, and any questions,
and then ask Deborah to sum up at the end.
So, Abby.
Thanks, Chair.
Couple from me.
One is what, if any, modeling's been done
around the new pathway to kind of try and project
what improvements we'd make.
That was kind of an obvious question.
I thought that would be great to see
if there's been any work done there
to see how quickly you can move those people through
and what rates.
And then I guess the second bit, Mark,
to your point around comms out to carers
is who do you kind of plan to target there?
Is it people, because obviously there's kind of people
within the system, I suppose, as it were,
but then there's lots of people who might not yet know
that their child is autistic.
And so I guess it was kind of,
and how would you proceed to do that?
Would it be through just kind of health networks
or would you be looking for charities
and voluntary sector to put that out for you guys as well?
Yeah, and Nicola.
Thank you, just Mark has probably answered
quite a lot of what I was going to ask about,
but as a specific thing, I just wondered,
if I referred, if I'm GP, if I referred a patient now,
When would they be seen?
So I wanted to understand that.
And then the issue, it's a bit about the cons here,
but I think it's probably about transparency as well on this.
And on page 16, paragraph 6, it's
got officers want to ensure parents understand
the process of the pathway, which I think
is really kind of important.
And I would support that openness.
But I wonder if it would be helpful if patients, people,
understood what the waiting time is at the point when they enter the pathway.
Because I think it might just help with transparency and openness about this, because everybody
understands that this is a really difficult area and we're working hard to resolve it.
But I think it might help manage patient expectations and help families, therefore, to plan and
understand what support they might need in the interim.
So I think it would be helpful all around, really.
And I would support Mark's point about the authorship of this paper.
It's just a point of process, really, I guess, because the organizations are working very
closely together to crack some of these really difficult issues and therefore a
paper like this I think should come to this board probably jointly authored I
think that would have helped us to understand in reading it where it was
coming from and and then just finally I think could we bring back an update to
this board and plan when that would be because I think we need to be assured
that progress is being made because this is quite a long time and it's an it is a
national issue we're not the only system that's struggling with this but I would
I would love for us to see some progress.
Absolutely, Nick then.
I think the paper does actually call for
my council and partners to be held accountable.
That's actually in the recommendations 1C.
What I do is I'll take questions
from clusters of three for Deborah.
Or indeed, I think Mark would probably want to answer
one or two of them so we don't actually lose sight
to what the questions are.
So first of all, Deborah, have you got any comments to make on the first three contributions, please?
I think to go back to the last point that was made around wait time, I think one of the main reasons why we've worked, you know, and to be clear, I've worked very, very closely with Robert Dyer and all of St George's Hospital, Mark, Mike, etcetera, in terms of the development of where we need to go.
But I think there's an understanding at the moment that because the diagnostic pathway to a larger extent
the actual waiting is being held by the local authority.
If a parent was to come to us and say how long is the waiting time? It's something that we
can't answer because obviously the diagnostic element has to be done through a clinical
setting, through a clinical expert. There isn't that expertise in the local authority.
it has to be done through, you know, pediatric services.
So one of the key elements of changing the pathway
is so that wait times can be advised to parents
by the people who know when the child will be seen
by the pediatrician and at the right time.
So that was one of the key things for us
because to a larger extent,
parental complaints are not necessarily about the fact
that they are not receiving the right support in school,
but it is because they don't know how long they've got to weigh.
And I think that's been recognised by the ICB and St. George's Hospital
that that's part of the reason for change.
One of the other things as well around the pathway
is that we're looking at it right from the very beginning
when it comes in from the referrer
and the best way to move it forward more quickly.
And that is through a health model
rather than coming into the LA and going back out again.
So that's one of the main reasons to close that gap.
In terms of improvement, we've taken a lot of information,
both from our own knowledge inside the local authority
and the ICB and St. George's Hospital
around what it is that actually parents want
and what they're asking for.
And a lot of the improvements that we're trying to make
is from the very start, is the parent experience
from the point that they are referred in
for an autistic diagnosis and the support and groups and sessions that they can attend
to actually help them work with their child at home and with the school or the education
setting. So we've started to look at how the referrals come in, where they go, who looks
at them, how we get that support into the child and family much, much earlier. And so
those improvements have already started with the way that we're developing our services both inside
the local authority and in St George's. So we've started to make those improvements but we've just
got to actually make this pathway much much quicker than it already is. I absolutely agree around
communication, one of the biggest issues for parents is around a lack of communication and
I think we both accept that and that's something that we need to improve on and it's something we're
up very closely and as Mark correctly said a letter has been agreed that we'll be going
out to one of the parents shortly to actually explain what we plan to do. I think that addresses
the current questions but please tell me if they haven't. Thanks Lord Deborah. Mark.
So just agreeing with everything that Deborah said but also I think just in terms of Abi's
challenges. So there is something about seeing what others are doing and using
best practice and so we know that some of our colleagues in Epsom and St.
Helier have just looked at their pathway and they've got some positive and
negative experiences. So we want to learn not only from London but elsewhere. I
think the waiting list, the magnitude of the waiting list, I want to reassure that
on that waiting list there's a cleansing exercise that we also have to do. Are
people already accessing the correct support.
So there is hopefully a relatively,
a cleansing exercise to help us reduce it immediately.
And I agree with Nicola just really in terms of
bringing up a regular update.
I would suggest that we give us a couple of months
to get all the arrangements sorted out
and then bring that back at a later date.
Excellent. Thank you very much. Next round of questions.
Tihania.
Just a few comments. I think this is a very nice summary of where the situation lands
and stays. I see three major areas of why all this problem, health problem, has not
result. One is autism is more and more recognized and appreciated as a child
healthcare issue so there is more incoming as a disease. The second issue I
think is here and in general the NHS system it is very fractionated. How I see
that one hand doesn't know what the other hand does,
so patients are getting lost in the system.
The third is the bottleneck of the specialist
to actually see the patients.
So I'm just wondering what,
you cannot help the number of patients, they are coming in.
The problem is, I think what you can help,
or can be helped is somewhat make the link between GP,
school health, nurses, communicating with each other
much better to find the patients.
It doesn't solve the specialist bottleneck
to have the diagnosis, but on that front,
I think triaging would be helpful
to get the more severe, clinically more demanding patients
into the system with the specialist,
especially because those children, parents,
are the most affected and unable to handle.
So this is just my kind of comment
of how this might improve over time.
Thank you.
Thank you, that was very helpful.
Kate.
Thank you, Chair, yeah, thank you.
Thank you Deborah and thank you Mark for your kind of explanation of the papers
just really kind of adding from my perspective on behalf of kind of children
and parents across the borough in my role I think the points that have made
about communication are are entirely right I think a lot of what we hear at
our parent carer forum is is that uncertainty of the wait time is causing
significant anxiety and having a significant impact on parents I know
with our own service, we try to clear as clients
at that point that Nicola made earlier
about making sure that parents are able to know
as soon as possible after a referral
actually what is the weight going to be.
I think actually that will support and help
parents and carers who are in this situation.
So again, just thank you for your acknowledgement
around children are having to wait too long for a diagnosis.
I think that is right, we can't sit here and accept that
as a status quo though, so I think I'm keen
that we have these pathways finalized,
that they're mobilized at pace,
and to make sure that all partners, I think,
a number of us were in the room
when we had our offset sentence section
that Deborah referred to, and there was acknowledgement
that positive progress had been made,
but perhaps a comment that all partners
need to be moving at the same pace,
so it's really important that we continue to do that.
I completely recognize the points
that we made about challenges.
I think that's the challenge that is shared
across all partners, but equally these
are priorities that are in our shared written strategies,
and we need to make sure that those written priorities are
followed by actions.
And then there was just one question or point of clarity
for me from page 17, paragraph 13, just around the aim being
an aim to establish a St. George's pediatric -led
multi -disciplinary diagnostic team.
And just to clarify if that is kind of a commitment
to do that or if that's just the aim
and that's still being explored.
Thanks.
Okay, very helpful.
Can we go to Deborah first, and I'll come to you, Mark.
So, Mark, can you turn your?
Deborah.
So in terms of the current issues around parents,
I absolutely agree with the view that was provided earlier, both Robert, myself, you know, from the ICB and from the local authority have met with parents on a number of occasions to carry out parental workshops on what they would like to see, how they would like to see this working better, what they see the potential barriers are.
and we've worked together, Robert and myself, on unpicking all of that information.
But to clarify, we both meet with the Parent Carer Forum very regularly,
and we've also offered to come out whenever we're requested to, to talk to parents.
But absolutely, one of the main points that we want to make sure happens in what we do next
is that parent communication is there from the very beginning.
And so that both the local authority and health communicate with parents all the way through as to where they are,
what they can do, what they can access, where they can go, because that's absolutely critical.
But a lot of the recommendations that are in the paper have stemmed from those workshops with parents.
I absolutely agree with the point as well around the number of children that are coming through for a diagnosis.
You know, the numbers are no different here than they are in other local authorities.
They're substantially higher than they were before, which is putting demands on all of the services, therapies, our own support services,
which is why both St George's, the ICB and the local authority have looked at how we change our services in order to meet the demand.
But I would agree with the point Mark made earlier that the demand is outstripping our ability to keep up.
But this is not a Wandsworth issue.
This is a national issue.
And I think part of the government agenda around the new SEND and AP improvement plan
is to look at how we actually then make that that much easier.
I do agree as well with the point around early triage, which is the point that was in section
13 of the paper.
The ICB and St. George's Hospital are very clear and very committed to that early triage
and to making sure the most complex children are triaged much earlier,
because we see children with very, very complex needs coming through as early as two,
two and a half. So effectively, the triage element is something that we're all committed
to making sure that that is a main focus of what we do next. I hope that answers it from
my point of view. And I apologize, Mark, if I've picked up anything that you would normally pick up.
No apology needed at all.
I think just in terms of the number of patients, what we are trying to do is design the service
to meet that need.
I think in terms of the comments around fragmentation, that's why we've got to integrate our approaches
so that actually we are in some ways working as one around the families and so that communication
not just with families but also between partners is really, really key.
I think the triage element, what we want to do is bring the expertise further up the referral
process so that actually that triage happens.
Because we do know that it may be that we have to go back and look at things like universal
offers in education, et cetera, to make sure that the people most in need are getting the
service as quickly as possible.
And then with communication, and I know that Deborah was talking about the forums, and
picking up on Abbie's point, it might not just be about attending forums, it might be
about how do we communicate with a wider population, whether that be through schools, whether it
be through voluntary organizations, and that's something we need to consider.
And just to kind of emphasize Councillor Stocks, these are our most vulnerable children.
We need to make sure that these are absolutely the priority.
And so therefore, going back to my comment around resources, we need to make sure that we,
in some difficult times, and we might have to make some difficult decisions,
but we need to make sure that we are putting the right resource to meet the need.
Philip, I'm going to let you have your hand up.
Thank you, Chair, and apologies, I can't be there.
What I was reflecting was that what we often see where we get, sorry, what I wanted to reflect is,
what we often see where we get backlogs like this is, as we improve our services,
I suppose hidden demand can sometimes come out,
i .e. people either seek alternate ways to get input and support,
or they don't ever come forward saying,
well, what's the point? I'm going to wait three years.
So I suppose it's a comment, but also asking those that are closer to it.
Do we think we run the risk that as we put these services in place,
we will see new demand coming out and we might see the position worsen
rather than improve in the short term?
Yeah, a good question, Philip.
I suppose my answer would be, well,
if I'm just going to help people,
and if there is unmet need,
we obviously need to address that.
But anyway, I'll leave it to our experts to comment.
First of all, Deborah, any comments
on that particular point from Philip?
I think that the point that Philip has made
is absolutely valid.
But I have to be honest,
I've been doing this type of work for a very long time.
And looking at the data, we had a major explosion,
you know, sort of post -COVID,
where a number of children were coming through.
And I think it's been very difficult
for both education and health staff
to actually look at those children
and try to figure out what is the COVID impact
and what is actually a more long -term difficulty.
But I think Mark would agree with me
we've now started to see those numbers not plateau so much but that substantial growth that we saw in
a short period of time which we're now experiencing seems to be slowing slightly and what we've moved
back to is really the high numbers in the three to five category and not so much the the older
children which we were seeing coming through before but I will hand over to Mark but I think
We are now beginning in the local authority with the numbers that we gather in seeing a slight plateauing of that.
Sam, Deborah answered that brilliantly. I think the thing is, is Philip, just to make sure that we are building in the capacity to meet the needs.
When we go through that cleansing exercise on the list, we need to learn from the data that that gives us.
So actually how many of those people ended up with a diagnosis of autism and what's the
alternative if they haven't, where are they accessing services.
So I think it's a valid question.
I don't think we know the answer to that right now but I think as long as we track what we're
doing and share that information across partners, then we may need in a different way going
forward and it might be a different range of services but that's part and parcel of
with us looking and reviewing this now.
Sorry, are there any further comments
from any members of the board?
If not, I think that was an excellent discussion.
So if we can move to a decision,
and hopefully to agree the recommendations
are set out in paragraph one of the report.
And for the benefits of members of the public,
I will summarize, I won't read them all out,
you've got them on the papers,
but the first is to know the current issues
experienced by families associated with obtaining
a diagnosis for the child with autism spectrum disorder.
Secondly, to note the new model
for the emerging needs pathway introducing
two new pathways running in parallel
to reduce diagnostic waiting times.
and thirdly, hold the council and partners to account for their areas of responsibility
acting as a critical friend. Can we agree those recommendations please?
Excellent, thank you and I think that was a very good discussion. I know Kate, I think
you are dashing off to my ward of Roehampton for the launch of the family hub, so thank
Thank you for attending for our first item.
Hopefully you found it very useful.
And please do give my apologies for lateness to the launch.
Okay, excellent.
So moving on, I'm very pleased to welcome Stephen Hickey,
representing Health Watch.
That's okay, don't worry.
Good to see you anyway.
So if you can move on to the next item,
one of two concerning the Better Care Fund.

5 Better Care Fund - End of Year Update (Paper No. 24-250)

The first one, paper 24 -250, is the end of year update, pages 19 to 36.
This is a report by the executive director for End of Social Care and Public Health,
Jeremy D 'Souza.
And I gather that Brian Roberts, who is the head of Health and Care Integration, will
introduce a report with Ninh Wild, the assistant director of Health and Care Integration, in
attendance to answer any questions.
So Brian, would you like to lead us off?
Thanks.
Thank you, Chair.
So this is the first of two items for the BetterCare Fund, so the first item being the
end of year report, which then actually acts as a baseline to then complete the refresh.
So I'll move from one to the other if that's okay.
Before I start, I just need to acknowledge that both the end of year return and the BCF
So it summarizes all the partnership work in the borough
and all parties contributed to both reports.
So and there's a shared understanding of the demand
from intermediate care and the capacity needed
and provided to meet that demand.
So we've got working groups set up to do some of this work
and it felt very much like that was happening
in partnership.
In terms of the end of year update,
So this was due in early May,
so apologies for it not coming here earlier.
It consisted of the following areas,
so agreement of the national conditions
around the BCF, which we confirmed were met.
The progress on the metrics, so avoidable emissions,
discharge or use of place for residents,
emergency emissions for falls,
long -term residential emissions and re -abornment,
and of which we didn't achieve avoidable admissions
and residential admissions, but achieved the others.
Avoidable admissions, we saw a rise in patients
going to St. George's with heart failure and Campbell Flack
and from CLCH is working with St. George's
to work out some of that reasoning
and how best we can support those people.
Residential emissions, we saw a spike during the year,
which were small numbers, but unfortunately,
we're working from a very small baseline,
and so we missed that target.
Thirdly, spend against plan for the BCF,
which we confirmed that that was fully spent.
We had to refresh our demand and capacity plans
for intermediate care and put actuals against the planning,
which we did.
Probably the notable thing to point out there is the CLCH
and then Battersea Healthcare, CIC,
Urgent Community Response, we were expecting an increase
in people seen by those services,
and we saw an increase over and above that,
so lots more people being supported
to remain at home during the winter.
And lastly, feedback on delivery successes and challenges.
All partners believe this was a successful BCF period.
Actually, in terms of successes,
there was a lot of joint work across the health
and care system, a lot of system understanding.
And there's joint work to support people
in care homes, remaining care homes,
via the enhanced health and care homes work
that happens joint between the council and the ICB.
In terms of challenges, so one of those challenges
is quite frankly that the demand was greater
than the finances we had to support that,
and we're obviously working through some of that
at the moment.
And the other one we flagged here is
quite a lot of the information about
demand and capacity that's centralized
is on a trust -wide basis as opposed to a borrow -by basis
to NHS England.
And again, so some of that you will see
starting to be talked about in the demand capacity plan
in the 24 -25 refresh.
But they're the ones to note.
Yeah, partners worked well to pull together the reporting.
There is a Better Care Fund oversight and delivery group
that we use for that purpose,
But also there are links through to the Urgent and
Emergency Care Delivery Board, which is chaired by Mark Hillman.
So some of that reporting is joint, and it feels like we've sort of joined some of that up.
So just lastly to note, so any of the data in the report isn't just about St.
George's, though I mentioned them earlier, it's about any resident anywhere who
who goes into or comes out of hospital
or is supported at home.
Obviously most of those are around St. George's
and Chelsea Westminster, but this is the view
of the population and not just the view of St. George's
as a trust.
I think that's a whistle -stop view of that
considering I'm gonna be talking for a little while
on these reports.
So probably any questions.
Yeah, thanks.
Thanks, Brian, for that.
Any questions or comments on this report
from members of the board?
Stephen.
Thank you, Chair.
As always, the BCF papers are incredibly techy
and sort of spreadsheety and therefore not quite,
you sort of, I glaze a little bit.
But the point I just wanted to ask about was in last year's out turn, we missed two targets,
avoidable emissions and reablement, and those reappear in this year's targets.
And I wasn't totally clear from this what – is anything changing this year that means
that we might actually achieve them, or is this – are these impossible targets that
going to fail to meet year after year.
Any other comments from anyone?
No in which case Brian, right away.
Thank you.
So I'm sorry about the return template, that's the H .S. England return template.
I wish it wasn't quite as it is. You do get used to the colour yellow quite quickly.
So in terms of, so re -abment, so re -abment target
has now been dropped, but we obviously do have
local measures around successive re -abment,
and we do know that a very high proportion of people
who have re -abment actually go on to need much less
or no long -term care.
So thankfully we have got that measure
that we can continue reporting, although not in the BCF,
and that's been dropped from there.
In terms of avoidable emissions, so this is,
so absolutely, we see rises in this cohort.
I think for me, Steven, this is how things like our MDTs,
things like our intermediate care offer,
things about our UCR, this is where we need
to take this data and ensure that we are being
as responsive as we can to that.
So there is achieving or not achieving the target
or the ambition, but there's also using the information
behind it to try to transform and configure
our services to meet that need.
So I think we didn't achieve this,
but actually we have been doing a lot of work
trying to support the people behind these numbers.
Mark?
I suppose just in response to Stephen is that actually, as Brian said, there's a lot of
work going on around a number of areas.
Now, they include things like rapid response teams.
We have a virtual ward that also has a step -up facility, not just a discharge facility.
And there's also proactive care and general practice
and multidisciplinary teams which are becoming
very much part of the integrated neighborhood team approach.
And what we need to do is make sure that as we develop
that all partners are there working around these individuals
to make sure that they're not admitted to hospital.
Thanks, well, Thiramia.
Thank you, I'm not sure that this is the right place
to mention this issue.
Being a carer and being with other carers for now two years,
there are a couple of major deficiencies
which we experience.
The second paragraph is the discharge to normal place.
It's on target.
Maybe the number is on target.
But I think the problem is,
and I speak now from personal experience,
that when a patient in need being discharged from the hospital, there is a total chaos.
How the patient and the families and care potential future carers been thrown into total chaos
and the need for structured guidance,
how the carer should be supported
and how the clinical follow -up should be organized
in terms of mobility, rehabilitation,
all the rest is total chaos.
So my suggestion would be,
I don't know whether this is the right place to say.
But when a newly diagnosed acute patient
goes back to the normal place at home,
I would put a person
like a patient advocate
or ambassador of that case.
Now it doesn't mean that that specialist
who would guide the care of that particular patient
is the one to one.
But let's say my wife was discharged from Charing Cross
and we got like 15 different people.
And nobody knew who was doing what.
And I had to figure it out all the way through.
So my recommendation would be a patient advocate,
advocate and ambassador at the time of discharge would ease everybody workload,
including the patient and the carer, to put a carer plan custom -made for that
particular patient. It might sounds a lot but would save a tremendous amount of
resources for the healthcare.
Thank you, Jeremy.
Yeah, useful point, useful point indeed.
I think Philip, you have a comment to make.
Thank you, Chair, and thank you for the report.
So what I was reflecting on is, it's all well and good to consider how well we did and whether
we hit the targets.
But what does all this mean for reducing health inequalities?
So we can see that we've done very well on discharging people back home.
We've hit 93 .8 % of the target.
But where we're missing the target,
have we got a disproportionate impact on certain elements of our communities?
And therefore, are there any underlying trends that we need to reflect upon in terms of our processes
so that we're not causing more inequality rather than reducing it,
which is what we should be doing.
So I just wondered if there's anything behind this,
because that's what I'd be interested in.
And it's, we look at this stuff every year,
is what's that sub analysis telling us
and what are we doing about it if it exists?
And if it doesn't exist, can we get it?
Yeah, thanks, Philip.
Another good question.
I mean, some of the questions are probably more relevant
to the second paper,
but I'm quite happy for the discussions
to continue in parallel.
Hopefully it'll mean that when we do actually come
to the refreshed paper,
we will have largely answered those questions.
So Brian, would you like to address
those three particular points?
Thanks.
So in terms of carers, thank you for that.
I mean, clearly we need to do a lot more work
around how carers are supported out of the hospital.
So again, some of those will be hopefully covered
in the refresh or in the work that we're trying to do
to support carers out of hospital.
So whether that's a regenerate rise,
supporting people to get back home or other services,
yeah, it's a difficult balancing act
in terms of trying to get the speed
of getting someone out of hospital and home
and supporting them holistically.
So and obviously we are doing work
in terms of, you know, Raven and other services
is try to pick some of that stuff up.
I absolutely appreciate your lived experience
and thank you for that.
Philip, in terms of your point, in terms of inequalities,
so I think we absolutely have to look at that.
So the headline figures are the headline figures,
but actually we have to look at those people
that are being missed and not supported.
So I thank you for that and we absolutely will look at that
and try to bring something back
in terms of those people being, you're right,
both questions are absolutely right,
people being discharged home,
a large proportion of people are being discharged home,
but actually who are we missing, who are we not supporting?
Where do we need to fill those gaps?
And that will sit on the work plan of the BCF oversight
and delivery group and other groups,
I think as we manage that.
Moving seamlessly onto the refresh, again,
Sorry, while I'm saying Brian is quite happy
to take the discussions in parallel
because they're obviously overlapping.
Can I just sort of check whether anyone wants to add
anything in relation to this paper?
Okay, Nicola and then Mark, thanks.
Yeah, I'm not quite sure which paper it relates to really,
but if taking over, that's all right.
So firstly, just on the point about the carers
and the kind of proactive care planning,
which is I think what you're talking about here.
So we do do proactive care planning
for our patients who we think are at high risk
of admissions in general practice
and with wider multidisciplinary teams.
And I think it's a really important angle
to ensure that within that our carers are considered
and the whole plan takes into account
that element of the patient's care.
So I think that's a good one for us to take back,
just to make sure that we are actually doing that
in a structured way.
I think that will really help, so thank you.
The other thing is sort of a reflection, really,
on the fact that for the unplanned admissions,
we have historically had very low rates.
So it's very difficult to continue to achieve that target
without going into the realms
of actual clinical safety issues.
And I think it's very important that you look at cases
to understand what it is the system is delivering in terms of care.
So the patients who you think they went into hospital
and it probably could have been avoided,
we should as a system be reviewing those cases
to see what we could do better to keep them at home.
But the other way as well,
when you get down to the numbers we're talking about,
is very important that we do admit patients to hospital
when they need to be admitted.
And patients sometimes need to be admitted to hospital.
And we should look at people who perhaps have been kept at home
inappropriately when we get into these kind of quite small numbers and narrow
margins and I think we need to take that into account when we're reviewing how we
manage people's care.
And just to share that we have an integrated discharge hub now between
local authorities and St. George's and part of that and CLCH sorry and part of
that is ensuring that the discharges are not just safe
and clinical, but also the right support mechanisms
are being put in place, including information
and advice for patients and carers.
We have had conversations about moving that support
up to admissions, so therefore, actually,
when people get admitted, they get information
about what to expect at discharge,
and that's something we need to pick up further
with our, George's colleagues.
And just to say that we have quite a vibrant voluntary sector, a range of services that
are there to support people in their own homes on discharge.
And apologies for your experience at Charing Cross.
Just a quick answer.
The services there was fantastic.
There is a lot of offer from different part of rehabilitation.
The problem was that it was not organized.
It took me one year when I figured out what things are available
and how to put the service and support together for my wife.
So I'm not saying that the services are missing.
I think the structure and personalized support
at the time of discharge, and I think what you mentioned
at the start at the admission would be even better
because then everything is ready when the patient goes home.
And in this way, the patient will stay at home longer,
the carer will be less distressed
because everything is available and structured
and built up time by time.
Thank you very much.
Thank you.
That clearly is an important point about coordination, people knowing what each other is doing, et
cetera.
Are there any further comments from the board?
If not, I'll ask Brian to say something about the refresh paper.
The discussion has really overlapped both, so we might as well continue with that discussion
and then hopefully we can agree the recommendations in both reports fairly quickly.
So Brian, would you like to say anything about the refresh papers specifically?

6 Better Care Fund 2024-25 Refresh (Paper No. 24-251)

Great, thank you, Chair.
So the refresh paper is – so obviously the BCF between 2023 and 25 was a two -year BCF
with a refresh period, and this is the refresh period.
All of the information in it is built on the end -of -year return, so including refreshing
the intermediate care demand and capacity reporting,
including the spend and trying to use some of that spend
to best affect in terms of tech -enabled care,
in terms of supporting the integrated transfer of care
over St. George's work that's continuing
and to meet additional demand.
So in terms of, so part of that was also
a narrative update, just trying to describe
to describe the plans in terms of
demand and capacity for intermediate care.
Some of that was about actually the further ambitions
for the metrics which we've discussed.
I think it's also worth acknowledging
there are a couple of new things in there
that I just want to bring to the board's attention.
And one of which is the demand and capacity plan
has a, for want of a better word, a new metric
which describes the average time in days
between when someone is referred to be discharged
and when their service starts.
So which I tend to refer to as the turnaround time,
so how responsive we can be in terms of hospital discharge.
And that's supporting some of those conversations
in the borough about actually how quickly and safely
can we discharge people, where those blockages are.
And that feeds into also the conversation,
both in terms of the quality of discharge,
which we've spoken about, and also making sure
that those people that are going through the St. George's hub and the Chelsea Westminster hub to be discharged
are supported adequately and quickly enough.
And that then talks then about have we got enough capacity to meet the demand that we're expecting in the system.
So that's in place.
There will be further reports that give actuals to that.
So at the moment we're in the middle of the quarter
to return which we will bring back to the health well -being
board to show that progress.
But I think that's probably the thing
I would want to highlight other than the thing I started with,
which was this is a system -wide view.
So all this reporting has been put together
between the council employees, the voluntary sector, CLCH,
St. George's, and the ICB.
And as best as we can get it, this
as a shared understanding of where our system is
in terms of what we can achieve,
where we think the gaps might be,
and where we need to face capacity to meet those demands.
Thank you.
I'll pardon any further comments
from members of the board.
Ariane.
I'd just like to thank Brian for the paper submitted.
And some of the metrics were very encouraging,
especially in view of the fact that the population
ages complexity increases.
And I'd like to also maybe reinforce what Nick
alluded to in that there is this proactive care model
in place in GP surgeries, with particular emphasis
on the patients that are the most vulnerable,
called the enhanced care pathway,
which again is mentioned in the model.
Services like Quick Start with effective social care
immediate on discharge provided by CLCH
are working really well with GPs.
And then there's the Urgent Community Response Service
that GP practices try and ensure that patients are seen
within two hours of presenting
by the new total trial system.
So all of these services are in place
and working effectively and probably contributing
towards this reduction in urgent admissions.
I'd just like to take this opportunity
to encourage the newer model of discharge and re -enablement
to link up as much as possible with GP surgeries
is because one of the things we do face on a regular basis
is not having all the information at our fingertips
when patients have been discharged,
when we have the means and capacity
to improve the seamlessness of that transition.
And my final point is, within every surgery,
within Wandsworth, to the best of my knowledge,
there are allocated members of staff
called care coordinators, and they could effectively
could we take on the role TMO is struggling to find
in navigating the NHS?
Even as a doctor patient,
navigating the NHS can be challenging, to say the least.
So if the information was shared about a discharge
with primary care more regularly
and they were incorporated more into that pathway,
care coordinators could take on that role
and ensure that advocacy was maintained.
Thank you.
Again, a very useful and important point.
But I was gonna suggest, unless anyone wants to make
a note or comment, I mean the Medicare fund is reported
to the Health and Wellbeing Board once every three months.
I mean, I know meetings don't always take place
once every three months, but they are reported quarterly.
So there is plenty of opportunity to follow up on this
and to check that things are happening.
So as I said, unless anyone has any burning questions
or comments, what I was gonna ask you to do,
Brian and also Lynn, I think we've heard some very useful
and pertinent comments from people.
If you could go away and reflect upon those
and then at the next report to the health well -being board,
if you could just summarize what actions
or what proposals you have in relation to them,
I think that will certainly go a long way to dealing with those issues.
Do you wish to comment?
No? Okay.
Just check.
Oh, Philip, sorry.
Have you got your hand up?
I have, Chair.
Sorry, I know it's painful when you're not in the room.
Me neither.
As you said earlier, I'm behind your head.
I suspect Lyn might be able to second guess what I'm about to ask.
So in the first paper, we reflected that some of the targets we haven't been hitting and,
you know, we heard that there's work ongoing with St. George's and other providers to reflect
on that.
And equally, even where we are hitting the targets, I wonder how much we've looked at
how we're delivering the targets or indeed the services that in many cases we've had
in place for many, many years and reflecting do they still give us the outcomes we want?
do they still, or sorry, and in addition, do they reduce health inequalities and target
those most in need populations rather than just rolling over the same process and the
same contracts, delivering the same things. It's a bigger piece of work and would need some
potentially tough and very difficult decisions, but I just wonder whether or where we've got in
that process because we have talked about it a number of times in the past but neither
of these papers to me have brought that out and where that review or thinking has got
to.
Okay, yeah, interesting point.
Would you like to comment on that briefly at all?
Hi.
I think, Philip, we have reviewed it and you're right, it is complex and it is, it's not
in the services that we need to change, it's the how we deliver them. And as a system,
we are committed to thinking about it. At the moment, there's a lot of focus as we've said on
the hospital discharge and specifically in how the integrated transfer of care hub supports that to
be effective. And the second thing that I think there's a lot of discussion around where we need
to start landing it into action is in that intermediate care
space.
So whereas we've got a lot of good services which
deliver excellent outcomes, we need
to create more coordination between that.
So we stretch our resources just a little bit further
and meet the needs of more people.
So I think that you have absolutely
been heard on the health inequalities thing.
It's a really important analysis which, to be frank, we probably haven't done sufficient
justice to and we will report on that next time.
Excellent.
Thank you, Chair.
Yes, thanks for that very important point and thanks, Lynn, for that answer.
Health inequalities is, as far as I'm concerned, what drives us in relation to virtually every
single item on the agenda.
So it is vitally important we do monitor that.
So I already summed up, which is basically
the asking Brian to go away,
take on board the very pertinent comments
which members of the board have actually made,
and to bring the paper back as is routine
to the next meeting of the health and wellbeing board
with some commentary on the proposed actions, et cetera.
Now with that, for the sake of formal record, can we move to the recommendations?
First of all, in the end -of -year update, the decision of the recommendations in paragraph
1 to sign off the Medicare fund plan end of year review for 23 -24 is set out in the report.
And secondly, to note the demand and capacity plans and assumptions which feed in to the
planning of the 24 -25 Medicare fund refresh, which we will come on to shortly.
Can we agree those recommendations in relation to the end of year report, please?
Thank you very much.
Moving to the refresh, which was paper 6, paper number 24251, the recommendations from
that is to sign off the plan refresh for 2425, set out the report, and to note the refreshed
better care fund demand capacity plans and assumptions for 2425.
can we agree those recommendations as well please?
Thank you very much indeed, yeah thank you.
And again that's another very good discussion
that usually takes place in the health and wellbeing board.

7 Joint Local Health and Wellbeing Strategy Delivery (Paper No. 24-252)

Now the next item is the joint local health and wellbeing
strategy delivery, paper number 24252,
page is 5968, it is a report by Shannon,
the director of public health.
Would you like to introduce the report
or delegate it to someone else, thanks.
Thank you, Chair.
I'll roll up my sleeves on this occasion.
I'm really excited to present this report,
which marks the start of the delivery phase
of our joint local health and wellbeing strategy,
which is 19 Steps to Health and Wellbeing.
The purpose of this report is to recommend a proposal
on the delivery arrangements for the strategy.
As the board will be aware,
the strategy was collaboratively developed
with system partners to ensure that there'd be joint
ownership of the agreed priorities
and the subsequent actions by the different system partners.
This report presents a proposal for delivering,
monitoring, and oversight of the strategy
over its life course.
The strategy will be delivered through the health
and care plan with each step prioritizing specific
activities over the next 12 to 18 months.
The key points to highlight in the report are the key roles that have been designed to support delivery and oversight,
which are the step sponsors, step leads and action owners, and these roles are outlined in Appendices 1 and 2.
The Board will note that significant progress has been made in identifying people to fill these roles,
although we still do have a few gaps, so this is a work in progress.
The steps particularly around mental help for both adults and children, childhood immunizations
and screening, I think still require further consideration in terms of sponsorships.
I welcome any comments or offers around the sponsorship of these steps.
We will update the board using the bulletin after this meeting once we've clearly identified
and confirmed all the roles in the appendix.
The second point to highlight is table one,
which outlines when each of the life course areas
start well, leave well, and age well,
will report to the Health and Wellbeing Board on progress.
The proposed timetable is indicative only,
and we're happy to adapt that
to the requirements of the board.
If the board requires certain steps to be brought forward
or pushed back accordingly,
then we will work with the step sponsors and leads
to accommodate that.
Finally, I just wanted to highlight the last appendix,
which is an example of the form that the updates
will take to the Health and Wellbeing Board
and gives you a flavor of some of the information
and the snapshots that will be brought
to the Health and Wellbeing Board
to provide assurance that work is happening
and also be able to highlight some case studies
demonstrating the impact that is actually happening
for residents in the borough.
May I also take this opportunity to thank Fusi Adeki
and her predecessor for all the work that they've done
to get us to this point.
It has been a long journey, but finally I think we're getting
to the point where we're actually delivering
on the priorities and being able to report on them.
The Health and Well -Being Board is recommended
to note the report and agree proposals
for coordinating the delivery.
I'm happy to take questions.
Thank you.
Thank you. Any questions or comments from members of the board?
Yeah, thanks.
Thank you, Chair. I think I may have joined after the paper was prepared,
and just to confirm that the childhood immunization and adult immunization gap for the STEP sponsor will be me.
Thank you.
Any other comments at all?
Just on the screening, I think we will take that back into our organization as well to
see if we can identify someone to sponsor.
I said we will take the screening step six to eight just to kind of see if we can identify
a spot.
That's excellent.
Good.
Any further comments?
Yeah.
Lucy.
Yes.
Just to comment on the screening update,
we do have a provisional name of Sophie Ruiz on there.
So it would just be good to get your reflections on
if you're happy with that representation.
And Lucy Sneddon as the step sponsor.
Good, that's excellent.
Anyway, thank you for your comment, Robert.
Then any further comments?
I think you got off lightly, Shannon.
But I mean, it is a comprehensive piece of work
and the reason why there aren't any questions
is precisely because you've involved everyone
that you needed to involve, which is as it should be.
So hopefully we can move to formally agreeing
the recommendation and it is simply to note the report
and agree the proposals for coordinating the delivery
of the Joint Local Health and Wellbeing Strategy
as set out in paragraph six to 22.
Are people content to agree that?
Thank you very much indeed.
And obviously the actual delivery of that strategy
is really the key thing.
So I'm sure everyone will play their part in that.
Anyway, thank you very much indeed.
So we can now move swiftly on to college substantial work

8 Health and Care Plan 2022 - 2024 Final Report (Paper No. 24-253)

paper, Paper 8, which is the health and care plan of 2022. It's a 2024 final report,
Paper No. 24253, pages 69 to 140. So this is a report from South West London ICB,
place executive Mark Creelton. Thank you very much. So buckle down, we're going to go through
every slide, slide by slide.
We're not.
No, you're not.
You're definitely not.
So just to say that the health and care plan very much aligning
to the health and well -being strategies.
We had a two -year plan and we are bringing this report back
as a kind of closure document for that plan.
Mary's going to kind of give us the highlights in a second.
But just to say moving forward, we want to make sure
that absolutely the 19 steps and any health and care plan are absolutely one in the same
and we are really aligning those activities including things like time frames.
So we want to align some of our time frames so we're not repeating a health and care plan
every two years, we can do it in five years with the health and well being strategy.
Mary will then take you highlights through the report.
Mary please.
Thank you Mark, thanks to the Chair. So as the Chair noted, we are talking about the
report that is detailed on page 69 to 140. If I can, and I will take the paper as read,
so if I can just re -remind ourselves of the vision that the Health and Care Committee
identified back in 2022. So to provide the same life chances for all residents in Wandsworth,
healthy, independent and fulfilling lives, dynamic, thriving and supportive communities
and equal access to health and social care. As Shannon has outlined, the approach that
we took for the previous health and care plan was start to live and age well. Again, we
have detailed the vast number of projects that were delivered and I will just really
quickly touch very high level on a few of the fantastic results that we achieved. So
the Promoting Alternative Thinking Skills or paths in the Start Well, we increased the
uptake in schools and the students that were supported around emotional literacy and resilience.
100 % of the teachers and head teachers felt it was very useful and 80 % of the pupils had
a very positive experience. Again, childhood obesity, the number of schools achieving the
awards for healthy schools in London. In the live well section, we had some physical health
activities that were really targeted towards the specific communities where they were able
to identify health needs and then signpost them to the relevant healthcare professional.
Mental health and inequality is a fantastic program around active wellbeing, which had extremely low DNA rates and really strong engagement in completion.
Again, apologies. There are lots and lots of projects rather than me going through and I know we are overrunning.
I guess I just wanted to say a huge thank you to colleagues that assisted in delivering this program.
If we note, I said one of the earlier things was about how we are working together as a system,
and I do think that the health and care plan really demonstrates that from a delivery perspective.
I also wanted to extend my thanks to the partnership group.
So as Shannon outlined in the previous item, we want to plan to essentially revive that partnership group for the new health and care plan.
but again I think the previous iteration, a real strong group that really drove and challenged the
projects but also offered the support where required. If I can just highlight three
challenges that I think were common across various projects. Workforce, so again if we can think
going forward around how we're recruiting, thinking about staff turnover, but equally how we are
advertising roles that they are appealing.
Equally competing pressures.
So health and social care,
equally our local authorities,
equally education, as well as our
voluntary community sector.
We are all overwhelmed, but equally
thinking about how we can try and align
some of those priorities and
work together to deliver them.
Finally, around data.
So again, I think the partnership
group were very strong around using data to make sure we are driving the impact and the
changes we are hoping for. But just to note, some of our data isn't always immediately
available. So for example, it may be academic year focused, etc. And so how we are assuring
ourselves that the projects are making the difference, just to be conscious of that.
So I'm asking the board if you can note the activities that have taken place and to approve
the report. Thank you. Thank you very much Mary for that quick run through the highlights
of the last two years. Any comments or questions from members of the board? I don't suppose
even yes. There's really a comment, I mean I think there's excellent stuff so you know
I think that was read.
The thing which I always struggle a bit with these reports
and applies to all of us is keeping a long -term perspective.
I mean, this is obviously, and by its nature,
reporting on two years' activity,
and by definition, two years' activity,
a lot of activity, but the data is always going to be
a little bit, you know, what it's telling us, really.
And I'm not sure whether this is the right place for it,
but somewhere I kind of feel the need.
We ought to be always reminding ourselves
a little 10 -year kind of perspective.
You know, are these problems actually getting better or worse?
And this report might not be the right vehicle for that, but somewhere I kind of feel the
need to have that.
Otherwise, we drown in lots and lots of activity, lots of quite short -term statistics, you know,
we hit a target, we didn't hit a target, all that stuff, which are all important and essential.
But keeping an eye on, you know, are things actually improving or staying much the same
or getting worse is kind of hard to see at times.
Yeah, very rather than a fair point,
I sometimes raise this myself in relation
to a range of different things, so Shannon.
Thank you, and that's a really fair point
in relation to the outcomes, which is something
that obviously from a public health perspective,
we're always focused on and keeping an eye on.
You'd probably be aware of the Public Health Board,
which is a combined Wandsworth and Richmond board
that I chair, part of that board's responsibility
is to look at and review public health outcomes
using the national framework, outcomes framework,
and provide a longer term view and oversight
on how things are changing and the trends
exactly as you said.
Earlier this year at one of our quarterly meetings,
we did have such a review, and you'll be aware
that on an annual basis, we do then report back
into the Health and Well -Being Board
on the work of the Public Health Board.
So I'd definitely be very happy to share some of the
highlights in terms of the longer term indicators
that we're both pleased about in terms of progress,
but also the ones that we're concerned about,
where we feel that there should be more
concerted work to do.
And a possible recommendation for the board would be
whether it would like to consider a high level summary
of the kind of snapshot of the public health outcomes
framework in all their 121 of them,
And just, you know, I mean, it's rag -rated, you've got the comparisons to London and England,
but you know, very quickly you can kind of get a snapshot of areas that, as a system,
we should be concerned about and areas where we've got good improvement.
So that's an option as well.
Thank you.
Yeah, fine.
Thank you, Shannon.
And I think that's actually a very good suggestion.
Perhaps we'll put it on the agenda when we haven't got quite so many agenda items.
But yeah, no, I do think that's very important to monitor things over a much longer period
of time.
Naomi.
In the previous report and in this report, there are a number of diseases and health
conditions listed as focus for care and improvement.
Being a pediatrician, I'm just – let me surprise that one of the most common chronic
childhood disease, type 1 diabetes is not on the list.
Type 1 diabetes is a very serious condition.
I mean, obesity is an issue, but type 1 diabetes
is actually shortened the lifespan by 10 years.
And early complex healthcare delivery system
and support for patients with type 1 diabetes
and their parents would be a major focus, at least probably because I'm a little bit
biased because I'm a pediatrician, but I know the healthcare impact of type 1 diabetes,
and on that note, it's at least a serious issue, if not more, than childhood obesity.
In fact, every single hour, there is one newly diagnosed type 1 patient in the United Kingdom.
Every single hour.
This is a very serious issue and I think I would recommend the board to consider to put
some focus on this.
I appreciate it.
Yeah, I'm starting to get one.
Yes, so perhaps just to remind people of the status of this plan and what we were required
to do and what we've done with it.
So this was at the beginning of where South -West London became an integrated care board, and
each place, Wandsworth being our place, was required to put together its health and care
plan.
And we had a whole process where we talked to lots of people and tried to make sure that
we were going to be focusing on the right things because we knew we couldn't focus on
everything and what we wanted to do was make sure we were focusing on things that we could
do better at if we worked at them together.
And so I completely understand your point of view regarding childhood diabetes, absolutely,
but there's lots of work goes on with that all over and obviously we can be involved
in a lot of that in our general practice services and caring for children generally.
But it wasn't in the plan because of the process that we went to to decide what it is that
we can achieve together.
So I remember Stephen saying at the time, hang on a minute, waiting this is very long,
why aren't we dealing with that?
Well, because actually that goes somewhere else and we didn't think together that would
have been where we could have most impact.
So that was just to kind of remind people where we got to with this.
The complicated thing is that we've got lots of plans around.
And trying to align them all and make it make sense is really important.
I'm really struck by what we've been talking about, about the 10 -year thing,
because of course we've just had the Darzi Diagnostic,
which has been looking at how we've got to where we are
and what the problems are in the NHS
with related issues about social care, of course,
because you can't look at them in isolation.
And we're going to be having a 10 -year plan coming up in the spring.
So, do you know, it's a really good time to take stock
of what we've done throughout a decade.
And some of us were sitting here a decade ago.
So I'll remember what we were doing
and I'd be really pry was looking at a longer term view
of where we are because with some of these things,
they were important 10 years ago
and they'll be important in another 10 years.
It doesn't mean to say we shouldn't keep trying.
And they might've got worse
if we hadn't been doing what we're doing.
They might not have got better,
but there are some of these things
that are out of our control.
and I think we need to make sure that we understand
what it is we can impact on
and what we can collectively do to most effect.
Yeah, absolutely correct.
I mean, perhaps we could sort of take offline
with meeting the issue of type 1 diabetes amongst children
and give you some further thoughts.
I mean, clearly it is a serious problem,
but Nicola's equally correct
the health and care plan is very much directed
at what we can immediately impact upon
and have the greatest impact on.
But perhaps we can take the issue of childhood type 1
diabetes offline and give some further thought.
Nikkei.
Hello, yes.
Just to add to the general discussion,
I really agree and welcome that the talk
about taking the longer term approach
but I just felt I needed to remind us
that the health and care plan,
the joint health and well -being strategy
all came from the back of taking a long -term plan
by looking at the Joint Strategic Health Needs Assessment,
which did all of that,
highlighted some of the key things,
and that's what informed that.
So while, yes, we want to look at the 10 years,
we will probably need to think about
which point do we want to take the data from
and do that look.
So I just thought before we leave here thinking
let's go and do another, the past 10 years,
it's that we have that data, we refresh it,
as I'm going to highlight when I get to my part.
But that doesn't mean that things don't emerge
and we will pay attention to some of those emerging points.
The only thing I wanted to also ask
with your permission, Chair, is how we start with linking,
if we're looking at a type one diabetes,
really linking with the people who see it,
because it's always, as Nicholas said,
getting the data and knowing where it's happening,
and that's what would lead into really understanding
how we address it, as we can see with even the
autism pathway.
So those are kind of the reasons why some of the,
not small numbers, but the ones that don't cut across
everything don't necessarily make it into
the Borough Health and Care Plan.
Thank you.
Sorry, Chair, can I just add a comment?
Because I think whilst colleagues have been thinking
of what I came to present today was the past
Health and Care Plan, I guess what we are planning
to do going forward is what Shannon outlined earlier.
And so at the moment, childhood diabetes does not
feature as one of the steps, but equally around
childhood obesity, physical activity, et cetera,
absolutely does. Now if for example there is a subset of the overall step that we absolutely
want to focus on which may be childhood diabetes, absolutely, but again I think we should as
colleagues have already outlined be doing that as a system opposed to being reactive.
And secondly again just to pick up the points around the long -term plan versus the short -term
plan. I think we need to do a both and and. So absolutely we need to be thinking about where we
wanting to get to, what's our vision over the next 10 years, but equally what are the marginal gains
we're going to achieve to be able to get there. And so again I take the point around maybe we
should be thinking from the partnership group, are we still keeping our eye on the long -term vision
rather than just thinking about this is our two -year plan, this is our five -year plan etc.
Thank you.
Yeah, thanks Mary again, another very helpful contribution.
Given the time, and people really have something very urgent to say, I mean as Mary quite rightly
points out, this is actually a final report on activities 22, 24 and obviously further
work is going to be done on a new report etc, a new plan. So I'm sure that the
authors of that plan will take into account again the very pertinent
comments from members around the board but if we can move to a decision and
recommendation is that we simply note the activities delivered under health
care plan 2224 and approve the final report attached as appendix one to the
report but I should say I think there has been as Mary indicated very
substantial and significant improvements and successes and whilst clearly we need
to also focus upon those areas where we haven't been quite so successful I think
you know that it is thus demonstrate the value of a plan like this a targeted and
focused attempt to address some of the most serious issues
impacting upon our population.
So with that, can I ask if you agree with recommendations?
Thank you very much.

9 Homelessness and Health Needs Assessment (Paper No. 24-254)

Next item, which again is a very substantial
paper and discussion,
Homelessness and Health Needs Assessment.
This is paper 24254, pages 1412224.
This is a report from Shannon, Director of Public Health.
Thank you, Chair.
At this time I will hand over to a colleague in the gallery, Jabir Draman.
Welcome, Jabir.
Yes, thank you.
My name is Jabir Draman.
I'm the public health lead covering homelessness and health.
Just to give you, I'm just gonna give you a background regarding the report and then
I'm going to hand over to my colleagues in housing just to give an update in terms of
their provision and services that they provide.
So in terms of the report and the needs assessment, we hadn't undertaken one for some time.
The last one was conducted in 2010, but that was drafted and never published as we were
in the NHS and then transferring over to the local authority.
The pandemic and COVID -19 really brought to the fore the need for us to do a needs assessment
because the trigger was Everyone In, which was the then -governed initiative around bringing
in rough sleepers and providing temporary accommodation to them during that period.
And through that engagement process, we identified substantial significant health and well -being
needs, particularly for our rough sleepers within the borough of Wandsworth.
So the needs assessment was principally undertaken by engagement with stakeholders and service
providers.
We didn't directly engage with people experiencing homelessness because of COVID restrictions
at that time, but we did get significant input from frontline staff engaged with providing
support such as colleagues working in housing, such as colleagues working at St. George's.
So the needs assessment we carried out in 2022 finalized in 23 and published earlier
this year and some of you may have seen the report in the place committee which I think
it may have gone to.
In context of South West London, Wandsworth has historically had the second largest number
of rust sleepers and statutory homeless applicants after Croydon.
And so it is quite a prominent issue at a borough level.
The needs assessment highlights eight key issues
and they are to, as a system,
to increase collaborative working across the sector
to improve the health of people experiencing homelessness,
to improve the mental health offer
for people experiencing homelessness,
to reconsider where and how services are delivered,
especially for Rust Leapers,
to improve the primary care kind of appointments
for rough sleepers as well,
improve access to preventative healthcare support,
particularly around the industry,
podiatry, and musculoskeletal services,
better targeted collaborative working
to reduce health inequalities,
increasing social support,
and finally, adapting as a network
to support people experiencing homelessness.
And that, again, links into the need
for collaborative working.
So since the needs assessment was carried out,
we've had considerable joint working,
especially with colleagues in housing,
our substance misuse team, as well as the ICB.
And we've had a number of initiatives,
such as the Health and Well -being Days
being delivered by SPEER, our outreach,
homelessness outreach,
organ charity that we commissioned via housing,
and the Driving for Change bus,
which is around providing support for rough sleepers,
particularly around wound care
and kind of initial dentistry assessment,
particularly in the Clapham Junction area.
So the other initiative that our colleague
in Housing will highlight is around
our new rough sleeper assessment hub in Lavender Hill.
So there are further work to be undertaken.
The ICB is currently, through the Southwest London
Homelessness Working Group, is looking at a strategy
around how they take forward the recommendations
outlined in the needs assessment.
And I think they'll be developing paper early next year
for presentation to the health and well -being board,
as I understand.
We, within public health, will be working with our
colleagues in housing and setting up a six monthly meeting to then progress the key recommendations
and working with colleagues within that forum.
Just as a kind of follow -on, I'm just going to hand over to my colleagues in housing to
highlight their initiatives.
I'm not sure if Dave Worth is online.
Is he online?
So I'll give it over to Dave and then Michael from housing.
Thanks.
Yes, thank you, Chairman. Good evening. Good evening. Good afternoon, colleagues. So, yes, we have been successful pretty much on the back of the Everybody One initiative, although we were building it prior to that in really building our Rough Sleeper street homelessness service over the last four or five years.
The previous government and the current government have put significant monies into that and
we've got, we've drawn in several million pounds of funding.
Part of that goes to our street outreach work where we have our main partner charity, Spear,
out in the early hours of the morning twice a week verifying where the rough sleepers
where they've been reported by members of the public,
through the street link service, et cetera,
seeking to engage with them
and seeking to find a housing solution.
So this report is very much welcomed.
It adds a lot to that piece.
And chair with your agreement,
I'll hand over to my colleague, Michael,
who's leading and is very, you know,
invested in the development of the Hubbard Clapham Junction
and he can explain to members of the board
how that's gonna work and how's it's going.
Thank you.
Welcome.
Yeah, thank you very much for having me.
I'm very glad to update the board
on all the work that's going on in this field.
As Dave just mentioned, we've had quite a rapid development
of street homeless services in Wandsworth.
Only five years ago, there were no services whatsoever.
So throughout that process, we've essentially been able to recruit specific services and roles to sit within statutory services because of the multiple disadvantages that street homeless people face.
Those specific services are required.
So we've had a lot of really, really good outcomes since the start of COVID.
We've housed about 700 people off the street, which is obviously great.
However, we still have people who are currently street homeless, and they at the moment fall
under three categories.
So those with a considered low need, low priority need in terms of vulnerability, those who
are extremely entrenched and find it very hard to engage with services or accept offers
of accommodation and those with no recourse to public funds.
So essentially, we still have people on the streets.
If we're able to offer accommodation,
often that's temporary accommodation
that's very far away.
And we've got lots of bespoke services, which is fantastic,
but they are spread across 15 different buildings
across the borough.
So that is where the hub concept came from.
So thanks for bearing with me for that little background.
I think it's helpful to explain where this whole project
So essentially the hub will offer a local accommodation space for people who are currently
street homeless who are currently not accepting that offer.
So that really applies to a lot of the entrenched people who won't go to Croydon because it's
outside of their support network.
And we're not going to be applying any kind of priority need requirements.
So anyone who's low, sort of assessors being low needs would be placed in that building
as well.
The other very exciting side of this is that we have made,
we haven't filled the building with bedroom accommodation.
We've made a large provision for office space.
So essentially, if you are a service who supports people
who are street homeless,
you will be co -locating into this building.
And that lends itself to all of the points
that Jabu was making about collaborative working.
Essentially, at the moment you've got someone
who is street homeless, might have to engage
with their outreach worker, housing worker,
drug and alcohol worker, mental health worker,
social services worker, and it's essentially,
it's very, very difficult for that person to do that,
and for services all to work together.
So essentially, by bringing it all under one roof,
it also presents us with another opportunity
for a new way of working, which is my last point,
which we're very excited about,
which is our super outreach approach.
That essentially is based on two main principles.
One is that every door is the right door.
So regardless of what service someone who is street homeless
comes into contact with, it will enable them to access
any other service within our pathway.
And the second principle is that no one should have to
keep on repeating their story.
We essentially have a cohort of people who are
street homeless that I would say the vast majority of which
have trauma in their backgrounds and expecting people to
repeatedly go over their story.
And I'm sure we all go to the doctors
and you get a new doctor,
you have to repeat everything again
and it's frustrating for us.
Imagine having to do that with six different professionals
all the time.
So this super outreach approach essentially means that
someone who is street homeless
would pick their trusted worker
and it could be anyone that they have
their best relationship with
out of all of these different services that are involved
that are all based in the hub
where this person would be staying.
And that trusted worker essentially coordinates the work.
Doesn't do the work of the other people,
but essentially coordinates the work of everyone else
in the sort of team around me approach.
So that approach requires not only the people
who are all involved in the case to be talking
to one another and letting the trusted worker
communicate that to the person involved,
but everyone in this approach also needs to know
what each other's jobs are.
You know, and I think at the moment,
if I ask my outreach worker,
what exactly does a drug and alcohol worker do,
they wouldn't be able to tell me.
And I think that's also really exciting.
And yeah, we're essentially gonna be asking people
what do you want rather than what's your,
what's your, are you a heroin user
or are you paranoid schizophrenic?
It's more of a strength -based approach, what do you want?
And yeah, we're basically sort of like,
yeah, starting afresh and thinking actually
how is the best way to support this
extremely vulnerable cohort?
Happy to answer questions.
Thank you, Michael.
I mean, I was very pleased to see
this particular piece of work.
It is very important.
It's really good to see housing colleagues
that are working with our social care,
et cetera, and children's, et cetera.
That is how we need to go forward,
a very holistic approach in relation to that.
And also, the one -stop shop you described
in terms of the facility, again, absolutely essential.
So really pleased to hear this.
I know time is pressing.
I'm not doing a very good job as chair,
but we have quite a lengthy agenda.
But can I ask, I don't wanna suppress any discussion,
but can I ask if members of the board have any comments?
Ariane.
I'll try to keep it very brief.
I just want to thank you all
for a wonderful presentation of some really visionary work
and just how it's your vision of actually collaborating
and centering it around the individual for their needs
is really inspirational, I think to the extent
that Philip might not be asking questions
about identifying the most vulnerable patients
because clearly that's where you've started.
The HIT team in St. George's has changed cultures
amongst doctors so that homelessness is really on everyone's radar.
And again, I've seen that being quite transformative in junior doctors.
There was just some mention about whether they would get ongoing funding.
And I was wondering if there was any update as to the continuity of that,
because you're very thin on the ground in terms of capacity,
looking at all the data you've submitted.
So I wholly support the work you do and applaud it.
Thank you.
So just.
Yeah, sorry, can we take over comments
and I'll come back to you at the end.
Stephen.
Yeah, I wanted to thank housing colleagues
and Public Health for this paper.
We've always said that housing is one of the major
determinants and it's really good to have us
a proper discussion about it at this committee.
So congratulations on a very thorough piece of work.
and welcome very much to the work you're doing.
Two sort of follow up though.
One is you have identified, the paper,
it doesn't include an action plan as such, I think.
So there's a kind of step to go
and you obviously are doing a lot of action,
so that's welcome, but I suppose the question is,
are all the recommendations here being picked up somewhere?
My other question is, this is a really important aspect
of housing, but there are other aspects of housing that we might want to consider.
And think about the quality of housing.
I mean, people are not necessarily homeless, but are living in poor accommodation.
And I don't know at the moment whether that is a big issue in Wandsworth or not, what
data have we got, and what processes have we got to address that where it is an issue,
and including links between GPs where they're picking up issues like asthma in children,
that kind of thing, and housing.
So I think there's another dimension of housing that would be really useful at some point
to address as well, but very strongly welcome the fact that having a conversation about
housing at all at this point is really important.
Thank you.
Yeah, I mean, I'm glad to say if I address that from a council perspective, I mean, one
One of the objectives of the administration is to ensure much more joint up working between
the various departments within the council.
And I think this is actually a very good example of what's been done.
I mean, the paper is very specific about homelessness.
And there is, of course, a legal definition of that, which is actually set out in the
paper.
The other points you make around housing are entirely valid.
And I do know we spend a lot of time in cabinet talking about how we can increase the housing
stock and actually improve it and repair it.
I mean there are certainly some parts of the housing stock which do actually need urgent
maintenance which has been neglected for a very, very long time and is now catching up
with buildings, many erected before the Second World War.
So your point is entirely valid, I think, but this paper is very much focused upon homelessness.
I mean, we can look at the other issues, of course, in due course.
So any other comments?
Yes.
Oh, what about you?
Shall we go to Dave first?
He'll probably disagree with everything I've just said.
No, Councillor, not at all.
Just to amplify.
I mean, you're right, this paper is focused on the health needs of homeless people and
Michael has just spoken about the arguably the most vulnerable amongst the homeless,
those who are literally without a home.
But on the broader piece, the problems described are generations in the making, I think.
So we've got an aging stock, we've got a large stock of social housing, but it's aging.
We spend a lot of money repairing it.
But just some points to mention.
So members of the board are probably aware
of the Thousand Homes Program.
So that's where the council is building 1000 new,
modern, decent, affordable social rent homes
across the borough.
We're currently up to rough numbers,
about 300 odd completed and let another 300 odd onsite
at the moment and another 300 odd at the pre -planning stage. So we went on track to achieve that.
The other thing to mention I think to pick up the health related impacts of things like
overcrowding, damping mould and so on which we all know have been highlighted in recent
times is that where the council is doing its regeneration schemes on the Winstanley York
Road and currently out to consultation on the Alton Estate in Roehampton, the new homes
are designed around the needs of the people whose current homes are being replaced. So
if someone's in a two bed and is overcrowded, the design of the regenerated estate will
meet their need, not their current property size. So those are things that we're doing
which are both in the department and across departments,
all positive on this agenda, but really, as I said,
the problems are generations in the making,
and it's really for the new government to set out shortly
where their priority on housing is going to be.
So that's something to watch very closely.
And of course, where necessary,
we would come back to the board with updates as necessary. Thank you.
Yeah, thanks Dave. This is obviously a major piece of work, one of the top priorities for
the council. We can certainly discuss how we can look at the health impacts from housing,
but yeah it is widely recognised, certainly from my perspective, housing is the principal
determinant of health inequalities and of course it stems also from income.
distribution and inequalities,
but I think that's certainly something we can take away.
Michael, quick comment before we move to the recommendations.
Yeah, just coming back on the comment
about the homeless inclusion team.
Yeah, I know we're short for time,
and I want to do a whistle -stop tour,
but I think I forgot I was presenting to the health board.
We are very much linked in with Danielle Williams
and the amazing work they do at St. George's Hospital.
I'm also very aware of the precarious nature
of that funding.
One of the benefits of doing all of this
and the cross departmental shared responsibility
and approach to commissioning is that we can look
at things like that in terms of funding.
So we're very aware of that at the moment.
And yeah, just a last point.
The Danielle Williams and the homeless inclusion team
and Dominic in particular been fantastic at designing
and sort of the clinical space that we have at the hub,
which is a specific space that will have medical equipment
from St. George's Hospital there to be able to deliver health interventions for people
where the average deaths of males is 45 and women is 43 for people who are street homeless.
So just as a last sombre point to end on.
Sombre thoughts indeed. I mean, I think Stephen raised a very important point in terms of
what follows the needs assessment. Usually what follows the needs assessment is then
an action plan or something very similar. So I think, you know, this paper actually
said its purpose. Hopefully we can agree with the recommendations, but I think certainly
looking forward we'll obviously be looking to see actions arising from this as to how
we're going to address those recommendations. So unless again anyone's got any burning comments
So please.
Thank you, Chad.
Taweena Smith here on behalf of our Assistant Director for Strong Green Safe Heart, Kiran
Bagraw, which gives her apologies.
Just welcome this report and some of the work which our community safety team are also doing
alongside our housing partners and SPEAR in terms of the outreach.
One of the areas which we, in terms of getting those interested, like interest from communities
around the perception around Ross Leepers and also some of the difficulties and
wider experiences that they may face and maybe the council not being perceived as
doing enough so I think we definitely welcome the fact that we'll have this
happen we'll have this initiative available to those individuals and we
definitely welcome the work which will pursue in regards to those who are
really hard to engage or maybe find it difficult to access services to support
them in terms of moving on. My only consideration around this was around the
the transient nature of some of these rust sleepers
in terms of coming maybe in and out of the borough,
maybe not engaging as well,
but then reappearing again in another part of the borough,
and where our community safety officers
and ASB team are kind of picking up
and having to take enforcement action.
So just thinking of that in terms of the second part
of your action plan to build into that work.
But happy to work alongside you with that work.
Thank you.
Thank you, Chair.
Yeah, I find thanks indeed,
and of course, community safety are an integral part
of the total holistic approach.
So can we move to the recommendations,
again, contained in paragraph one,
to know the findings of the needs assessment.
I think we've provided feedback on the implementation
of the recommendations.
We'll take that away and develop a plan
and just support the dissemination of the findings
from the needs assessment.
Can we agree those recommendations, please?
Okay, thank you very much.
Now I have found miserably to keep this on time
to two hours.
We have got through quite a lot of stuff.
I do know that I think there was intended to be

10 Interactive Semi-Automated JSNA Production Update (Paper No. 24-255)

a presentation in relation to the next item,
interactive semi -automated JSNA production update.
I think if whoever is presenting that,
which is I think Nikkei, it is important,
If you could try to keep it as, I mean, I know it's a complex area, but if you could
try and keep it as short as possible, I think that would be much appreciated.
Thanks, Lil.
If I can just get onto it.
So I'm going to share my screen.
I will take the paper as read.
So the purpose of today, thank you very much, is just really to share, give you a chance
to see the JSNA, the automation, because sometimes people look at it and think, how do we use
it? So we've made very good progress. There's two products, the interactive JSNA 2024 and
the JSNA at a glance dashboard. They have key indicators and they're on the council
website as of July 2024. It went live onto the website.
Move to my next slide. So the JSNA, it has three functionalities,
which I will show you at the end. One is it's got a very clear web structure.
It has a JSNA guide that you can use, and it also has this process of actually updating
things which I will show you. I've got a colleague Ben Humphries online who will click into the
web link once I get to the end of this to avoid us going to and fro. We were going to do it now
but in the interest of time we'll just do it at the end. This is the other one I was talking about
which is the JSNA at a glance dashboard which we will show you as well. What I will say to you now
before we go into it because you'll be wondering when you see it can we copy
this can we cut and paste if you hover over that camera if you look when you
when it's online you'll see the camera if you hover over that you can copy and
paste and in the at a glance you can just right click now I'm going to ask my
colleague I'm going to stop sharing and I'm going to ask Ben to please take us
into the semi -automated dsna on the webpage as you would see it if you
wanted to use it. Ben, do you mind going to the web page itself first?
Yes, so when you go into the JSNA, that's what you'll see. You'll see, Ben, to the one
that has the dev, if not people won't know which one we're doing.
Okay, so normally when you go into the front you'll see JSNA and it will have DEV, so you'll
know you're in the correct interactive version and when you go into that it will give you
a breakdown of all the areas that the JSNA has.
One of them is JSNA people and then if you want to, you know, go into JSNA at the top
of it as well, you will also have the user guide. For some reason, Ben has gone straight
into the thing but not gone to the front page. So I'm trying to show you how you go in from
the front page, but we're not starting from the front page. So on the front page, you
would also have the user guide, and the user guide will take you through how you can use
this as well. So if you can imagine that you have front page with Dev and then you go in
A list of everything so you can pick which ones you want to go into yourself.
And then we were going to pick population.
Yes that's it.
So this is what it looks like.
And then you can see the user guide.
You can see a list of everything that's in the JSNA.
And why it's interactive is if it was paper you'd have to go to everything from the first
page to the last page.
But this way if you only wanted age, well if you only wanted to get something about
the population you could go directly into the population. So then now if you want to
just go to that population one just to show so people feel comfortable. So if you only
wanted something about some data you could just go directly to that and if you went on
to, do you want to go to 1 .2 now with the graph? Just because of time we're doing it
quicker than we anticipate having to do, but that's fine.
So if you've got the graph, you could hover over the graph.
It will show you all the boroughs in London.
You could hover over London.
You could hover over any of them to get the data,
to get the numbers you wanted.
So like there.
Yes, you could, you know, so you wouldn't have to come out,
you know, if it was in a document,
you'd have to go to a table.
So you could get that and you could,
and this is where I was saying,
if you wanted to copy it at the top,
just before the search, you could see a camera,
then you could, if you hovered over that,
it would help you take a picture of this chart.
Thank you very much, Ben.
Should we now go into the JSNA at a glance documents
so people can just see that as well?
So what we've also done, and this fits in
with some of the conversations earlier
about how is Trend doing, how are we doing,
how are we comparing? We have a JSNA at a glance that you can just go into it
has all of them it's rag -raised it for you so you can see and it mentions
whether it's higher than the year before or whether it's lower. It would and then
if you go into if you click on 1M so each one will have something just click
on it on one of the at the bottom yeah it is also accompanied with some
narrative so you can see the time trend you were asking for so a healthy life
expectancy and it then gives some indication about where we sit, what it looks like and
just that's why we've called it the at a glance. So the narrative is there.
Why it's semi -automated and why we're sharing this is every year it refreshes. So where there's
routine data like Fofn stuff, it will instead of us having to sit down like we had to all sit,
we've used whatever the digitalization all these things that I have in there, Python and it just
all uploads, we then upload the narrative where we need to.
And what we're trying to do is do this in the cycle
of joint health and well -being strategy
and the health and care plan.
So when you want the big refresh,
we will then also have a big refresh of everything.
That's probably what we wanted to show you.
The other two points I'll very quickly make
is just to highlight the next steps.
So the next steps will be, as I mentioned,
we'll have this periodic template refresh.
We will try to train people for the ongoing management.
It's a technical group, and I just would like to thank
InfoInsights, the provider who did it,
the JSNA working team, my colleagues Ben and Martin,
who really did a lot of work to really get this
to where it is, and to let you know what I've said already.
We'll do the major refresh in line with the cycle.
And we've also varied the contract from a two plus one because to meet the timeline
it was going to end in 2026, we've moved it 2027 so everything happens chronologically
at the same time.
That is all over to you Chair and members if you have any questions.
Thank you.
Thank you very much indeed.
I think that's a very, very useful tool for all of us,
and I look forward to actually exploring it myself
when I get the time.
But I mean, yeah, there's a lot of very useful information
there indeed.
And any comments or questions from members of the board?
Mark?
Fantastic.
It's my only comment.
That's what I like, short and sweet.
Shannon?
Thank you.
Maybe not as short and sweet.
I just wanted to highlight as context for some of the board members who may not have been there when we embarked on this piece of work
That the JSN a doesn't just support the health and well -being board. It's used by commissioners
It's used by the voluntary sector to position themselves for the market. It's used by students doing research
It's used by people wanting to find out about the borough
So actually increasing the accessibility and making it easier for people to interact with the JSN
DNA is at the crux of the reason why we produce it so that it can really be used and embedded
into everything relating to the borough.
So it's an excellent job and well done to the team.
Yes, indeed, thanks.
That was a good point, Shannon.
But do pass on our thanks to the team.
I think that really is an excellent piece of work.
Okay.
Well, if that is the case, no further questions on that.
We are asked simply to note the interactive,
semi -automated JSNA products, which are now live,
and the next steps for ongoing maintenance
and management products, including future JSNA production.
So can we agree that as a recommendation?
Thank you very much indeed.

11 Revision of the Terms of Reference (Paper No. 24-256)

Right, well hopefully the next two items
shouldn't take too long but then perhaps I'm attempting fate.
Revision of the terms of reference paper number 24256,
pages 227, et cetera, report by Jeremy De Souza,
director of social care.
And Lynn, I think you're going to introduce this report.
Thanks.
So accept the challenge to make this as quick as possible.
I think the paper is fairly self -explanatory.
I hope it is.
So the key changes is just updating some of the things that there is no longer commissioning
plan, changes in the number of seminars delivered, because we have found it quite hard to set
the original target and to define what deputations are, and then noting how we might involve
wider participation in the board in our attempts to ensure that we are relevant.
It is marked up in the appendix and then there's another appendix where it's all cleaned up.
So hopefully you'll agree that it's good.
Thanks, and thank you very much, Lynn.
I wanted to say very briefly from my perspective, you know, we've been sitting here all afternoon
and we've been having some really great discussions around reports.
The Health and Wellbeing Board is very much report orientated
and we ended up, and there's no criticism,
anyone with 260 odd pages of documents.
And what I would actually quite like the board to explore
would be to invite interested groups to come along
and give presentations to the Health and Wellbeing Board.
That is including the proposed change
to the terms of reference,
to encourage deputations as well,
and that is also part of the revised terms of reference.
So I mean I do see this as quite a significant
potential change.
It will take some time to develop,
but as I said, I'm quite keen.
We have some really great discussions here,
and I often feel that sometimes they're a bit lost
though other people could benefit from them,
and we can actually benefit considerably
from other people with expertise in specific areas.
So those are two of the most important changes for myself.
Obviously recommending the carer representative,
that's the vital important part.
But any comments on that please?
Abby.
And thanks, and thanks for redoing the terms of reference.
and there's this comment from me,
which I had previously given to Luke.
So I guess FUSI is just around,
kind of we talk a lot about health inequalities.
We've gotta make sure that people who aren't in this room,
who don't talk in jargon and understand how the NHS works
and stuff understand what the point of this board is.
So I think that terms of reference have improved,
which is good, but I would encourage maybe to think
about things like an easy read version
or different languages and so forth
to try and help inclusivity,
because I think a lot of people who really need
to understand what people in this room do
don't really have the foggiest clue,
which is not a criticism anyone in this room at all,
I think is the way it is,
but I think we just gotta be really mindful
of trying to make it as easy to understand
and accessible as possible.
Yeah, that is a very good point, it is as well.
Something I do sometimes mention,
I think it's almost a function of this being
sort of port -driven really.
and obviously as you say the people around here are all part of the cohort, you do understand,
most if not all of the terms, but yeah clearly in terms of communication with members of the public,
our residents who ultimately are on the customers for everything we do, we do actually need to ensure
that people are very clear on what we mean about certain terminology.
and unfortunately every profession has its own jargon
and nine -tenths of the battle is actually to understand
what that jargon is.
So again, very well, good point, Mayd, Abby.
Any further comments?
Yeah, Nicola.
Yeah, so just on the membership,
the bit that's about the ICB membership
with the roles in primary care,
I just think we might need to work through that a bit.
We've had a little bit of change in structure and we've got an impending appointment of
a clinical director, for example, and I think we just probably need to future -proof this
a bit and if we could just have a little time to have those discussions, that would be great.
Thank you.
That would be great, Nicola, if you could.
We can just sort that out offline in terms of title, the idea of title rather than names.
Yes, exactly, and the principle of having three representatives there, I wouldn't disagree
with it.
about who they are in our structures. Thank you.
Okay, excellent. So with that matter,
then Nicola will take that away.
Any further comments? If not, can we approve the revised terms of reference?

12 Health and Wellbeing Board Work Programme 2024 (Paper No. 24-257)

Thank you very much. Right, so we now move on to what I think is the last item here,
Health and Wellbeing Board Work Program 24257, page 245,
et cetera, and this is another report from Jeremy De Sousa.
And Lynn, I think you're gonna talk to this one as well,
thanks.
And I'm not going to dwell on this,
because it's completely self -explanatory.
I'm just going to make the usual things.
If you have something you'd like to bring,
or a deputation indeed, do let WUSI know so we can put it onto the forward plan.
And if for whatever reason you can't make the deadline, just let us know and we can
shift it to a time that does work.
The thing we were hoping to – we haven't yet firmed up a date, but we were thinking
that we'd have maybe our second seminar in January or February next year about developing
our partnerships, so picking up on Councillor Henderson's intention to make this as relevant
as we can as a board, rather than just as a place where we nod at worthy papers. So
just to draw your attention to that. Otherwise, any questions?
Yeah, any questions on the board program at all?
No?
Excellent.
Well, in which case, if we can,
does the board note the work program?
But do you think, Lynn, up on the Rofl,
there are particular groups of people who,
specialists or whoever, who have a keen interest
in any issue related to health particularly,
obviously focused on health inequalities,
then I do have a chat to Lynn
and hopefully we can schedule them to come along
so we can actually have a full discussion on the topic.
So if we can approve that work program,
yeah, agreed.
So I think the date of the next meeting

13 Date of Next Meeting

It's held on June 21st, November, a bit like buses, they come along one after the other.
So we don't have a meeting since February.
And now we've got another one in a couple of months' time.
But that's unfortunately the nature of the scheduling of meetings and elections and unplanned
elections and a whole range of other things.
I think – I'm sorry, I must apologize for my very poor chairing that we've run
over by 15 minutes. But I do think we have actually discussed an enormous amount of excellent
stuff, particularly since we obviously did drop a meeting as a consequence of the elections.
But can I just simply thank you for your contributions, for attending, and also to thank any members
of the public who may be watching this and who have stuck through to the very end. Thank
you very much indeed. Thank you.
.