Health and Wellbeing Board - Thursday 21 November 2024, 1:00pm - Wandsworth Council Webcasting

Health and Wellbeing Board
Thursday, 21st November 2024 at 1:00pm 

Agenda

Slides

Transcript

Map

Resources

Forums

Speakers

Votes

 
Share this agenda point
Share this agenda point
Share this agenda point
Share this agenda point
Share this agenda point
Share this agenda point
Share this agenda point
Share this agenda point
Share this agenda point
  1. Webcast Finished

.
.
.
Hello everyone.
If I can start the meeting.
First of all, good afternoon and welcome to this meeting of the Health and Wellbeing Board.
I am Councillor Graham Henderson and I am chair of the health and wellbeing board.
I think I am particularly grateful for you coming out on such a cold day.
Members of the board, I will now call your names in alphabetical order.
Please switch on your microphone to confirm your attendance and once you have done so
please remember to switch off the microphone.
Professor Abby Carter.
Present.
Mark Creelman.
Present.
Councillor George Crivelli. George, I think you are joining us virtually.
That is correct. I am here but not in the room, unfortunately.
OK, fine. Jeremy De Souza. We have apologies from Jeremy. Stephen Hickey from Healthwatch.
I believe you are also joining us virtually.
He is not here yet.
OK, fine.
Well, he will be.
Ariam Jogia.
Present.
Thank you.
Nicola Jones.
Present.
Tiamar Auburn.
Present.
Thanks, Ar.
Mike Proctor.
This is in.
So apologies for that.
of the
borne
aging
and
joining
the Resident
leave
.
.
I would also like to welcome
Krista Shawcross, who is the chair
of the safeguarding adults board
who is attending to present her
board's annual report.
A number of officers
will of course as usual be contributing
and they will introduce themselves
as to when their item comes up
for discussion.
Again, can I ask
when you are speaking, you can refer
to the page number at the top of the agenda pack
and the paragraph number so that members of the public
can follow the discussion.
Please also, as normal, indicate by raising your hand.
Once I've invited you to speak, please turn on your microphone
and please remember to switch it off
once you have finished speaking.
Excellent.
So I think we can move first of all to the item of the agenda, which I probably should
have read in advance.

1 Apologies for absence

But anyway, apologies from Robert Garl, Shannon Couture, Philip Murray, Anna Popovici, and
Brian Riley, who has taken over as interim chief executive.
And Anna Popovici has taken over as interim deputy chief executive.
though I certainly wish them well in those roles.
Moving on, declarations of interest.

2 Declarations of Interests

Are there any declarations of either pecuniary
of the registrable or non -registrable interests?
Please declare any interests quoting the item
and paper number in which you have interests
and describing the nature of your interests,
including whether or not you will be taking part
in the item.
Can I ask if there are any interests in relation to this afternoon's papers?
I take that as no.

3 Minutes of the meeting held on 3rd October 2024

Item 3, the minutes of the 3rd of October 2024, is on occasion and the meetings are
so close together you could probably actually remember what happened at the previous meeting.
But are there any comments on the accuracy of the meetings?
Excellent.
I will sign them as a true and accurate record.
Okay, thanks.
Thank you.
Cheers.
Excellent.
I have been advised by officers
that there are no matters arising
from the
minutes.
So moving to our
substantive items,
and having had a

4 Richmond and Wandsworth Safeguarding Adults Board's Annual Report 2023/24 (Paper No. 24-344)

jam -packed meeting on the 3rd of
October,
this is a somewhat lighter
meeting,
but still considering some very
weighty
issues.
The first one is the
safeguarding of adults,
which I'm sure
you will take extremely
seriously.
seriously.
Formally, it's a report from the Executive Director, but Christabelle Shawcross, who
I introduced earlier, the Chair of the Safeguarding Adults Board, is to introduce the report.
Over to you, Christabelle.
Thank you very much for attending.
Thank you, Chair.
Thank you for having the report for discussion.
As you know, the Safeguarding Adults Board is a statutory requirement and some representatives
around the table, their agencies are represented on it, so that's the local authority, the
ICB, and the police who aren't part of the Health and Wellbeing Board.
But our role is very much to work in partnership with all our partners and particularly to
provide a way in which we can help with the health and wellbeing strategy, public health
strategy, working with children's partnerships,
and the community safety partnership.
And I'm pleased to say that we've done a lot of work
and a lot of progress on this for last year.
So the report that you have is outlining what we did last year
and of course we're now nearing the end of this year
and I'm thinking about what we're going to be doing next year.
So what I'd like to do is to draw your attention in terms of our key principle,
which is making safeguarding personal, to give you the assurance
an overview of the residents of Wandsworth who needed safeguarding and what their views
were on that, captured on our page on page 27.
I'll tell you a bit about our strategic priorities, our strategic initiatives last year, which
resulted in a more local focus.
So we do now have a strategic partnership for Wandsworth particularly, and a separate
one for Richmond, whereas before we had joint meetings.
And we did feel it was really important to have more of a focus on what was happening
within Wandsworth and enable wider community partners to contribute to that.
And I'm pleased to say that we've achieved that.
Another key area is around learning.
Learning when things don't go well and we have to set up a mandatory review, which is
called safeguarding adult review, which we report on in the report.
But also we have an ambition to look at and learn from other reviews and the children
service areas, domestic homicide reviews, and from the coroner's prevention of future
death reports.
So we're beginning to try to collate and look at what those issues are for all our partners.
And crucially, what is the role that the Safeguarding Adults Board can have in bringing everybody
together to ensure that everybody understands how to work better together?
And one of our key responsibilities is to ask agencies to seek assurance themselves
of how well they're doing, but equally to let us know how well they're doing and what
can the SAB do to help them go forward.
So in terms of the residents of Bournsworth, we had a rise in the increase of concerns
people telling us about concerns of abuse and a significant rise, 26 percent increase,
in those going forward to become an inquiry, which is when it's deemed that there is an
issue around safeguarding that needs to be looked at.
The numbers that we have, we have to report the instances of abuse.
So in fact, the 3 ,366 instances relates to 3 ,068 people,
some of whom may have had several areas of abuse reported.
And the same goes for the inquiries.
And the fact that it's been an increase to my mind is a good thing.
It means more people are being referred.
and if they don't meet the safeguarding criteria,
then they benefit from a screening
to see what advice and information,
how to promote their health and well -being
can be done in a different way.
And we do also look at what happens
to some of those people as well.
So what are the protected characteristics of people?
Well, in Wandsworth, as we know,
there's a high proportion of young people
from black minority and other ethnic groups.
And although our data shows that 63 % of referrals
are from white people, we also know that the majority
of those will be over 75.
And indeed, you can see that about 46 % of referrals
are for older people.
But underneath that, there are strong cohorts
of younger people.
And black people are usually over misrepresented
in mental health referrals.
And we do get quite a lot of instances
of safeguarding, working with the trust on that.
One area that we particularly wanted to focus on
and that links with our partnership with community safety
and the children's partnership is a growing understanding
of the needs of young people 18 to 25,
although we've actually got 18 to 34 here.
Because of the issues concerning young people
coming through the care system,
young people coming through health and education,
care plans, people with learning disabilities, or indeed people who may not be captured by
any service and who may end up with substance misuse, issues of rough sleeping, homelessness,
and we've done a lot of work to try to ensure that we understand well how those young people
can be best supported because as we know, young people don't traditionally fit around
our services and the emphasis is very much on ensuring that we've got multi -agency systems
and partners that can fit around the individual, the person, who needs different styles of
engagement than the traditional approach which may be sending a letter or just making a phone
call.
It's being more proactive.
So, I'm very pleased that we've been pushing on that work this year.
I've mentioned our local focus.
We know that within Wandsworth particularly the issues around homelessness are being well
addressed and we've had a lot of engagement with the new homelessness hub lead person
for that and Ross Sleeping and looking at how we can learn from the reviews that are
carried out and with public health on the unexplained deaths or unexpected deaths of
people to see whether there is any way in which safeguarding could have been considered
at an earlier date and brought more people to look at the support provided for individuals
themselves.
A particular issue that I raised last year was around we would like to work more effectively
with our Health Watch partner.
And I know the chair of Health Watch was here last year.
Maybe he's online at the moment.
I hope to be here to hear the report on what they've done last year.
I'm really pleased to say that we've had much better engagement with Health Watch.
We've done some work with them on carers, on our carer strategy, and trying to ensure
that carers understand where there may be safeguarding needs and how to seek help, particularly
where there may be difficulties in encouraging the person they're looking after to receive
appropriate health care, because often people don't want the appropriate health care.
and then it can end up into a situation where it could become self -neglect.
And we need to work closely with our GP partners,
community health services to identify those situations.
Another situation unique to Wandsworth is of course Wandsworth Prison,
which you will all be well aware of.
And last year, I think I said we had started to make engagement with the prison
who have had a lot of different governors.
I had engagement with the second governor last year.
We had an effective engagement meeting
with a lead person in the prison to look at the issues
around safeguarding.
And I want to stress that the SAB does not
have the same responsibility for engaging with partners
as it does with health and the police and the local authority
to have assurance on what is happening
as it does with the prison.
As rightly, the prison comes under the Ministry of Justice
and has its own safeguarding system and requirements,
albeit the local authority and the Commissioned Health
Service, or police trust, provide the health
and social care assessments for those at risk within there.
So there is an inroad into the prison on the social care
and health side.
But in terms of the protection of people within prison,
we knew from the adverse inspection report
that they've had over the past few years
a high number of self -inflicted deaths of people who were self -harming.
And I know Public Health originally were helping us look at how to provide advice to the prison
on that.
After that very good start, there were lots of changes, more issues, as you will know,
nationally and locally, within the prison in terms of what was happening.
And until a few days ago, I was going to have to say we're still trying to engage.
but I'm delighted to say that the new PRISM
governor who started in June was really keen to make links
with the community.
We met Alice Sniss, who's here, my business partner, who's
the engine room behind all of this.
We met with him, and he's really keen to engage
to attend our groups.
And whilst I'm not keen for people
to come to meetings for the sake of it,
there's got to be a definite outcome.
But in terms of the PRISM being able to understand
and what our concerns are and how we can help then,
it will be a really good start.
So one of the key areas is on the pathway
of people coming out of prison.
As you know, Wandsworth is by and large a remand prison,
so different from other prisons where people are literally
in there for a long time.
And I know through discussions nationally,
and I'm part of a national group looking
at a criminal justice framework that we
can develop with local partners.
So that would be probation, housing, community safety,
under prison where we have that, to look
at how we can work better together
when people are released.
I mean, there's a particular issue here with people
being on remand.
People turn up in court, case dropped, they're left.
And although probation are there,
in theory, to provide support, they may not always
be able to do that.
And so we want to do some more work.
So I'm really pleased that we're making progress on that.
But obviously, it's a really, really difficult issue.
They've got a lot of issues within the prison itself.
Transitional safeguarding, I've already mentioned.
And we will be wanting to do more work, develop better,
I think, integrated approach with the Wandsworth Children's
Partnership.
I had a meeting with the scrutiny some months ago now.
And we want to go back there, really,
to have a better approach to that.
We've got a more integrated service on the Richmond side, which involves Kingston and
achieving for children.
So we will be doing that and learning from that as well.
We know that the police themselves have had a lot of changes, so they are going to be
reviewing, I think, how they better engage on a more consistent basis with the SAB.
We know they're well engaged through community safety.
we have a safeguarding adults boards executive
where the police are representative
and they are reviewing that.
But some issue for this year will be
how we implement new arrangements on the MASH,
that's the Multi -Agent Safeguarding Hub
that is a Met Police Review with local authorities.
So we will be reporting on the better working there
on that for this year.
I mentioned I would look at learning
because one of the key areas we have
is learning from either where things go wrong locally,
and we think there's learning through safeguarding
adults review or other ways of learning.
And those are detailed in the report.
We actually had two referrals from Wandsworth this year,
which didn't meet the criteria.
And although there was good multi -agency working,
there were particular issues on both cases.
One we believe will probably has gone to the coroner's court,
so if there's any learning from that, we'll be looking at that.
And the other was a single agency issue around a homeless man.
And there was very good learning and new systems brought into place by the Health Trust there.
So we look at what the learning is from that.
We don't then go and look at it again.
That's not necessary.
In terms of people with learning disabilities, for which there is always a lot of concern,
particularly those in large institutions, lots of organizational abuse issues raised
nationally, but locally in terms of people who are placed either within Wandsworth or
elsewhere the NHS through its learning from reviews because people with learning disabilities
typically die earlier than would be expected.
So we do tell in the report the numbers there and the learning and the good work that's
been happening on that, but we're hoping to get some more information on the age and ethnicity
of people to see if there's anything more that we should be doing there to work on that.
Quality of services is absolutely important, and the report itself at page 31 does identify
the quality of our provider services, which are both people who are cared for at home
and people who are in nursing homes and care homes.
And I have to say that we've provided this information
via CQC, but it's a moving data set, I suppose.
And a question from Councillor Henderson just earlier
was on how do we work with people who require improvement.
Is, there were three noted here,
but my colleague here, Brian, has done a quick check
on the CQC website, and I'm pleased to say
that there are no longer three homes requiring improvement,
and it looks as if those three have gone up into being good.
And that I think is testimony to the very good
provider quality forum that Wandsworth will have
with the CQC, with health and other providers
to look at what's needed in terms of improving the quality.
It's not always necessarily a safeguarding issue.
Although I would say most issues are safeguarding
because it tends to be about the quality of care
or the quality of environment, quality of staff that's provided.
So that's very good.
And also to note that we do have an outstanding care home.
We'll also be looking again to let Councillor Henderson have that information, which of
the homes, which one was outstanding.
Is it one of either people with learning disabilities, mental health, or older people?
There's different types of homes and equally the same with our care at home services.
So, I wanted to say a bit about what we're focusing on this year.
We had our new strategy.
We've got our new local strategic partnerships.
One area which we were challenged from the ICB colleague last year was about how can
we relate our data sets to health inequalities and how can we look at improving the understanding
of safeguarding in those areas.
Well, the initial work that we've done
has shown that overall, the numbers that we have
are very small.
And in any one area, in terms of the public health,
we've looked at it, they're probably not statistically
significant to say that's really what we need to focus on.
But we've had an offer from public health
to look in more detail this year to help us see if there's
more raising awareness.
Because one of our key strategic priorities
is to prevent safeguarding, to promote awareness,
particularly with families and local communities,
about what is safeguarding and where to go to
if you're worried about somebody.
So we want to look more at those areas.
Obviously, working with community safety,
I mentioned our cuckooing guidelines,
which came out of the CIL a couple of years ago.
That will be looking at, are there particular areas
on any particular estates where there are concerns
either from local councillors, from the housing provider,
from local neighbourhood police that we need to focus on.
And that's obviously a moving target, if you like,
in terms of those areas.
I've mentioned homelessness particularly.
So we are getting more information and data on deaths
of people who were substance misuse happened
and where we can look at what the learning is from that.
Because I probably mentioned last year there was going
to be a second national SAAR review of all the SAARs in England, and all boards reported
on that, to look at the learning on those SAARs. And homelessness came up as one of
those key areas. So we work across London on that as well. But it also reflects in terms
of the types of abuse that we had reported, the majority of which were self -neglect and
neglect. That is also the national picture, although acts of omission were also quite
high, but that can feed into neglect as well.
One area that is very, very low nationally in here
is determining that discriminatory abuse was
a factor in what happened.
So we've been trying to do more raising awareness of that.
That's really important to look at the protected
characteristics, particularly in an area like Wandsworth, which
has a high proportion of people either from black minority
ethnic groups, so is racism an issue there,
or people who have physical disabilities or learning disabilities.
So is disability awareness something that we need to raise?
And obviously work with police on disability and hate crime.
So those are the areas we have this year.
There was one area I just wanted to raise,
which is not actually reflected here,
and is coming out of a cell that actually isn't a Wandsworth cell,
but we know, I think, from some of our national data
is likely to be a more general issue,
which affects, I think, public care and the ICB in terms
of the commissioning for palliative care,
and the services that are provided for people
with substance misuse and who may be nearing homelessness
or not, and end of life care.
So I just really leave that as a thought
to see how that might be developed.
I have to say that's me saying it.
I'm not speaking here on behalf of the SAB,
as it hasn't gone through the processes.
but I couldn't not take the opportunity
with the Health and Wellbeing Board to raise that.
And I'm sure that is probably an issue
that has been thought about elsewhere.
So I'm happy to stop there
and take any questions and comments.
Thanks a lot, Christabel.
I just want to say to Christabel,
since we have a relatively light agenda,
that she shouldn't feel too constrained by the time.
And I think that is very, very comprehensive.
You've certainly answered some of my questions.
I mean, particularly around Wandsworth Prison,
we had a meeting of the Community Safety Partnership Board
a couple of weeks ago.
All I would say is that
I think a number of partners and different organizations
are concerned about a whole number of things
which go on there, which do impact upon safeguarding,
but I entirely accept that,
because the Ministry of Justice has a primary role.
The other thing I'm really pleased to hear
is the joint working between yourselves and other agencies.
That, of course, is vitally important for us
to make progress on all these issues.
Anyway, enough from me.
Over to members of the board to ask questions, please.
Nicola.
Thank you, Chair.
And, Christoph, thank you.
It's an interesting read, this report.
I always find it's really, there's a lot in there.
But I just had a couple of questions.
One is about the concerns and inquiries.
I just wondered about the source of them.
I don't think I missed it in here.
Could you just give me a kind of view
of where they're coming from generally.
If you've got some specific numbers, that's great.
But just generally where the most come from.
And then the other thing was, in your introduction,
you mentioned GPs.
But they're not specifically noted really in the report.
and I just wondered how it feels from your point of view
in terms of the engagement with general practice
and the wider primary care.
Thank you, I don't know whether.
Look to my colleague here, Ali,
to see if we do have the data on the referrals
and we break it down very, very well.
In fact, I was asking a question about that the other day.
The majority of referrals will either come
from a range of emergency services,
so that'd be ambulance and police,
but mainly from adult social care,
who tend to go in a lot.
We've also, thank you for answering that question,
actually, because I was also going to say,
we've also been looking at who is referring situations
when they're concerned, maybe it should be looked at
by the Safeguarding Adult Review Board.
And we do know nationally and locally
that health are very low referrers,
so we want to do some work on promoting
the understanding about that, because it's not just about seeing does it meet us all,
but it's looking at is there anything we can do as a board to help bring those agencies
together in a different way to look at the learning from that. But I can get back to
you with a very detailed outline, okay, high level outline on that, because what's important
to us is to, or the reason we look at it is to make sure that a broad range of partners
are understanding what concerns are. So we could say actually there's too many concerns
coming from this agency.
That means they're not understanding
the role of the safeguarding, and they
could refer to other people.
Equally, we may say, actually, they're not referring enough.
And I think probably GPs is an area
we want to promote understanding on.
Perhaps they're not doing enough either.
What I would say, one of the issues for GPs
is, and I don't know if there's an ICP representative here,
but Wandsworth does not have a GP lead for safeguarding
for adults.
whereas Richmond does and other areas do.
And potentially that could be a gap in having that link
in promoting awareness with Wandsworth GPs
and health centres.
I leave that as a thought.
Thanks, very interesting.
I believe Kate, Kate Symeck, you have a question online.
Thank you, yeah, more of a comment really
because I sort of shared this with you,
got a safeguarding team here at St. George's. My name is Kekzla Mecka, I'm the managing director
of St. George's. And just today, St. George's is an active participant in the Community Safety
Partnership and Wandsworth and supports significant data to support wider safety work,
violence tracking, because I think the sharing of data is absolutely key, isn't it? The information
sharing to tackle violence sort of initiative. And this data complements police data and seeks
to give a more rounded picture in relation to Syria's violence duty and help us better
target violence reduction interventions. And then we also just want to say that we have
now got an amnesty bin installed at St George's that happened a little while ago and it took
a while for that to happen, but that is now in place.
Excellent, thanks. I'm Thiam Tama, who represents CAIRAS.
Thank you very much for the report.
I have a question.
On page 53 there is a beautiful report on care at home services, 33 registered care
home services and their evaluation based on quality condition criteria.
So my question is, what was the method of collecting this information and this grading?
Is it self -reporting by these care providers?
Assume one of those like Bluebird.
So if it is a self -reporting based on this report is on that self -reporting, wouldn't
be helpful to actually evaluate the care at home service from the carer point of
view, i .e. get the feedback by a questioner or other means whether they
actually receive what the at home care provider services they actually do. Thank
Thank you.
So the information that's on the provider quality page 51 details the care quality commission
rating of the care at home services as well as the care homes.
So these are where the care quality commission requires services who are providing personal
care to be registered with them and to meet their standards, all of which will follow
so the leadership, safety, medication,
working with users, user feedback, and so on.
And these may well be a bit out of date,
as I just said earlier,
because the CQC only goes in at certain times.
However, having said that,
this is information that is used alongside
the local authority and NHS,
who will be commissioning personal care services.
So there will be more
Up to date, in the moment, if you like, information about providers that are shared there to look
at what needs to be done.
So whilst the CQC may not have gone in to change their rating, if there were serious
concerns they would be referred to CQC who may or may not, depending on the issue, go
in to look at what's happening in the agency.
I don't know whether there's anybody from commissioning here who wants to speak about
all the quality assurance mechanisms there are.
but anybody, so either NHS or the local authority
who have contracts with care providers
will have their own contract monitoring.
And one key area of that will be the feedback
from service users and their carers particularly.
There is a plan to actually get the feedback
from the carers regarding the service?
I would, well I think I will ask my colleagues
to say whether that should be happening
at the moment in some way.
Yes, well we have a robust set of a number of things that happen in terms of feedback.
So the people who receive services and the carers will all raise concerns about quality
or complaints, etc.
All of those are monitored as part of our contract monitoring process with providers.
And we deal with that collectively with our colleagues from the NHS, who also commission services,
as well as colleagues from CQC in a provider risk panel, where we consider what we're learning,
that's intelligence from the feedback we've got from everybody. So yes, there is feedback from everyone.
Thank you.
I think you had the...
Sorry, Ariane.
I think Ariane sucked his hand up first some time ago, so I'm sorry, my apologies.
Thank you for your report, Christopher.
I made very good reading and very reassuring on many fronts.
As a representative for GPs for Wandsworth, I just wanted to come just make a couple of
comments, if I might.
Personally, it's absolutely true there's no adult safeguarding lead for GPs in Wandsworth.
All GPs are required to undertake level three safeguarding, which they do.
The range and breadth of training available is limited.
I think I'd leave it at that.
Just with regards to your suggestion that we might be under -referring, I mean, I think
unless the capturing of data for the referrals is robust, it might be that it's just not
being picked up.
Certainly within our practice, we are regularly referring to adult safeguarding and have a
safeguarding lead for both adults and children, and I suspect that's the case across the
board.
So the under -referring might not be accurate in terms of the data you're capturing and
also the fact that you mention yourself that high -volume referrers might be over -referring
and we're just more aware of what's appropriate and not
in terms of referral.
A key change that has happened in the last couple of years
with regards to our links to children's safeguarding
is that we get feedback.
And that's huge because it really
does help direct how we're managing cases.
And often when we make safeguarding referrals
or we get Section 47 or 17 submissions to us,
which is safeguarding alerts regarding vulnerable children,
And we replied, but we didn't always hear back what the outcome was.
So a lot of GP practices would have alerts for safeguarding cases, which actually were
closed or anything.
But we're now getting more and more information back.
And the dilemma lies in the fact that there are different IT systems, so it's not that
we can just look on social services and see what's happening with the case.
So if I might suggest that there's more feedback with regards to joint shared cases,
that might be a very good way forward, especially in view of the fact that we've got a population
that's aging, increasingly vulnerable, and the 10 -year plan is all about addressing this.
Thank you very much.
I did just want to – as Christabel said, she didn't have the data in front of her.
I've got a set of data in front of me,
and certainly the referrals are coming from GPs as well.
And bearing in mind, this is adults,
and you're looking at adults and children, aren't you?
So you're doing both.
And in fact, we've seen a rise in concerns
from a police hospital, GPs, everybody.
So there's a positive awareness in our community.
I just wanted to give that piece of assurance.
I suppose it's just to pick up on the adult safeguarding GP lead.
So there is a review going on across southwest London to ensure that there's equity in each
borough.
I do anticipate that it won't be long before we're recruiting into that post.
Can I just add something else?
And that's just going back to your comments, Christabel, about particularly mental health
services and the overrepresentation of black communities and services. So I think speaking
on behalf of the Mental Health Trust, I think there's a lot of work now going on around
coercive practice around a culturally competent organization. And actually they are seeing
improvements in terms of the likelihood to be admitted. Now there's still a long way
to go. But I think our mental health trust is working very hard to kind of look at those
safeguarding issues, particularly organizational -led ones.
Waka.
Thank you very much, Chair. Christopher, thank you very much for a brilliant report, I think.
Christopher, I just want you to understand a little bit about the criminal justice safeguarding
framework and I'm going to in a moment invite you to help me understand a bit more about
that arrangement but also to understand the mechanics in a bit more detail in terms of
how that will unfold.
I'm aware that there's a lot of work done in other parts of society in terms of tackling
abuse.
So for example, the police are now authorized to apply for domestic violence protection
orders.
The courts and probation service have various programs
on say DV, but also they have programs on getting people
to address their thinking and thinking skills programs
are quite rife amongst the court system.
There are programs for people who are on post release
and so on and so forth.
So there's a lot going on in the criminal justice
and police system and over the last few years
there's been, you could say a revolution
in terms of what facilities are offered to people.
So it just seems to me that the opportunity
for the local authority to exquisitely engage
with the criminal justice system is really
aposite at this moment in time.
So I just really wanted to get an understanding
of the mechanics of how this safeguarding framework
is going to work to bring about the wrap around care
and surveillance we need for patients who are vulnerable
and families that are vulnerable.
Let's just take the last one.
So the criminal justice framework is a very basic framework, insofar as following what
other boards have done with other prisons and probation, is basically to get an agreement
to come together.
So we set up a task and finish group to look at a framework that gave expectations about
what the criminal justice.
So we're talking about probation, police, community
safety, and the prison here.
To be engaged with the safeguarding adult board
and what that might mean, what the benefit would be,
and how we can promote awareness of safeguarding
when people are in the criminal justice system.
Because I think I've mentioned GPs,
and I would like to say everybody probably
needs to refer more.
So I don't want to single anybody out.
But I think clearly, probation may be an area
we want to target as well more.
And it's about our understanding as a board then.
How can we help promote the awareness of where there may
be a safeguarding issue to refer to,
to enable people to come sit around the table with others
to look at, well, is this safeguarding?
Is it self -neglect?
Is it neglect?
Is it abuse in the traditional sense or not?
And how can we prevent something from happening and raise
that awareness?
So at the moment, we've had some people look at it.
Our prison governor is going to look at it for us to see if we've got that at least as
that basic to say this is our expectations and this is what we can do.
Just to add to that, the prison were very keen if we could offer some training and learning
to help them.
It's not strictly speaking our role, but it's in our interest, I think, to make sure they
understand how the WAMS system works.
So they're going to be looking at what might help.
and we have loads of training available,
which is all online, which isn't the best way, I know,
but at least they can know what there is
if they want to encourage their staff
to undertake such training.
And we would work with Community Safety on that.
And does that involve His Majesty's Courts
and tribunal service?
Because I think they would be quite a rich repository
of data and ideas.
Yes, well we could certainly,
we haven't thought of engaging them,
or how we would do that.
We would expect perhaps probation
to help be the link with that.
But obviously, we know our probation service is very busy too, but that's certainly a helpful
suggestion.
Thank you.
So if I can just come back to the comments on engagement with GPs.
Yes, so I mean, we'd be very pleased to look at if there's more perhaps in -depth training
needed, because there is quite a lot of learning out there which goes beyond that sort of basic,
and we can certainly help with that.
And one of the other areas is, and it's not just your piece, but it's sort of knowing
what has come out of SARS.
And particularly there are a few panels which we know agencies aren't as aware of, as I
would hope they would be, to perhaps make a referral to bring people around the table
to talk about, particularly I mentioned this situation earlier on palliative care, substance
misuse, mental capacity, a big issue.
And people are not quite sure what to do if they think someone's got capacity, but with
for substance misuse, it can be fluctuating,
or actually they may not be able to make an informed
decision on their physical healthcare needs
as in this situation.
So there's an opportunity to come around there,
and GPs are often very involved with situations like that.
So it's about providing that support as well.
Nicola.
And I was actually going to already ask just about that,
because I think I might have said this last year,
and so at the risk of being a strict record,
I think that the model that we have for child safeguarding
and education is much closer to what we need than what we've got at the moment with adult
safeguarding. But I think even the child safeguarding could be improved. But GPs every three years
have to do eight hours of adult safeguarding training. And you know what, there's only
so many times you can do the online mental capacity act kind of stuff. It doesn't bring
it to life for you. And whilst you know the technicals, when you do have to actually deal
with that, it's so much better if you're dealing with it with colleagues who you understand
what it's like to be in their shoes. So I think that multi -discipline, multi -professional
learning together for all of us in Wandsworth, if we could look at how we could do that in
a more kind of, you know, it could have so many more positive benefits than just understanding
the theory. I think it could really help build a real expertise in Wandsworth amongst many
of our professionals. Can you champion that?
Yes, well, I actually have our SAB executive next Tuesday where I will be reporting back
the issues raised here and we have the ICP representative safeguarding there as well,
who happens to be the Wandsworth lead.
And we have discussed this issue about the lack of the GP leader in safeguarding and
I know his colleague has said that's being looked at.
But in terms of that, sort of in -depth training, that's certainly something we can discuss
and try to get into our plan for this year.
Thanks, Abi.
Thanks, Chair, and thanks, Christabel, for your report.
Just to say I 100 % agree with you there.
I work for the Learning Disability charity,
and I think, obviously, you mentioned there around the stats about
and wanting to do a bit more work on
or understanding the discrepancies between
age of death and learning disability, then within that, with ethnicity.
People from minoritized ethnic backgrounds
with a low disability die at 34, and if they're white, it's 62.
So this suggests there's something very badly wrong going on there.
And I think there's probably a lack of understanding in the health care
sector about how to adequately communicate
with people with low disability.
But one of my questions was just around deaths
of people who have been diagnosed with autism.
In the report, it says that no autistic people
recorded as dying in southwest London last year, which
does seem highly unlikely.
So I'm just wondering if the issue is that people
don't know that they should be reporting that,
or whether people do know but aren't reporting
if you knew what the reason was there for the zero number.
The NHS survey.
Okay, start again.
It's an issue across NHS England and the requirement to report on people with learning disabilities
who have died.
And I know people with autism was brought into that.
And so I don't know why that is the situation.
But again, I can ask.
That's probably better rather than, you know, I don't quite know the answer to that.
But I don't think it would be that people wouldn't know to report.
But I don't know.
So I need to find out.
Thank you.
Thank you.
Excellent.
Any further comments from anyone behind me?
No?
I mean, I did raise one point with Christopher, which I think I will cover fairly quickly.
And that is about sort of learning from a range of different organizations, children's
services, et cetera, various reviews that you've instigated, I think, in Kingston.
and what my question is simply how do you see that working in Wandsworth and
how can we best enjoy in something very similar? So we're trying to set up a
meeting with our colleagues in Children's Partnership and the
scrutineer to actually ask that very question having had the experience of
what's been developed with Kingston and Richmond which has lots of advantages so
So we will be asking how can we do that?
Would that make sense in Wandsworth?
Because obviously not.
It's slightly different because Richmond, as you know,
is part of the, oh, what's it called?
Achieving for Children, thank you, with Kingston,
hence Kingston's involvement, which
can complicate things because they're not
quite part of the same system.
But they are part of Southwest London.
So the learning is the same.
So it's about getting that particular focus.
Excellent.
Thank you very much.
Well, I think there has been an excellent discussion
and a vitally important topic.
We usually see Christabel once a year,
but the comprehensiveness of the report
and the work that she and her team done,
that does, I think, is unquestionably excellent
in terms of protecting adults.
So on behalf of the council,
on behalf of the Health and Wellbeing Board,
thank you very much and do pass on our thanks
to your colleagues.
I think that was a very rich discussion indeed.
For the purposes of any members of the public
who you may be watching, I will actually read out
the recommendations in paragraph one of the report.
A is to note the information in the report
and the assurance that safeguarding practice
in Wandsworth is monitored and multi -agency arrangements
for oversight improvement and joint working
are in place and working well.
And I certainly think that we can say yes to that.
B is note that the Richmond and Wandsworth Safeguarding
Adultery Board is aiming to map out main locations of abuse
and then compare these with areas of health inequalities
to consider if there might be any links
between these and how to address those.
and I think I'm sure you'd all agree
that it's also vitally important going forward.
And thirdly, to consider if there are more links
in joint working between the Health and Wellbeing Board
and the Safeguarding Adults Board,
which should be explored.
I think we've actually done that as well.
So our members of the board can tend
to agree with those recommendations.
Thank you very much indeed.
And thanks again, Christopher, for turning up.
You're all welcome to stay if you wish,
but I'm sure you're very busy.
It's true, it's an excellent report.
Oh, excellent, excellent.
Okay, well, let's move on to the next report,

5 Joint Local Health and Wellbeing Strategy - Start Well Delivery Update (Paper No. 24-345)

which is the joint local health and wellbeing strategy.
We decided to break this up
because it's obviously a massive agenda
into Start Well, Living Well, and Age Well,
two sessions on Living Well,
but we're starting off with Start Well from younger people,
reported by the director of public health and Lynn Wild on behalf of the council assistant
director of health and care integration is to introduce the report.
So thank you Lynn.
Thanks.
So I'm really just going to remind members of the board that the joint local health and
well -being strategies, five -year strategy, it spans a life course and we've got an
expert team here from Public Health, I think the whole of Public Health,
who are going to actually talk us through the first four steps of the Startwell.
So I'll rather leave them time. We have asked colleagues to keep it really brief,
so there's time for each step for people to ask questions. And what I propose, if this is okay,
Chair, that we take one step at a time and give them five minutes per step.
not to talk, to talk and answer questions.
Thank you for that, excellent.
Otherwise you may well be here till well past three o 'clock.
But anyway, thanks a lot.
If the officers could announce themselves
and tell us who you are, et cetera,
before you start speaking.
And I presume you have some type of script and order,
so I'll leave it entirely up to you, thanks.
Good afternoon, my name's Graham Marquel and I'm the Senior Public Health Lead and I lead
on mental health and public mental health.
And the first step is around self -harm and children's mental health.
And what we can see in terms of our priorities, we recognize that over recent years there's
been a steep increase in the prevalence of poor mental health within children.
and we recognize that we need to have a primary preventative approach, a secondary preventative
approach, and a tertiary preventative approach.
We recognize that the NHS cannot solve the problem of mental health disorder on its own,
and that we need to very much work as a system to ensure that we make children more resilient.
And we are doing this through services to children and families, through family hubs,
and through mental health support team coverage.
Our mental health needs assessment identified that we needed to improve our coverage, and
this year we will be taking our mental health support team coverage up to 100%.
But it's more than that.
It's about the system working together, and it's about ensuring that children are at the
that they have personalized care, shared decision making,
and early intervention and holistic support.
So if there are any specific questions
that you want to pose on this first step,
then I'm more than happy to answer those.
Excellent.
Any questions on children's mental health?
Big topic could take all afternoon, but.
But in relation to the actual strategy, I think, if we may narrow it down a bit.
Mark.
So, Graham, thank you for the update and the progress, which is aimed at ensuring that
we're kind of – there is additional access and additional services.
I just wonder what's the mechanism to learn from those services as well, though, just
in terms of are we seeing different trends or different presentations that perhaps will
shape future services for us.
So we're kind of looking ahead as well as addressing the now, if that makes sense.
Yes, thanks, Mark, for that question.
Absolutely.
I think our Mental Health Needs Assessment was able to drill down and pick up on emerging
threats.
I think what we saw is an impact of social media, particularly on young people, and recognizing
that we need to safeguard children from certain aspects of that.
I think that's a key focus.
And I also think we came across a lot of trauma, and recognizing that adverse childhood experiences
our significant contributors to children
and young people's poor mental health.
And absolutely our services need to look at
how we can prevent those from happening in the first place
and intervene early once that's happened.
And again I would point to the family hubs
that are now set up within Wandsworth
in Roehampton at the moment and in Battersea,
which is specifically there to ensure that there are multi -agency one -stop shop services
that are available for communities to pick up these issues really quickly and ensure
appropriate responses.
Thanks.
I gather, Councillor Crivelli, George, you've got a question.
Yeah, I've got a question and I think it's probably not just relevant for step one.
It might be all relevant for step two, step three, and step four as well if you'll indulge
me, but I wanted to ask a question about the initiative that started back in 2021, the
Social Workers in School initiative, because I know that Wandsworth were quite supportive
of that initiative.
I think there's about 20 educational establishments in Wandsworth where they're using social workers
in schools to build relationships as part of the prevention framework.
I know social workers in school is something that I have seen as playing a prominent role
in the prevention framework.
I was just wondering if any of the officers could see how that actually fits in with the
sort of role that we were talking about as part of the overall health and wellbeing strategy?
I can pick that up, Councillor Crivelli.
Absolutely.
I mentioned primary prevention being one of our focuses,
but secondary prevention, I think early intervention
is a key aspect.
We need to ensure that those with increased
vulnerabilities and increased needs are supported
from the earliest outset.
And I couldn't talk in detail about the social works
in school program, but I have spoken to schools about this,
and I know how valued it is.
And speaking to those with pastoral responsibilities
have said that it's really been a game changer
in terms of getting the help and support
to families that need it as quickly as possible.
And we know that the earlier intervention,
the more positive the outcome.
And I would say that that program
is certainly supportive of that
from a mental health perspective.
Thanks, Kate.
Thank you.
Thank you Graham, and thank you for the update
and the report and the good work that we're doing
and really great to hear about the increased spread
of support across the borough and also acknowledging
kind of the opportunity that we still have
in terms of family hubs.
So just kind of picking up on that in a way.
In the strategy, our ambition is to kind of improve access
to early intervention, self -help, and specialist support.
So you've talked about in the report
kind of what progress we may have made so far.
But as I understand it, you know,
various different levels and tiers
of kind of mental health supports
are just really keen to kind of understand
where we still think the gaps are.
Thank you, Councillor.
I think we recognize the sheer demand
is one of the biggest challenges ahead.
And as I've said over the last few years,
we've seen from one in 10 children
with a probable disorder to one in five.
And we all know as well that we've had to,
in terms of public spending,
in terms of spending on the NHS,
there have been considerable restrictions,
which has meant that there has been an increased demand.
For me, we're working really hard as a system
to try and ensure that we can pick up
and prevent these issues from occurring in the first place.
And I think the mental health support teams
have a huge role in that.
So I really do see a good bedrock of primary prevention.
I think we can do more to support parents.
We are doing a lot to support parents.
There's some great programs out there,
but I think parents and carers, I should say,
really would appreciate, I think, some additional support
in terms of just pathways, knowing how to navigate
through a system, a complex system.
And so we're working really hard to ensure
that the pathways are accessible,
that they're understood, and that people know
where to get help when they need it as quickly as possible.
I think we could probably spend a very long time
talking about children's mental health
and perhaps bring it back in the future meetings
as a very specific item.
But thank you very much, Mr. Markwell,
for that very important report.
I mean, this is essentially an update
on where we are in terms of the strategy,
which obviously enables the health and wellbeing board
to focus upon things we want to come back to and discuss.
So that's very helpful.
As I said, I'm sure you've got an order of script,
so I'll leave it up to the next officer to present.
Thank you.
Good afternoon, everyone.
I am Tolu Oloye Ade.
I'm Public Health Lead for Children and Young People.
So I'll be talking about the childhood obesity update.
Similar to the children's mental health,
there has been a national increase of the prevalence of childhood obesity,
especially coming from the COVID -19 pandemic.
So in one's worth what we're how we're tackling that is firstly looking at
increasing up and promoting breastfeeding just because of the benefits,
obviously the benefits between relationship of mother and child,
but also the protective factors as well for the child as later down the line,
and they are less likely to develop childhood obesity.
Then we've also got a family weight management program
that's delivered by our zero to 19 service
and they particularly focus on three main areas,
so the two to five postnatal mothers
and also children who are five to 11.
And through that,
through the National Child Measurement Program,
when children are identified as obese or overweight,
they're usually referred into that service for intervention.
And then finally we've got some work that we're doing
with our leisure partners around the Wandsworth strategy.
Wandsworth, sorry, Leisure and Environment Strategy.
Just a couple of key things that you probably have noted
on the report.
We are, obviously we've got our data for childhood obesity
that kind of shows us already that year six,
the prevalence of obesity in yes six is increasing
and getting worse.
And also just to highlight some of the good work
that we're doing, I probably will get some questions
about involvement with family hubs,
but at the moment we're working with family hubs
to support them to achieve their UNICEF BFI accreditation,
which is a program that helps other services
to promote breastfeeding to their families as well.
So if anyone's got any specific questions,
I'm happy to take those.
Tama.
Thank you for the report.
I'm not speaking a little bit in the role
of being a pediatrician and reading this data,
it's very worrying, I must say.
One recommendation is that when you look at breastfeeding,
which is very important to start with,
looking at six to eight weeks is definitely not sufficient. The minimum is
six months or beyond. So first of all I would recommend to look at the
breastfeeding success up to one year, at least for the first six months. How to
improve that? In my personal experience the breastfeeding falls off after being
discharged and home visit with the mother to actually encourage and teach
breastfeeding people think that is so easy. Some ladies they have inverted
anyway so there are some issues which are not all that trivial and these
ladies especially the prima gravitas they need at home help and service and
I'm just wondering whether that is happening or not. Secondly, sorry okay.
But yeah, Tiamat, if you can be brief and summarize,
because we are.
The second is the obesity is disastrously increasing,
somewhat related to the breastfeeding.
But what is, I think, is missing here
is the link to metabolic diseases
and type two diabetes and screening
and prevention for that.
Thank you.
I think is that Rick?
Thanks, Lyle.
Would you like to respond to that briefly?
Thanks.
Absolutely, thank you for that question.
So the reason why this report specifically highlights
six to eight week data is because we take this data
from the Office of Health Disparities
and they only report on six to eight data.
Funny enough, there was actually a point
where they were doing nine month data
and I think that's completely stopped nationally.
So at the moment we're only able to report
on six to eight week data.
However, just to touch on your point
about support for families.
So as I mentioned, we do have a health visiting service
that has a successful breastfeeding service
that offers clinics to families
who are struggling with breastfeeding.
So they have those families on the radar
and there is support available for them.
And they're also looking to increase that support as well.
So unfortunately we're not able to supply much more
than the six to eight week.
I mean, yeah, it's unfortunate because we've only got
the national data to work with,
but it could be something that I can take back anyway
and see if there's anything else.
Excellent, thank you.
Any further questions on child obesity?
No, well thank you very much for the presentation.
Excellent.
And can we move on to the next officer's presentation?
Thanks.
Good afternoon.
I'm Holly Stone, I'm a senior public health lead
and I'll be speaking to the childhood immunizations update.
I also have with me my colleague Pooja,
who co -leads on this step from the ICB.
We work very closely.
But I'll lead on the update.
And Pooja, if you have anything to add, please do.
So in terms of the headlines,
actually if you look at the date,
the latest data in terms of childhood IMs,
the routine IMs show that actually
those higher levels of coverage across the majority
than regionally, but lower than England,
which is not unusual for London virus, unfortunately.
There's not necessarily been a significant change
in terms of the routine IMs,
where we're seeing a national decline in childhood IMs,
with the exception of MMR -1 and 2
doses at five years of age.
In terms of the work that's going on
to support the strategy. We've actually got some really exciting projects that
we've been delivering. Um, hopefully colleagues will be familiar with our
annual director of public health report, which saw engagement with our
communities to really understand some of the challenges around childhood
vaccines. Um, that's all engagement with parents, GP staff as well as, um, as
young people who have the opportunity to take up vaccine in school. And there
At the beginning of this year, there was a comprehensive measles, mumps, and
rubella vaccination campaign delivered to protect children from measles,
which people may have seen in the media, was a real threat to child health.
And that campaign, we know in Wandsworth, saw an additional 389 children
receiving the MMR vaccine in the one to five age cohort
when comparing the coverage to the same period the year prior,
which is really good news.
Public Health have worked to develop
a make every contact count training module
so that we can facilitate vaccine positive conversations
amongst our communities, and that offer of training
is available to voluntary sector organizations,
anyone who's essentially working with our residents
to really facilitate those positive conversations.
There's been actions across the system
to protect infants from whooping cough,
In particular, working with maternity services where vaccination during pregnancy is really key.
And then there's a number of other projects working with the school age immunization service.
In terms of a call recall center that tries to encourage parents to complete consent forms for
the flu vaccination as well as some engagement approaches.
as we work closely with our schools as well
to get those messages cascaded out to the schools
as well as to the parents who receive communications
from schools.
So I'm happy to take any questions.
Thank you very much.
Another important question on the camera.
I will be brief.
For this report would be very useful
if there would be a table of the percentage
of the fully vaccinated children in each of the vaccination on time. That
would tell you the story. How good is the vaccination immunization program
is? Thank you.
Nicola.
So partly following up on that to help out with that. So I'm a GP and I'm
just trying to join some dots here because yesterday are integrated care
board meeting, we had a paper on childhood immunizations.
And so it's really, really challenging
to achieve childhood immunization targets.
And we want to achieve herd immunity,
don't we, which is about 95%.
And we're not that far off that
with the first series of childhood vaccinations,
but once you get to beyond a year old,
it kind of, it goes down and down.
So that's the broad picture,
probably enough detail, really.
And at the SCB, we also do, and this is so important,
infectious diseases are something
that we can actually prevent.
We want to do everything we can.
So I think you're doing all the right things
and tackling them, because what we also don't want to do
is increase health inequalities by just focusing
on the things that are easy.
Big issues with data in our system,
it's quite hard to really understand who's vaccinated
and not, which seems ridiculous,
but it's actually very complicated.
And I'm going to steal a line from yesterday's board meeting.
So when I was a GP, there were about five vaccines that you gave, and now there's like
35 or something like that.
You know what?
It's actually so much more complicated.
But we must do more and infiltrate into our communities to help people to understand about
vaccines and to encourage people to have them.
And just one other thing to join up.
Royal Marsden Partners also presented yesterday at our board meeting.
and one of their priority areas,
you could think, hang on a minute,
what's cancer got to do with this?
Well it has because there's a vaccine for cancer
which is HPV, which we're not particularly focused on,
but if they are, and then we also are,
then that will help, won't it?
So I just wondered if it's maybe something
you might want to build into next steps.
Not that you're already not doing a lot, but thank you.
Thanks, if you'd like to respond to those points.
Thank you very much, thanks for the questions
and for highlighting the number of data points
with regards to all the different vaccines,
I think it is challenging, so thank you.
Yes, we have certainly linked in with our own partners
regarding that initiative, and we're going to be bringing in
the school age IMS team who are primarily delivering that
into that discussion, but thank you very much
for highlighting that.
Excellent, thank you, another very important topic.
If there are no further questions on childhood immunization,
Then shall we move to the next one?
Any attendances?
Councillor Hensson, I'm afraid that the lead is on annual leave at this point in time,
but we certainly, if there are any questions on that from the panel, we can take those
away and respond quickly.
Yeah, thanks a lot.
People need their annual leave.
Maintains they're good at mental health and physical health.
Any questions?
You do have a slide on the attendances.
If you have any questions here,
alternatively you may wish to put them in writing
and the team will obviously respond.
But are there any immediate questions
on any attendances and hospital admissions
caused by unintentional and deliberate injury.
If not, and if there's no one behind me, okay, thanks.
Well, as I said, don't feel inhibited
from asking questions, putting them in writing,
and putting them to the team.
No, thanks, well, I think that probably
concludes the presentation.
and can I thank the officers for presenting
those likely important subjects.
As I said, the real purpose of this was to satisfy ourselves
as a board that the work which is being undertaken
in terms of the health and well -being strategy
is achieving its principal goals
or alternatively working towards them.
And hopefully, I think, I hope you would agree
I think that's certainly the case.
I mean clearly members of the board
would like to revisit some topics in greater depth.
I mean I would generally welcome
board members actually suggesting topics.
I mean I've been in discussions with the LGA
and hopefully we'll have a seminar I think in January
talking about how we can work together a lot better.
I'm very aware that we're very sort of focused on reports
and I would ideally like to make the health and well -being
board rather more interactive,
particularly for members of the board
to actually suggest things they may wish to discuss
in greater depth.
Anyway, back to the actual item
and this is for information.
Yeah, this is purely for information.
So thank you very much indeed.
Excellent.
Right, good.
Now another very weighty and important report

6 Healthwatch Annual Report (Paper No. 24-346)

from Health Watch, the annual report.
And Stephen Hickey, unfortunately,
who's the chair of Health Watch, he had to leave.
But we're very fortunate to have Sarah Cook,
the Health Watch Manager present
who actually presents the report.
So thank you, Erin, over to you.
Thank you, Graham.
Thank you for the opportunity to present our report
to you today.
We hope that you'll read it as an opportunity
to celebrate some of the engagement
that has happened with local people.
What we do like to do is include
many of the organizations that we're working with on that.
So it's actually, there's quite a lot of you
who are involved in one way or another in our work,
so thank you for that.
So we publish our annual report every year,
and in it we've listed the sorts of things
that we've been working on, and many of those
are areas that require integrated working across the system,
addressing some of the issues that actually
are fitting between lots of different services.
And we've put a list here in our report to the board.
We also welcome any questions on the report
and suggestions about any potential topics
that we might consider in the following year.
Although we can only focus on a couple at a time,
we like to include as many opinions and views as possible
and to understand the context
of what you're all going to be working on.
Thank you.
Excellent, thanks.
Any questions?
Thiermo.
I have a question on number six.
It says access to healthcare services
after hospital discharge.
As a carer is, I think last time I mentioned
the difficulties of patient carers
who take home the loved ones and look after it.
I was recommending a kind of patient ambassador
to streamline the access to services.
I'm just wondering what is implemented at this point,
and what is the plan to actually ease the access
of the complex and multidisciplinary access
for the patient care when they go home?
So I suppose that question relates a bit more
to other work that we did last year
on hospital discharge and the experience of carers.
So we had a report with various recommendations
which reflected the sorts of things
that carers were telling us
they were having difficulties with.
A toolkit was created for the hospitals
to better support people.
And St. George's Hospital,
if they're still on the line,
have been looking into all of the difference,
quite a lot of different things that they can do
to support carers.
And one of those things is a discharge hub,
which they have.
and there's a team who look at the different
Voluntary Sector Support and other support
that could be put in place before somebody goes home.
And there's even initiatives where some of the
Voluntary Sector organizations are going into the hospital
to speak to patients and their carers before they leave.
There's developments around information packs
within hospital as well.
So there's quite a lot going on,
but it takes time to implement
and we're trying to follow what's happening next.
In terms of this priority, it's more about primary care.
So it's the care that people are having
outside of a hospital that is not urgent.
And it's accessing things like GPs,
maybe support via a pharmacy,
so that they're getting the support
before they go to hospital.
And our remit is a lot about collecting insight
and understanding what people are having trouble with,
So that's the phase that we're in with that one at the moment.
Thank you.
Thank you.
Abi.
Hi.
This is a kind of question on behalf of one of the voluntary sector organizations I represent
around your work in terms of strengthening the ICB's digital inclusion strategy.
It was kind of just, if you're able just to explain a little bit more about what you're
doing, that would be really helpful so I can take that back.
I will try my best.
This is something that we're doing
with the other health watchers in South West London.
There's a sort of a director level person
who's employed on behalf of the different health watchers
to go to various meetings and work with the ICB
at ICB level, which unlocks a bit of time
for the other health watchers to focus on the local.
So it's very important that we work in that way.
And I've asked for an update from her
based on the meeting yesterday that you all had.
So she's told me that there is a self,
let me just check the email, sorry,
there is a Southwest London Digital Strategy
and that's just been published literally this week.
So she's been back to look and see if the recommendations
that we were making have been included and they have.
There's things like case studies
and references to lots of our insight reports
that have been referenced in that strategy,
which I can send more detail on afterwards
if that's of interest.
Thank you, that would be great.
And if I just made just one other quick question,
or more offer really, which was from the Wandsworth Carers
Centre, just saying that I'm very happy to survey care
that's there from your behalf, and just the longer
the lead time, the better, just so they can plan that in,
which is probably stuff you hear all the time,
but just wanted to note it for you.
Definitely, thank you.
Thanks a lot.
I think Kate Slomek, you have a question?
No, I was going to just supplement what Sarah said around,
I know, sort of, raising questions about how carers
can be better supported, which is a really good question.
It's something that we've really tried to improve.
St. George's, Wendy Doyle,
who's our head of patient experiences,
worked really hard to look at what we can do differently
and do some significant work this year.
support carers, we've got a new tab on our iCLIT, which is our IT system, to actually
make sure we're capturing details around carers and we're involving them more in decision -making
and contacting them earlier in the process. Co -designing an external web page with a governor
carer, we've got intranet pages for staff and training for both planned and bespoke
work team requests and a new group carers forum which again helps us sort of learn and
think a little more broadly about what the needs are and how we best meet them and we're
already partnered with the community and several reps attend our steering group including one's
worth rep as well so it's something that we're really working hard to improve because we
know traditionally yeah hospitals haven't been as good as they could be around supporting
and the carers involved in them.
Thank you very much.
I think it's extremely reassuring
that there are some movements to improve this
because there is quite a bit of concern
in the carers community.
Appreciate it.
Yeah, thanks, Kate.
That was actually very helpful.
And yeah, clearly this is an area we do need to focus on.
So particular thanks to Health Watch
for actually focusing upon that.
George, I believe you also have either a question or a comment.
It was a question about the focus that you've put on homelessness and mental health.
And, you know, I think that's very laudable that you've, you know, you've highlighted
the very real concern that there is between mental health and homelessness.
I was going to ask you about the emphasis that you're putting in, if I understand it
correctly that a lot of people sort of experience homelessness but they only sort of receive
the support from health services once their mental health has deteriorated significantly
and they are actually in effect, in some cases, they're actually street homeless. Do I understand
it correctly that your emphasis is now more about services being proactive and ensuring
that people don't fall through the net? I mean, I make that assumption with the new
Assessment Hub, which seems like a really positive
initiative on your part.
I perhaps should make it clear that we are a kind of
insight gathering organization.
We do the research and we provide suggestions to services
for what they can do to improve.
So the Assessment Hub isn't something that we're
implementing, but what we do is we provide those
recommendations after having spoken to service users,
people with lived experience to help guide how they develop their services.
So the people developing the assessment hub will have read our reports and our
recommendations and then we follow up to check that there are initiatives that
are being developed along those lines. So I think the key thing that we took away
from it is there's always, and I think this goes across no services actually,
there's always more that can be done to support people around mental health. I
I think the concern we had was that the prevalence is so high
amongst people who move into homelessness,
so they already may have mental health concerns,
the various determinants of health
that have led them to where they are,
again, are all associated with increased risk
of mental health conditions or problems.
And then once they get there, the impact on mental health
when you're struggling with your housing
or actually homeless.
So we were trying to make the recommendation
that every service that deals with people who are homeless
are considering mental health
and trying to bring those connections to support
a lot quicker than, or as quickly as possible.
No, thank you, Kate.
Thank you, thank you for the report.
Just interested in one of the research priorities
that you've identified for next year
around access to support autism.
I'm really interested to hear that that's come up, some conversations you're already
having with parents and families in our family hubs and something certainly we hear is a
concern for local families.
So just it sounds like this is probably something you've already done by inference looking at
the report, but just to ensure kind of you're reaching the widest possible voices, just
to kind of if you plan to engage with some of our parent forums that already exist in
such as parent champions, the SEND,
and parent care forum.
I think we have been to all of those.
I think we have, but when we write the report,
we'll list it.
I think when it links to the comments we were just making,
I think mental health is coming up
as one of the things at the moment.
That sort of support whilst people are waiting
for the diagnosis, particularly for parents as well.
And I think that's already been mentioned today,
So that's really reassuring that people like Graham, Markwell are actually aware of that.
Excellent. Any further comments on the...
Yes, if I can just make a question, ask a question.
I know we've worked much more closely with you this year, but it occurred to me with some of your projects,
it would be really good if we could have an early alert, which you might be looking at,
so we could perhaps help define a safeguarding question
in terms of understanding how people might feel safe.
It's all about wording, I think, that might help us as a board
also know what more we can do in terms of raising awareness.
Sure.
That's good.
I mean, we produce a business plan in about July time.
And we do circulate it, I think, to this board.
Is there a way that we can include the safeguarding
adult board in that as well?
and then that hopefully will prompt those conversations.
Yeah, thanks, that's excellent.
One of the roles of the board is to bring people together
and ensure they're all joined up working,
so that certainly sounds a very sensible suggestion.
Thanks, Dr. Christabel.
Any further questions on the Health Watch annual report?
Right, okay, so if I can take the recommendations, the first one is simply to note the annual
report, and I think we have, I think Sarah has provided feedback about progress and priorities
and important topics for the coming year, and obviously members of the board have contributed
on that.
So can we please note those recommendations?
Yeah, thanks.
And Sarah, on behalf of the board and the local authority,
can you take back our gratitude to the work you do?
It is vitally important, and in particular,
to thank all the volunteers who I know
are doing an absolutely disturbing job
throughout the course of the year.
Thank you very much indeed.

7 Better Care Fund Quarter 1 2024-25 Update (Paper No. 24-347)

The next item is the Better Care Fund, quarter one,
2024 to 2025 update, page 123, 128.
A report by the executive director and Brian,
we've been sitting incredibly patiently
throughout the entire meeting.
Hopefully you've actually found the discussion
which is generally interesting.
But Brian Roberts, I gather you are introducing the report.
I am, and thank you to the Health and Wellbeing Board
for having me here to introduce this item,
as well as signing off the Better Care Fund refresh
for the last meeting.
So as part of the BCF plan, there is a quarterly report
that is produced and returned to NHS England
and then comes to the Health Wellbeing Board.
For quarter one, that return was only,
so the only request in there was to monitor
and report the spend of the discharge element of the BCF.
For quarter two, that's a much bigger report,
and actually that contains quite a lot of impact,
some metrics, which the board will be much more familiar
with, and that will also include some of the requests
the Health Wellbeing Board had last time
of what impact the BCS, BCS is having.
So that is on its way and that will be there.
But just briefly, in terms of the discharge fund element,
so which was about 6 .6 million pounds of funding
between the ICB and the local authority,
at the moment actually all the schemes to support discharge
are up and running.
The spend to June, so 25 % of the way through the year,
So actually we've spent about 37 % of the money.
And actually those schemes are having an impact
on discharge and shortening the time between
when people are referred for discharge in hospitals
to be discharged.
And again, that's some of the impact work
that you'll see next time.
So with that, I believe that's probably
the shortest report I've ever given anywhere.
Okay, thanks.
Questions, yeah, brevity is always appreciated.
Abby.
I'll try and make this short as well.
Is it usual, Brian, that you'd kind of
front -load your spending, so be spending more upfront,
or have you got any concerns about the fact
you've spent 37 % of the money in 25 % of the time?
So where we've spent ahead of plan,
so some of that is where we've spent specific things,
So there was a review done by the Care Transfer Hub in St.
George's in readiness for winter, which was paid for.
But actually there are some areas here where demand has increased for home care,
for re -abment, for residential emissions, which we're using to meet through here.
So in that demand, we are managing as best we can.
All partners are managing that as best we can.
And so obviously we're monitoring that internally as well as these reviews, but demand is only
increasing for this area.
Good question.
Mark.
I suppose it's just to say there's an awful lot of work going on between partners, including
the local authority ourselves at the ICB.
Kate who's on the call around
How do we enable discharge to be as sleek as possible and one's what council commissioned an
Organization to support us looking at that and there's some quick wins which we need we've collectively signed up to
Which doesn't really come across in this report?
There's an awful lot of what trying to get the patient experience
The patient out of hospital quickly safely and into the break care environment as much as possible
So I just wanted to kind of add that there's a lot going on.
It's not just a static picture.
Sure.
Any further comments?
Actually, just one quick one.
I mean, how do the allocation of monies between the ICB
and the local authority, I mean, how's
the expenditure between those two funds actually work?
So the local authority part of the discharge fund is centrally mandated.
That's handed down to us as a grant that comes directly to local authority.
The ICB funding is given to the ICB to split between the six boroughs within South West
London.
And a lot of work goes on in the area splitting that fairly and to achieve outcomes.
And on page, sorry, thank you.
So on page 124, you'll see that there's some hosted monies there which pays for mental
health step -down beds in a unit and that supports five of the six boroughs.
And obviously that agreement was then, so the reason it's five or six boroughs is Croydon
point towards a different direction.
They point towards SLAM and this is sort of a South West London, St George's provision.
And so a lot of work goes on to actually make sure it's fair and equitable across the boroughs.
And I have to say this is the second year this has happened in this way.
And actually it feels like it is a fair representation of how that split
and a lot of work goes in it by the ICB to ensure that happens.
OK, thanks.
I've obviously prompted quite a few discussions there.
I'm just intrigued, how is money assigned to each of the ICP and the local authority?
I mean, what determines ICP expenditure and local authority expenditure?
Or, Lynn, do you want to answer that?
I can probably do better than me, but it's a part of a different formula that is used.
So in the allocation of the adult care discharge fund, NHSE or the DOH decided to use a particular
formula in which ones with counsel is slightly less advantage than if they'd used a different
formula.
But other friends of ours close by are more disadvantaged than we are, let me say.
And so it is weird because not all the things are done in the same way.
But at Southwest London, we've agreed to use a different formula to split the money, which
which is more fair and considers the size of each, you know, the relative sizes of six populations.
I've obviously opened up a can of worms here, but anyway, Mark and then Kate.
Mark?
So I think it's just worth offering the clarity is that these aren't within our existing budgets.
This is a ring fenced amount of money that comes down centrally and then it's kind of
allocated across the board.
As Lynn said, where there are any decisions to be made, it tends to be on weighted population
and bringing in deprivation as well.
But yes, it's just to make sure that everyone understands that this is ring fenced and not
actually sat there in a budget.
We get this on an annual basis.
Absolutely, absolutely. Kate?
Yeah, just to reiterate, we spent a lot of time together as system partners talking about
discharge and flow and how we can do things differently and better. Only this week we
had a big meeting working that through. And I think for me, with this Better Care funds
and allocations, it would be good over time to see the impact that we think each of these
schemes as having and having the ability to flex over time, maybe move pots of funding
around. I think that's something that we hope we consider buying to do together. I know
there's an element of fixedness in some of it, but to have that sort of opportunity to
flex where that's possible. I have to say the quick start bridging has been, that makes
an enormous difference. So more of that would be fantastic because it's getting people out
quicker whilst they're waiting for their actual packages of care to be available.
So there are some things that I recognize here that make an enormous difference,
but it's just understanding the impact of all of them on the overall pathway and
the ability to flow patients as quickly as possible out of hospital when they're
ready to go.
Well, we all thought this was going to be quite quick items, didn't we?
So it's also worth acknowledging that this is about discharge from
So it's not, so is, obviously St. George's is a big part
for that, but obviously the work we've done in this borough
is also supporting mental health discharge.
So which not every borough has done.
Some are very much focused towards the acute system,
but we recognize that actually the mental health system
needs support and needs support in this way too.
Yeah, absolutely Brian, because we have a mental health trust hospital in our borough.
Yeah, that's absolutely correct.
Good. Well, I don't see any further comments, but again, very important topic.
And formally as Brian said, it is simply
for the health and well being bought to note
for on the transmission to the NHS England
in terms of what money has actually been spent.
So the recommendation, et cetera,
does the board note the BCF spend and outputs activity
for those schemes reported on for the period of April
to June 2024 as set out in appendix one,
which I suspect is probably not the most challenging
of decisions you've been asked to make,
but can we agree with that, please?
Thank you very much indeed.
Good, excellent.
So we're now on the home street,

8 Work Programme (Paper No. 24-348)

and item eight is the health and well -being board
work program, and Lynn, I think you're going
to introduce us.
I know this is everybody's favorite item.
So I'll take about 15 minutes and read it to you.
It's all very clear what we've got coming forward as ever.
The forward plan may change, is subject to change.
As ever, I would really encourage, as Councillor Henderson said earlier, that members of the
board do offer ideas, reports, and topics for our consideration.
I'd also like to draw your attention to our exciting seminar program.
So the first one, which will be in January or early February, is about the LGA work,
thinking as a board about what can we do better, what can we do more of, how do we get more
connected to our residents in terms of the work of this board.
And then Abby's offered to do an interesting topic, we haven't figured out a date yet,
on health inequalities with learning disabilities and we're potentially looking at spreading
and scaling innovation.
So again, ideas, thoughts, where we can spend a little more time in a seminar reflecting
on something, please do come forward with ideas.
On the understanding of course, as Abby learned, if you come up with an idea, you get to do
to work.
But please do come forward.
Great, any comments on the report that's currently drafted
in which a number of items being listed
for future meetings, particularly the one in January.
But yeah, I'll just simply reinforce what Lynn said.
We are actually looking to develop the Health and Wellbeing
board into something which is much more interactive,
involves community, et cetera,
that should be the opportunity of our seminar
either at the end of January, beginning of February,
but don't let that inhibit you from putting forward
suggestions of topics you think could usually
be discussed by the board.
So on that basis, I think we're just simply being asked
to make the report, if we can do that, excellent.

9 Date of Next Meeting

So the date of the next meeting is due to be held on the 27th of February of next year
and I've been told, please note there is no other business included on the agenda.
So that now concludes the meeting.
Can I thank everyone for attending, especially since it's only seven weeks since our last
meeting.
Can I also thank all the officers who have presented.
I think we have had very detailed discussions and a whole range of vitally important pieces
of work.
And I think it only remains for me, and this does seem still a bit early because I'm still
old school, but I will nonetheless wish you a Merry Christmas and a Happy New Year.
Thanks a lot.
We've actually finished.
We've only got 15 minutes.
Amazing.
Excellent.
Okay.
Thanks a lot.
Cheers.
Bye -bye.
.
.