Health Overview and Scrutiny Committee - Wednesday 27 November 2024, 7:30pm

Health Overview and Scrutiny Committee
Wednesday, 27th November 2024 at 7:30pm

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I'm going to call the names of the committee one by one, so please switch on your mics

to confirm your attendance and make sure to switch them off after you finish.

And we have had apologies from Councillor Davies and Councillor Gussain.

Do we have any other apologies?

Don't think so?

Great.

So, Councillor Caddy.

Good evening.

Councillor Correlli.

Good evening.

Councillor de la Sejour.

Hello.

Councilor Marshall.

Hello.

Councilor Rigby.

Hello.

Councilor Varatharaj.

Good evening.

Councilor Worrell.

Good evening.

Also in attendance is the cabinet member for health, Graham Henderson.

Good evening.

Lovely.

We will now have the floor.

start the meeting. I'd also like to welcome Stephen Hickey, chair of HealthWatch,

who's present online this evening and at the meeting. I'll ask Stephen to come in

and comment on any item that he's indicated that he would like to ask a

question on when we get to that item. And hopefully most councillors have seen

that unfortunately due to illness the lead presenter at St. George's Mental

Health Trust is unable to attend tonight,

so we're gonna defer that item to the next meeting.

However, if counselors do have questions,

we'd really welcome them on that report in the meantime,

so that they can answer those questions.

And we have a number of offices present virtually,

and in person, who will introduce themselves

when they first address the committee.

So moving to the first item,

The minutes of the 18th of September meeting are the minutes of the previous meeting agreed as a correct record

Great. Thanks everyone

And moving on to declaration of interests. Are there any declarations of either pecuniary or

Vegetable or non -registable interests and please declare the interests quoting the item

Councillor Worrell

Yes paper three six seven. I work for an organization that makes

Referrals into the East service. We do not receive any financial recompense for the for the actions and I'll be participating in the discussion

Thank You council or any other interests that need to be declared

So moving on from the first item which would have been Southwest London St. George's mental health report we're going to start with

Homelessness and Health Needs Assessment Paper 24 -364,

pages 43 to 126.

We've got a number of officers here

who'll be able to talk to this paper,

but Shannon, Director of Public Health,

is gonna start and kick us off,

and then I think we've got some housing colleagues,

welcome, who are gonna take some questions.

So over to you, Shannon.

Thank you, Chair.

Good evening, my name is Shannon Couture,

and I'm the Director of Public Health.

I'm going to give a very brief introduction to the report

and I'll take the rest as read.

Having a safe, secure, and warm home

is one of the most important determinants of health.

And we know that when people don't have that,

then it can significantly impact on their health and well -being.

And we know that the health outcomes of people who do not

have a safe, warm, and secure home are worse

than people who do.

You can expect a life expectancy reduced by more than 30 years

for people who are homeless, and a lot worse,

as well, for younger people.

So it is in this light that a homelessness health needs

assessment was undertaken for one's worth.

One hadn't been produced for a while.

And it was conducted as a rapid needs assessment, which

which was published in 2022,

and then work to update it

and to publish the findings happened in subsequent years.

So the purpose of the needs assessment really

were to understand the scale of homelessness in Wandsworth

and to underestimate the health inequalities

that are experienced by people who are homeless

in the borough, and also to identify unmet need

in terms of the support and the services available

for people and then consider what the implications are.

The key findings from the needs assessment were that

there are increases in homelessness rates,

and this is nationally, but also affecting London

and the borough, particularly among statutory,

in terms of statutory homelessness

and people who are rough sleeping.

The report also found that there's a need

for more support and better access in the context

mental and physical health services for both rough sleepers and

statutory homeless people.

It found that the availability and appropriate location of health and

well -being services, including the need for outreach,

especially in the context of unpredictable living arrangements,

digital exclusion, and cost of travel, and

physical condition of rough sleepers was important.

and that there was a lack of a joined up approach

to services, both at a borough and southwest London level

for people who are homeless.

And just very briefly, the key recommendations

from the needs assessment in order to try and address

some of the health inequalities experienced

by people who are homeless included

increasing the collaborative working

and targeted working in the homelessness sector

to improve health and reduce health inequalities,

to have more flexibility,

including better targeted outreach access

to health services for people who are rough sleeping,

including particularly access to primary care

and mental health services.

There was also a recommendation to improve access

to preventative health support,

including dentistry, podiatry,

musculoskeletal services for people,

particularly those who are rough sleeping.

And finally, to increase social support

for people who are homeless,

to help them support and maintain relationships

that are beneficial for health.

I will take the report as read,

and happy to take questions

together with colleagues from housing.

Thank you.

Oh, lots of questions straight away.

I think I had Councillor Worrall first,

Councillor Rigby, then Councillor Caddy.

Thank you.

First of all, I'd like to commend Dr. Bannerman and the team who actually developed this report.

A lot of work has gone into this.

There's some really interesting findings in here.

And it just reflects the depth that the team has gone into actually looking at the issues

around homelessness and the causes and some of the solutions.

So from my part, a big congratulations to everybody that's worked on this amazing report

in terms of the information.

One of the issues that's contained in the,

one of the themes that runs through the report

is the public health approach

and looking at social determinants,

which I really welcome.

And I know, Shannon, that you've been a real champion

of this in the council, and together with your team.

I was just wondering if you could,

are you able to elaborate a bit more

about how this would roll, how this actually works

in terms of then working outside of the homelessness team,

but actually picking up on the issues

around homelessness across the council?

Thank you.

So a public health approach recognizes the need to look at the causes of the causes.

So it's looking beyond kind of the superficial level in terms of the presenting need and

trying to understand the unmet need as well as the interventions that could be put in

place upstream to try and prevent, for example, people becoming homelessness in the first

place.

A public health approach also recognizes the need for interactions between services because

often the risk factors that act in terms of homelessness can be interlinked and can compound

each other.

So structural factors, for example, can include poverty, housing supply and unaffordability

or unemployment or access to social security.

and then their individual factors that can be both the cause or exacerbate the risk of homelessness.

For example, if people are experiencing issues with mental health, disability, or they're in poor health.

So basically that is the public health approach that tries to look at all those different risk factors and how they interact

in terms of what needs to, you know, the solutions and the interventions that need to be put in place.

Thank you. Can we go to Councillor Rigby now? That's all right.

Yeah. I think this is, for me, in my six years, this is one of the most devastating papers I've actually read.

And I think, you know, thank you for putting it together. It must have been really hard at times to have to deal with some of this data.

and, you know, especially I think the qualitative feedback, some of the statements were so hard

to read.

I think some of the things that can happen in Wandsworth is that our society can get

quite divided by hate and othering of homeless people.

I mean, I've even seen Wandsworth councillors writing on Next Door that, you know, this

group of homeless people, it's a choice, they're not homeless.

You know, they've done it as a choice. It's a lifestyle choice and that diminishes empathy

And it is highly irresponsible

One of the things that I would really like to have as a resource as a counselor

I can't send this whole report to people who write to me saying get rid of the homeless

under Ballin bridge

But what I'd really appreciate is like a one or two pager that has this it lays out the situation

It lays out the health issues. It lays out even some of the verbatims because I think we need to

work as counselors to, you know, create shots of empathy because I do get emails every week saying,

can you just get rid of them? And it, you know, it's hard to read. It's hard to respond to those

emails because, you know, we want to, I think we had even a counselor at one of the last

committee saying it would be her best birthday present if we could just get rid of rough

sleepers.

I mean, it was just such a lack of empathy.

And yeah, that would be something that I would really value as a counselor to help to give

to the community to say, these people are going to die probably 30 years younger, earlier

than you will. They're going through all these health issues and they have no access, so

this is something we're doing. Yeah, thank you.

Thanks. Officers, is that something we think we can bring back and circulate to the committee?

Yes, absolutely, and I mean I absolutely agree with the point that, you know, the hidden

complexities that may not be apparent to people, particularly when they experience rough sleeping,

but we know both from the needs assessment and from some of the outreach services that

some of the compounding issues may be related to mental health issues.

We also know that sometimes issues around substance misuse as well that people need

to be supported holistically around those.

So that's certainly something that we can look to produce

to help people understand the issues.

Thank you.

Councillor Caddy.

Thank you, Chair.

What struck me when I was reading it

in conjunction with all of the other papers

was how critical housing and homelessness

is to all of the other aspects that we're

going to talk about at this meeting.

And it's a shame that the mental health paper isn't coming,

because that was one of the things

that I wanted to draw out of that.

but specific, so I think it's a really valuable paper.

I guess my biggest concern is that the recommendations

don't feel very sort of detailed and specific

and measurable, and I wondered whether there was gonna be

any extra work or further work done

to get those recommendations kind of, I guess,

honed down into something much more specific

that particular departments can work on.

And then I had a couple of sort of factual questions.

On page 116, it references housing plans as an issue,

and I wondered whether we were gonna share that

with the housing team in terms, or the planning team

in terms of looking at the mix of housing

that we're providing, because obviously there's a concern

over, I guess, one bed or studio flats being provided

at the expense of some of the sort of larger flats.

On page 107, I think there was a comment

that over half of rough sleepers have found temporary accommodation or hostile placements

on discharge. I mean, what happens to the other half? Should it not be 100 %? Is that

something that we're specifically working to? And then on page 84, there's a reference

to employment and how beneficial that is for mental health. And I wondered whether we'd

circled back with the EDO and the lifelong learning team

to try and maybe get some recommendations

for improving help and support into employment

for people who are homeless.

That was my.

Thank you.

Is this Chantal and Michael?

Is that for you, Michael?

Do you wanna introduce yourself?

Yeah, can I come back on that?

Hi, so I'm Michael Sherenwalla.

I'm the street homeless service manager

for Richmond and Wandsworth,

so I commission the services that support people

experiencing street homelessness

in both Richmond and Wandsworth.

Just on the point about the non -specific recommendations

in the needs assessment, for us it's been incredibly helpful

to have such broad recommendations that are not so heavy

in detail but very, very clear.

That's been very, very helpful to us

and they quite encouragingly are reflected very much

in our plans related to our new street homeless hub

that we're gonna be opening on Lavender Hill

and also our new integrated super outreach model,

which is only made possible by the hub model as well.

So actually, just on that point,

we have very specific things that have come

as a result of the broader recommendations

from the needs assessment.

Sorry, Shannon.

Shannon, do you want to come back on the others?

Yes, thank you.

If I may add to the same point,

And since the needs assessment was published,

actually the recommendations have been referred back

to a wide range of stakeholders and support services

for people who are homeless.

So that includes, obviously, housing colleagues,

but also the drug and alcohol commissioning teams,

primary care operations.

We've worked with Southwest London ICB, SPEAR,

the outreach providers, St. George's Mental Health Trust.

and we've found a way where those different stakeholders

can own some of the recommendations

and actually thresh them a bit more

within their service plans and provision

in terms of taking them forward.

Earlier this year in March,

I think there was a workshop as well

that was held and chaired by the cabinet member for housing

which involved ones with housing providers

and other stakeholders were there as well

and that was another opportunity to look at the

recommendations and to try to get ownership from the

different parts of the system in order to address those.

We have also agreed subsequently that we'll convene

a biannual forum between public health and housing

and other stakeholders just to monitor progress

on those recommendations and how they're getting

on with them.

Great, brilliant, thank you.

And I just had, I think Councilor Rorab had a quick

follow up and then I'll come to you.

Okay, Councillor Corvelli.

First and foremost, can I thank you on the report

you've done, it's very, very thorough

and there's a tremendous amount of data

in that, it's a really well compiled report.

I was really pleased to hear the point you're making

about access to primary care,

because that's clearly a very big issue

for people who are homeless, in particular,

people who are street homeless.

Difficult for some of them to register with GPs

for a number of reasons, and I see that GPs

have gone out of their way to really try and emphasize that,

to try and work.

I was going to say that the experience that I have working

with organizations like, just for example, Crisis,

I know that these sort of organizations like Crisis,

Glass Door, they're in effect very good, I think,

at interacting with giving assistance to people

who are street homeless.

And I was, I'll give you my own example.

I know some work that was done by,

I don't think they do much work in Wandsworth,

but I know they do it in Central London,

Quaker Action for Homelessness,

and I know that they've employed volunteer psychologists

to actually try and interact with people

who've got PTSD issues, which is a quite common feature

for people who are street homeless.

And I was just wondering,

is the case that we interact with these charities

and use them as a means of trying to encourage people

to get direct access to primary healthcare?

because clearly it seems to be interacting with,

getting over that first hurdle of even getting registered

with a doctor or even having a medical appointment

is something that is few and far between

for a lot of street homeless.

That's the question I wanted to ask about health.

I wanted to ask a second question, if I may,

and I see on page 51 you mentioned scenarios

about housing, about people being made homeless,

and you've said a scenario there,

person leaves prison with no accommodation.

I have to say with my own personal experience, I know that in a number of occasions you've

got people who are actually, say for example, incarcerated and they can't even get bail.

They may well be a candidate for bail while they're awaiting the trial or something like

that.

But because they don't have an address, they're then held in the prison system when they could

be outside rather than being incarcerated.

And I was just wondering, this does seem to be like a perennial problem with people, one,

not having addresses that they can go to

so that they can make a bail application.

Then secondly, of course, they may well be granted bail,

their case may come to an end, they may be acquitted,

and then what happens is they're out on the street.

I was just wondering about, tell us about the sort of work

that you're doing and that sort of thing

to stop these people ending up on the street.

Which, so I would like to respond.

Michael?

So with regards to your first point about the barriers

to people who are street homeless,

who present with extremely complex needs.

The new, you're absolutely right to point out

that that is probably one of the biggest issues

that leads to entrenchment.

And the, what we've been able to do

over the last sort of seven years,

because it's worth pointing out that seven years ago

there weren't any commission services

that support people who are street homeless in Wandsworth.

is that we've been able to create new roles and teams

and embed them within the existing statutory services

across the drug and alcohol service,

the mental health service, physical health.

And I think it's those, expecting statutory services

to support people on the street clearly is unrealistic

and doesn't work, so you need those bespoke services

embedded within them to be able to go and conduct outreach,

which is what Shannon referred to

as part of the needs assessment.

So we're already doing that on a commissioning basis.

So the crisis is a fantastic organization,

but we are commissioning other services

like St. Mungo's and SPEAR within our own borough.

But yeah, it's absolutely right that we should be drawing

on the expertise of those fantastic organizations to do that.

And just a second point on that is that our new hub,

health has been at the forefront of the design

of that entire building.

Having all of the services co -located under one roof

makes access to those services so much easier

for people on the street, so they don't have to go

to lots of different locations to access

lots of different things.

All of those services are in one place.

And we've also included on our plans,

there's going to be a clinical space

where we're gonna have GPs coming from

the homeless inclusion team at the hospital,

which is run by Dr. Danielle Williams,

who's absolutely fantastic, and that team's gonna be

coming down and delivering health interventions

along with nurses as well, along with our drug and alcohol

team who'll be able to deliver drug and alcohol

interventions from there as well.

So yeah, absolutely recognize what you're saying,

and yeah, just to assure you that that's been included

in the designs of this new service.

Just to go onto your next point, I don't know whether

Chantelle you wanted to mention anything

about prison release, oh sorry, Shannon.

I just wanted to highlight a couple of examples of work

that is being done jointly with the voluntary sector

and other partners to try and join up the interface

that people who are homeless have with health.

The first one is health and well -being drop -in days

that are led by SPHERE, sorry, that bring in health

and other partners so that people can access

all those services or at least they can start

to have their needs assessed around some of their

other health issues under one roof.

And the other initiative is the Driving for Change bus,

which is an innovative service that offers a range of services from a bus,

including mobile dentists, testing, vaccinations, and

access to various advisors.

And it also even provides useful products such as toothpaste, soap,

as well as mobile charging and haircuts as a means of just engaging some of

those people that might have entrenched rough sleeping issues and providing an opportunity

for them to more strongly engage with health services.

Just to say we've got Kieran with her hand up online. Kieran, did you want to come in

on this? I thought I could cover off the question around

prisons. Oh, great. Thank you.

Yeah. So, obviously, we've got Wandsworth Prison in our borough. As a community safety

partnership, reducing offending and reoffending

is one of the key priorities for the partnership.

So we've done lots of work around some of those pathways.

Housing, mental health, substance misuse,

they're all clear pathways that need

to be addressed for individuals to make sure or prevent

them reoffending.

In fact, about two weeks ago, we held a multi -agency workshop

to look at what housing pathways exist in the borough.

Because when people come out of Wandsworth Prison,

And if they don't have any fixed abode,

then they do come out into Wandsworth,

and they end up being our statutory responsibility.

So we've got some real close working with the prison,

with colleagues in housing.

We know that there's a unit of 33 units on the borough,

as well as a throughput.

So there's lots of multi -agency working going on at the moment

around how we tighten up that housing pathway for people

who leave prison so that they aren't homeless or end up on the streets.

And that's part of the work we do with community safety

in partnership with housing colleagues

and in partnership with public health and prison as well.

Yes, of course, I just wanted to add on the resettlement

prison discharges and doing that early doors, early work to be alerted of people likely

to be discharged, it is really, really important and as the colleague said just earlier to

me that we have that early doors, early alerts because that is what we want to do.

That's what the legislation leads us to doing.

So we do have things like resettlement panels where conversations are had about people who

likely to be discharged from prison soon.

So there's that planned approach to how we will support and avoid the instances where

someone will come out of prison and find themselves street homeless.

So there are things like duty to refer arrangements where public bodies must or should alert us

when someone is due to be discharged or released from prison.

So we do encourage a lot of that early doors work.

and as the speaker said before me,

it is absolutely imperative that we have those conversations

about a planned pathway so people do not find themselves

in more challenging circumstances

post a release from prison.

And as we know, if people don't have settled accommodation,

you end up in that revolving door syndrome

where you're going back into those pre -habits

and we want to minimize those as much as possible.

Thank you.

Thank you so much, Antal.

Councillor Warrell.

Yes, thank you.

In terms of the paper, the paper works through a number of different demographic groups,

which is really helpful.

One I want to pick up on, though, is one group of people with no recourse of public funds

or who are overstayers, and outside of the immigration system.

Often this group of people, either for the home office or they have no statutory rights

to access certain services fall under the radar

and often then get picked up when they're admitted into A &E

with severe health issues

and then get discharged back once again.

I'm just wondering, for this group of homeless,

the subgroup of homeless population,

who are most of the time off -street homeless,

although sometimes can be sofa surfing, I recognize,

what work is being done to support them

and engage with them and actually support them

in terms of their health and their health needs?

Dean -

However, we always say there are potential avenues for support.

The main ones are the local authority may have some limited opportunities to be able

to assist where, for example, there's – for example, if children were involved or where

there was a care need or a return to their country of origin posed a human rights risk.

There are some charities who might be able to offer services, support services to people

with no recourse to public funds, like Refugee Action, sometimes the Salvation Army, and

there are some specialist housing projects.

But the reality is, really, with people who have no recourse, the options become a lot

more restricted.

So a lot of the time we will have conversations with perhaps agencies like the Home Office

around if there were no impending issues

why they can't return home,

how we can work with them to assist them to return

from wherever they may have sort of arrived from.

But it is difficult, and of course there's also advice

around immigration, getting the right support, legal aid,

in order for them to regularize their status

where that is possible.

But then that then opens, once your status is regularized,

it opens the avenues to mainstream housing.

But the legislation is very in terms of homelessness is very clear on who's in and who's out and but it is a challenge

But we do do a lot of work. I know Michael you were talking about

Council you were talking about

People who are street homeless around the ballum area etc

We do know that some of them are have no recourse to public funds and my colleagues in in Michael's team

We'll work with the police and other agencies to try and find short term and you know longer term support

But the reality is the options become quite streamlined where the eligibility issues are

at the fore.

I hope that answered your question.

Annabel's got a little bit more to add on there, of course.

I was just going to add that we recognize that this is a particularly difficult area

to work in, and as part of the new refugee services team that's been in place since

We are looking at and bringing in a resource of a person with expertise to work in that team that will be able to support all the teams in the council that are dealing with people with no recourse to public funds as a kind of advice and support resource.

Yeah.

Oh, more questions.

Yeah.

I didn't see you there, Samantha.

Just to quickly add on to that point, as part of our borough sanctuary accreditation, we

have actually made a commitment to lobby the national government on kind of changing the

policies around public resources so we can try to do it.

So yeah.

Sorry, but my question was to kind of echo

what other councilors have said,

thank you to everybody that was involved in the paper,

to all the contributors.

My question is that the last needs assessment

was done in 2013, and obviously homelessness

has been on the rise over the past few years.

So why was the needs assessment not done a lot sooner?

Shammett?

Thank you, I can answer that.

Conducting a needs assessment is not something

that has a sort of specified period or time scale,

and it's just due to a combination of professional judgment

in terms of when we think that the level of need

might have changed to such a significant level

that we need to go back and assess it again,

but also just in the context of juggling other priorities.

And a needs assessment would probably have been conducted

much sooner outside of all those extenuating circumstances

and it just so happened that just coming out of the pandemic felt like the time to bring that work forward.

Thanks. Councillor Crivelli.

I was encouraged by the point that you made on page 93 about Wandsworth is now supported by a high tolerance facility,

which enables access to maintain their accommodation if they're still drinking and using substances.

I know from some of the hostels that I knew in Central

and then they did three rules, no drugs, no drink,

no violence, and then of course if you're somebody

who's alcohol dependent, you find that you're not able

to access any of those sort of facilities.

I was just gonna ask about that service in general

because you said that you have engagement and motivation

and referral routes to treatment.

I was just wondering if you could expand on that

and tell us what you're doing around the referral routes.

Yeah, of course.

So I think it's a really good point

that you've made, Councillor.

People who are street homeless are often

at a pre -compensative stage of recovery

where they aren't yet in a environment

where they're able to even think about stopping using substances

or alcohol.

So they need somewhere where there is support in order

to give them the foundation to then work on that.

And yeah, so the place that you're talking about in question,

it was previously support accommodation,

and we've essentially used additional funding

to upscale it to put in additional support

in order to take on people who are on the higher end

of those complex needs of co -occurring mental health

and substance misuse.

And essentially we need more of that

because I think that is a model

that works really, really well.

At the moment, we have people in temporary accommodation

who obviously do not have that support.

And actually, there is the need for this kind of provision

far outweighs what we actually have in the borough.

So that's something that we're definitely gonna be looking

at in terms of commissioning in the future.

Can I just ask about the referral routes?

Are you working with the AA and other things like that

to try and encourage people to,

or is it more sophisticated than that?

Well, I don't know whether it's,

well, I think it's sophisticated enough.

So essentially, this all came about,

we've got lots, after the pandemic,

we essentially took a lot of people off the street

and into temporary accommodation, which was fantastic.

But what it was left with was we essentially had

a lot of people with high needs in temporary accommodation,

which isn't suitable, and all of the supported accommodation, or most of the supported accommodation

in Wandsworth was very silted up with people not able to move on.

So we established a supported housing panel, which essentially allows us to use government

grant that's under our budget to move people on from supported accommodation into other

housing options that are suitable when people don't need the supported accommodation, and

and then we essentially move people from then who need it from temporary accommodation or

from the street into those new vacancies. So that's been working really, really well.

But it's all through our own street homeless service.

Thank you. And we've got a question from Stephen Hickey. So can I ask Stephen to ask the question

that he submitted? Thank you, Chair. Firstly, can I echo the

praise for the report which is really an excellent piece of work so thank you very much to the team.

My question is this is clearly a needs assessment and it finishes up with recommendations and

enablers. My question is almost a process one. What happens next in terms of recommendations as

a whole? Will there be an explicit action plan which sort of moves on to the specifics and the

and so on, and how and who will be monitoring the implementation of the action plan when

agreed and reporting back on progress against the proposals in this excellent report.

Thank you. Shannon, would you be able to come back on that?

Thank you, Chair. I think I had alluded to it slightly earlier when I mentioned the fact

that the recommendations have been discussed

and disseminated to a wide range of partners,

and we've agreed some biannual,

a biannual kind of coming together to review

and monitor progress against the recommendations.

So I suppose to answer the specific question

around an action plan, there isn't one central one.

We've embedded the actions within plans

from different stakeholders, but we'll ensure

that there's the leadership, system leadership,

to bring those different stakeholders together

at least a couple of times a year

and review overall progress with the recommendations.

I don't know if Alison called this one.

It would be great if that could come back to this committee

at the appropriate time so we could have an update,

if that's okay.

Yeah, thank you so much for all the great questions

and just to echo, it is a really fantastic piece of work,

so thank you and we've got one more comment

from the cabinet member.

Thanks, Chair.

Very briefly, because I think we have had

a very in -depth and very, very good discussion.

I'm delighted, in fact, we have actually spent the time

to actually input into this very important

and valuable report.

It is an impressive report, and it reflects the joint work

between a number of departments, obviously,

housing, public health, and community safety as well,

as well as engagement with external organizations.

This is a subject which in my opinion

has been subtly neglected for far too long,

almost swept underneath the carpet.

People's immediate response to homelessness

and rough sleepers is perhaps not always

as caring as it should be.

This report does actually make very challenging reading

as Councillor Rigby said, but I do believe

has actually set a path for at least moving

towards improving the situation

for very many homeless people in Wandsworth.

Thank you.

So we're just taking this report for information.

So can the committee confirm they're happy

to note the report and take it for information?

Great.

And we look forward to seeing updates.

Thank you both.

That was great.

Thank you.

Okay, moving on to commissioning of extra care services

at Chestnut House and Ensham House,

paper number 24 -366.

So this paper is for a decision.

Then we've got Rachel here,

who's gonna give us a introduction to the report.

Thank you, Chair.

Good evening, I'm Rachel Soni,

the Director of Commissioning for Adult Social Care

and Public Health.

My colleague Hannah Allapor is online as well,

who we'll invite as necessary.

Thank you for taking this report

regarding our extra care housing services

that are really important essential services

for our residents in the borough

to meet their housing and care needs.

We are seeking approval to recommission,

so we have existing contracts and services

in the borough across two services,

Ensham House and Chestnut House.

It's about 86 units in total, 40 odd in each scheme.

So we're seeking to recommission

because the existing contract expires in August 25.

People have their own tenancy

and their own front door in these services

and then we commission the support provider

to come in and provide registered care services

to the tenants who live in these services.

So we've carried out listening exercises and engagement

with people that live in the existing services

and listen to what matters to them

and built that into the service specifications.

We're looking to engage a strategic partner

to work with us in partnership to deliver high quality care

services for us for the future for a four -year contract

with a potential to extend for two years

at about 10 .9 million pounds.

So really crucial services for us.

We have got an enhanced provision

that we're looking at through the specification.

We're looking at listening to the residents.

They've told us that having something really to do

in the day and having meaningful activities

is really important.

So we've looked at adding and enhancing

our service around that.

We are going to commission on a core set of hours.

So the provider will make sure that there's core hours,

people on site have waking nights,

enhancing the waking night offer.

And then a flexible staffing that

can support people in what they need when

they need it in the service.

So I'm happy to take questions on the report.

Thank you, Chair.

and as will Hannah who's joined us online.

Thank you.

Thanks, both.

The Councillor Marshall, did you have your hand up?

Yeah, over to you.

Thank you very much.

This is obviously a wonderful initiative to see this kind of service being developed

and promulgated in Wandsworth.

I just wondered if you could expand a little bit about some of the costs.

Just my own arithmetic on this suggests

it costs of 21 ,000 pounds per year per person accommodated

if you're at full accommodation, I suppose.

And I just wonder what the costs have been previously.

Is this a big change?

That'll be my first question.

A second one related to that is

what actually drives the cost?

Is it the total hours of service provided

or is it the number of residents?

Thank you.

Over to you, Rachel.

Thank you, Chair.

Thank you for the question.

We are seeing an enhancement in our specification,

plus the current contract doesn't include

a contractual requirement to pay London Living Wage,

so we will expect an enhancement

to what we currently pay for the contract.

Previous hourly rate, or the current hourly rate,

is about £19 .71 per person,

and the predominant feature of the cost is staffing costs,

So the number of hours that we commission to provide care

to the people who live in the building

is what drives the cost of the service.

So we are expecting an increase, but it's not

a huge shift in budget.

Plus, we'll have to accommodate inflation and that increase

in workforce costs.

But we hope with that enhanced service and building,

working with high quality strategic partner,

how we work together in partnership with our provider

we'll also facilitate that.

And building a really good relationship with the landlord

who runs the tenancies is really important as well.

And that helps provide higher quality,

more efficient service if that's working well

in terms of the three -way relationship between us,

the landlord, and the care provider.

Thank you.

Did you have a follow -up?

Or are you okay?

My follow -up on that would be,

86 is a good number, but I imagine it's a drop

in the ocean really compared to the number of old people

across Wandsworth who might be eligible for

and want accommodation like this.

What's the vision for developing it further?

Thank you.

This is, there are, will be four extra care services

in Wandsworth.

I'm really pleased to say that we are opening

a further scheme in Roehampton.

And so that will meet the increased demand

that we see for people's housing and care needs.

So really that gives us really good coverage.

And with the commitment of the council

to continue the funding and enhance this service,

that will give us quite good borough coverage.

There are sometimes a waiting list into the services.

But also sometimes there are vacancies.

And it's about how we manage where people would like

to live and receive their care.

And ideally prevent people going into long -term residential

care, where people can retain their own tenancy.

So it's a good model of provision

and trying to prevent escalating care needs for people.

Councilor Regnier, do you want to comment?

Yeah, I'm interested in hearing more about

the enhanced services and what they include,

and also hearing a bit more about the new coordinator

and what their role will be.

Thank you.

I'll invite my colleague in because she's worked

really hard talking to the residents

and on the specification and enhancements. So Hannah if you'd like to speak to that.

Yes of course, so good evening everybody. I am Hannah Allipore, Senior Commissioning Manager for

Regulated Old People Care Services, so I work in Rachel's team. In terms of this activity,

social inclusion and wellbeing role, that really came out of the feedback that we heard when we

went to visit all of the tenants in both Enshan House and Chestnut House. So just to give

you a bit of background information, we held a lot of engagement events through both paper -based

surveys, going to group meetings at both schemes and individual one -on -one meetings to make

sure that we heard the quiet voices that you do sometimes find happen when you go to visit

schemes. What came through really strongly from everybody that lives in Extra Care is

They value the fact that it's very much got this community ethos, but for everybody they don't necessarily feel connected to their neighbours.

They want stimulating activities that happen within the schemes.

There are some residents that had previously lived in sheltered housing. They found that was really vibrant.

There was lots of activities, whether it was, you know, bingos, movies, activities that might involve going outside of the scheme on occasion to say,

a local park or a theater.

And they felt that that was an area that was really

strongly missing to help them connect to their neighbors

or new people that move in.

We also spoke with our Wandsworth Older People Forum.

So we presented to them the feedback

that we'd heard from our service user engagement in ExtraCare.

We asked them for some of their solutions to the feedback

and the concerns that we'd heard around the lack of activities

and said, how do you think we could meet this need? One of their suggestions was the activity

coordinator role and it was also having a care provider that could support the setup

of a residents association. So what we are looking for in this activity coordinator role

is somebody that will work very closely with the people that live in Extra Care to organise

and design activities and events and schemes. I would envisage that they would set up something

like a formal tenants committee or forum where they can get a group of tenants together,

listen to their views about the activities they want to see, what frequency they want

to do the activities, come up with a mechanism for finding out is that activity that's

being put on meeting their interests, do they enjoy doing it, is it happening for long enough,

is it too long, is it too short, what can be changed, what can be tweaked to make it

very interactive and responsive to make sure that everybody in the scheme that wants to

be able to participate has that opportunity.

I think it's through having that dedicated post that's got the time and the creativity

and that really good values of wanting to make that difference to people that live in

extra care, to make it vibrant and not just being accommodation that they live in but

someone that's really vibrant and it really thrives.

So it's very much investing in that service to make sure that that happens based on the

feedback that we've heard.

Thank you so much, Hannah.

That was a really thorough update.

Does anyone else?

Yeah, Crivelli, would you like to ask a question?

Can I just ask a question about a cost?

Because you pointed out in paragraph 37, the contracts will be subject to indexation.

However, the actual financial implications will be not known until the procurement is

completed and appropriate budget adjustments can be made.

I appreciate we're talking about a contract

that will start in September 2025.

I mean, the figure that you've got there,

the 10 million over four years,

sorry, nearly 11 million over four years,

it could be more than that, couldn't it?

I mean, that's...

Rachel, would you like to come back on that?

Or is that one for...

I will, thank you, Councillor Credle.

Yes, we never know until we receive our bids from our bidders what the tendered rate is.

We obviously have an affordability issue and we work with providers, have conducted market

warming, we have a specification and quite clearly actually setting out our requirements

and the number of hours that we expect to be delivered,

which should help with relatively accurate bids being made

that ideally will come in on budget.

But there is no guarantee that all the bids

will be affordable and we will assess the bid

based on price and quality.

And this is what we expect the service to come in

over four years plus two over the total contract term.

The indexation, we expect London Living Wage

should be paid from the beginning of the contract,

September 25, and then annual inflation

based on 70 % London Living Wage, 30 % CPI,

is what we are anticipating our contract terms to be.

Thank you, Rachel.

Would anyone else like to ask any questions

before we move to a decision on this? Okay. Oh, sorry, we've got Health Watch. Stephen,

would you like to come in and ask your question?

Thank you very much. A rather specific one. On page 151, which discusses sexual orientation,

there's quite interesting figures there showing that all those who declared their sexual orientation

have shown themselves as straight but there is still a significant though falling minority

who are not or unknown and there's obviously various reasons for that and the question really

is about whether in the contract and the relationship with the ultimate provider

there will be any requirements to ensure that non -straight residents will have their

there'll be sensitivity to their needs and any particular requirements in the absence of any

statistical evidence at the moment that you know they exist at all which is unlikely in truth.

Thank you Stephen. Rachel do you want to briefly come back on that?

Thank you for the question. There will be a requirement around equality, diversity and

inclusion and we're also requiring providers to collect more information and better information

about protected characteristics.

Also looking at best practice, I also

know that Hannah and her commissioning team

in developing the spec have been out to specific workshops

around LGBTQ plus and around dementia and their carers

and supporting older people and how

we can build some of that into our specifications.

So it's important to be reminded and ensure that we are always

promoting and improving our specifications

around our EDI, so I appreciate it.

I don't know, Hannah, if you do want to add anything

or whether that's adequate.

I think you've covered it all, Rachel, thank you.

Thank you.

Let's move to a decision on this paper then.

So does the committee support the recommendations

in paragraph two?

Yeah, unanimous.

Okay.

and the recommendations are therefore agreed.

So we'll move on to the next paper,

which is the continued participation

in the London Sexual Health and Contraception e -Service,

paper 24 -367.

This is one that we'll make a decision on,

and I believe we've got Leah to introduce.

Yes, hello.

Thanks for having us and for considering this paper.

So Wandsworth has been participating in the provision of the London Sexual Health and

Contraception e -service since 2018 for STI testing only to date.

And the current contract is commissioned by City of London Corporation on behalf of 30

collaborating London boroughs.

The contract that is in place at the moment

is delivered by a partner called Preventex,

but it's coming to its natural end in 2026.

So the City of London Corporation needs to go through

a form of procurement for a new provider,

and as such, needs us, local boroughs,

to get our local approval to continue participating,

to be named as named participants in the process so that they can then go out and do their

procurement once we provide them with that assurance.

So that's why we're coming here today, asking the executive to agree to the recommendations

at point two in our paper, which essentially is just please could we continue participating.

It outlines that the indicative contract term is five years plus a possible two plus two

extension, so up to nine years, and that there is a small governance fee that we pay annually

to the City of London team to obviously administer it on our behalf.

I welcome any questions.

Thank you so much.

Oh, yeah, Councillor Caddy come to you and then cut lower

I mean, it sounds like a great service and it sounds like a no -brainer in terms of decision -making

The only question I had was on page 162. I

presume

The ones with representative on the service management board means that we will have some say in

Terms of what the contracts asked for and what kind of things we need and how we want it to look in when it is

tendered

Absolutely. All of the participating boroughs are members of that board and anything that

is agreed by the board membership, which is mainly commissioners who really know what's

happening in the local services, then goes up to the strategic board for approval, which

is the likes of me. So my team are involved and I'd be on the strategic level and in fact

member of Shannon's team on public health side is also involved at that point. So that's

correct.

Thank you.

Councillor Worrell?

Thank you.

It's a great service, so I have no comms in supporting it.

I suppose just a couple of technical questions about the paper.

The first one is about the market testing exercise.

From my knowledge, there's only two real providers in the market, which would be PreventEx and

SH -24.

So I was just wondering what sort of market testing exercise has been done and how many

potential providers could be brought into play.

Thank you.

So the City of London team did do a soft market

testing exercise which received seven responses.

There has been some significant change in the system.

Like you're right, the two main providers

are the two you mentioned.

But in time, things are moving.

This is a rapidly evolving area,

which is one of the other benefits of being able

to go out to procure at the moment.

In recognition of that, there were various meetings held

with the management board and also at the strategic board

to discuss whether we should be looking at direct awarding

or going out to a competitive tender.

And on the basis of that level of interest

in the soft market testing exercise,

it was agreed that we will be going out

to competitive tender.

Are you satisfied with the results?

Do you want to come back?

I've just got a supplementary follow -up to that.

Great, and that's great news to hear,

and I'm glad the market is developing.

I just wanted then to just pick up

in terms of the tendering exercise itself.

On page 165, paragraph 26,

you mention a number of potential options or proposals,

including the appointment booking system,

increasing prep access, and other forms of testing.

I was just wondering then,

And in terms of what's being asked for the money, would this service, these additions

be commissioned within the envelope, or would you be coming back to ask for extra money

should these be a consideration?

Thank you.

So the funding mechanism for the service is activity -based at the moment.

And so with any additional options, then boroughs have the option to either switch it on or

or not, and as such, the mechanism continues so that they would then pay for activity for

anything that they are participating in.

So, in that respect, there isn't a funding envelope as such, which is limited as a block

amount, and we wouldn't be charged for any development costs as such.

The idea is that these would be developed.

You then, as a borough, choose to switch it on or not, and then you pay for the activity

associated with that provision.

so then that funding for that specific additional provision

funds that element and doesn't have a knock -on effect

on the existing core offer of SCI testing and contraception

and wouldn't have any impact on any KPIs

relating to those as well.

Thank you.

Yeah, of course, come on.

Final question, I'm happy to know.

I suppose it's just in terms of this program

and was designed to be a channel shift,

to shift some activity away from sexual health clinics

and reduce costs, which does really well.

As this is recommissioned and there's

proposed increased activity, I'm just wondering then,

would that have any impact in terms of the tariff rate,

in terms of the activity in the sexual health clinics

and the tariffs that are charged?

My concern with this question is sexual health clinics

are already under strain.

They are short of money, and there are several papers out there.

And my concern would be by supporting this, which is a great initiative, that we don't

actually put the sexual health clinics at a financial disadvantage.

Yes, so absolutely not.

We aren't putting them at a financial disadvantage.

The system is under immense pressure at the moment.

There is more demand, and there are, you know, there was even a report by the LGA in January

this year highlighting the pressure that clinical services

are under at the moment.

So the whole purpose of the e -service is that it's been

designed to complement the face -to -face offer that is there

as opposed to take anything away from it.

And so the benefits of being able to see low complex cases

or asymptomatic cases online is that it frees up that space

within the clinical face -to -face provision to see the people

who really need to be seen face to face.

And so they work in synergy in that respect.

Thank you.

Yeah, Shannon, did you wanna come in?

Thank you, if I may add, I just wanted to highlight

that a recent sexual and reproductive health needs assessment

that we undertook this year actually highlighted

the increase in uptake through this particular service

during the pandemic period, but actually that has been

sustained beyond the pandemic period.

and I think that highlights that it's meeting

a particular need for our residents

where maybe they don't need to go in to see

a physical service because the service

meets their needs online.

Thank you for that addition.

Any additional questions from the committee?

Okay, let's move to a decision on this paper.

So does the committee support recommendations

that are in paragraph two?

Agreed?

Fantastic.

So we are supporting the recommendations.

Thank you very much.

Report is new.

Thank you so much.

So onto item seven, roadmap to health and care integration.

Paper 24 -368.

This is quite a comprehensive paper.

So I'm going to hand over to Lynn to give a bit of a brief overview.

Thank you, Chair.

I'm Lynn Wild.

I'm the AD of health and care integration.

And I'm...

I can try.

Is that better?

There you go.

So the purpose of this paper is really to outline the areas in which the Council, particularly

adult social services are working with partners in the NHS, primary care, our local community

and voluntary sector organizations to deliver services to our residents.

The key aim of integrated working, I know this isn't a new concept, we've been talking

about integration, haven't we, for forever?

But the key aim of integrated working is not about structural integration or changing,

you know, making a mega organization,

but rather about a cooperative working across partnerships

to ease people's access into health and care services,

so that services collaborate rather than people

having to access various points

to get the services that they need.

At least that's the aspiration.

Our priorities are outlined here about prevention,

hospital discharge, intermediate care, or reablement,

about mental health and integrated neighborhoods.

And I think you can quite clearly see

how those priorities align with the three shifts

in the NHS long -term plan, which is from,

just to remind you in case it's a test,

is from treatment to prevention,

from analog to digital and from hospital to community.

And I think it's clear how some of these initiatives

are really trying to pull services away from what we do now

to something that's better aligned

with the needs of our people and for the future.

I think clearly the word integrated working

is a bit of a jargon word

and it can mean anything really, or nothing.

And I think what we're talking about here

is working on shared priorities with a common purpose.

So really linking it to our population level health needs

and how we improve access and outcomes for our residents.

So speaking really to addressing issues

that I know are dear to the hearts of our residents

and our members around things like addressing health inequalities, improving access, hearing

people who are seldom heard.

I know that the work of neighborhood, integrated neighborhood teams is probably of great interest.

And it's fair to say that post -FULA, everybody's sort of scratching their heads to think how

exactly do we deliver this.

And it's very much left...

could you just explain what the fuller report is,

just for those that might not know.

So the fuller report is on integrated neighborhood teams,

and she particularly sets out how primary care,

so GP practices will work with the rest of the partnership

to improve access for local residents.

And what we need to work out, I think,

is there isn't a blueprint given down to us

by the DOH or NHSE, NHS England.

It's rather a thing that we need to work out locally.

And we've got really good collaboration going on

through our partnerships at place committee

and at our newly established Wandsworth provider alliance.

And where we've got to is that we

want to work at neighborhood footprints of about 30 ,000

to 50 ,000 residents, which broadly align

to our primary care network, so groups of GP practices.

And the idea is that we'd find ways

to meet the really quite hyper -local needs

of those residents.

The example I've given in the page, plan on a page,

is Battersea to Brazil, which fundamentally

is about finding people who often don't present

at services and supporting them to get the health needs that they need.

We also have in place a proactive care program which has been working at GP practice level

for a number of years where it's GPs, nurses, social workers, therapists, and our social

prescribers considering a group of people whose needs are not yet that top level of

need, but who would become that, and trying to support those people, give them the support

that they need so that they can maintain their health and well -being as long as possible,

and don't hopefully delay the tip into having higher levels of need.

I think I'll stop there and ask for any questions.

Thank you, Len.

That was really comprehensive.

Councillor Worrall?

I feel like I'm talking all night here.

Apologies to everybody.

Thank you for this report.

I found the appendee with the diagram, diagrammatical approach really useful and a nice visual way

to understand some of the processes.

And thank you for trying to explain what neighborhood means and partnerships.

I think you're right, it's such a vague term that we all struggle to understand it.

And I like the way that you were trying to describe it.

It gave me something to hang on to.

So thank you, that was really useful.

I suppose my only question is, and you partially answered this, is if I was a patient,

remember the public, what would I see difference or

what would I feel in terms of difference for this coming into play?

I said you partially answered that, but I was wondering if there's anything else you'd

like to add.

I hope what you'd see would be that it's easier to navigate the system.

The health and care system can be quite hard to navigate, and often people with multiple

health conditions can spend their lives going on to various appointments, and that's all

there is time to stand in queues to go to appointments.

So to try and bring services more locally and in a more integrated way in a way

The team around the person to deliver the services is what is the ultimate?

aspiration so that

we work more closely with health colleagues with retail involuntary sector and

The access for our residents is easier

Just just to build on council or oils point. I guess what are some of the kind of tangible?

integrations that we can expect?

Like will teams come together physically,

you know, a council, health, other VCC organizations

in this integrated way or will it be more virtually?

Like, you know, what will it feel like?

I think there's a little bit of a combination of both,

depending on the scale at which things are being delivered.

So for example, intermediate care or reablement, which is about supporting hospital discharge,

but also preventing hospital admission through a range of provisions such as therapy, social

care, et cetera, that would be likely to be more at a sort of a borough -wide level with

ourselves as social services working much more closely with community and voluntary sector and our health providers.

So a virtual team, but seeing ourselves together in physical spaces.

I think in some of the other things, it is about using resources like our buildings, our family centers, for example,

as places where interventions, services can be delivered from and sharing space.

Because we do know that presence, for example, in offices is often less than it was pre -pandemic.

So a lot of organizations have some space available.

How do we share that space meaningfully?

And we know particularly locally, our community and voluntary sector often looking for spaces

to deliver services.

if we share spaces, we bring services to people,

and it works for all of us.

I'm not sure if I answered your question.

No, no, not that, thank you.

So the reports for information,

do we have any other questions

before we move to note the report?

No, is the report noted?

Great, thanks everyone.

Nice, okay, we're on to annual complaints report

for Adult Social Care, 2023 to 24, paper number 24369.

And we've got Nancy, who is here.

Welcome Nancy, to introduce the report.

So can you give the committee a bit of an introduction?

Good evening, I'm Nancy Carissa,

Complaint Service Manager.

The report's a good news story.

It captures learning from complaints,

including case studies at the end of the report,

and it also gives examples of some of the excellent

compliments that adult social care receive to ensure that we also learn from what we're

doing well.

The numbers are consistent with previous years.

There's been a slight drop.

Complaints are spread evenly across the teams.

And overall complaint numbers are low, so there's no areas of concern.

And the themes that are coming through are the themes that we expect to hear each year.

Finally, the good complaints practice in Wandsworth is reflected by the low number of escalations

to the Ombudsman of which three progressed to a formal investigation during the year

and I'm happy to answer any questions.

Fantastic. Councillor Caddy, go for it.

Thank you very much, Chair. Yeah, really interesting report and I guess my only comment is really

glad to see the lessons learned point because I think any large organisation is always going

to have some complaints coming through but the key is that obviously we learn from those

complaints and change our systems going forward. So I thought that element of

the report was great. So thank you very much. Thank you for noting that

Council Caddy Council would be. Yeah, I just want to acknowledge all the work

that not only went into preparing the report, but to actually get those

number of complaints down, it must have had a really big boost on staff morale.

Have you noticed if it has helped with any retention or recruitment that we've

been able to produce figures like this.

Can I clarify if you're referring to retention

within the complaints?

Within your team, yeah.

We have good retention in our team.

We have long -standing members of the team.

We're a supportive team.

We love complaints, we love the work we do,

so I would say that we do.

Be reframed.

We do, no, we think that they're brilliant.

I think they're free information for the council.

And receiving complaints isn't always a bad thing.

But we do such excellent work with adult social care teams

to resolve things when they come in

and look for opportunities to stop things

from progressing to form complaints.

And I think that's shown in the reflection

in the drop in numbers.

So I would say yes, it does have a good impact on morale.

Thank you.

It is really good to see that culture of real transparency

and openness around that.

So thank you to you and the team.

Please pass on our thanks.

And we've got a question from Steven Hickey.

Would you like to come in Steven if you're there?

Yes, it was on page 203, which is about the equalities data.

And it's really a sort of a curious question really.

It's about whether we're getting enough complaints or not,

to put it that way, from disadvantaged groups in particular.

It may not be within your gift, but I suppose behind the question is the slight concern

that there may be groups of people with complaints or with issues who may not be raising them,

and particularly from disadvantaged groups, and whether there's anything, you know, we

should be doing just to almost check that out and to encourage people to conform with

complaints.

Perhaps it might be helpful to kind of explain how you practically reach out to communities

who might be otherwise have barriers to complaining.

I mean, yeah, we strive to be as accessible as possible in the complaints team, and we

publicize the fact widely that we want to receive complaints from anybody who wants

a complaint.

We welcome complaints.

Our policy and our website is clear that we make adjustments to make the process of complaining

easy for anyone.

Our complaint literature that's on our website reflects the diversity of our service users.

Thanks very much.

Did anyone have anything else to add before we take this report for information?

Okay.

Thank you so much Nancy and is a report noted just to confirm noted. Thank you very much everyone

Okay, we are on to item number nine

quarter to budget monitoring

2024 25 paper 24 dash 3 7 0

This is a paper that Annabelle is going to introduce

So I'm Annabelle Parker, the Director of Adult Social Care, and I'm introducing this report

to you in the absence of the author, Sarah Evans, our Director of Business Resources.

So this report provides an overview of the forecast revenue position for the remit of

this committee, which includes adult social care and public health and community safety.

the forecast position is an overspend of 2 .7 million or 2 .8 percent compared to

a revised budget of 97 .3 million. There are significant budget pressures for

adult social care and public health and it is the budget for social care

services that are the most challenged for all groups of residents receiving

necessary services for which we are experiencing increased demand, rising

care needs and rising costs of services. Increasing complexity of need and

market conditions are leading to increased prices within the market.

In addition, the significant pressures facing our NHS partners are impacting adult social

care, with patients presently waiting longer for some treatments or surgery and being discharged

earlier, needing more intensive social care support.

Paragraph 14 of the report sets out the mitigating actions being undertaken within the Directorate,

so we're endeavoring to manage the increased demand and to reduce the pressure on the budgets.

We continue to focus on our vision to support residents to lead fulfilling longer healthy lives,

to meet our statutory duties via a strength -based approach which supports residents with social care

needs to be as independent as possible for as long as possible and which seeks to prevent delay

and reduce the need for long -term care services. Via our transforming social care program we are

implementing a range of initiatives to help manage future demand for services and to improve

efficiency. Some examples are identifying opportunities for using technology to

work smarter and deliver better outcomes for residents including the use of

digital care technology, driving service integration, focusing on improved

reablement, some of the things that Lynn's been talking about earlier,

anticipatory care and a more strategic approach to mental health commissioning,

embedding intelligent commissioning to support local care markets to become

more sustainable, meet increasing and more complex demand and address workforce

challenges. But there are, as set out in paragraph 16 to 21, key financial risks

and challenges remain for the social care sector, not just for Wandsworth, but

nationally, as evidenced in the recent ADAS survey, which arise from a

combination of increased costs due to increased complexity of needs, financial

pressures faced by the NHS, increased costs due to inflationary pressures,

increased costs due to market pressures and demographic pressures. Myself and

colleagues in the room are here to answer any questions.

Councillor Caddy first then Councillor Crowley and then I'll come.

I've got three questions. The first one is relating to paragraph 18 and obviously

reading this report it's clear and all the other reports it's clear that we've got an issue of driving our costs up where we're saving costs for the healthcare services.

which is an entirely rational thing to do for the system as a whole.

But obviously it's causing us a problem and I wondered whether we were able to

quantify that at all and be able to sort of say, well look, our policies are getting people

discharged from hospital much more quickly. We're looking after people in their homes

much more often and for much longer, which means it's adding an additional cost of x

pounds for us and saving that cost for the healthcare system. And I appreciate,

you know, it's a different budget, but it would be good to at least be aware of that.

The second question is, I wondered if the costs or the predicted budget overspend included

the effect of the recent budget measures, and if not, how much that would add.

And then also the mitigations, I wondered whether there were any numbers on that and

how much we might close the gap by with those mitigations.

Do you want to come back, Annamal?

Okay.

So I think on the first one about the,

so we are obviously in constant conversations

with our NHS partners, and we recognize their challenges

and they recognize ours.

We've both got challenges, and what we want to make sure

is we don't forget the people in the middle

and make sure that they get the right things.

And we do, there is support there where it works.

I mean, Lynn's can talk about some of the things

that we're doing together to address some of the challenges,

especially, for instance, a good example of that

would be the Mental Health Rehabulance Service,

which we're working on together to try and address some of the demand upstream and to

– because I think obviously we're looking for things that are going to reduce the number

– the needs coming towards us.

And then also we've got the things in the market, which we're working – we're

obviously looking at our commissioning strategies together with the NHS to again think about

how we can manage the costs as well.

I mean, there's a lot of things going on.

I haven't got specific details here, but that's kind of the sorts of things.

Did you want to briefly touch on the National Insurance?

I think Rachel's going to just...

Shall we just take that and then we can come to Lynn after.

Yes.

Obviously for next year and the announcements around national...

the employers and National Insurance

and increases to the workforce, London Living Wage, etc.,

that will impact again next year.

We have just had a round of inflation uplifts with our providers

and we're currently working on the analysis of what that looks like. We know that the

analysis from the LGA and ADAS, the Association of Directors of Adult Social Services, have

started producing analysis and we've collectively doing that, as well as working with South

West London across the boroughs so that we've got a collaborative approach of how we address

and support the market. But there is going to be an impact in terms of driving costs

in our provider sector for next year.

Thanks, and Lynn, did you briefly want to touch

on that integration point?

I did just briefly want to mention in terms of quantifying

that sort of is there cost shifting between

health and social care?

We have a piece of work which the directors of

adult social care across South West London

have commissioned, led by,

coordinated through South London Partnership,

which is to identify that,

and that's joint piece of work with NHS colleagues,

just to identify where we each think

the other ones cost pressuring,

and then to start to understand that

and to agree the action.

So although we don't have the answer just yet,

we will in a few months time.

Thank you.

Should I just briefly come to,

or do you want a quick follow up?

Just that last thing was about the value of the mitigation.

So on that point, we are seeking at the moment to put figures against the different measures

about what we think we can achieve in terms of helping us to get back on budget.

And then again, we're currently looking at the position in 24 -25 as part of the budget

review to assess the full year impact of the growth in service user numbers, the higher

than average cost of care packages, and all those other costs so that we can try and start

we're moving forward with them, you know, I mean the problem that we have is that you know

The report sets out obviously activity patterns remain uncertain and there is demographic growth

It's difficult to predict but we will bring more information back to this committee again in September

Thank you and councilor Crevek really I think you've mainly covered the point about the the mitigation which I

Was going to ask but I mean the the chart on

page 211, the biggest problem that you have is the continued increase in demand and any

increases that you have in funding or anything appear to be automatically wiped out by increase

in service user demand.

Do you think that these mitigating actions can actually address long -term the fact that

it seems to be an inexorable rise in the total number of service users?

So I think that's a difficult one to answer, but I think that some of these measures longer

term will have a significant impact in, I think, in some of them are quite innovative

and quite groundbreaking, but of course it's very difficult because the demand is going

up and it's hard to know when it will stop.

I suppose in some areas, some of the demographics we can understand, but there are other things

that are happening as well that sort of you can't, that can't necessarily be predicted

in the way that we can be sure of.

So we're doing the best that we can in that respect.

And I think as Lynn referenced earlier,

the three shifts around hospitals,

community analogs, dialogue, like over time,

if we work in this more proactive and preventative way,

should provide the money upstream

that should prevent some of this spending.

But obviously it does take time,

so thank you for outlining that.

Did I have another question?

Yeah, go for it.

Thank you very much, Chair.

Just coming back to paragraph 14 again,

I just wonder if you could give me some examples

of care technology.

Sorry, I have a follow up after that.

So there's a huge range of care technology out there

from specific things for care, like wearable devices,

but also just things that you can buy anyway,

like an Alexa can be a really, really impactful device

to have in the house for a person with a disability.

So we're using the technology that's available there

for everybody, but also specific care technology

that can just monitor what people are doing.

It can talk to people and remind them to do things.

There's so many different things that can happen.

And also the other thing that you can do is say,

if you're not sure what's happening for somebody at night,

then there are also things you can use

to monitor the situation at night

to see whether someone is having disrupted sleep

or needing more support.

So it's a huge range, it's really,

and there's more new things happening every day.

Thank you.

I guess my sort of slight concern

that I'd just like to probe here,

I mean if I look at the language in your third bullet point,

it's estimated that care and support needs

have been avoided for 59 cases this year.

I mean the care and support needs

are gonna be what they are.

It's how they're met, I guess,

that perhaps that would have been better worded as,

but I just wonder whether this is slightly indicative

of the fact that some of these care technologies

are coming obviously at lower cost,

but what's the depersonalization of the service

that's implied here, and how are you watching out for that

and taking it into account?

Thank you.

So you're quite right.

I mean, we're in the business here of meeting eligible

social care needs, and how we meet them

depends on what the person's outcomes might be,

And it's really important to us that the care technology is there.

Sometimes it might reduce the need for other care and support.

Sometimes it might promote someone's independence.

Some people would prefer to have less people coming into their homes.

But it would never replace a person coming in if that's what someone actually needs.

So we're very careful to make sure that this is augmenting the care and

helping to promote independence, but it's not a replacing.

That's really reassuring, thank you.

Thank you.

Yeah, go for it.

Apologies, I did have one very specific question.

Page 218, one of the biggest, in fact, page 216 is probably the best place to start.

Services for adults with learning disabilities has one of the biggest variances.

But the number of learning disability service users hasn't really gone up.

So I wondered whether there was something specific that happened to the costs.

All of the other items seemed fairly consistent.

So the numbers are increasing and the costs are increasing.

But this one just looked odd because the numbers

weren't increasing.

So for the variant, the main drivers

for the change in the forecast between Q1 and Q2,

you're right.

They were in learning disability.

And actually, in this case, it was a substantial sum

because of a small number of residents with learning

disability being reassessed as no longer eligible for fully

funded NHS continuing health care.

This means that the council becomes

responsible for meeting their social care needs and for funding their services.

Okay. So is this report noted? We don't have a decision required by the committee. Yeah?

Noted. Great. Thanks for a really great discussion on that one. So coming to our final report,

we've done well for time. So we're on Wandsworth corporate plan, actions and key performance

on indicators paper 24 -371.

And we've got Bibi who is going to introduce this report

and then we've got Kieran that's also gonna come on

briefly on some of the new KPIs.

So Bibi would you like to go first online?

Okay, so I'm Bibi Jean -Glesgar.

I work in the corporate performance team.

This is a standard report that the overview

and scrutiny committee receives roughly

every six months. This particular mid -year report provides progress updates on the corporate

plan actions and sets out the key performance indicator results that are related to this

committee's remit. The corporate plan actions and KPIs are refreshed each year to ensure

that they remain fit for purpose and reflect the council's priorities. The current sets

were agreed in the June cycle.

And so that's just a brief instruction.

And obviously if there's any queries,

myself and colleagues will hopefully answer them.

And Kieran, can you talk to us about

some of the new community safety KPIs that we've introduced?

Yeah, sure.

So, I mean, colleagues, sorry,

Kieran Vagawal, Assistant Director

for stronger and safer communities.

So members will see that we've provided

quite a detailed update on some of the new refreshed KPIs that we've got. So we've covered

off for example the KC report that the Met Police have got. So we've aligned some of

our KPIs with that and some of the outcomes that we've provided as well. There's a clear

focus around neighbourhood policing for example. We've shown some examples of work that we've

done in Tooting, Broadway and Clapham Junction but also to say that there's been other targeted

areas as well by both the police and community safety, for example, St. Mary's Ward, Shaftesbury

Queenstown, Ballum. We've come to the committee before to sort of let you know, to share some

of the work that we've done in Ballum, et cetera. So there are other areas that we've

covered as well. I thought I'd also share with the committee that the police in September,

they thanked the partnership and the council because they've had consistent increases in

confidence in policing in Wandsworth.

It's the only borough in the Southwest BCU

that have seen these increases.

And the increases have been round about 10 %

of our local community agreeing that the police

can be relied on when they're needed,

that they do listen to concerns

that our local residents have.

They've also seen an 18 % increase in confidence

that they're tackling ASB

and a 13 % increase that they're tackling knife crime.

Although those things aren't on the KPIs, they're an outcome of some of the intense

work that we've done in some of those targeted areas as well.

Also just to highlight, we refreshed all the VORG indicators as well.

So we separated out the positive outcomes for domestic abuse and we've separated out

sexual violence offenses as well just to sort of represent the priority that we're giving

around VORG.

And I think the final thing really to note

is that in terms of our IDVA referrals,

there's been a lot of work that's gone on

across the partnership to raise awareness.

And you can see that we're above target

for some of our IDVA referrals as well.

Thank you so much, Kieran.

I think I've got a question from Samila.

Thank you.

I just want to say that first of all,

it's fantastic that we are on target for all of our KPIs,

obviously, except for the one on occupational therapy.

But as Kieran said, I just want to highlight that it's great to see that we are above target

for our referrals into the independent domestic violence advisors.

Obviously, the council launched its work strategy in August this year, and it has been a priority,

so it's kind of great to see that translate into the results here.

So I just wanted to highlight and welcome that.

Thank you, and thanks to the work of your team, Kieran, for all of your work on that.

Do I have other questions?

Yeah, Councilor Caddy and then Councilor Worrell.

Thank you very much, Chair.

And the first question was on the percentage

of eligible people who have received an NHS health check,

and it was really just that it's incredibly low,

and I know the target is low, so we're beating the target,

but it just seems like a really low number

if that's something that people could be doing,

and given that prevention is a focus,

I wondered whether there was anything we could do

to try and bump that up.

And then the second one, and this might just be

because I'm relatively new to the committee,

The number of physically active adults supported by a council funded project,

I wasn't sure what that meant or why it would necessarily be a good thing,

because it doesn't even, it sort of doesn't speak to any benefit or outcome.

They may have taken part, but it doesn't sort of say why that's good or whether it worked.

Shannon, would that be you to kind of come back on those KPIs or is it other colleagues?

I can cover the one on NHS health checks.

Okay. We'll start on that.

So the NHS health checks indicator is actually,

although it appears low, is a positive story.

I don't know whether committee remembers

that we've had at least a couple of years

where that indicator has appeared as red

and a lot of effort was going on behind the scenes

to try and recover it,

primarily from the impacts of the COVID pandemic.

Obviously this is a service which is primarily delivered

through GP practices and that was impacted

and we recovered that.

But also subsequent to that, we've expanded

the delivery model and actually commissioned

some of our local pharmacies as well,

six local pharmacies to additionally deliver

the NHS health checks.

So it is actually an improving picture

and one that we're proud to kind of see the turnaround

compared to the last two years.

Thank you, sorry, I obviously wasn't aware of the history, but yeah, that's great. Thank you.

And who will cover the one on physically active adults, give a bit more context around that.

So, Chancellor, could you just remind me of the question?

So, from looking at the numbers, it looks like we have had 849 physically active adults supported by a council funded project versus a target of 750.

but it doesn't sort of speak to why that's good

or what, you know, have they said that that's helped them?

It just sort of taking part in something

doesn't necessarily mean it's helping.

And it might just be that I,

there's another part of it that I'm not aware of,

but, you know, how is that sort of helping

support health needs in the borough, I guess?

Thank you.

That is a really good question,

and I recognize the fact that the indicator

doesn't come with the explanatory context. So this is a new indicator which was introduced this year

and it was based on the fact that particularly again during the COVID years we saw the impact of

that on the number of people who had become physically inactive and actually Wandsworth

is one of the boroughs with the highest rates of physical is the borough with the highest rates of

physical activity across London,

and we sought to address that through introducing

some additional schemes that would support residents.

So because this is the first time that we're looking

at the indicator, that's why it's probably high level,

and I think the next question that you are asking

is the right one in terms of maybe starting to look

at what impact that is having at an individual level

and some of the sort of clinical benefits

that we know people being physically active will help them with.

Should it say physically inactive adults in the description?

Because I was perplexed as to...

Because if it's physically inactive adults being encouraged to get active, that makes

more sense.

But if they're already physically active, I'm not sure how that helps.

No, there isn't a typo because the number of people who are physically inactive in the

borough is a national measure that is conducted by a survey.

What we can more accurately measure at a borough level is the number of people that we are

supporting to become physically active through council funded activities.

So it is correct.

But maybe we need to do some thinking. I think it would be great

Maybe next time to yeah come back with a little bit of detail around some of some examples of what that meant

Thank you for raising that councilor Cuddy and yet councilor Rigby. Yeah, is it the the number of

Adults supportive to become physically active. Is that what it means? Yes, absolutely

So, these are people who might not have otherwise been physically active if the council hadn't

introduced them to the offer.

So, any other questions on our last paper?

Yeah, Councillor Crielli.

Can I just ask about the point about the NHS check?

And we've got the one that says percentage of NHS checks identify people at high risk

of developing type 2 diabetes.

Is that a separate check from the one that we see

where we've got the first percentage of eligible people

who've received, or is that 6 .9 % of 3 .2 %?

Thank you.

So the latter explanation is correct.

They are related.

The NHS health check is an initial gateway

to support people with several issues,

including cardiovascular disease

or people who might be overweight

or be at increased risk of conditions such as dementia.

So we've particularly decided to highlight

how the NHS health check is contributing

to tackling diabetes because we know

that this is a significant issue for our residents

and it's a health inequalities issue as well

because of the disproportionate impact on some groups.

So it is 6 .9 % of the people who receive the health check.

Thank you.

And Councillor Warrell?

Yes, I'd just like to pick up on the point that Karen made about confidence in the police

and police activity and social behaviour, and just complement her and the team and the

police in terms of work done in Shaftesbury and Queenstown, for example.

Some of you may know, in the last year we've had one person killed.

We've had several people killed on our borders of the ward.

And it has affect public confidence and it has affect the way the public feels about

social behavior.

And we've seen a lot of activity from the safe neighborhood teams and from Karen herself

and from other officers coming in, meeting the public, responding to their needs, setting

up a bereavement service, actively engaging with the residents' associations.

And I think this is a prime example and good news to show how effective those interactions

can be working at the grassroots level and just as I say to commend her and the team

in relation to the work that's been done.

Thank you Kieran, lots of praise for your team tonight so please do take that away.

Thank you.

Great.

Any other questions before we close?

Okay.

So is the report noted, no decisions required on that?

Okay, that now concludes the meeting.

Thank you everyone, that was a really rich discussion.

Thank you.

We welcome your comments

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Health Overview and Scrutiny Committee - Wednesday 27 November 2024, 7:30pm - Wandsworth Council Webcasting

Health Overview and Scrutiny CommitteeWednesday, 27th November 2024 at 7:30pm

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Health Overview and Scrutiny Committee
Wednesday, 27th November 2024 at 7:30pm