Health Overview and Scrutiny Committee - Wednesday 12 February 2025, 7:30pm - Wandsworth Council Webcasting

Health Overview and Scrutiny Committee
Wednesday, 12th February 2025 at 7:30pm 

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  1. Webcast Finished

of health committee health committeeú poverty.
good evening and that you're here Councillor Correlli good evening I'm here
thank you councillor Davies good evening
councillor de la Sejour I'm also here councillor Hussain good evening
councillor Marshall present and we have apologies from councillor Rigby and
Councillor Stutters, Councillor Varatharaj.
Good evening.
Councillor Worrell.
Good evening.
Also in attendance is the cabinet member for health.
Would you like to introduce yourself?
Ryan Mensing, good evening.
Lovely.
So we'll move on to the contents of the evening,
starting with the first item.
So are the minutes of the previous meeting agreed?
Lovely.

1 Minutes - 27th November 2024

I'd also like to welcome Stephen Hickey,
Chair of Health Watch,
who's attending virtually at the meeting.
I'll ask Stephen to comment on any item
he's indicated that he wishes when we get to that item.
I'd also like to welcome Kate Semak
and Natalia Henry from St. George's Trust,
who are attending on the Trust's item.
Just at the back there.
Thanks for joining us and we've got Philip Murray
and Priya Samuel from
Southwest London st. George's mental health trusts and with Mark Creelman and
Kate from the ICB. So thanks everyone for joining us this evening
We've also got a number of officers present who will be attending in person and virtually and they'll introduce themselves
as the committee goes on
Does anyone have any declaration of interest that they'd like to make before we get started?
Okay

2 Declarations of interests

So let's move on to item three report by st. George's trust an update on performance and key issues
I think Kate and Natalia you're gonna welcome this report if you just like to

3 St George's Trust Report on an Update on the Trust's Performance and Other Key Issues (Paper No. 25-57)

Introduce yourselves and give a brief introduction and thank you for coming to see us this evening
Thank you.
Thanks, Councillor Dobras.
My name is Kate Slemich.
I am the managing director at St George's and I am with Natilla Henry who is the group
chief midwifery officer at St George's.
We have provided quite a broad report in the usual way covering a whole range of areas
of how we are doing performance wise, our financial framework that we are operating
in at the moment.
We have provided a fuller update on maternity following the CQC visit and Natilla will be
happy to take any questions on that.
We've had quite a lot of CQC activities,
so happy to discuss and share anything
that would be helpful for you to hear tonight
with regard to that.
And the usual quality and workforce updates.
So I think in the usual way,
I wasn't going to go through anything in any detail
unless you would like me to hand over
to any questions that people have,
because I know you've read the report.
Yeah, we can go straight to questions,
if everyone's happy.
I think we've got a lot on this.
So yeah, Councillor Marshall, straight up, you go first.
While there's been very good progress on the elective surgery waiting list, I would
like to point out that three wards had to be closed due to norovirus.
I'm just wondering what the knock -on effect of that has been generally, but particularly
on the waiting list for elective surgeries.
Yes, I think as you've probably both read in the news and also sort of heard more locally
with St. George's we have been impacted by norovirus and it does change.
We've probably got about 30 beds closed in the organization on a number of wards which
norovirus prevents us from emitting into those wards.
We've actually had very little impact on our surgical wards interestingly.
It's mainly impacted our medical wards.
we keep our surgical ward complement very separate
from our non -elective emergency ward.
So at the moment, it hasn't had an impact on elective surgery.
But obviously, we have to be very, very vigilant
around norovirus because obviously, it
spreads very quickly.
But so far, no impact, I'm pleased to say.
Thank you.
Dr. Carazzi?
Karim Ali.
Can I just ask a question building on the elective treatment
you've said on page eight paragraph three,
sorry, you've talked about consultant -led elective treatment
waiting time remains a priority for the trust.
And you have said that you are performing better
than your peer average, obviously that's commendable.
You pointed out there's 31 patients
waiting 65 weeks or longer,
and 858 patients waiting 52 weeks longer.
Appreciate if you were one of these patients
that was waiting that length of time.
Obviously the fact that the peer average
doesn't mean anything to them.
And I was just, you say we do have a detailed plan
to mitigate the growth of that.
I was wondering, out of curiosity,
is there some particular form of treatment
that makes up the bulk of these patients?
Or is it just scattered all over?
Is there one particular thing that you need to focus on
as a trust to address these waiting times?
So in terms of the 65 week wait,
and I totally agree with what you say.
I mean, waiting that length of time
for your elective surgery is really distressing
for individuals and we absolutely,
so whilst we're ahead of many other organizations
in a way that's absolutely irrelevant,
we want to bring those weights right down
to where they used to be.
We're teetering around the sort of 30, 40 patients
who've been waiting over 65 weeks.
The intention is to get that to zero by the end of March.
I think that is quite challenging,
but we're certainly aiming to do that.
The key, we have a number of services
that are key drivers for those weights,
so it isn't spread across a lot of specialties,
but neurosurgery is one, as is general surgery
and gynecology, so there are particular areas
where we are having to do a lot of work
to make sure we're bringing long -waiters in.
We're also really focused on bringing our 52 week waiters down.
We have brought the number down since the report was written and the sort of government
intention is to have only 1 % of the people waiting over 52 weeks by March 2026.
We're really confident about hitting that.
We're about at 1 .5 % now.
So, and of course then it's also looking at how we go back to the standard of measuring
how long generally people are waiting and bringing that sort of up to a higher level
so that less people are generally waiting long period for their surgery.
So we've got lots of programs of work in hand to address that, including validating our
waiting list and making sure people are still waiting for that procedure because actually
that is an issue in itself because often people are on a number of waiting lists at the same
looking at how we're utilizing our theater lists,
making sure we're booking chronological order.
So obviously particularly around long waiters,
we have to get our emergencies in quicker,
but making sure we're dealing with patients
in chronological order.
So and just generally improving our productivities.
And I'm confident we're gonna get there,
but we need to try and get there as quickly as possible.
Thanks, that's reassuring to know
that there are lots of plans in place around that.
Councillor Gassane.
Thank you, Chair.
The trust reports a 14 .3 million deficit.
I mean, the information is probably available elsewhere,
but there's no breakdown in the report
about how that deficit came about.
There's mention of a review by Deloitte.
Would it be able to say what structural financial issues
were identified by that report
and how much additional public funding
may have been allocated to cover deficits.
And there's a mention of cost improvement program.
Are you able to tell us how much cost cutting
has been achieved and if so,
what the impact on patient care is?
So I'll try and answer most of those questions.
So I'll start at the end.
So in terms of a cost improvement program.
So just first and foremost,
we have to go through a quality improvement assessment
of every cost improvement program that we do,
and depending on the size and the quantum
of that cost improvement program,
depends on where that's reviewed within the organization,
but it involves a clinical review
with an operational management review as well.
We are on track to deliver up to 60 million pounds
worth of cost improvement programs this year,
which is a significant increase on last year.
It equates to about 5%,
so better than we've achieved before.
And a lot of those, you know,
they're things like reducing temporary staffing,
looking at nursing rosters,
improving our consultant,
the way we work with consultants
and actually their job plans are done,
a whole range of things, obviously procurement.
And there have also been some benefits
on the income side where we've delivered
a higher level of activity
which links to improving our waiting times.
We have got, in terms of structural deficit,
we have an underlying deficit at
St George's
and some of that
is
,
we had an underlying deficit
pre -COVID
and managed to get things
back on track and post -COVID
that has returned.
There is a whole range of
reasons for that.
When we deliver cost improvement
programs they are not always
recurrent and of course
you carry that deficit
through to the next year.
This coming year
we are about to move
into is incredibly challenging financially. I think it's probably one of the most financially
challenging years we've probably ever entered. So we will still have a deficit going into
next year. We have a deficit agreed deficit plan with within the system and with NHSC,
but we do need to work through how we're going to close that deficit over time. But that's
going to take a number of years to achieve. So just on the business anything else I haven't
answered from what you asked me.
No, I think you pretty much covered everything.
Just related to that question, so it's
mentioned that the use of private beds is still happening.
How much of the budget is spent on outsourcing
to the private sector?
Is that growing or is that diminishing at present?
It's diminishing.
I think we use very little private capacity.
I'm not sure we use any private beds at all now, actually.
Probably the most recent we've now,
we know now no longer using within cardiology,
because we had a big cardiology backlog,
we've managed to clear that down.
So we work really hard, not, obviously there's a,
we have the plurality argument that actually
we should be allowing people to have that choice,
which is there.
Most people don't want to go into the private sector,
because they want to have care at St. George's,
and our waiting lists aren't so long
that generally people want to do that.
But we have very little of our budget
goes into the private sector.
I think Councilor Marshall, we next?
Do you still have a question?
Oh no, you go for it first.
So I just had a question on the pediatric cancer care.
So our mayor of London, Sadiq Khan,
he said in recent press releases
he wants to see the pediatric cancer care
St. George's to be strengthened.
So just on the back of that,
Have Georgia received any guarantees from NHS England
on continuing pediatric cancer care?
And Georgia's kind of what's going
to happen in the handover period or kind of just what's
happening.
So I know you're aware that we're
seeing pediatric cancer is moving to the Evelina.
And we will still be undertaking outpatient cancer care.
We are working with NHSC about becoming a post -skew enhanced.
I'm gonna have to remember,
that's a pediatric oncology care unit
of a higher level than we currently are.
So we're in negotiation about how we land that post,
post the service moving to the Evelina.
Sorry, could you explain for committee members
what that means?
Yes, it's a pediatric oncology shared care unit
where children would come with a higher level of need
but not need an inpatient bed or inpatient treatment.
so it would enable us to support,
continue to support children locally
with a high level of cancer need
with the right conditions and services available
to support them.
I was just trying to remember what it's,
so you're still calling it Povski, sorry.
So we're in discussion with NHSC about what else
we can work with them for St. George's
to make sure we're maintaining high levels
of tertiary care for children,
but we won't be delivering inpatient cancer care.
That will be moving to the Evelina.
And who's next?
Yeah, Councilor Horrell.
Thank you, Chair.
First, just some feedback.
St. George's often gets a bad rap in terms of the press.
And I recently, in fact, this weekend
had an MRI at St. George's.
The waiting time was about just under 3 and 1 1 2 weeks
from referrals, actually getting the test done,
and an excellent service.
So it's nice to have some good stories
throughout St. George's, and a big thank you to your staff
in terms of quality of care that was actually delivered.
And I would be grateful if you could feed that back
to the MRI unit, how pleased I was
from the moment of contact all the way through.
So it was great to see a coherent pathway in place,
and a really good pathway.
So, a big thank you for that.
In terms of your report, I just wanted to go back, go to on page 8, you talk about the
transfer of Care Hub.
And I was just wondering, what was, if someone comes into that, what's the average time for
discharge that somebody could actually expect, and what might be the particular challenges?
The press is often full of stories around bed blocking and no packages of care being
available, et cetera.
And we know that the press often spins stories
in the negative lights.
It's often sell papers.
So I'm just trying to get an idea,
what is the real picture in terms of discharge time,
the weights, but also a realistic assessment
of what the challenges might be and how
we might be able to help you.
And thank you for that positive feedback.
I will make sure we feed that back.
And that's always appreciated.
So the Transfer of Care Hub is a multidisciplinary, multi -agency
the team, I suppose, who are hospital -based,
who work with the wards to support discharge
and flow out of the organizations.
They become experts on discharge,
particularly more complex discharge.
We have social workers, voluntary sector,
nurses, therapists, and our community provider
within that hub.
So it's a sort of center of knowledge and support.
In terms of, I mean, it wouldn't be right to say
we don't have any issues with flow,
because we absolutely do.
And I work very closely with Wandsworth,
obviously my colleague Mark behind me,
about what can we do to take out delays in the system,
both internal and external delays in the system.
When somebody needs a three times a day
or four times a day package of care,
that can take longer than one would want it to,
to organize and obviously people who are
on what we call a pathway three
when they're waiting for a home,
I think people end up waiting quite a long time
for that as well.
So I think it's still a bit variable,
more variable than we want it to be.
The transfer of care hub and the teams
and the way they work try to reduce lost days
at various points of the pathway
to at least make sure we're working really hard
to notify social care early in a patient's pathway
rather than at the point that they need to be discharged
so they can start planning their discharge earlier
and start negotiating with packages of care, et cetera.
We're getting better at doing that.
So it's about being more joined up,
trying to take out those wasted steps,
and obviously acknowledging that some bits of the pathway
do take longer than one would want them to,
because actually setting up the care takes longer
than ideally it would do.
But that sort of joint way of working in the moment
on the site makes a big difference.
Thank you.
Any further questions?
Yeah, Councillor Cravelli, go for it.
Can I just ask, going back to the paediatric services and the fact that it's being moved
to the Evelina, correct me if I'm wrong in saying this, but is there not a transition
cost involved in moving these services in the first place?
And I make an assumption that in effect you're just going to have to bite the bullet on that
one.
Is that correct?
Are you getting any assistance?
and what's your plan?
Quite surprisingly, both ourselves, the Marsden,
and the Eveline have been given quite a reasonable amount
of transition money to enable us to both appoint
program managers additional HR support
and to free clinical staff up and backfill them
in order for them to engage more fully with the transition.
So that bit has worked well.
The area that we're in, I've got a meeting tomorrow
with NHSC that we really need to land is the stranded cost
that St. George's will experience as a result
of losing that service and how we replace that
with equivalent activity that should be happening
at St. George's with the type of work we do there
and maintaining some of the expertise we have locally
as a result of many years of delivering that service.
And we're moving slower with that,
but I think we're beginning to make some progress.
So that's the area that we really need to land,
but the transition support has been good.
And I'm just going to bring in Stephen Hickey, who has, I believe, a question on this paper.
Thank you very much. My question was actually also about the 52 weeks, and I very much welcome
the fact that the numbers are apparently coming down. That's really good. I just want to,
if you could just clarify something you said. You said that the government is setting a,
I think you expressed it in percentage terms, a target, an aim for a year, well, just over
year from now, but I wasn't clear. Could you explain roughly how that percentage relates
to the sort of numbers you've currently got here in terms of how many in broad terms you
would expect on that assumption to be still waiting 52 weeks?
Yes, I think I mean I could probably get you the exact number Stephen outside of here,
but the expectation is it should be no more than 1 %
of your RTT list should be over 52 week waits.
And we're just around 1 1 1 1 2 % now.
So I'd say it's probably going to reduce down
probably to around the 300 mark.
But I can get you the exact number.
But we'll be aiming for lower than that.
But that's, and that's a reflection that many trusts
have thousands and thousands and thousands
of 52 week waiters.
and again, totally agree that it's the comparator
is not helpful in terms of the individual patient,
but it gives you a sense that we're nearer
to where we need to get than perhaps
some other organizations.
Thank you.
And Natalia, while you're here,
would you briefly mind touching on the CQC report
and kind of plan next steps to reassure the committee
around maternity services?
Yes, thank you.
So you may know that we had a CQC inspection
back in 2023, March 2023 to be exact, and we've been working through those actions.
We received some must and should do actions, and we've made really good progress on those,
and we expect that those should be completed by the end of March.
And then we had another inspection in October 2024.
We received some immediate feedback on that, which again we're working through, but some of that we had already made progress on from the previous inspection.
So some of the areas that they had concerns around were our maternity triage process and how women are able to access the service,
either because we also run a helpline
and it was how we were able to distinguish
between the helpline and the triage service that we provide.
And also ensuring that we have the right level of staff
to see women in a timely manner,
and that they are reviewed by our medical team
appropriately as well.
So that's one aspect.
There was also some concerns around,
raised around our governance process
in terms of how incidents are graded
such as postpartum hemorrhage in particular
and third and fourth degree tears.
And we've done a lot of work on that
so we were able to make some representations to the CQC
about what we had already done and achieved in that area.
Lots of improvement in terms of classification
and investigation and sharing of the learning
so that we're improving as we move along the journey.
There's also in this recent inspection
around medicine safety and how we are managing that process.
and we're working really hand in hand
with our pharmacy colleagues to get that process right
across our different services within maternity.
Thanks so much and thank you so much both
for coming and speaking to the committee this evening.
You're very welcome to stay,
but if you would like to go and enjoy your evening
then please do that as well.
Thank you very much.
Thank you.
Okay, is this report noted for information by the committee?
Yep, great.
Okay, moving on to Southwest London St. George's
Mental Health Report, we've got Philip and Priya,
do you want to come and sit around the table?

4 South West London & St George's Mental Health Trust Report on Key Mental Health Areas Delivered by the Trust (Paper No. 24-363)

This was just to remind committee colleagues,
this report was deferred from the November meeting
and we did send around some questions
that the trust answered via email,
But if people have further questions that they would like to ask
Colleagues now that they're here about the report then please do so, but I'll just let them introduce themselves for that. Do you want to go first?
Thank You councillor Dobre's and good evening ladies and gentlemen
Firstly of course profuse apologies for being ill in November and not being here to present you for which I'm sorry
Rather like our colleagues for st. Georges obviously you've seen the paper
if you've had a chance to read it,
and hopefully you've digested it,
it covers largely our main initiatives,
or two of our main initiatives,
our adult patient journey,
and making our trust a great place to work,
and then goes on to give you more detail
in some of our performance indicators.
And as Councilor Dobre said,
you did table, or give us, or share with us,
as I should say, a few questions
which we have provided written answers to,
so really, rather than present any further,
but I was going to open up to you
to ask us any further questions you have,
which either myself or Priya will try and answer.
Priya, do you want to just briefly introduce yourself?
Thank you, Chair.
I'm Priya Samuel, Integrated Partnerships Manager
at South West London and St. George's Mental Health Trust.
Great.
Do we have a comment?
Oh, straight away, yeah.
Councilor Gray.
I'll stroke where the iron's hot.
Thank you for the report, it's very comprehensive
and you've talked about a lot of really important issues
in mental health and the tremendous work that you're doing
to try and tackle mental health issues.
Can I ask you, you're talking about
the adult patient's journey and you've talked about
a number of things here that are really good
in enhanced crisis support, family placement scheme.
Can I ask you about something that isn't touched upon
in the report?
And I talk from a personal point of view,
because I work in the courts.
And every day, on a near daily basis,
I come across people who are in mental health crisis.
And that's why they're in trouble with the police.
That's why they end up in court.
And I was interested if you could just explain,
do you have any interaction with the liaison and diversion
teams that appear at court?
Because obviously, a lot of the people that are in effect
answering to the court for issues, criminal offenses.
There are people who have been led there
because of their mental state,
and obviously if it was the case
that there was intervention to address that issue,
a strong possibility they wouldn't be in court
in the first place.
I was just wondering, you'd say how you interact with that.
I'm gonna be honest, I'm probably not gonna be able
to give you a detailed clinical answer of how they operate,
but we absolutely do run a liaison and diversion service,
which is part of our forensic division, if you will.
The forensic services operate across
the three mental health trusts in South London,
so South London and Maudsley and the Oxleys Trust,
and what they do is they run all of those services
as a triumvirate, if you will,
to make the best of the resources they've got,
so we share the beds and provisions
to ensure that we make the most of those resources
and indeed our liaison and diversion teams work together.
Indeed, I can probably say without breaking any confidence,
we've just recently submitted a joint proposal
to expand those services to NHS England colleagues.
We await to see whether we're invited for interview
and through that we would look to be enhancing
that interface.
What we've also run in the past are street triage services, so proactive work, going out,
trying to work with the police to identify people that might end up in the situation that you've said, so that they don't end up in the courts.
And obviously, as I know you will be aware, things like the section 136 suites,
we hope working with the metropolitan police that they will divert patients into the section 136 suites.
what rather than coming through a judicial process,
obviously as you say, unfortunately we do find ourselves
with a number of patients that have come through
the judicial process and indeed a number of our patients
under Ministry of Justice sections
because of their activities
and the unfortunate illness that goes with it sometimes.
Do I have further questions from the committee?
Councillor Worrell.
Yes, thank you.
Sadly around the world there's been a big attack on EDI work and EDI initiatives, and
in fact a lot of organizations are rolling back their initiatives.
I'm just wondering in terms of the trust itself and its anti -racist agenda and equality work,
what might be the principal – sorry, let me start again – what are the principal
challenges at this moment in time and actually taking forward this area of work and strengthening
it and allowing further integration within the trust.
I mean, it's a really, as you've really alluded to, it's a really complex thing to look at
the many inequalities that exist.
And we need to remember that actually just suffering from a severe and enduring mental
illness means that you do in yourself suffer inequality.
you will have a life expectancy probably 20 years less
than the rest of the average population.
And then if you have other comorbidities,
physical health ones, et cetera,
that worsens that inequality.
So everything we do is targeted in a way
at reducing inequalities.
But of course that's a slightly trite answer.
What we're trying to do is to then look below the data
to understand, and one of our initiatives
is our M -HIP project where we're working
in Wandsworth initially, and that's expanding
across the other boroughs, looking at some
of the particular inequalities that people experience.
So we know, for example, that young black men
are more likely to be sectioned in our beds
than other sections of the population.
We know that some sections of our population,
Asians, are less likely to access talking therapies.
So we need to understand and work with our communities
as to what the specific interventions are,
such that we can get a better representation
and a more appropriate representation.
Some trusts, so Merseycare is a really good example,
a way ahead of many trusts in this,
so we're trying to work with others like Merseycare
to understand how they're using the data
to what they would call identify an actionable intervention
because there are many, many inequalities.
And obviously we could spend many, many years
researching them and make no difference.
So I think what we need to do and what we're trying to do
is to use the data to identify the biggest areas
of inequality and then find some key interventions
to make a difference.
The M -HIT project, of course, is one where
what we're hoping to do is now it's been running
for some time, get some review, independent review
of its, the efficacy of it, so we can then evidence it
and roll it out and hopefully show to other areas,
other geographies as well, the benefits of it.
So that's what we're trying to do.
We're trying to use the data, do small projects
to evidence the practicality and the efficacy
of the intervention and then roll it forward.
I think we have made progress, but is it enough?
Of course it's not enough, because we've still got many,
many inequalities, but I think, I do think,
I'd like to think we have made some positive progress.
I'm not gonna say it's easy,
and it's gonna be a long journey, I think,
before we can really say that we've made a big difference.
Thank you.
Ms. Miller, did you have a?
Okay, perfect.
Any further questions?
Councillor Kussain?
Thank you.
The first question is about the Adult Patient Journey
program.
I'd like to reiterate what the other councillors have said about the good work that you do.
So if I'm focusing on the negative stuff, that's my job.
It's not to diminish the good work that you do.
But there is a deterioration from 1 ,715 to 1 ,784 occupied bed days.
And the target to reduce the average length of stay from 44 to 38 days hasn't turned
turned out as you would wish and it's actually increased.
So what are the explanations for this deterioration?
So again, I'm not gonna bore you with statistics.
So some of it's an artifact of the way
that these things are measured.
So for example, what I can say to you
is that one of our problems is that
we suffer from a 50 % grade to the national average number
of patients that are clinically fit and ready for discharge
but are still residing in our beds.
So we have about 15 % of our bed days
that are lost to patients that might reasonably be elsewhere
on a clinical basis and aren't.
When we discharge one of those patients,
it then artificially changes the average length of stay.
So we know that over the last few months
where we've been working with colleagues in the community
to find more appropriate placements for those patients,
that that has pushed our length of stay up.
In addition, what we're also finding is that
the complexity of some of our patients
means that they're coming in through, say,
A and E departments, ED departments.
They're coming into a psychiatric intensive care.
They may be going to a working age adult,
what we call acute mental health ward,
and then into rehab.
And the case mix is becoming more and more complex
so that the average length of stay is increasing.
Now some of the things that we've done have, I suppose, exacerbated that.
To liken it to physical health, where you introduce day surgery, you take some easy
surgery patients and you put them into day surgery.
So what's left coming into your inpatient surgery is by implication more complicated.
So in 2016, 17, way before the numbers you're looking at I appreciate, we introduced the
Lotus suite and that took out most of our zero to three length of stay.
So that pushed our length of stay up.
And what you've seen in our reports is that
we have been relying on some private sector beds.
And as is typically the case,
when we seek a private sector bed,
they review the patient and they will normally take on
those that are less complicated because they don't have
psychiatric intensive care units.
So of course what that's done is taken the next cohort,
i .e. normally naught to 30 day length of stay
and move some of those to the private sector
So we've further exacerbated our own complexity.
And what we have seen particularly since COVID,
it's both complexity and comorbidity.
So the nature of the mental illness is more complex,
but the associated comorbidity,
so physical health needs, et cetera,
have also become more complex because that's what's left.
Nonetheless, we obviously need to look
what we're doing because that isn't acceptable.
You asked our, put the people in the seat previously,
you asked St. George's about their use of private beds.
We are having to use private beds,
and of course what we'd rather be doing
is spending public money on NHS facilities,
not private facilities.
So what we're looking to do is to,
that's why we call it adult patient journey,
because it isn't about only when someone's in bed,
if we can, in a bed, one of our beds,
if we can intervene at the start of the pathway,
had the question about liaison and diversion, but picking up people that might end up in
the judicial process, picking people up before they end up in A &E departments and needing
to be sectioned, but then equally being able to pick them up at the end of the pathway
such that we can bring them out not when they're perfectly well, but when they're well enough
to be cared for again in the community such that people have a more acute episode in the
hospital and we manage them more in the community.
So that's why we're focusing on the journey,
not our length of stay.
And the impact of those, we hope,
will be to bring that length of stay back.
I think because we will be focusing on
trying to move some of the longer stay patients
into the more appropriate settings,
we might see periodic blips up.
But when they're normalized,
which hopefully we can present that data more clearly,
we'll need to internally, I think,
we'll be able to understand and share that with you,
and what's really going on.
What our chief operating officer told me today
was that when we take out
there's the extra length of stay patients,
our length of stay actually is in the 40 days,
which is a lot lower than the headline number,
considerably lower.
Thanks for that very thorough answer.
Can I ask another question or two?
The other question is about M -HIP.
And I would all agree about the important value of this work,
but I was wondering whether you could say something
about the metrics and how reductions in disparities
and sort of use of coercive practices and detentions
is measured and whether you have any of that data
at present to sort of demonstrate
whether the current approach is working.
I think Priya has got some of that information to hand, so I'm going to ask her to take that.
Thank you.
Since the report was published, we have received data in terms of the key interventions, and
I would be happy to convene those against each key intervention and share that with
the committee.
We have got further developments, as you can imagine, over the period of time.
recently employed an officer within the trust
to support the family emplacement scheme.
So that work will be progressive
in terms of engagement sessions,
cultural awareness, and development.
So that's just one example.
But again, more than happy to obtain some recent data
and information against performance
and share that with the committee.
We can do that in the next report.
Equally, I can provide something outside of the committee in advance of the next report.
I believe the next report is due in November.
We can arrange for something outside and circulate it to committee members.
Thank you.
Does anyone have any further questions or should we move on to the next paper?
Is the report noted for information?
Thank you.
Oh, yes, Priya.
Do you want to come in apologies? I just wanted to
Confirm with the committee that Councillor Davies had asked some questions around cams
The responses haven't been included here because we had a further meeting to obtain further information
And once the responses have been gathered, I'll share them with the committee to be published
Thank you so much and thank you both for joining us this evening again
Welcome to stay if you'd like to equally go ahead and enjoy your evening. Let's do that as well
Thank you.
Okay, moving on to our ICB report.
Mark, Katie, I think we've got Katie online, is that right?
Hello, yes I am here.

5 SWL ICB Report on Integrated Care Developments in Wandsworth (Paper No. 25-58)

We've also got my colleague James Walker online who's been instrumental in this work so far as well.
Great.
Hello, good evening.
Mark, would you like to briefly introduce the report?
Yes, now I'm going to ask the committee to bear with me as well because I think one of the questions was
From the report was around the work of the ICB
So I was just going to give you a two -minute snapshot of what the ICB is doing
So you've heard from parts of the ICB already tonight, so Georges and Southwest London and St.
Georges are very much part of the ICB
But in addition to that it works at two levels Southwest London ICB, and then the place
which for us is Wandsworth, and that's really including
things like primary care, our community services.
Also, we recently had the delegated authority
around pharmacy, optometry, and dentistry.
And really for place, it is about bringing that together
into kind of an integrated way of working.
Now, in the paper we say team, but actually it's about
integrated working, not necessarily teams of people.
There is new operational guidance out for the NHS.
There are four key targets really,
and that's about reducing A &E and ambulance response times,
reducing planned care waiting times,
which I think Kate previously touched upon,
access to primary care and urgent access to dentistry,
and then improving patient flow and care
for mental health and learning disabilities.
So the ICB is the kind of catch -all.
So we work with our providers within the local system
to ensure that we really are kind of trying
to improve the health outcomes for local residents,
to tackle inequalities and target services to those.
You've mentioned M -HIP.
I'm the SRO for M -HIP, so I'll make
sure we get the data for you.
And I think overall, what we are trying to do
is move that, the dial from treatment to prevention,
analog to digital, accepting that not everyone has access to digital, and also moving services
from our acute into the community. And that's probably the ICB in a snapshot. I'll hand
to Katie just around the paper, but we will be brief and take questions.
Yeah, thank you, Mark. As Mark says, I'll assume the paper's been read. But the one
I did want to flag up that is that in the deluge of paperwork that we received from NHS England
and the Department of Health two weeks ago in relation to kind of the guidance that the NHS
needs to follow over the next year, there was a significant amount of new information around
how we should be developing integrated neighbourhood working, which is what this paper
focuses on. However, the good news is, having read across that guidance, we are absolutely going in
right direction in Wandsworth and are actually ahead on a number of the areas that it focuses
in on as well. So I just wanted to flag that up as a real positive position that we're
already in in terms of what we need to deliver over the next year. And James, did you want
to add anything just upfront or should we go straight to questions?
Great. Okay. And thank you so much for coming. I think committee members were really interested
in the work of the ICB and hopefully we'll have a good discussion this
evening so we'll go to Councillor Davies first.
Yeah thank you for the paper. So I'm interested in a few different aspects. So paragraph 3
it says that the ICBs receive annual resource to cover the costs of providing
the health services and I just wondered like what kind of balance is expected in
the distribution between the different sectors.
I wonder if that's one for Mark actually.
Are you there Mark?
Yep, so I can absolutely go back and get the exact figures for you.
What we do know is that the majority of spend is in the acute trusts.
We have ring fence spending in mental health and then primary and community services as
well.
I'll get the exact figures and there's a lovely pie chart I can send to you that tells you
how it's distributed.
I think as an ICB, a paper went to the ICB, I think October of last year, saying that
ICB is really committed to moving some funding to be more focused on primary and community
services and I think it's probably one of the only ICBs in the country to make that
statement.
and financial challenges across many public services make some of those mechanisms quite
difficult, but I think the commitment is there to shift the dial, so to speak, in moving
money towards community services.
So I suppose on that I'm just thinking about the voluntary sector as well as being just
one extra partner.
But then I'm also interested about the enriching the collaboration between the organizations
and wanted if you could just expand on that.
You know, it's great to hear that, you know, Wandsworth is a bit ahead of the curve there.
But I just wondered whether there's any kind of maybe a pan London framework that you can
work within where, you know, partners are learning from each other.
It's something that's still quite new, really.
Or whether you know of councils that you think are very much the beacon for best practice
and yeah, can support you.
Thanks. So just going... Shall I start Katie and then I'll hand to you. So I just
think in terms of the voluntary sector when we talk about prevent moving it
from treatment to prevention the voluntary sector are absolutely key to
that because actually many of our residents will access their services
before actually coming to kind of traditional health services. We do have a
London integrated neighbourhood framework. I think it allows flexibility for us to reflect
at Wandsworth in that. It's still at its early stages and what we're trying not to do is
be held back. We want to kind of move forward and then I'll hand over to Katie just for
some of the specifics around particularly the partnership approach.
Yeah, so you mentioned how we are enriching things. So partnership working isn't new in
Wandsworth. So we have over a number of years had successive initiatives and contracts in
place that have incentivized, particularly our general practices, to work together with
their partners to look after the patients who we know are frail, who are elderly, and
most at risk of going into hospital.
However, what we've identified over the years is that that poses some challenges, particularly
for both health and social care partners that operate at a wider scale than GP practices
to actually be able to meaningfully engage in those conversations. And we know that true
integrated working requires not just GP practices and their staff to be around the table in
those conversations. We need a much wider group of people, including the voluntary sector.
And so what this new way of working will do is bring those groups of people together to look at, look after communities on a wider geographical footprint than just an individual GP practice, and make use of a number of additional staff who have been employed over the years, through practices, to actually look after those patients in a more coordinated and collaborative way.
So, for example, we have social prescribers employed by our primary care networks,
and they can support patients that need to access voluntary sector services to access those services
effectively and to get access to them when they need them.
We also have health and social care coordinators who are working out, particularly in Battersea
at the moment to really connect the people in the communities with the services that they need.
They're there, but often it's just a challenge in actually putting the two together and getting
people into the right service when they need it. So that's what this new way of working will focus on.
Thanks. I'm just going to add to Councillor Davies' question there. So in terms of integrated
neighborhood teams, IMT's. What will that mean in practice in Wandsworth to actually take that from
a kind of integrated working and working together to actually to that next level? You know in some
areas of London, in Camden, you know they've got a big neighborhood kind of building in an estate,
you know the James Whig practice where you've got social workers, children's services, etc. all in
the same building, providers, authorities.
Is there anything like that that we will be able to expect
or I know the committee members were interested
to maybe go and visit any kind of projects
that really bring it to life.
And the second part of that question is,
how will this be different to patients and to people
and what will people actually notice
that's kind of any different in this approach?
Because as we said, we've been kind of doing
integrated working for 10 years,
how will this be different?
So I'm going to ask James to respond to this one because he's actually out there in the
communities working with the practices and the health and social care partners to bring
it together.
Yeah, thank you all. Thank you very much. And thank you very much for inviting us to
this really important discussion. I think in terms of the ambitions that we have, we
want to ensure that the neighbourhood health services that we are developing for Wandsworth
fit really well with the local communities and some of the local geographies that exist.
And we want to make sure that those services are really readily built around sort of true
neighbourhoods that exist within this area rather than drawn upon lines that have been
made for sort of organisational boundaries. So what we're really keen to do is to start
our work in three particular areas. We've already heard mention of Battersea and we
also want to ensure that we're commencing work within Tooting and commencing work within
Roehampton. And what we want to ensure at that point in time is that the groups of professionals
that are looking after these very vulnerable people in the first instance truly know those
individuals and feel really, really connected to them and understand sort of the broad range
of needs that they have and really want to make sure that there's sort of a wider determinant
of health approach taken with this, not just sort of an illness -based approach. It's also
really important for us that we want to make sure that we don't just put everybody into
the same building and think we've solved the problems of integrated working. What we feel
that we could see with that is just groups of professionals that are siloed within a
smaller space. So our work is very much going to be focused on establishing a really good
working culture, establishing trust between different providers, between different professionals
and making sure that the patient and citizen interest is at the heart of everything that
we're doing.
Any further questions? Councillor Faraj. Thank you. I just want to firstly really quickly
say a huge thank you to the ICB because they were one of our partners when Wandsworth was
developing our borough sanctuary strategy and they still come to our regular Wandsworth
migration forum. So just a huge thank you and to show our appreciation for that. My
question was just around the areas. So the neighbourhoods I think the proposed places
are Battersea, Roehampton and Tooting.
When I think of a neighbourhood,
I think Roehampton kind of feel like a neighbourhood,
but Battersea and Tooting,
they're two very big constituencies.
So how, is there any scope for that to kind of change
or into smaller like neighbourhoods
or just kind of why Battersea and Tooting
and then Roehampton just because Battersea and Tooting
seem like very big places?
Thank you.
Sure thing.
I think that's a really important question.
And we've been very much sort of,
in some respects we've been data led and in some respects we've been sort of led by where the level
of need is that we that we know and understand that a lot of the planning assumptions that we
make are working on a 30 to 50 ,000 population level and that is purely from a sort of primary
care network health basis and however the footprints that other services work to whether
that be our partners within adult social care or whether that be our partners within sort of
our community health services or our partners in the acute services work to different levels
of population management. What we want to do is make sure that we're providing services
that meet the needs of absolutely everybody and we know that there will be some services
that have provided a really hyper -local level. As Mark has mentioned previously, the voluntary
sector will be absolutely instrumental in doing that, but there will be some areas where
we need to think about planning it, a different footprint and delivery, and it's another footprint
as well. What we wanted to ensure that we were doing was providing coverage for the
entire providing coverage across the north, west and south of the borough and so that
that's recognized by the local authority localities. Wanted to ensure we were providing
support in those areas that based on sort of indices of multiple deprivation and number
of people sort of living in this 20 % most deprived population and sort of diversity
mix as well, we're receiving support. And from there, over the course of the next five
to ten years, we want to continue to build upon this approach to develop as a signal
within Neighbour Health Services guidance published at the back end of January, to develop
a comprehensive set of services for Wandsworth that will facilitate those moves that Mark
spoke about. So from analogue to digital, from acute to community, and from treatment
to prevention. I hope that answers your question.
Any further questions?
Councillor Orell.
Thank you.
I'm not too sure who's based on this question, whether it's you, Katie, or you, Mark.
You mentioned a whole range of guidance coming down from central governments and from NHS
England.
And I'm wondering about the impact on the new planning guidance that's actually been
issued in terms of the financial stability of the ICB to meet the requirements, and especially
in terms of Wandsworth on the ability of the ICB to commission services at the Wandsworth
level.
So I think I'll probably take that one, Katie.
So within the plan engagements, there is a very, very strong emphasis on the NHS living
within its budget. And like many other public services, that will be challenging. So we
do anticipate, and I think Kate alluded to it earlier, this year we are expecting a really
quite challenging financial environment to work within. And so that, some of that may
include some quite hard decisions to make. But I think actually our relationship with
our partners is such is that we want to be transparent when we get to those decisions
and give people the rationale for those decisions.
But also make sure that we've done that kind of quality impact assessment.
What is the impact of any of that decision make on the residents of Wandsworth?
So we need to put every decision kind of through that process.
We are at an ICB level, there is a place committee, there's a Wandsworth committee.
So the plan is to take any decommissioning plans through that committee,
which is attended by officers and counselors
from the borough, so that we can actually share
some of the plans ahead.
What we aim to do though is to try and minimize
the impact of any savings plan that we have
on direct patient care.
So we will be going forensically through our spend
to ensure that we are targeting the savings
in the right place.
And we've got a question from Steven Hickey as well.
Stephen, would you like to answer your question?
You're on mute.
Sorry, thank you. I double -clicked. Thank you very much. My question actually was really in some ways
building on yours, Chair. It's about how wide the multidisciplinary group might be and how you would
actually operationalize that. I mean, you said you didn't envisage a single building or a single room
necessarily but I'm thinking for example in some cases housing might be a really important issue.
In other cases it will be the voluntary sector but the voluntary sector we know is
at least 800 organizations I think in Wandsworth and probably more. So actually making this work
in practice strikes me as quite well clearly is very challenging and I wonder if you could
put a bit of flesh on how wide that might go and how you would actually make that work on a
practical day -to -day level. Thank you.
So shall I take the question about how wide in the first instance? So we've had a steering
group running in order to get this off the ground and the key partners we've had around
the table at that steering group have been GP practices. We've had community services,
we've had social care, we've had a representative of the voluntary sector, we have had St Georges
and we are engaging with the South West London St. George's Mental Health Trust as well. So that's
kind of the key organisations that we're looking to start the conversation with. And as I mentioned
earlier, the fact that we also have social prescribers operating in each of our primary
care networks at the moment mean that we have a practical means of making the links to the
wider voluntary sector when there's a need to for specific patients. I think in terms of the
actual coordination and delivery of the service, a lot of it, I think in the initial days, is going
to rely on good IT and software solutions. So, you know, since COVID, we have all been working
in a far more digitalised situation. There are pieces of software out there that specifically
enable multidisciplinary working. And what we're looking for, some of our phase one sites,
as we're calling them to do, is test out some of those. It may be that we already have,
we all use Microsoft Teams at the moment in the NHS, but there may be alternatives out there that
we can explore. So that's one very practical means of doing it. We also, out in our primary care
networks, have health and social care coordinators. And we think that that role is going to be
absolutely intrinsic to bringing the relevant people together to discuss a group of patients,
and then making sure that the outputs of those meetings are fed back out to the relevant parties and the actions are taken forward.
But I don't think we're kidding ourselves that this isn't going to take time to evolve.
And as James mentioned earlier, those kind of relationships and trust are going to take time to evolve as well.
So this isn't going to be done and dusted in a year, I don't think.
Thank you.
Any final questions before we move on to the next paper?
Thank you Mark, thank you Katie, thank you everyone.
Is the report noted for information?
Thank you.
I think we'd love to hear from the ICB again soon so hopefully see you soon.
Thank you very much.
Thank you.
Bye bye.
Okay
So now we've got first report for decision
We've got the CCTV strategy and we've got Tom Crawley ready to give us an introduction now. We've also got and

6 CCTV Strategy for Wandsworth (2024-2029) (Paper No. 25-59)

Kieran able to answer any questions around wider community safety issues as well. So I hand over to Tom
Thank You councillor
So I'm Tom Crawley. I'm assistant director of resident and estate services
Now the council CCTV networks managed by the Joint Control Center within the Housing Department,
but given the CCTV's important role in community safety and help to protect all residents,
it felt it was appropriate to bring the strategy to this committee rather than the housing
committee.
So when considering the strategy, it's important to note that use of CCTV is just one part
of the council's response to issues of antisocial and criminal behavior.
Indeed, most antisocial behavior issues can be successfully resolved without the need
for CCTV. To add some further context to the report, Wandsworth has over 1200 cameras and
those cameras are part of an upgrade program that's nearing completion. In addition, we
have a growing number of deployable CCTV cameras for use across the borough. So this strategy
sets out the Council's plan for that CCTV network over the next five years. It will
help the Council create safe neighbourhoods where communities feel confident and protected.
So in order to achieve that, it covers three key themes.
The first is to ensure the effectiveness of CCTV.
So that's making sure that deployment is intelligence -led,
infrastructure is maintained, and the impact is evaluated.
So a key example of that is that we introduced a CCTV
monitoring pilot in October 2023,
which was a significant investment.
And what that's done is that's placed
CCTV monitoring officers within the control center
to monitor the CCTV at peak times
and work with a police officer there.
And they've done some fantastic work
in preventing and detecting crime
and also locating vulnerable people.
We're also starting to utilize those officers
to help identify and prevent environmental crimes
such as flight tipping.
So I will be returning to this committee later this year
with a proposal to make that pilot permit.
The second theme is to do with the growth
and sustainability of the network.
So that's really in relation to prioritizing resources
to make the most impact.
So that may not mean increasing the number of cameras,
but it's making sure that we have a sufficient number
and in the right places.
An example of that is where on our housing estates
when we were upgrading, we actually ended up
with fewer cameras in some locations
because we had cameras that kind of tilted and zoomed
and could cover a greater area.
We've also, as I say, increased the number
of deployable CCTV cameras.
So we have 24 at the moment, but we will soon
have 38 across both boroughs.
And they allow for much more flexible deployment.
We can install them quite quickly
to address antisocial behavior hotspots.
And we also continue to look at different types
of new technology.
So an example is pattern recognition software.
So for example, if the police were trying
to locate a vulnerable person, we could search for their details
and that would pick up people matching that description
up across the network.
We'll also be maximizing income opportunities so that we've already increased charges to
insurance companies and we're looking to offer some services to other housing providers and
possibly retailers in our town centres.
The third theme relates to the usage of CCTV being lawful and justifiable.
Obviously we have to ensure the council's compliant with the relevant legislation and
that means ensuring there's sufficient evidence and an operational requirement to use CCTV
and that the deployment decisions are regularly audited.
And there's obviously a risk to the council
not complying with that legislation in terms of fines
and potentially reputational damage.
So to ensure that we meet all these objectives,
we've set up a new CCTB steering group
with a range of representatives
from different council departments,
but also external partners such as the police.
And there's a single point of contact
that's the principal liaison for requests for new cameras.
So following the approval of this strategy,
a guidance note will be issued to all members
explaining the process for requesting new cameras
and just giving you an indication of the kind of timescales
involved in that and the decision making process.
So I'm happy to take any questions.
Yeah, Councillor Della Sinchou.
Thank you.
I was actually rather baffled reading the paper
because I felt that you're asking us to approve a strategy
but from paper to me it's unclear what this strategy actually is.
I don't understand.
In your mind, what does success actually look like by 2029?
Are there any KPIs that you can use,
hard tangible KPIs to actually measure progress on that five -year plan?
And my last question is, if I were to vote in favor of this strategy,
it feels to me like I'm giving you carte blanche to do whatever you want.
Is that right?
and how we use the data that we gather.
And this is the first CCTV strategy
that the council have had.
So it's really setting out much of what we do already
in terms of those operational requirements,
but also, I suppose, a plan to make sure
that where we have lots of cameras,
cameras, which we do, we have more than most other London local authorities, we're using
them as effectively as possible.
That they're not just kind of sitting there and not being used when they shouldn't be.
You know, we're making sure that we're using the data we get from the police or from community
safety to ensure that the camera's in the right place and that they're helping the police
to prevent and detect crime.
It's very difficult to produce KPIs for something like this because either you can, the best
I suppose is probably crime statistics,
but CCTV, as I say, is only a small part of that piece.
So I couldn't be able to say in 2029,
these are the KPIs and these are the performance stats
that this strategy has produced
and this is the success we've had.
But I think it will make sure that
our communities feel safer and it will have an impact
in terms of the work that the police do with us
to make sure and try to reduce crime
and social behavior across our borough.
Thanks, Tom, for setting that out.
Yeah, do you want to come back briefly?
Please, if I may.
In terms of numbers, KPIs, et cetera, whatever,
what does this strategy mean in terms of
potential numbers of cameras within five years?
I think you said you were 1 ,200 right now.
How many could we get to within five years?
I'm just wondering if there's a target
of a number of cameras that we wish to meet.
Because as I said, we already have very good coverage
in terms of fixed CCTV cameras across the borough.
We've increased the number of deployable cameras
because they are more flexible.
If there's an issue in a particular place,
we can get a deployable camera there relatively quickly
and then deal with that particular issue
because obviously,
and social media can quite move around.
So they're a much more effective way
than probably putting in more fixed cameras
than we have already.
We will be undertaking periodic reviews and audits,
so it may be that that number of cameras even reduces
because at the end of a year,
we may see that a camera in a particular location
just hasn't been used at all,
and therefore it doesn't appear
there's an ongoing need for it.
So it's the potential to decommission.
However, on the flip side,
there is the potential to put more cameras in
if we were to find there was a particular area
where we kept putting deployable cameras, for example,
and it therefore made more sense to actually increase the network and put
more fixed cameras in that location.
Councillor Davies, I think you had your hand up.
Yes, thank you Chair.
Yeah, I mean I can think of one example of a deployable camera being used for a short
amount of time, working with the police as well, you know, using range of options
and the problem just dissipating.
But I do wonder what the possibilities,
but there are occasionally limitations,
like the lamppost can't be adapted,
or it's a slightly awkward position,
or something like that.
And I don't know whether it's possible to consider
how to increase flexibility here,
and how to manage that.
Yeah, thank you.
I think the vast majority of lamp columns can be used to put deployable CCTV cameras
on, but we usually have to fit what's called a commando socket to kind of enable them to
do that and just do some load testing to ensure they can carry the weight.
There are sometimes other options, so for example, putting a camera on the side of a
building, but you're right, I think there will always be some locations where CCTV just
isn't possible because of the location, you know, the kind of geography, the physical
layout of it and that comes back to I think the work that Karun's team and my
team would do in terms of the other options you know working with the police
and making sure that if you can't proceed to be there you're doing other
things to solve that problem and to reduce the the risk of antisocial
braving crime in that area. Thanks I think Councillor Kossain and then we'll
come to Councillor Marshall. Thank you chair. My question is really about the
governance structure. I'm really concerned that there's a lack of
democratic accountability. If you look at the membership of the Steering Group,
for example, there's not one elected representative on there. There's no
description of any formal review processes for councillors or the public
to raise concerns. There's no requirement of the Steering Group to present annual
reports let's say for council or to an appropriate LSC like this one and you
know my concern is that without this democratic accountability that the
interests of residents won't be served and you know that we know or limited
opportunity for residents to raise concerns so are my concerns justified
no I mean the if this is an overarching strategy so it's quite fairly high level
looking at our general approach to CCTV.
If, for example, we were to introduce something
like facial recognition, which we have no intention of doing,
that's clearly a significant change in policy
that we would come back to a committee to seek approval for.
Likewise, if there was to be a significant growth in the network
or if we were to need to renew all the cameras
and change the way in which they work,
those kind of significant changes we would obviously
come back to committee to seek approval for.
The steering group is really to oversee the content
of this strategy and make sure that it's implemented.
And much of that, as I say, relates really to regulations
and making sure that we're compliant with regulations
and using the network as effectively as possible.
So my concern there would be that it's very much dependent
on the steering group to come to the OSD
to full council is something to report,
but it isn't a requirement.
So essentially, that they will come whenever they see fit
rather than the public through democratic mechanisms
making that request.
And we're here as elected representatives
to do that for them.
So is there really no scope for council involvement
or democratic processes within this?
I think there's scope for resident involvement, certainly.
The use of CCCV is broadly guided by legislation
rather than kind of political steer,
but as I say, resident involvement is a fair point, I think.
And I think that's something that we can have a look at,
whether we can have a resident
that's a member of the steering group.
Obviously, there might be data protection issues
involved in that, but it would be interesting
to have their input and probably quite helpful.
Thank you.
I think legislation is political.
Yeah, I mean, yeah, I mean, yeah, it's almost the definition of political.
So I don't necessarily see that distinction between legislation and the political.
Thank you.
Okay.
Thanks.
Councillor Marshall.
It's all over the place, and a very small number of eyeballs looking at them.
I'm just wondering how that gap gets bridged and what the strategy for that is.
And one of the ways I would have thought, for example, was face recognition.
As a magistrate, I can think of lots of ways where that could have been used to set curfews
or bail conditions, say somebody's allowed to come into a particular shopping center
where there are prolific shoplifters and that can be picked up by cameras, for example.
But I'm also looking at some of these case studies where you talk about page – this
page 66, you identified a vulnerable person.
You were observing two suspects.
Presumably that was done by operators
sitting behind the camera saying, oh, that
looks like a vulnerable person to me.
Is there no scope for face recognition at all?
Is it considered a complete violation of civil liberties
to ever use it?
It seems a bit extreme.
You were very emphatic about it.
You weren't considering.
And secondly, really, I suppose behind that,
what's the general strategy for AI here beyond just face
recognition?
but identifying patterns of movement, context,
predictive things rather than something happened,
let's go back and look at the footage
and see if we can find out who done it.
I think Kieran has her hand up,
unless, would you like to come in first, Tom?
Yes, that's okay.
Yeah, of course.
Yes, I said there's no plans for facial recognition,
and that's obviously the case, but as I say,
if it was to be something that we would consider,
we would come back here to discuss that point, I think.
We have, as I say, introduced a CCTV monitoring pilot.
So previously you would have all these cameras
and the vast majority of kind of viewing of it
would be reactive and kind of after the event.
So a crime would perhaps happen.
Police would ask us was there CCTV covering this?
We would then go and have a look and show them the footage.
Whereas the monitoring pilot has meant
that we now have CCTV officers in the control room
and they are there during peak hours,
so that's kind of basically the evenings.
And later on the evening on Friday, Saturday.
And that means that they're kind of looking out
and kind of digitally patrolling, if you like,
to see whether there's any particular kind of
incidents going on.
And they have contact with, direct contact
with the police radio as well.
So a lot of that is if there's a live incident
that the police are reporting through their radio,
they can ask if there's cameras covering that,
And then those officers can help the police to follow that instance and track a suspect,
for example.
And the same applies for a vulnerable person.
If there's a call out that there's a missing vulnerable person, which we've had several
of, they can help find that person and then direct the police to them.
So I think there's already really good systems in place to kind of find vulnerable people
but also locate people that we think might be involved
in criminal activity.
In terms of AI, as I said, we'll kind of always be looking
at what technologies there are available
and considering whether they might have a use
in the Joint Control Center.
One of the examples I mentioned
was the pattern recognition software.
And that could be used where, say, for example,
there's a missing person that has a white shirt
and black trousers, you could refer to that
and then it would search the network for anyone who has white shirts and black trousers,
and that would help you locate that person. So there is some technology which is already
being kind of considered to be used in that way. Karen, did you want to add to that?
Sure, I thought I'd just pick up the point around facial recognition. So the police have
piloted facial recognition on our borough at Tooting and Clapham. It's a whole operation
that sits behind that in terms of what you're using that facial recognition for, uploading
the information, et cetera. So there's lots of lessons that can be learned from that.
However, as I said, that's been very, very targeted in terms of how it's being used.
So it has been used on the borough, but not by the council. But as Tom said, it's certainly
something we will keep our eye on. I think just in terms of governance, just to also
add, we have the Community Safety Partnership Board. It's a statutory board with partners
and the steering group will feed directly into the statutory board.
Also as part of the code of conduct for CCTV, we have to publish the code of conduct.
There has to be clear signage up where we've got public safety CCTV.
There also has to be a point of contact in there where the local community can get in
touch with us if they've got any concerns around CCTV as well.
And I thought I'd also just add that there's a whole partnership effort to support how
we deliver on CCTV in terms of making sure it's very intelligence led, because we're
the fine line between directed surveillance, where we need certain authority, and then
just general public safety surveillance.
So the police meet every two, three weeks.
It's a precision crime fighting forum.
My officers attend that meeting.
They go through all the various crime areas across the borough.
They feed through those hotspots every two or three weeks to the control room, where
we sort of direct our surveillance
in particular hotspot areas.
So there's a whole piece of partnership work
that operates behind the monitoring
that takes place in the control room.
And obviously the operators that we have there,
it's in consultation with the police,
it's looking at our crime data for the last year or two
and making sure that we are there at peak time.
So there's a clear accountability that we have
to make sure that it is intelligence -based and led.
So it's not a free for all that we can just go in
and do whatever there has to be,
some checks and balances in place
in the way that we operate
and sort of focus our surveillance.
Thanks, Kieran.
Really good point about the Community Partnership Board.
Councilor Correlli.
Can I ask a question here that might be aimed at Kieran?
It's the data that's on page 75 of the report,
and you've given a list of tackling and reducing crime,
you've produced this list of figures about crimes in there,
but there doesn't seem to be any correlation
between what you've produced in that report
and any correlation to CCTV.
What you have said in the monitoring outcomes is
the group of IATs outcomes of CCTV deployments
by reviewing available data,
and then you've gone and see what that data is.
Isn't that data something that we should be considering
as a committee so that we can have a look at the data
and make an evaluation about how that correlates with CCTV?
Karen, do you want to come back in on that?
Yeah, sure.
So the crime data table, that shows the relevant crimes
that we think potentially CCTV can impact on.
It will be difficult to find correlation of activity
as such. What we have correlated is the days, times that particular crimes take place. For
example, robbery would be one. Drugs, vehicle crime might be another. Burglary may not be
because that's inside the house potentially and it may not get picked up. And a question
was asked earlier around what does success look like. So the kind of successes that we
would have is where, for example, I know there's some case studies in there, where we've sort
of the police have sort of there's been a crime that's been committed and the police
have sort of attended the scene and they are, you know, in real time directly liaising with
the operators on the radio who are navigating to them potentially of where this individual
has ran to or where the car has gone. So there's some real time activity that takes place here,
which is the value of this. So which is, you know, what Tom alluded to earlier around those
KPIs, arresting two or three individuals, which has happened a lot more than that.
They might be responsible for 30 to 50, even 80 other crimes that have taken place.
Arresting one individual, there's an example at a bus stop where actually our operators
picked up on an assault that took place on a female, because of the safety around women
and girls.
It was our service that called the Pleat Emergency Service in to attend at the bus stop and then
navigate them where to go.
So you can't put a number on that
when you've got that incident where you've actually
caught somebody who primarily you couldn't have a call
if those cameras weren't on
and if the operators hadn't picked them up.
Who knows how many other victims
they might have been with that individual.
So it's very difficult to correlate like that,
which is why the case studies have been provided
in the report.
Obviously we can't go into a lot more of the case studies
because some of them are still subject to
a judicial process where there's been an arrest,
we're still waiting to go to court for them
and the criminal prosecution around them as well.
I hope that's kind of like answered your question.
It has partly, I mean I fully accept the point
that you're seeking about the data on page 75
that say for example, somebody doing an online fraud,
CCTV is completely irrelevant in respect
of that sort of thing.
Somebody committing an assault,
a domestic violence assault inside a house
or something like that, CCTV is completely irrelevant
and wouldn't assist.
I fully accept that point.
The point is that you're monitoring outcomes
and you're saying, the group evaluates
the outcomes of CCTV by reviewing available data.
Isn't it possible that we can have a breakdown
of that data saying something like,
there were four street robberies on Tooting High Street.
The CCTV in that respect assisted the police
in ensuring that those robbers were apprehended.
There was a criminal damage in the Thamesfield Ward,
which involved cars being damaged.
The police were able to detect who committed
this criminal damage by doing that.
There was drug dealing on Carlton Drive in East Putney.
Such and such was prosecuted as a result
of the evidence used in it.
There must be some way, I mean, you're talking
about reviewing the available data.
Surely there must be some way that we as a committee can have that data.
Can we not?
Yes, so we are capturing that information as we said.
So Tom said that, you know, in terms of us doing some form of an annual report, the pilot's
been running for a year.
There have been outcomes like that.
We aren't in a position to put that in front of the committee today.
But as time goes on and some of those convictions, judicial process have completed, et cetera,
I'm sure we will be able to provide that detail.
But also just to say, as Tom said, we've brought it to this committee because this committee
also scrutinizes community safety.
There's a separate piece of work happening with community safety where we do annually
a strategic crime needs assessment, which does number crunch in that way, which does
bring in all the other interventions that we've put in.
So potentially when we come back to this committee at a future date with an annual report on
community safety or some of that, we'll draw some of that data in.
But I think, you know, it's been a year.
there have been successes, but as time gets on,
we'll certainly be able to share
some of that information in that way.
Thanks, Karen.
I think it would be really good to see
the impacts and the outcomes of CCTV
and that presented in that way,
which crimes and which interventions
have been related to CCTV and which haven't,
because I think there's clearly been
some really good case studies.
So that sounds good.
Dick, can I just check, did anyone else
wanna come in before we go back to Council Crivelli?
Okay.
Can I ask a question that's in the report? Again, you've talked about growth and sustainability
of the network and you talk on page 79. The cost of the CCTV system for ones worth of
£280 ,000, that's the year 2023 -24, and that's obviously not including staffing costs. There
was a discussion that we were having about deploying cameras at the request of, if councillors
brought to the attention of the council that there was a particular issue with anti -social
behaviour or fly tipping. Can we have more information on the specific cost of the cameras
overall? I appreciate that that's a global figure for how much it costs, because obviously
– I don't know, just speculating, say it costs £2 ,000 to deploy a camera in one
street. Is that not part of the evaluation process overall about whether or not it's
worth deploying the CCTV in the first place.
I can tell you the sort of capital cost
of one deployable camera is about two and a half thousand pounds.
I wouldn't be able to tell you offhand
what the cost of kind of each deployment is,
but I can come back to you with that.
I make an assumption here,
I mean that was quite a good guess on my part,
two thousand pounds, I'm far off it.
But I make an assumption that having deployable cameras
is fixed and mobile, there's a difference in cost,
I make an assumption there.
The second thing is that some places
where you have a camera, it costs more than others,
depending on the number of cameras you have in the street
and so on.
That's the sort of thing I was just wondering,
is that something that we can have a breakdown on?
Because obviously if we are being asked to approve
how much overall budget for this sort of thing,
we're going to ask that it's bit of an idea about how much each camera costs and whether or not that's cost effective overall strategy do
Yeah, I do. I think
Obviously each case is different
There's obviously the capital cost of deployable camera mentioned and then there's where you would place it whether you need a commando socket fitted to
The lamp column whether any changes to the lamp column might be required
But I can provide you with some some sort of indicative costs of roughly how much it costs to do that
I think also it's part of the operational requirement
consideration I suppose is how much is this gonna cost
to do, is it feasible, as well as is there an evidence
need for this camera to be put in place.
So for each operational requirement for each camera,
there is that kind of consideration made.
I think just, Graham, did you wanna come in?
I'm sorry, you've got a question.
Go for it.
Do you mind if I just ask a question of Councillor Crivelli?
In the line of your questioning, it sounds to me like you were saying we want to know
the cost of depolar capable cameras in particular areas and then equate it to results in different
crime areas.
But if that is the case, I'm just questioning whether it's possible to put a value or a
judgment on different crimes.
I don't think you can put that sort of value on it because, again, I don't know how much
– I took a guess at 2 ,000 pounds, I wasn't far off it.
But the point I'm making is how much does each camera cost to deploy?
we don't have limitless resources.
So say for example, you had an area where there was
a lot of antisocial behavior and you had another one
where there's less antisocial behavior,
you may have to make a decision about how you're gonna
deploy the cameras.
That was the point I was making, whether or not
there is a difference in the camera price.
That was all.
Thank you, Chair.
I think the first thing to say,
to get this in perspective,
is that CCT use and monitoring since 2022
has improved immeasurably.
The pilot project to employ more people
in the Joint Control Centre
has been an overwhelming success.
And I think the proof is in the pudding.
The police originally said that Wandsworth
was one of the worst performing councils
in terms of providing CCTV to them for operational reasons.
They now consider us to be the best.
Killings cited, well, two examples.
There were a number of other examples
which were actually set out in the community safety report
which actually came to this committee.
So I think first of all, we've got to say
that the system is, it would never be perfect,
but it has made enormous strides forward.
The CCTV strategy is certainly a reflection on that.
As Mr. Crawley said, amazingly, we never had one.
We didn't have one under the previous administration.
I understand some of the issues they face,
and I'll try to address them.
But what the CCTV strategy is about
is demonstrating we actually deploy cameras
according to the law, that we actually have a defensible
position should anyone actually challenge us
in terms of how we go about that.
I'm certainly grateful to Mr. Crowley and also to
Bhagirat in terms of explanations.
So he currently in particular covered a lot of the points
I was gonna mention, particularly around the
Community Safety Partnership Board,
because all this is being done in partners
with the police and other agencies as well.
Let me address the issue of democratic accountability.
First of all, in this paper,
there would be very little democratic accountability.
We have actually brought it to a scrutiny committee,
which have never been brought before.
And indeed, it is the scrutiny committee
which actually represents that democratic accountability.
You've already heard from Kieran
that we intend to submit annual reports.
I stand by that.
I think it's absolutely essential.
These will come to the scrutiny committee for their comment.
And finally, of course, I'm the cabinet member
for community safety because ultimately,
I am responsible for what actually happens.
And I'm prepared to stand up and say that.
The buck ultimately ends with me.
but I am certainly proud of the very considerable
advances we have actually made.
In addition, Mr. Crawley mentioned that
there is our intention that councillors
will be given guidance on how to ask for CCTV coverage,
which has never existed before.
I think the original criteria for deployable cameras
was essentially a police requirement, a police request.
There was no involvement from councillors, no involvement from members of the public.
We are rectifying that.
We are giving councillors and potentially members of the public the opportunity through
their councillors to ask for CCTV cameras.
In addition, in terms of the actual quantity involved, I'm given the significant improvements
in technology, as Mr. Crawley said,
in some areas you have been able to reduce the total number
simply because CCT for cameras have improved considerably.
But to give you an example, in 2022,
there were 12 deployable cameras
for Wandsworth and Richmond.
And Mr. Crawley has pointed out,
we increased that number to 38.
And I think finally, in terms of this paper,
I think Mr. Crawley would certainly acknowledge
that there was very considerable discussion
on the part of myself and also my cabinet colleagues
in terms of this final report.
I think the final point in relation
to democratic accountability, the suggestion
that the councillors should sit on the oversight committee.
I mean, frankly, there are just so many of these
covering a multitude of different issues
across the council.
and it really is, in my opinion,
quite impractical for councillors
to sit on things like that.
Ultimately, that's nearing a group responsible
for providing the legal oversight to ensure
that we are deploying cameras properly,
but ultimately, if people have a particular issue,
they can certainly raise it through their councillors,
and certainly with me.
Thank you.
Okay I'm conscious of time. Okay a quick comment. Can I say I think the
you know role in CCTV out in the borough is excellent. It is a very good safety
initiative. The issue about the democratic accountability, I think it's a
fair point that the way that the OneDrive wants to address this is that
councillors will feed in and say well I think a camera is needed to be deployed
in my street, there's a lot of anti -social behavior, I'd like to see it
in this area because there's a tremendous amount of fly tipping.
And it's sort of, the officer said, you know, it makes sense to have resident input.
I appreciate that we can't expect Councillors to sit on every single committee there is.
Does the cabinet member not think, what would the harm be in the cabinet member sitting
on the CCTV steering group?
Because you would give that feedback about Councillors and residents while you sat on
the steering group.
and I don't think it's an onerous commitment, is it?
I think it meets quarterly.
Yes, certainly, and I think, Councillor Cravo,
that is a reasonable approach.
Certainly, I envisage that those reports
would actually come to me,
particularly in terms of anything which may be controversial,
but I'm certainly prepared to consider that, yes, certainly.
Okay, let's move to a vote.
So, does the committee support recommendations
in paragraph two?
I wanted to move an amendment in relation to the CCTV.
We wanted you to try and commit to a couple of actions here.
I don't think these are unreasonable overall.
We wanted to present an annual CCTV report to the full Council on an appropriate overview
and scooter committee.
I don't think that's difficult for you to comply with.
The issue that we talked about the CCTB's doing group
to include elected councilors,
you've said that you would consider that.
We wanted to see the minutes,
publish minutes of the key decisions
as the in -group maintain public accessibility
to list of the active CCTB locations
and introduce a formal process for residents and councilors
to challenge the placement, use or misuse of CCTB cameras
and commissioning the independent audit of CCT
at regular intervals.
I appreciate some of this,
The last one is a lot of statutory regulation already, but I can't see why you would disagree
with, say for example, presenting an annual CCTV report to the full council or this committee,
or say for example, considering reforming the CCTV steering group to include elected
councillors.
Are you willing to accept some of those, or would you want every single one of those,
if I was to agree now?
I would very much like to consult on this if possible.
I think I've already given a commitment and a report
on CCTV and I must confess I thought it was somewhere
in the actual report either way.
Kieran said that that was the intention.
I see absolutely no problems with that and quite happy
to come here and to be subject to the normal processes
I am more than happy to consider my attendance on the steering group.
I certainly intended to give it considerable oversight.
I think some of the information you are asking the council to look at earlier around statistics,
I mean I really would have to ask officers in terms of the practicality and complexity
the complexity of that.
But I mean certainly quite happy to produce a report
and through the guidance to counselors,
counselors will actually be able to raise issues
which particularly in circumstances where they feel
deplorable or other camera may be necessary
but for one reason or another it has been refused
and certainly that process I dream of as it will come
through counselors and ultimately to myself.
Can I just ask you about the process for residents and councilors to
challenge the placement of the CCC because obviously a lot of it is about us
feeding back information about where we think they should be deployed. It
doesn't seem clear anyway if say for example residents want to raise
any subjection about that?
How does that process come about?
We certainly envisage that because this is
certainly very high level, and I mean, clearly,
we've got quite extensive CCT coverage,
the best in London.
Nonetheless, these things do actually need
to be approved according to statutory requirements.
We don't intend that members of the public
should necessarily be able to require a CCTV.
I think that any administration, any future administration
would find that exceptionally onerous.
But what we are suggesting in the normal process
is the members of the public can contact their counselors.
As indeed happens at present,
I mean this certainly happens with me,
and through counselors and through the guidance
which will be issued to counselors,
They can actually raise these issues as members inquiries. They can write to myself as a cabinet member
And if they do not get satisfaction clearly
I will look at it and if I think it appropriate will institute a further consideration
Okay
Just be clear you are quite happy to produce a CCTV report for this committee
You are going to consider reforming the steering group potentially cabinet members sitting on it if that's possible
and the process in rega...
I mean, publishing the minutes and key decisions
in the steering group, does that get done anyway?
Well, it should be.
Mr. Crawley, perhaps you can have eyes on
how you envisage a process will actually operate.
They're obviously minutes in the meetings,
but those minutes aren't published certainly as yet.
I think as Kiran says, the feedback from the steering group
that would feed into the community safety partnerships.
They'd become available in that way.
So they are available?
Well, they're not at the moment, no,
but they will feed into the community safety partnership,
and so there'll be an element of scrutiny
that comes up at that meeting,
and they'd be available through the minutes of that.
Okay, great, thanks.
Okay, are you able to take those as agreed actions?
Yeah, if those are agreed actions, then.
We're happy to take that.
I'll just agree that was a comment.
Thank you for that.
OK.
Take it to a vote then?
Yep.
Are the recommendations agreed?
Agreed.
Great.
Thanks, everyone.
That was nice and collaborative.
OK.
Moving on to the Wandsworth sexual and reproductive health
strategy report from executive director of adult social care
and public health.

7 Wandsworth Sexual and Reproductive Health Strategy 2025-30 (Paper No. 25-60)

We've got Ramya and, sorry, I don't have the name.
Oh, and Kate Jennings.
Sorry.
Would you like to introduce the report?
Yes, absolutely.
So I'm Dr. Rameer Ravindran, consultant in public health.
I'll just give you a brief introduction to the strategy.
So it's the Wandsworth Sexual and Reproductive Health
Strategy for 25 to 2030.
It's a really collaborative action -focused strategy
developed alongside our health and volunteering
community sector partners.
It's based on the findings of the Wandsworth
Sexual and Reproductive Health Needs Assessment
that we undertook in 2024.
And this includes not just quantitative data,
but a really extensive array of qualitative data
that came about through engagement with those
that live, work, study, and socialize in Wandsworth.
The strategy takes a life course approach,
which means that it takes into account
the differing needs from young adults
through to older people.
And we endeavored to make sure it
was aligned with existing strategies,
both locally, across London, and nationally.
So for example, on a local level,
it has strong links with the Violence
Against Women and Girls strategy and the Youth strategy.
And it also links very closely with the HIV Action Plan
for England and the Women's Health strategy as well.
And we got very valuable feedback
from Councillor Worrell in relation to aligning strategies
and also in regards to particular groups
facing inequalities.
So that's embedded within our approach.
In terms of the structure, the strategies based on the WHO,
so the World Health Organization Framework
for Sexual and Reproductive Health,
and this framework has eight key intervention areas
that cover the breadth of sexual health
and reproductive health from education and prevention
through to treatment, looking at, for example,
or antenatal, intrapartum, and postnatal care
all the way up to sexual function
and psychosexual counseling.
So it's a very broad range of interventions.
Each section within the strategy takes
one of these key intervention areas
and then breaks it down in terms of the data,
what the community's saying,
what's already happening in Wandsworth
in regards to these areas, and where the gaps are.
So what are priorities and next steps should be
alongside the key owners of these actions.
Really importantly, and what I alluded to before,
is that each section has a big focus
on reducing health inequalities
and creating a very collaborative
and joined up approach between partners,
so council, health, volunteer, and community sector.
The strategy has clear actions to implement,
and the implementation will be overseen
by a multi -agency partnership group
called the Sexual Health Implementation Group
that was also key in developing the needs assessment
and the strategy.
and we're gonna be evaluating the implementation
over the five years of the strategy as well.
So happy to take any questions.
Right, and thanks for all the work that's gone into this.
Chancellor Worrell?
Yeah, you'd expect me to have a comment on this.
I just want to bring to the attention
of my fellow counselors the amount of work
that's actually gone into developing this.
I mean, it's a very comprehensive strategy.
A lot of consultations gone into it, a lot of research.
and sexual health unfortunately is one of the areas
that is often marginalized, but actually has major impact
on the health of our population in many different ways.
So I said a big thank you to you and your team
for bringing this together and the way that you've actually
worked to align it with different strategies as well.
I would recommend that.
I also just want to highlight the way that it's laid out
in terms of the linkage of actions with priorities
and developing a matrix that can be measured
and rolled out across the borough and the voluntary sector
and our various partners.
So as I said, there's a lot to learn from this strategy
that other strategies can look at
in terms of the way it's actually worked
and brought together.
So a big thank you for that.
I just want to bring,
there's just one point of clarification in this.
In paragraph 22 and on page 29,
you speak, sorry, page 139, you speak about
the issue of data gaps.
Now I recognize that often in a stretch,
we're talking about very marginalized communities.
So we're talking about people who might be sex workers,
for example, have a stigma associated with drug use,
come from other communities as well.
And gathering that data is often quite difficult
and quite controversial.
but if we are to be data led and rolling this forward,
I just wonder how you're gonna go about ensuring
that those data gaps are actually filled.
It would be through training or a different change
in system, just some ideas around that.
Yeah, absolutely, that's a really good point.
It's something that we picked up during the development
of the needs assessment and the strategy,
and as you said, it's referenced
in the equality impact assessment.
And at the time of both those pieces of work,
we worked with partner organizations
who work with those marginalized groups.
So we took a qualitative approach
where we couldn't necessarily use quantitative data
because the numbers were so small,
we spoke to individuals from those communities.
And an example would be, we even had a sex worker
who represents that group and does work
with our integrated sexual health service,
come and speak to the sexual health implementation group
to get their perspective on their needs, essentially.
So that's an example of what we had done.
In terms of going forward to make sure
that we continue to address the gap
when we implement the strategy,
again, we're going to look at the qualitative data
when we can't get the necessary quantitative data,
so continuing to have conversations, focus groups, et cetera
with those relevant communities.
We can also look at what we can do around the numbers,
the quantitative side.
So for example, looking at London level data
where you can get larger numbers
which we could use, extrapolate,
and apply to us in Wandsworth,
or we can look at combining years,
so therefore we get large numbers
and we can draw some conclusions from, for example,
a three -year rolling period rather than the one year
so that we can avoid the small numbers issue.
But again, it will be something that we work on
through the Sexual Health Implementation Group.
So like you said, sharing knowledge and understanding,
and there's always new innovation.
So as services develop and they look at their data gathering
and data sharing, that's something that we will raise.
And so for particular groups, for example,
ethnic minority groups, LGBTQ +,
that's something we'll focus on.
And then where there's intersectionality,
so where, for example, you're part of multiple groups
and the number's even smaller,
that's even bigger focus for us
because obviously their marginalization's heightened.
So that's something that we'll continue to focus on
and hopefully improve over time.
Thank you.
Counselor Cremet, did you want to come in on that point?
Yeah, go for it, Shannon.
Yes, thank you.
The other opportunity that we use
when we want to focus on particular issues in terms
of data collection is to use contractual levers.
So for example, we'll probably be
looking to renewing our locally commissioned services
with GPs and pharmacies.
And I'm sure within the sexual health contract as well,
the main contract when it comes up.
So there's an opportunity to look at incentivizing,
collecting certain types of data so that clinicians
can be more focused where they think those issues
are relevant to ask the right questions and enter a code
that will help us to capture that data.
So we will look at that as well.
Counselor Corelli?
Can I just say thank you for your reports.
There's so much work gone into it
and the research is superb.
I just want to ask you about part of the report
on page 125, if I may.
And you've talked about prevention and control of HIV
and other STIs.
And you've said, what does the evidence tell us?
And one of the features that you said was STI diagnosis
in Wandsworth in 2022 was 1 ,900 per 100 ,000 residents.
That's 1 .3 times higher than the London rate.
And then you go on to say that there's 14 ,336 per 100 ,000
were tested for STIs.
And again, that's 1 .6 times higher than the London rate.
Looking at that bigger figure, you might think there's a problem with STIs in London, sorry,
in Wandsworth.
But am I correct in saying that actually what's happening is you're doing more testing?
Is that why the figure looks higher?
Have I got that right?
So it's a combination of things, more testing.
Wandsworth's a very mobile population.
It's a very young population as well, which will affect the numbers compared to other
at a London level, my understanding is that there has been
an increase in STIs, so this reflects some of that.
I don't know if my colleague Kate wants to add anything.
Yeah, I think, well we do know nationally that the STIs
are increasing, and I think that I really want to
kind of add to that is strategies such as this,
it may not, it won't bring it down to zero,
but it goes some way to work to reduce it
and to continue with that kind of preventative angle
on SDIs and that hope that it would continue
to start to go down.
In addition to that, when you look at some
of our benchmarking data, I mean, obviously,
if you test more, you're bound to find more,
but when we do that comparative analysis,
looking at other boroughs, it gives us an indication
of where our testing rates are in comparison to those areas.
So if we're seeing that despite the testing,
we're still detecting more cases,
but our testing rates are potentially lower
than in other areas, it means that there
is a genuine issue in terms of the increase in the incidents.
Councilor Correlli, did you have anything to add?
Just basically, to understand, OK, some of it's
coming because we're doing more testing,
but you think it's the demographic composition of Wandsworth, and that's not something we
can do a tremendous amount about if it's a more transient, youthful population as compared
to other boroughs which are less transient and have the older demographic. Is that the
longer and shorter? But, I mean, we can do all the preventative work, but we have to
accept that no matter what we do, the demographic composition is going to make it more difficult
for us. Is that...? I think the demographic composition is something
that we have to recognize when we're developing
a strategy like this because it is one of the underlying
principles of, or things that we have to address
that we have a young population.
I mean, there are sexual and reproductive health needs
from young adult up to older age,
so it's not saying that it's the only population
that will be reflected in these numbers,
but it is something that we have to take into account
in terms of what services we provide,
how we do our health promotion, education,
and so the channels that we put messaging through,
we want to make sure it's targeted
to the younger population that we have,
but also make sure that it doesn't
marginalize other groups as well.
It's not to say that we can never improve this.
It's to recognize that this is a contributing factor,
and therefore we need to tailor the strategy
in our interventions to address that.
I hope that makes it a bit clearer, yeah.
We have a question from Steven from Healthwatch.
Thank you very much indeed.
Very comprehensive strategy and papers.
My question really was about working with partners in particular, a lot of these issues
clearly struggle between public health and various aspects of the health system, mainstream
health services, primary care, acute care, mental health and so on.
And I wonder if you just say a little bit about how you,
how you, in developing the strategy and going forward,
are you working well, better with those various partners?
How, because the strategy depends a lot on that.
I wonder if you could just talk a little bit about that.
Yes, absolutely.
That's a really, really good question.
The strategy was developed alongside partners
in health and volunteer and community sector,
but also, for example, school representatives as well,
because a lot of the education is
reach up productive and sexual health within schools.
So they're part of the development,
and they're also definitely part of the implementation.
I can give you a few examples.
So RSE, the syllabus in schools, is something
that we don't have direct control over as a council,
but we've been influencing and providing support on,
and also getting feedback from people that work
with young people on that.
We work, we obviously commission the naught to 19 service
and so we've been working with our NHS providers on that
in terms of antenatal visits, perinatal mental health,
that kind of area of intervention.
Going forward, working with St. George's on the midwifery
offer and what that would look like.
So there have been a range of partners that have been
engaged and will continue to be so through our sexual
Health Implementation Group.
Great, thanks so much.
So does the committee support the recommendations
in the paragraph two?
Yeah, okay, supported unanimously and this is moved.
Thanks everyone, thank you so much for all the hard work
that's gone into it again, really appreciate it.
Great, we're getting there with the papers.
And now we've got a verbal update from Jeremy DeSouza

8 Verbal Update on the CQC's Local Authority Assessment of Adult Social Care

on CQC's local authority assessment of adult social care.
Yeah, thank you, Chair.
So I'm gonna give an update on the council's preparation
for our forthcoming assessment
by the Care Quality Commission.
And just by way of background,
the Health and Care Act 2022
created the new performance assessment regime.
So there was a new duty on the Care Quality Commission to review and assess how the local
authority is performing in delivering our adult social care duties under the CARE Act.
So that's the main focus of the performance assessment framework.
And when the CQC carry out their assessment, they'll be looking at the Council's adult
social care services in terms of four themes.
So the first theme is how we're working with people.
And broadly that covers our functions
in terms of our assessments and review processes.
So how our social workers and practitioners
work with our residents to look at their care needs
and how we support them.
The second theme is about providing support.
And in summary, that's around how we commission services to support our residents and our
partnership arrangements.
So we work with a broad range of partners, health, voluntary sector in providing our
services.
The third area is how the local authority is ensuring safety within the system.
And this includes the council's arrangements
for safeguarding adults and the council's role
in as the lead of agency in setting up
the safeguarding adults board
and our work to keep residents safe.
And then the fourth and final theme
is around our leadership.
So how the council is working in terms
of our leadership role in how we provide adult social care.
So CQC started their assessment process in 2023, and they've now completed a number of
assessments in England and also in London now.
A number of London boroughs have been inspected, and the assessment reports are gradually being
published.
So we're able to look at them, and they're on the CQC's website.
So within the Southwest London region, now five of the six Southwest London boroughs,
including Wandsworth, are now in the process of the assessment.
So Wandsworth Council received our notification just before Christmas on the 9th of December,
and then we had a period of time to submit our evidence, which is a very comprehensive
of information return and effectively our own assessment
of how we're performing.
And that was submitted to the CQC on the 10th of January.
We're now waiting, the next stage will be notified
of when the onsite visit will take place
by the inspection team.
And we anticipate that will be within a few months
of that earlier notification.
So when CQC arrive for their onsite inspection,
they're gonna talk to a whole variety of people,
so including senior leaders, frontline staff,
most importantly, people with lived experience
who draw on care and support services, our local residents,
our care providers, our partners,
particularly in the health service
and the voluntary sector and Health Watch,
and then, and also elected members,
and specifically regarding elected members,
they'll be particularly interested
in talking to the cabinet member,
the chair of our, Councillor Dobras,
the chair of our health committee,
and Councillor Covelli is the opposition
speaker for health.
So at the moment we're focused,
we're ready for the inspection team to arrive,
and we'll keep the committee updated
as that process unfolds.
And the report we're going to bring back to committee and could you just remind us of when we expect to see the results of that?
Yes, so I mean clearly the whole process takes a few months
But we anticipate that we'll the report will be published and we'll be in a position to pub to bring that to committee in the autumn
So hopefully for the September committee
Committee members satisfied with the update and to bring the report in autumn. Yeah. Okay, fantastic. Thank you so much for that
for that date.
Okay, moving on to Adult Social Care Outcomes Framework
Annual Report.
We've got Claire, who's taking a seat now,

9 2023-24 Adult Social Care Outcomes Framework Annual Report (Paper No. 25-61)

Assistant Director of Assurance and Innovation
to give a really brief overview to the report
and then we'll go to questions.
Thanks very much, good evening everyone.
So this is the Annual Report,
which measures our performance
against the Adult Social Care Outcomes Framework
and it benchmarks us against all the other London boroughs.
It's made up of a service user survey,
a carer's survey, and a set of performance indicators.
It's very positive with 17 of the 22 indicators
in the top two quartiles.
And also feedback from people who draw on care and support
was very positive this year,
where we've improved in five of the seven indicators.
The report is presented really for information only and I'd be very happy to take any questions.
Thank you.
Any questions?
Councilor Gusei?
Thank you, Chair.
I've got a question about the ASCOF indicators.
It mentions that four indicators have been removed because they've not been monitored
nationally anymore.
And they're all very important metrics.
So the proportion of people who use services that made them
feel safe and secure, the proportion of adults
with learning disabilities in paid employment,
the proportion of adults in contact
with secondary mental health services in paid employment,
and the proportion of adults in contact
with secondary mental health services
who live independently.
Are those indicators still being measured,
even though they're not part of the ASCOF indicators?
No, they're not being measured.
The government, this is a central national change.
We don't know the precise reasons for why they've removed them.
It's part of the national work and they review these indicators every year.
So they have been removed from the whole framework.
We think that part of the reason is that some of these were quite challenging indicators
to measure.
So for example, the one around learning disabilities and paid employment didn't show the full
picture. So we also want to be looking at a number of people with learning disabilities
in voluntary employment. So there were some indicators that weren't as relevant anymore.
As you've seen from the report, they've replaced them with three other indicators that are
very relevant and are most relevant in terms of CQC assessments. So these are indicators
that will be fed into the CQC assessment. So they've really just nationally updated
the framework and keeping it up to date.
But is there any value of tracking those indicators locally still?
I know you mentioned that there is some difficulty in terms of getting data for some of them,
but I mean, I would have thought that, you know, it may be that particular metric for,
you know, determining the proportion of adults with learning disabilities in employment,
you know, didn't quite gather the data that you needed it to, but I would imagine that's
a pretty important metric to measure locally.
So we do, we bring up a report later in the year which is our performance metrics internally
which are not benchmarked against London and we do have some similar KPIs that we look
at on a local basis but obviously then we won't have the data to benchmark nationally.
So it's this bit of it is really about the benchmarking.
Councillor Rana Siraj.
Thank you, Chair.
The ASCO operating have improved considerably since 2022,
which is of course fantastic.
And what are the principal reasons for these improvements,
principal changes in the?
So I guess the indicator that I think we can be
really proud of is the one around feedback from people
who draw on care support in terms of overall satisfaction
of people who use services with their care and support.
Obviously that's great news that that's gone up
so significantly, it was around 55 .6 % in 2020 -21.
Hopefully that's as a result of all the work we're doing
around supporting people to live independently
and all the work we're doing around our strengths -based
approach to work very closely with people
who draw on care and support.
Thank you.
Any other thoughts?
Councillor Worrell?
Mine's not a question.
It's just a comment, really, is that tables like this are numbers on a page, but they
don't really show the amount of work that's been done behind the scenes by members of
staff in the frontline services, working at various levels, and often working with sometimes
very complex needs, and I hope I can speak on behalf of all the counselors around this
table to say a big thank you to those staff members and congratulations for the amount
of work that's been done to keep us with these good results, but also just to say to recognize
the often very difficult circumstances that some of these services are delivered in.
And I would like to, if possible, for you to convey hopefully our combined thanks to
members of staff either through the internet or something like that about the work that's
being done in relation to keep this up.
Thank you very much.
That will be very much appreciated by staff.
We will certainly be doing some internal communications around this and indeed external communications
as well.
So thank you for that comment.
Thank you very much.
Councillor Correlli.
Can I just ask you about one of the performance indicators that you mentioned, the percentage
to people in direct payments.
you said it had just slipped from the second quartile to the third quartile, and it looks
as though it's a rather harsh measure, because you've said only four more people receiving
support via direct payment would have seen you maintain the second quartile performance.
You talked about the shortages in the personal assistant workforce and the efforts the Council
is trying to resolve that. Is it fair to say that this is a resolvable blip? Is that one
ways to describe it.
Well, I haven't got a crystal ball.
And as we've mentioned in the paper,
it's a challenging market.
But yeah, as you've noted, a number of these indicators
are not perfect in terms of we're
looking at quartile benchmarks, and we haven't
got any margin for error.
So that's one where we have slipped.
We monitor this regularly, so we will keep it on review
and update you at forthcoming committees.
Thanks very much.
Yeah, of course.
Graham, come in.
Thanks, Chair.
Yes, if I can just make a general comment,
I'd certainly like to endorse what Councillor Warrell said
about the very considerable efforts that our staff,
and indeed our service providers, our contractors,
have actually undertaken to deliver these results.
And to deliver them in what can only be described
as extremely challenging circumstances
to actually improve our performance.
It is obviously relative to other councils in London,
but to do so significantly over the past two and a half years
I think is of very significance.
I think in answer to Councillor Varatharaj's question,
question. I think it really does come down to commitment. We have invested in
adult social care and also public health, but we have invested in adult social
care and that I think is the most important lesson to take you seriously
and have a genuine commitment, not just in words but also in deeds, particularly
in terms of providing the necessary money for adult social care to thrive. Thanks.
Great. So can the committee note this report for information? Great.
Okay, moving on to our final item of the evening. Thank you so much, Claire. Really appreciate
it and thanks from all of us. We've got Sarah Evans who's going to give a brief intro to
the budget report and then we'll have time for questions.

10 2024/25 Q3 Budget Monitoring and 2025/26 Budget, including Annual Review of Charges (Paper No. 25-62)

Thank you, Chair. Good evening, everyone. So this report covers the Quarter 3 budget
monitoring position for 24 -25 and also the 25 -26 budget, including the annual review
of fees and charges. As at Quarter 3, the forecast out -term position for the services
within the remit of this committee is $2 .7 million compared to a revised budget of $102 .7
As at quarter two, there are significant budget challenges
within adult social care and public health
around the budgets largely for our care services,
where all client groups have experienced
increases in care needs,
leading to increases in fee rates
required by the provider market.
Both complexity of need and market conditions
are leading to increased prices within the market,
along with the significant pressure within the NHS,
which is impacting adult social care,
with patients being discharged more quickly
into the care system.
There's been minimal change in the forecast
since quarter two, because we've built in some
resilience into the forecast for growth
in the later quarters of the year.
The report does set out mitigating actions to address the position along with the continued
risks and challenges that we're facing in this service.
The 25 -26 budget along with future year's budgets are set out in Appendix D and take
into account demand -led pressures through growth along with future efficiencies.
And for adult social care service users, most of our service users make a contribution towards
the cost of their care based on an individual financial assessment, so takes into account
personal circumstances.
The report does set out in the appendix the charges that are not based on a financial
assessment that they are minimal I would say. So yeah I will stop there happy to
take any questions. Thank you very much. Do I have any questions?
Councillor Cravelli. Sorry can I just ask a question about if we go to page 183
care home providers and home care providers and the rising costs.
The local government association said that the changes in national insurance would cost
councils about $637 million in direct costs, another $1 .1 billion in indirect costs.
Now, last night I was at the Children's Committee and we heard that the government is actually
going to introduce a grant and distribute a grant to schools to try and cover some of
the cost of that.
I know we've had the figures in the settlement this year, but is that it?
There's not any more money in the pipeline similar to the risk for education for this,
as far as you're aware?
As far as I'm aware, there is no more money, other than the additional 880 million which
is set out in the paper which came in between the provisional and the final local government
finance settlement.
But yeah, I'm not aware of anything else.
Can I ask another question that builds on that?
Just looking at from what a lot of – it's mainly what the LGA and other – some of
the county councils have said, that the private providers are saying that they're struggling
to provide contracts to councils under the existing financial disciplines that they have
because of increased costs.
There's the national living wage.
They've got increased costs for insurance.
insurance, then they've got the national insurance. And I think a survey said that 75 % of private
providers were talking about either cancelling contracts or not renewing existing contracts.
Have we had any feedback from private providers that might be a problem in Wandsworth a lot
along these sort of lines?
Our commissioners are meeting with providers to discuss the situation and to try to work
together to resolve it going forward. We haven't had any contracts handed back in Wandsworth
to date or any indication that they will be. But I think that process is continuing in
terms of discussion with providers. The commissioners are working at a south west London regional
level to try to get to a coordinated approach around the uplift process for next year as
well.
Can I just ask, I'm not really familiar with what the contracts are with the private providers,
but I assume that if they've got additional costs they're going to come back to us and
ask for increase in fees. That's par for the course if they have an additional sort of
cost but do the contracts that we have with these private providers, do they already have
inflation linked increases within them and things like that because I was just wondering
if it is the case they come back and they say well I need more fees. We don't have a
contingency in the budget for that do we? No, so there would be two types. So there
would be some contracts, actual contracts that we have out there, which as you described
will have an inflationary clause in there,
and that inflationary clause would hold.
But we do have a number of spot purchases
where we're purchasing care for individuals
in specific homes, and that's the uplift process
which will be impacted by this.
I have to say, it will differ in different markets,
and we are doing some modeling on that.
There's a wealth of information out there,
so LGA have provided a model, care analytics,
And we are looking at that because we do think that it will be important to look at the different
markets and come up with different uplifts this year in 25 -26 to reflect the employer's
national insurance.
Just to add to that point about uplifts, they're not, for most of the contracts where they're
labour intensive, they're not predominantly CPI.
there are a balance between uplifts in the living wage plus CPI to reflect the fact that
the prices and the changes are different.
So we've already taken that risk through the contract process.
Councillor de Sertal.
Yes, thanks.
I'm just intrigued, just looking at Appendix B which shows that the number of people receiving
services is actually very similar to what it was in 2018.
Clearly there's been fluctuations over the years, but I was just wondering the budget
by now is 102 million or thereabouts.
What was it in 2018?
This is what context challenges you're facing right now.
Sorry, was the question?
What was the budget in 2018?
Sorry, I don't have that figure here, but you're right.
And back in 2018, we had 3 ,387 people.
At that time, it was, we were,
the directorate were working on implementing,
promoting an independence program.
So actually looking at introducing a strength -based approach,
so working as part of our transformation
to look at how we could promote people
living more independently at home.
and that's the kind of slowdown in the numbers that we see in those early years.
Then 2020 we had COVID and since then we've seen that increase in demand,
but it isn't just about the numbers, it's about the complexity of needs,
and that is driving some of the costs in the later years.
Thanks.
The report noted, oh not noted, no, no, it's for decision, sorry.
Does the committee support recommendations in paragraph two?
Agreed, okay.
The report is carried.
Thank you very much everyone for attending the meeting and for really great contributions
this evening.
Have a lovely evening.