Health Overview and Scrutiny Committee - Monday 30 June 2025, 7:30pm - Wandsworth Council Webcasting

Health Overview and Scrutiny Committee
Monday, 30th June 2025 at 7:30pm 

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  1. Webcast Finished

Good evening everyone, especially new members of the committee to the Health and Social
Care OSC.
My name is Lizzie Dobres, I'm chair of the Health OSC.
I'll now call the names of the committee members in alphabetical order and if you could just
say that you're here. Councillor Anand? I'm here. Councillor Crivelli?
And we've got apologies for absence from Councillor de la Sejour. Councillor
Gassane? Here. We've got apologies from Councillor Jaffray. Councillor Lee? Here.
Good evening.
Councilor Marshall.
Present.
Councilor McLeod.
Present.
And Councilor Stutters.
Also in attendance, we've got the cabinet member for health,
Councilor Henderson.
Good evening.
And I'd also like to welcome as an observer,
Councilor Worrell, who is our new deputy cabinet
the committee, Councillor Orell will be observing the meeting this evening.
And may come and speak through a microphone at the back if he needs to intervene.
And yeah, apologies for absence for two of those Councillors.
I'd also like to welcome Steven Hickey, Chair of Health Watch.
And Steven will comment on any item that he's indicated and wishes.
And I'd just like to express sadness for some of the news that came over last week.
But thank you for still being with us today.
So thank you very much.
I'd also like to welcome Mark Creelman,
Executive Director for PLACE for Merton and Wandsworth,
Katie Bolger, Deputy Director for Primary Care
and Transformation, Mary Adoo,
Deputy Director of Partnerships and Inequality.
So all attending from the local ICB,
the Integrated Care Board for the item on integration.
And later we'll be joined by Dr. Tom Coffey, Wandsworth Clinical Lead for
the Mental Health Specific Programs Update Report.
We've got a number of offices present who will introduce themselves as and when we go through the papers.
And we will now move on to our first item, which is the minutes of the meeting.

1 Minutes - 12th February 2025

Obviously not all counselors were in attendance, but for those who were in attendance of those meeting, can I check that the minutes are agreed?
Yeah, great.
And moving on to declarations of interest.
Do we have any declarations of either pecuniary

2 Declarations of interests

or other non -registable or registable interests?
No?
Great.

3 Integrated Care Developments in Wandsworth (Paper No. 25-227)

So let's kick off with our integrated care development
in Wandsworth update.
I'd like to welcome Mark Creelman, Katie, Mary
to introduce the report.
I think they're online.
And apologies, can you hear me okay?
Yeah.
Yeah, and apologies we're not there in person as you can imagine, it's a relatively busy time in the health services at the moment.
And with the committee's approval, I would just like to kick off with some changes around ICBs and model ICBs,
and then hand across to Katie to do the piece on kind of integration in neighbourhoods.
So I'll just kick off. So in March, ICBs were told to save 50 % of their management costs.
Now that depended really on how much you spent on management costs and for South West London,
actually the figures more aligned to about 58 % of the management costs need to be saved.
So budgets are now going to be per head of population given to an ICB and they will run their management costs to that budget.
that budget being around £19 per head of population. It's to be really, really clear
that this is about the management costs of the ICB, not the commission services. Now
commission services do have significant savings challenges, particularly this year, and those
are felt by every sector across health, whether it be acute, primary, community, et cetera.
but what we're talking about is the 58 % reduction in management costs of the ICB.
Now in May, a model ICB blueprint was issued which really changes the nature of the ICB to be that of
a strategic commissioner. So for those of us that are of a certain age, it goes back to that kind of
data and evidence then driving a kind of plan to meet the health needs of your population,
commissioning and contracting against those needs and against that plan and then evaluating how
you're doing and changing going round in that cycle. We are already underway in terms of
identifying the 58%. We have done a functional analysis of everything that's in the ICB and
that 50 % applies to every function that we currently hold. Now in the future those functions
may change so the function of the ICB being that strategic commissioner, if it's not in
those functions, the functions will transfer to either NHS England, it could be to a provider,
it could well be to a local authority, and that's a process that we need to go through
in terms of identifying receiver organisations for some of the functions that will no longer
sit with the ICB. We are currently in the middle of a design phase, so we've looked
at all the functions, we are now looking at what structures would have to be to meet those
functions of the ICB and also starting to have conversations with other providers, NHS
England, about how the transition of functions might take place and the timescales to do
that. I need to be really clear, this needs to be done in this financial year, so actually
we need to have identified the savings by December so that they're implemented by
1st of April 2026. I'd just like to shout out on behalf of staff, this is very, very
difficult for staff who have already been through a management savings programme, which we took 30 %
out last year, we're now taking 58%. So staff really have been going through this kind of change
on a very, very regular basis. We do think by the 1st of April we will have landed that design,
we will be ready to be a new strategic ICB.
And just, not busy enough,
London also issued a case for change for neighbourhood health
and also a target operating model.
And that target operating model kind of set out things
like geography, integration partners, cohorts of patients,
and Katie will touch upon the plan
that we've got going in Wandsworth.
And then finally, we are also anticipating
that the 10 -year plan is issued on Thursday. And in that, I think, as the debez already
mentioned that we are expecting quite a lot of significant change as well, not just for
ICBs, but across the whole health system. So I'll stop on the ICB remodeling and then I'll
pass to Katie to do the integration. Thanks, Mark. Good evening, everybody. So since I
last update of the committee regarding the development of neighborhood health services
in Wandsworth, the London target operating model for the neighborhood health services
has been published. And helpfully, that provides significant amount of clarity and useful background
information I suppose in terms of what the model needs to look like going forward and
how success in delivering that model will be delivered. You'll remember we already have
a neighborhoods program of work that's set out for Wandsworth and that builds on work
that we've been doing over a number of years to deliver better joined up care for our most
complex and vulnerable patients. But what I think is really clear from the target operating
model document, if you read it, is that we need a step change in terms of both the pace
and the scale of the work that we're doing. And so to kickstart that discussion, we've
undertaking a stocktake of where we are against each of the metrics that that document sets out.
And our Wandsworth provider alliance that involves all of the key partners across health and social
care in Wandsworth have been coming together to develop clear action plans for each of those
metrics. And the starting point is going to be the thorny issue of agreeing what geographies in
Wandsworth our neighborhoods will operate across. So our phase one sites that we have up and running
for 2025 -26, focusing on the areas of Roehampton, Battersea, and Tooting. But they are based
around primary care network footprints. And what we're really conscious of is that administrative
footprints like primary care networks, like the footprints that our community providers,
like the footprints that our social care providers work on, don't necessarily mean very much
to the residents that we serve. And so what we're really clear about in starting that
conversation with our health and care partners is that the neighborhoods that we define need
to be meaningful to people that live within the borough and then that we need to work
with those partners and providers to align resources accordingly. So whilst we've got
these phase one sites, Battersea, Southampton and Tooting, actually that's a conversation
that's likely to evolve over the coming year. I know we had a really specific question come
back about the report in terms of the community and voluntary sector engagement that we're
going to do. So there is a clear metric within the London target operating model around community
and voluntary sector engagement. There's loads of work going on in that sphere already. I'm
sure some of you were involved in it. And what we need to do is complete our stock take
and to look at what's currently being done and then look at what we can do to build upon
that. One of the challenges that I guess you're probably all familiar with as well, and it's
already been mentioned, is there are some moving pieces. So we have to date through our conversations
about neighborhood health services and our Wandsworth provider forum been engaging with
Healthwatch. We've been engaging with our community and voluntary sector coordination body.
Both of those things are, there's some shifting pieces. So we need to make sure we work through
that. But what we're really clear about is that each of our primary care networks has
social prescribers really well embedded within them. Those places have been in place for
a number of years. And as we develop our neighbourhoods, we need to be looking at how we make sure
that those social prescribing resources are targeted towards the areas in those neighbourhoods
that we go into them. And that's a really crucial on the ground way that we will be
able to make sure that this work properly engages with our communities
and our laboratory centre partners as well.
Thanks very much. That was great. Thank you. So we had a bit of an update generally about the ICB and then on
neighbourhoods. So I'll take questions first about any kind of general
questions for the ICB. So I had Councillor Marshall and then we'll go
after that.
Thank you, Chair. I just wonder if you could clarify how these
cuts are actually going to be seen on the ground by Wandsworth residents.
If I understood what you said, it's the management costs are being cut and this is the pain of
this is initially anyway being felt amongst your staff who have already gone through one
round of cuts and now got another hefty round of cuts.
But how does that feed through into what the person on the street in Wandsworth is going
to actually experience as a result, please?
Can I come to Mark for that?
Yeah.
So that's probably, that's a really, really great question and that was key to me saying
that these are not about service costs.
So the services that are already commissioned will continue to be commissioned.
What I think it's probably challenging is to have the resource that develops some of
services, develop some of the resource plans, etc. So it's the kind of a commissioning function
which will be stripped back somewhat. So therefore that's going to be, I think, challenging really
down to a very granular level at front line. But commission services are going to continue
to be commission services. Yeah. So it may just be in terms of kind of future developments
that there may be challenges that we need to take a hint on. I think also just in terms of
the amount of change that's going on particularly around the NH and Katie Alliddedton neighborhood
health as well, it's about having the resources to be able to manage that, those transitions,
in a well -managed way. Thank you. Councillor Gassane or yeah, you go for it.
Thank you, Chair.
This is a massive structural change to how local NHS services are provided.
And I fully appreciate the hard work that everybody is putting into making this work,
because it can't be easy.
But I have to say, I struggle with this paper.
I think one thing that really stood out for me is that I think the word Wandsworth only
appears in this paper once.
And I think Councillor Marshall actually touches a little bit upon the main point of the question
that I want to ask.
There's very little data information on how the change so far is affecting Wandsworth,
how it's likely to affect Wandsworth in the future.
The thing is, you know, when things are aggregated, you know, the focus is on commonality, it's
not on uniqueness.
I'm curious, you know, what about how services have been provided in this
borough up till now will be lost by this change. I fully appreciate that in
terms of greater coordination of services and so on, there may well be a
lot to be gained from this change, but I struggle to believe that things won't be
lost with a change of this magnitude. Things always are. And ones with
residents, because this is an open access document, that you know they
could read this.
What they want to know is what does it mean for me?
And the answers aren't in here, I'm afraid.
I mean, there's no data on patient satisfaction,
service user feedback, on how metrics and indices
of effectiveness might be affected by this change.
And I appreciate that there are probably too many points
to address in this particular meeting.
But what I would like to see the next time
we do get an update regarding this change as that kind of data is included in the report
because our job as opposition councillors is to scrutinise and there's nothing for us
to scrutinise here. I say that with the greatest amount of respect because I appreciate that
you've got a very hard job implementing this but I think we need more to get our teeth
into.
Thank you. Mark, could you come back on some of those points?
Can I respond to that?
Yeah, oh, yeah. So again, thank you very much for that feedback. I think in terms of the brief for this meeting, it was about update on what we're doing around integration, not on the performance management of many of the services that we've got.
GP access times, et cetera, et cetera, all facing Wandsworth.
So we are more than happy at a later date to come back
and share some of that really granular information with you
because they were asked to date to just update around
actually what were the kind of plans for integration
rather than necessarily these are the services
that are being delivered to Wandsworth.
But I'm more than happy that myself and Katie
and the team can come back with a more kind of performance
and metrics about what the people of Wandsworth get. Although this is absolutely a South West
London and ICB blueprint etc, myself and Katie and Mary are all Wandsworth facing team members.
Our job is to deliver services and work with primary care, secondary care in Wandsworth for
Wandsworth residents. So apologies if that didn't come through. I think probably you alluded to the
kind of the vagueness of it. I think we're working in a very ever -changing circle. We've
got the London target operating model, the model ICB, and then we've got on Thursday,
we've got the 10 -year plan. I think over the next six months, we will absolutely hone those
plans into something that's very real. But also, one of our jobs is to maintain the quality
of clinical services in the borough of Wandsworth. So I think it's probably that actually our
brief was not to bring something that was about service provision, it was about integration,
we were more than happy to come back.
That would be great, thank you very much.
Can we make a note of that Laura for the minutes? Great, thank you. I think that is a really
good contribution.
I will have Councillor Crivelli and then I will come to you Councillor Suttors.
Can I ask a question about a paragraph that you have got on page 5, it is paragraph 6
It says, in response to the publication of the London TOM, the target operating model,
the South -West London ICB is in the process of developing and agreeing a governing structure
through which the delivery of TOM will be overseen.
In addition, an initial stop -take against the metrics articulated within the TOM is
being undertaken in each of the South -West London places and an action plan will be developed
in order to enable response.
I think anyone reading that might think that's a bit gobbledygookish.
And I was just wondering if you could put it in sort of layman terms, what does it mean?
But more importantly, what does it mean for somebody who is a care user in Wandsworth?
I think that's a very fair point. I sort of tried to articulate in my introduction that a little bit
more. So essentially, there's a set of things we need to deliver over the next year, two years,
probably beyond that, depending on what the 10 -year plan says. And that is all about delivering
better joined up care for our most complex, vulnerable patients. Now we know within the
borough we have a range of different communities with different needs. And actually this is about
tailoring how we design and commission our health services to better align with those needs. It is
absolutely about building relationships between staff that operate across different providers
and making sure that actually the patient who is at the heart of that is not having to repeatedly answer the same questions from everybody who walks through the door.
So if you are a carer or if you are a person with complex mental health needs, actually you should be speaking to a group of staff, whoever those are, who know you, who know the person you're caring for, and have access to their records as well,
so that they know who the last person was who visited, they know what they said, and
whatever intervention was made as actually being followed through. So on the ground level,
that's what should get better as a result of putting this in place. We then have to have some
governance in place because we're going to have to be held to account for how we do it. That's kind
of what that paragraph talks about. So there will be a steering group at a Southwest London level
that oversees what we are putting in place in Wandsworth. There will then be something at a
London level as well that oversees what South West London and the other London ICBs are doing.
But actually this is very much about a set of principles that have been developed across London
in consultation with patients and the public and carers and clinicians and care workers as well
to say these are the key things that we think need to be put in place to improve
care in each of the local boroughs going forward and that's what we'll be working towards.
Thank you. There are two things that we really need to keep at the heart of these often
global restructuring documents here is that actually we are aiming to improve the health
outcomes of our population and particularly address health inequalities that we know have
existed for a long time and in doing so it's really about bringing services down
into their neighborhoods run by neighborhoods guided by the people in
those neighborhoods to absolutely make sure that we are now meeting the needs
and addressing the health inequalities. Thank you and Councillor Sutter's had a
question from you. Thank you mine's actually quite a simple question you've
talked about Battersea you've talked about Tooting you've talked about
What's going to happen to Putney?
I represent Putney and hearing all these bright beautiful things that are going to go on as you work with everybody,
are we going to fall through some net?
Because we have more affordable housing and an awful lot of health inequalities in Putney.
I don't quite understand why, what's going to happen to us or indeed Wandsworth.
So, this is absolutely not going to fall through the net.
So, this is an approach that absolutely needs to be rolled out across the whole of the borough
so that nobody misses out.
What we have for this year is some sites that came forward to say, we'd like to try doing
some things differently.
And off the back of an evaluation of that different way of working, we will then have
some information and some ways of doing things that we can roll out more widely. But absolutely,
the conversation about how we divide our neighbourhoods up needs to incorporate everybody
within the borough and currently certainly will not miss out on that. Thank you. Just to add,
I think Katie also mentioned earlier that one of the requirements of both the Tom is that actually
every resident should be covered by a neighbourhood service delivery model. So it is about across
everyone and everywhere in Wandsworth. And Katie also mentioned that one of the challenges
is now is to pick up the pace in that. So actually it's not just one or two, it is borough -wide
coverage.
Thank you. Stephen Hickey, I know that I think Katie answered the first question in part
and we have had a fairly big conversation about the 50 per cent, but is there anything
more you wanted to draw out?
Yes, Katie did indeed pick up my point about the involvement of the voluntary and community
centre sector, so that's really helpful. I think coming back on the cost, though, there
is another dimension going on, if I've understood this correctly, which is as well as the ICES
the ECB being required to take out 50 % of management costs.
As I understand it, trusts and other organizations within the health service are being asked to make substantial back office cuts as well.
So I guess my question is, how are you ensuring that these cumulative cut reductions don't impact adversely on actual frontline services?
I mean, if both you and the trust are simultaneously taking out back office, unless the back offices
are stunningly over manned, which I kind of suspect isn't the case, it's quite difficult
to see how somewhere down the line services won't be impacted.
So how are you going to manage that risk?
So, Petey, shall I take that one just in terms of, so I think there are a number of different
things at play there, Stephen.
Well firstly, yes you're right, trusts are challenged with taking out 50 % of the growth in
their management costs since pre -COVID time, so about 2019. So what they have seen is management
costs within the trusts have escalated since before COVID and they're being asked to cut that
back by 50%, not all their management costs, so I need to be really clear there. Again management
costs are different from service costs and Southwest London ICB as a health system is one
of the most financially challenged in the country and so therefore there is commission service costs
which are being reviewed, which are being evaluated in terms of making a savings plan
and a sustainable NHS going forward. One of the key things there is that any decision or any plan
will have a quality and an equality impact assessment alongside it. So whether it's
St George's decision or whether it's something from a commissioned service
from the ICB. And that is one of the things Stephen that's really really important.
So all these decisions need to be evaluated so that the impact is understood,
whether it's on the residents of Wandsworth or actually in a particular community.
And every service
change should have the equality and the quality impact assessment alongside it.
Thank you very much. Yeah, I'll take a final question from Councillor Crivelli.
Sorry, I don't want to labour the point about the ICBs and the cost, but in paragraph 24
you talk about a detailed design process is now underway to identify the structures and
workforce needed to deliver the requirements of the ICB, but the situation is you're being
asked to make a reduction of 50 % in the overall cost.
Is it not the case that what should actually happen is that the detailed design process
needs to identify the structure and workforce needed and then you decide whether or not
costs of 50 % are actually achievable?
I appreciate that's not ultimately your decision, but do you understand the point I'm making
that it seems to be the wrong way around?
Yes, I think probably I'm not sure I can disagree with that, but I think what we have had is
a mandate since March to reduce our management costs by 58%.
So that design phase is taking account of what do we need in terms of the resources
to make the system work. Affordability needs to be a big consideration of that and so therefore
some of the conversations might be about actually which functions could we share with other
organisations or with other NHS bodies to kind of make some economies of scale make
the system work more effectively. But yes in an ideal world you would do the design
phase first and then come up with a financial reduction. Unfortunately, that wasn't my decision,
but yes, I think, and you make a very valid point.
Thank you everyone for a really good and robust discussion on that. And thank you Mark and
Kate for attending. You're obviously welcome to stay.
Could I just add one thing? Because my boss would kill me if I didn't mention this. So
So within Southwest London, there is a challenging end financial environment that has recurring
issues in it. So part of addressing that and part of improving the health outcomes is that
we're embarking on a clinical transformation plan. So an actual plan across pathways to
ensure that we've got the most efficient, effective and quality and safe services across
South West London. So the clinical team that is going to head that up is just in the process of
being appointed and we do think that that's going to be a real benefit to the people of
South West London and to Wandsworth because actually it's going to try and address that
recurring deficit financial difficulty so that we can then invest in the right places. I just wanted
to flag that there is a clinical transformation plan that is purely about South West London
in the offering as well and there will be engagement around that going forward.
Thanks, it would be really good for the committee to see a copy of that plan when it's available
when you're able to share it.
Yeah, I think the timeline is probably kind of next year, there's quite a lot of change
going on to cope with now but actually the plan is now starting to with the
clinical leads starting to be developed. Okay great thank you so much both and
yeah you're welcome to stay if you'd like to but if not thank you for joining.
Apologies I have little people to put to bed so I better I will see you soon.
Bye thanks everyone. Is the report noted? Yeah great okay we're gonna move on to
the Wandsworth corporate plan actions and key performance indicators. We've got Jamie,

4 2024/25 Wandsworth Corporate Plan Actions and Key Performance Indicators (Paper No. 25-228)

welcome to the committee, Jamie, who's head of policy and strategy here to give us a little bit
of a brief intro, but we've got various different officers who'll answer questions depending on
which policy area the committee is going to ask. So Jamie, handing over to you.
Thank you and good evening councillors. So this paper provides an overview of the performance
against the key performance indicators that were set in July last year and an update on progress against the corporate plans actions agreed for 24 -25.
The KPI data set shows that of the 18 indicators for this committee, 10 are green rated, which means meeting targets, none are amber rated, and two are red rated, which means they are more than 5 % off target.
They're the indicators relating to the rate of admissions
into residential and nursing care,
where performance was 478 .2 per 100 ,000
against a target of 454 per 100 ,000.
And the second red -rated indicator was the median time
in working days for occupational therapy assessments,
where performance was 70 days against a target of 45.
And the remaining six indicators are for data only.
The corporate plan then provides updates
on key projects within this committee's remit, including our work with the MET and their
work at neighbourhood level. I'll work on violence against women and girls, including
the very successful transfer to the new provider and the successful bid for funds to support
further work. Our work supporting tackling antisocial behaviour. I'll work on supporting
the supported housing market and the adoption of new digital technology, which is helping
people live independently. So I'll leave it there. Thanks very much for the
instruction and yeah there's lots of good stuff in that paper. Can I have
first questions from the committee? Yeah I've got councillor Crivelli. Can I ask a
question about part of the corporate plan that's on page 15 where you're
talking about the deployment of police resources and you say you want to ensure
that one's worth resources are deployed effectively and one's with ensure
local policing needs, local needs and then you say reinstate effective
neighborhood policing and talk about responding to the crime and anti -social
behavior issues that matter to the local community. I don't think anyone would
just dispute that. I do note that you mentioned later on about neighborhood
policing and you talk about the the Mets rollouts. One of the things that I find
quite effective as a ward councillor about identifying problems with crime in
in the local area is the safer neighborhood teams because the safer
neighborhood teams normally liaise with residents about particular issues which
arise within the area and you haven't actually mentioned that within ensuring
that Wandsworth resources are deployed effectively in Wandsworth and ensure
local policing needs I assume that that's what you're talking about
overall is it? I'm just gonna get Kieran who's online to come in on that did you
hear that all right, Kieran? I did, yes I did. So yes, in terms of the strongest ever
neighbourhood policing, that is referring to the safer neighbourhood teams that you've
just raised. It's talking about their focus in terms of ASB, local crime priorities, working
with your safer neighbourhood ward panels as well. So it's one of the same thing. Can
I was slightly surprised that it was not in the corporate plan, and that was about youth
offending, because it is a topical issue with issues such as knife crime and modern slavery.
I do know that the Wandsworth youth offending team have done a lot of excellent work, particularly
in the youth courts down in Croydon and in Wimbledon.
I was just wondering why you had not put that in as part of the corporate plan actions,
because obviously one of the things about stopping reoffending is stopping it amongst young people before it spirals out of control.
Yeah, sure. So in terms of youth offending, I think that would go to the Children's Committee.
In relation to this, I think, as you can see, the updates are quite detailed already.
However, when we talk about our response around violence, that will incorporate some of the work that we're doing with our colleagues and children and around youth spending as well.
Also, just to reassure you, as I said, I think in previous meetings, we have a statutory community safety partnership board which oversees this work.
And there's a regular standing item in that board where the youth offending team report back on progress around interventions, around stats and data as well.
So there's really good tying across community safety
and children's around youth offending.
And there's really good time in terms of youth offending
and the wider community safety partnership.
Thank you, Kieran.
Thank you.
Councillor Stutters, you had your hand up
and then I'll come to you, Councillor.
Thank you.
I wanted to talk about the safer neighbourhood teams too,
because I know that ours are being extracted
as many others are all the time.
and yet I never see the figures that say how often they are in West Putney or indeed in
Putney at all.
And it is a worry for residents.
I would like to think that we know that our police are there for us.
And secondly, when the Safer Neighborhood team in my area hold their meetings, they
very narrowly target it to West Putney when in fact my residents are rather worried about
some of the machete crimes that have been going on across just across the border in
East Putney.
and yet we don't get to talk about that either.
So would the teams be able to talk to our safer neighbourhood teams
and let them to just fuss up really to what's going on?
Because we're not just interested in bike crime.
Kieran, did you want to briefly come in on that?
Yeah, sure. So my understanding is within the safer neighbourhood ward panels,
the safer neighbourhood teams do provide some information and data
around what's going on in and around the ward.
I know you mentioned machete crime,
just to say that when there are serious offenses
in the borough of that nature,
the council do get notification when they come along.
There's a fine balance of us looking at,
we don't wanna unnecessarily increase
the fear of crime amongst residents,
but we also want to address crime and ASB in those wards.
So I haven't heard of the incident that you're speaking
about, but I know where there have been incidences like that
over the year whether it's been in other wards that has been addressed through the ward panels.
I'm happy to take that back in terms of anything else that you've got but I think you know
you can always reach out directly to your sergeant of your safer neighbourhood ward
and you can raise those issues directly yourself as well.
Thank you. And on extractions, could we talk about extractions?
So in terms of abstractions I mean obviously this is secondary information about what the
I think that we've got to acknowledge that there is quite a lot of pressure on the police
at the moment. They are having to sort of come together and respond to various protests,
other incidences across London. We have regular meetings with the Borough Commander. I think
we had one about two weeks ago with Councillor Henderson and the leader where we spoke about
this. They do keep us regularly updated about that. And I think the key priority really
around abstractions is that making sure that our response teams are fully staffed. Those are the
police teams that come out when somebody makes a 999 call. So what's a real priority for the police
is to make sure that they do respond to and have the teams in place to respond to those emergency
calls which come through the 999 route. Councillor Suttles, did you want to respond or are you?
No, that's fine. I just wanted to make the point. I know that councillors are aware of
it and I do know that abstractions are, there's a lot of them. They did give us the figures
at the last Safer Neighbourhood Board.
Okay. I have Councillor Anan and then Councillor Gassane.
Could the community safety team provide an update on the improvements of the KPI over
the past six months and share what achievements they are most proud of during the period?
Kieran, that's a question for you around the VORK KPI, what you might be most proud of.
Thank you.
So I think overall, I will come to the walk as well, but overall in terms of overall crime rate, you can see that we remain the lowest in inner London.
So that's a really good outcome. And in terms of our referrals into commission walk services as well, you know, we've had a high number of referrals.
we've had 190 referrals that we've received.
And that's quite a good outcome
because we have just recommissioned our services
and we've worked really hard to make sure
that there was a seamless transition
between our previous provider and our new providers.
The commitment we made to this committee previously
when we bought a paper around our recommissioning
of work for services.
So that's really good.
We've met the annual target of 700 referrals
and that again, that's happened during a time
in which we recommissioned a service. That's really good. And then in terms of, yeah, I
think that's the key one for us is around the infra service because that's been a key
change and we could have seen a dip in that target and we didn't.
Thank you, Kieran, for all your team's hard work on that. I know it hasn't been easy.
Thank you. And Councillor Kissane.
Thank you, I think I've got three questions on this paper, if that's alright.
I'll try and keep them relatively brief.
The first one I'm afraid is going to be a bit of a recurring theme this evening, and it's about the quality of data or absence of data.
I mean, there are a couple of examples in this KPI, and one that stood out for me.
I mean, the headline, sorry, page 17, the update on trust in the police.
And the headline piece of data is great,
trust in police for Wandsworth is at 78%, up 9%.
We'd all agree that's a wonderful thing.
But it says nothing about any sort of shift in attitudes
towards the police in those populations
where we know trust in the police is low.
And surely I would think that's probably
the most meaningful data.
So for example, amongst lower income males
from the black community.
Do we have access to that data?
Presumably we do, because it's meaningful, important data.
But why isn't that there?
Is that up 9 %?
Is it up more?
Because presumably 9 % is an average across the population.
Another example is later on, for example, on page 21,
when the money that's been sort of given over to various outreach initiatives is mentioned.
And we're talking about reasonably large sums, and we would all agree that they're being
spent on the right things, but there's no discernible evidence on whether these things
are actually making a difference.
And I think it's absolutely crucial that we have some indication of that.
And I would think that the corporate plan actions in KPI paper, which we have pretty
much every meeting, would be the perfect opportunity to do that.
So that's my first question, really, about these gaps in the data.
It seems that maybe the cynic in me, but the positive messages are being picked out and
some of the more sort of complicated bits of data
are being left out.
So I'd like that point addressed.
Are your other questions for Kieran
or are they for other officers, you know,
around community safety,
just in case we can give them to Kieran.
I have a lot of questions on community safety.
Okay, fine.
Kieran, do you wanna respond to some of those ones around,
I guess, first of all, the point around
if there's more specific data around communities
with trust in the police
and then the second point on page 21.
Yeah, so the data we put,
Obviously we're dependent on the police surveys that they conduct to provide this and they do cover.
They do conduct a sort of public attitude survey and these are the sort of headline figures.
I'm sure there's lots of other data in that, but it's how long can this report be in terms of that.
I think the same around the interventions, etc.
Because we can go into lots of detail on that.
There is one thing that we do with community safety, which is annually.
annually we conduct something called a strategic crime needs assessment. It's a bit like the sort
of the joint strategic needs assessment that public health carry out and it's in a lot more
detail and we usually publish a summary of that as well. And in the forward plan for this committee
we've got an annual report on community safety that will come at the end of the year so maybe
those are things that we can draw out in that annual report as opposed to this sort of annual
report on the key performance indicators. It's not to say that will become every
quarter. I will take back your comments and see what else we can provide just to
avoid it you know just to make it make sure it's not a lengthy document but
within the quarter reports we'll see what we can provide.
Yeah I think in particular Kieran the one around like the communities that
maybe have less trust in the police I think that would be really valuable.
Council Gissane?
Thank you for that response. Yeah I totally get your point about you know
that the paper would be too long
if you include every piece of data.
But I think the two examples that I highlighted,
they're not obscure examples.
The next question that I wanted to ask
was just briefly on the CCTV strategy.
This was something that was discussed
at one of the recent health committees.
And I put in an amendment to that meeting
and there was a verbal agreement
that there would be greater council oversight
and greater democratic scrutiny and certain commitments were made in relation to that.
I just wanted to ask the cabinet member if he still holds to those promises and yeah
if we can have an update on any movement towards those in any future updates.
Graham, would you like to come back on that?
Yeah, a few things.
The first council is saying if you want to find out more about our statistics I seriously
suggests you attend the Safer Neighbourhood Board where the police present quite comprehensive
statistics across the piece. So for example in part answer to Councillor Satin's concerns
about machetes. But in fact over the past 12 months life crime has decreased by 16 %
and in fact and this may well be something of a bit quirk I'd love it to be maintained
the past three months, it's gone down by 73%.
Now that's the type of information I think you should be
telling your residents to reassure them.
Nonetheless, in terms of those broader statistics,
it is the Safer Neighborhood Board,
and indeed, the Community Safety Partnership Board
reports to the council.
And I believe reports will actually come here as well.
Now in terms of the commitment,
essentially in terms of oversight,
I can assure you that I have very close oversight
in terms of the work that Tom Crawley does.
He works in housing because it is a purely historical work
that the CCT for the year is under housing,
mainly because initially most of the CCT cameras
are actually on housing estates.
But there is also the single point of control
who's the head of the Joint Control Center.
I'm in frequent contact with them
about a whole range of things.
And sending my message to councilors who approached me,
if they follow the guidance,
you may recall that I actually sent out guidance
on how councilors can actually request
deployable CTTV cameras.
Now, we're actually in the process
of trebling the total number from 12
when we took over in 2022 to 34.
Unfortunately for some reason it takes some time
to actually be manufactured in Germany and to come to us.
But nonetheless that guidance actually set out the criteria
and also includes strict legal criteria.
You can't just simply ask for a CCT camera
without justification.
And this is probably about six or seven different pieces
of legislation which actually cover the operation of CCTV cameras. So it's vitally important
that there is a strong rationale for deployment of a camera. It isn't based upon resources,
it's based upon justifying that deployment of a CCTV camera. And what we're actually
looking at Councils to do is effectively to act as a triage to ensure that there is sufficient
information, particularly in terms of being a persistent problem.
That is one of the key criteria for the deployment of CCTV.
So, long story short, we have expanded CCTV cameras and that has also increased the staffing
in the Joint Control Centre.
The police are incredibly happy with what we have done, given real -time information
which has actually resulted in them preventing some crimes
or apprehending criminals soon after
incidents actually occurred.
So I do think CCTV generally is a good news story,
but I am a member of the CCTV steering group,
and if I receive all the papers, I comment.
I think from time to time,
there may be the old meeting I can't attend,
but generally speaking, yes, I do exercise that scrutiny,
which is why I think CCTV is actually a great success story
for this administration, thank you.
Thanks, and just, Councillor Kossain,
can I just ask you to make your final point
so we can just allow a few other people to come in,
if that's okay?
I'll add another question, I could respond to that,
but I won't.
The other question, very quickly,
it's about the mandatory Mental Capacity Act training.
I've got a personal professional interest in this.
And you know there's a good level of compliance among staff, but I'm wondering you know
I would have presumed that this this training would be par for the course. What is
Important or different about this training was there deemed to be
Shortcomings in the previous approach to training so that the new training program was rolled out because you know I'm young
Medi capacity assessments are something, they're a big part of what I do for a living.
And often, I'm sort of dealing with the mess that's been left by
other professionals that don't quite do them properly.
So I'm quite keen to know what's being done to ensure that staff have the relevant training and
why has there been a need for this sort of latest training initiative.
Lenny, are you going to come back on that? Would you mind introducing yourself to the committee? Thank you.
Hello, I'm Lynn Wild. I'm the Assistant Director for Health and Care.
And the issue of mental capacity, as you know, is an evolving part of law which case law keeps redefining how we should act.
So it's always been a key part of our training.
But with the level of staff turnover as well as pressure in the system, we found that there
wasn't always consistency in practice.
And so the attempt was to ensure that we got practice at a high level consistently.
And that will continue.
That's not just the one solve and we've done it now.
We will continue with the training.
And we sometimes bring in specialists.
So most recently we had a big session with a specialist who came in and updated everybody
on case law, which sounds like quite a dry subject, but it was absolutely riveting.
And the staff attended in significant numbers.
And it really has started to show differences in practice.
That's good news.
Thank you.
I'll come to Councillor Sutter's next.
Just very quickly, is that on?
Yes it is.
I just wanted to let Councillor Henderson know, unless he doesn't, he may not know this,
but actually the police are also looking at residents cameras now, our CCTV.
In fact I had a visit after the terrible crime I spoke about because it is unusual in Putney,
That murder was very, very unusual, but it did, of course, because of that, caused quite a stir.
And they came round to my house to see if they could trace where the car went.
And I was just like, oh my God, this is, you know, so it's fantastic, really, isn't it?
Because it means that we're all playing our part.
Actually, it didn't come down Granard Avenue, so...
Thank you for that contribution.
Now I'll just come to Stephen Hickey to come in with your question now.
Thank you very much, Chair.
I just wanted to ask for a bit of clarification on this page 29, which I think was mentioned,
the wait for occupational therapy, where there's quite a big gap between target and current
performance.
And there is some explanation in the text, but I didn't really understand what this somewhat
meant.
It was about process efficiencies through digital solutions.
I wonder if you put a bit of flesh on what actually is being done to address this particular topic.
If I could play the other, not over the page, there's a very good green performance,
which is about the physically inactive adults supported by council funded projects.
And there's no real commentary on that, but it might be worth just saying a few words why that's been very successful.
But what is it that's enabled that to happen and be really helpful to hear?
Claire, do you want to take the first one,
and will it be Shannon for the second one?
Yeah.
Yeah, that's right.
Hi, my name's Claire Tew.
I'm the Assistant Director for Assurance and Innovation.
If I covered the occupational therapy one first.
And as you can see, this KBR has been challenging,
as we've reported before at this committee.
But I can update you that it is improving.
We have changed the counting methodology,
which is why it says NA in the direction of travel.
And it is now improving.
In terms of the specifics that we're talking about there in terms of process efficiencies,
there's several aspects to this, as obviously we've been looking at ways in which we can
reduce the wait time.
So one of those ways is using digital technology.
So we've been using a automated calling tool in a pilot to check on the people that are
waiting to ensure they're waiting well to check on any levels of risk.
That's a good use of resources because it's much quicker to call people using technology
than a very experienced practitioner, and that has saved us a lot of time, and so we
are planning to roll that out much further.
We're also looking at internal processes to review any process efficiencies.
So for example, where there are people that are able, could they self -refer for equipment
and enable themselves to access that equipment much more quickly.
So a number of areas we're looking at, and obviously we're trying to recruit all the
time as well where we do have vacancies, but we know that the indicator is starting to
come down.
The comparable position at the moment would be 55 days, albeit it's for a short period
of time since the beginning of this year, 25, 26.
Thank you.
And Shannon on the mental health, on the active piece.
Thank you.
Good evening.
I'm Shannon Couture, the Director of Public Health.
The Council has a physical activity plan produced by Public Health operating from 2021 to 2031,
which sets out how we'll support people to become more active at an individual level
within their communities, but also working with other parts of the Council to create
enabling environments that, for example, can support active travel, use of the Council's
leisure facilities or parks and open spaces.
So, through the physical activity plan, we had a short to medium term target of enabling
6 ,000 people to become more active since the 2020 baseline when the plan was produced.
So, some of the activity that is counted within this corporate indicator include, for example,
the number of adults and older people attending Brighter Living Fair, for example, who were
supported to try new activities that meet their level of ability and need that they
can then continue to take part in when they go home.
We also count people who are referred through the Exercise on Referral program from primary
care.
It includes our adult weight management service, which is a 12 -week structured program for
people who meet the criteria.
and it also counts people who are signposted
to the diabetes prevention decathlon,
which we had in place, which was there to support people
who are at increased risk of diabetes,
to then become more active,
and also to look at their healthy eating habits.
And finally, we include in that indicator as well
a program that we developed specifically for men
who meet a certain criteria called guys get active.
So it's a composite indicator of a whole range of activities
that the council funds to support people
to become more physically active.
Thank you, Shannon.
Some really fantastic work in there.
So thank you for giving a little bit more detail on that.
This is just a report for information.
Can I take the report as noted?
Yeah, that's great.
Thanks very much.
Thank you so much, Jamie.
We're now moving on to mental health specific place

5 Mental Health Specific Place Programmes Across Wandsworth (Paper No. 25-229)

programs across Wandsworth, and I believe we've got
Dr. Tom Coffey online.
Tom is Wandsworth clinical lead for mental health,
so thank you so much, Tom, for coming here tonight.
I know you've come from your surgery,
so greatly appreciated.
Tom, could you give just a brief introduction to the paper?
Yeah, thank you very much.
Thanks for inviting me.
I can mainly comment on the work of the community services, the work of the ICB commissions,
and I can also touch on some of the work that the Mental Health Trust is doing as well.
Any more specific questions on the Mental Health Trust I might have to pass on to colleagues
at a later date.
I'm joined also by my colleague Temi Fesiga, who is present.
He's our lead commissioning manager for Wandsworth, and he's a much more expert than I am.
but I will hopefully do all the instructory remarks.
So what I want to talk about very much is a Wandsworth focus.
I heard colleagues mention before,
there's no mention of Wandsworth in this document.
So I'm going to bore you to tears with the mention of Wandsworth.
The introduction of the paper very much talks about the South -West London strategy.
But what I'd like to do is talk about what we're doing actually in Wandsworth itself.
I'm going to divide our approach into adults and children.
and also to focus on the key partnership workers.
I have to say, the people in your room
are probably our key partnership team in Wandsworth.
Shannon, who's head of public health,
and his team do an amazing amount of work
on all our need analysis and our delivery programs,
and also the local authority commissioning teams
for both mental health, adults, and children
do a large amount of work.
So I would want to say a big thank you
to what they already do.
For children, what I'm going to try and do
is talk about progress in areas, but also challenges.
Because I think I would be deluded to believe that
everything is rosy in the garden.
So the progress I feel we've made, especially in children,
is the mental health school trailblazers.
This is an ambition to get every school in ones
who have covered.
And in fact, we're just starting our next trailblazer
area in tooting. That's an investment of many hundreds of thousands of pounds to make sure
those schools in the tooting area have a mental health worker based in secondary schools and
their link primary schools. Also, Place to Be, which is a jointly commissioned service
with yourselves for secondary schools, and we do a partnership with the primary schools
separately for that area, that provides a reasonably comprehensive service for secondary
schools and covers a large amount of our primary schools having embedded workers to support
the trailblazers.
I think what I'm trying to highlight for you is that we're really trying to go to
a schools -based approach to say where are the children and young people based in Wandsworth,
they're based in schools and colleges.
So one of our trailblazers is actually in South Thames College.
Also, for those children based in the community, we tend to use the Well Centre, a community -based
service to make sure those services are offered.
And obviously, we have our CAMS services.
CAMS does an assessment service and tier three for the children who are most unwell.
And that is a service provided by our Mental Health Trust.
For adults, again, the successes I'm going to talk about is the expansion of the Mental
Health First Aid training, led by Shannon and his team to make sure the voluntary sector
get the same access to this training as the established statutory sectors.
Councillor Gussain, I know, is a professional in this area and he'll know that many of
his colleagues get this as standard. But a lot of the people who work with our vulnerable
people, people working in food banks, youth centres, et cetera, need that training as
and we're trying to roll out that training to those people. The primary care -based workers,
which are the primary care plus for the serious mentally ill, and the mental health workers
for the anxiety and depression, are now growing within the GP surgeries. And also, ENABLE,
which again is a branch of the local authority, are helping us enormously in providing services
for those who are got serious mental illness, who've got a physical disability as well.
Because although the SMI patients, here is the people with a serious mental illness,
die 20 years younger than the average punter in Wandsworth, that isn't due to their mental illness,
it's due to their physical illness, diabetes and heart disease. And that's what enable part of your
team provides for these clients. It's an excellent service. But we do have challenges.
There are significant financial challenges. South -west London, as you have heard, is one
of the most challenged financial systems in the country. And therefore, as much as I would
like to do so much more, the finances have to be balanced. We are a responsible financial
system to use public money carefully. And therefore, every single service we've got
to make sure it's offering value for money, and often we find it difficult to expand services
for the lack of finances. Areas which I'm sure you're already aware of, where we have
challenges with mismatches of supply and demand, is children and adult ADHD and ASD services.
That capacity demand mismatch continues. Also, CAM services, children's services tier two,
Those community -based services, which are most children when they require a service,
that's the service they require.
But again, we have a mismatch again in supply and demand.
I do feel also that the secondary care services have developed a very innovative approach
to managing people who are victims of domestic violence within a hospital setting, within
mental health setting. There's a challenge there about can we continue a service like
that. M -HIP, which I think is a crown jewel in our services, is funded this year for the
first time. Fully funded, we're currently for ones worth over £800 ,000. But it's been
so successful, it's outgrown its accommodation. And we've now got to find a better accommodation
base for those services. So the picture I'm trying to paint for you is a service
we're trying to develop around the needs of our population where there's many
areas of good practice, there's areas we have of challenge, but the biggest
challenge is matching our supply and our demand. Thank you very much. That was a
really great summary Tom. Thank you very much for that. I feel like members of the
committee are incredibly impressed. Have we got a couple of questions? We've
We've got one from Councillor McLeod to kick off.
Hello there, thank you.
Looking at this paper, because of my day job stuff,
I'm particularly interested in the MHIP stuff.
Can you tell me a little bit more about how this will break down health inequalities,
how we think MHIP will work in Wandsworth specifically.
And by the way, I think you might be my GP, so hello.
And don't tell me you can never get an appointment.
That's another story.
So in essence, we based it on the idea that if you look at the data,
a black patient with a mental health concern in Wandsworth
have worst access, worst experience, and worst outcomes.
And therefore, we asked the experts,
We looked at people who are experts in ethnicity and mental health to design systems to say
what could address that.
And some of the key things were about making sure that the access points are barriers and
they're not places which instill fear.
So trying to move the access points out of that hospital place, which to be honest is
often seen as a place where you get sectioned and detained.
Secondly, to make sure that people who are experiencing mental health crisis and being
in patients have a much better experience.
What we have found the evidence should show that control and restraint is used excessively
with black patients within a mental health hospital.
Secondly, they do still are exposed to racist practices by staff and systems in general.
And thirdly, black patients are much more likely to be readmitted within 30 days of
discharge because the social support structure just isn't there.
So we've tried to address those three things by trying to make sure we have a control and
restraint training program to say there are different ways you can address a patient in
distress.
Secondly, to bring outside experts into how do we train our staff so they're culturally
capable.
And thirdly, how do we develop black families in Wandsworth who can become experts themselves
in looking after patients in mental health crises?
So that is the family support team who hopefully sometimes can see patients before admission,
but often to expedite the discharge into their care.
So the system hasn't been designed by me.
It's been designed by experts in the field, led by the Wandsworth Community Empowerment
Network, which are based in Battersea.
And the project, it has got what's
called a LEAP project, which is a Lived Experience Advisory
Project.
These are black patients who have been in patients
to give us advice of all the projects we're doing,
are they working?
Are they being designed appropriately?
We're trying to do that co -commissioning.
And I'm sure we're doing it badly.
But we're making every effort to try to address those issues.
Shannon, I keep talking about Shannon here,
did a report about 18 months ago looking at epic inequalities in healthcare in Wandsworth.
And we've tried to use some of that pieces of work to design this service.
Thank you very much. Do you want to come back, Maurice, or?
I need to say brilliant answer. Thank you.
And I think, Councillor Lee, did you have your hand up?
Yeah, thank you.
Thank you so much for this paper and for joining us tonight, Tom.
You sort of touched on what I wanted to ask about, which is the issues with supply and
demand and how are we going to be able to or how are we already trying to address this
mismatch.
and so make sure that all of these great programs that are listed here which look incredible
are the most suitable for our most vulnerable and marginalized residents.
So what I would say is first of all we've got to look at all our service providers and
work out who are the most efficient.
You know, a simple productivity.
If I gave someone 10 ,000 pounds and they had a certain quality of service, how many patients
would they see and how many of those would recover?
So Temi is leading of his work and he as a contracts expert will look and review programs
to make sure are they really good value for money.
Secondly, what also we've got to do sometimes is look at the pathways we put in place, which
are sometimes so inefficient.
The example I will give you is ADHD, adult ADHD and ASD.
At the moment, you only can get a diagnosis
if you see a psychiatrist.
We don't have enough psychiatrists.
In Scotland, the ADHD diagnosis is made by GPs
and specialist pharmacists.
We could have that system in Wandsworth,
which would slash the waiting list,
slash our costs enormously.
At the moment, we're paying the private providers
two and a half thousand pounds per patient referred to get a diagnosis
which allows them to have help with their life. We can do it quicker and
cheaper if we change the pathway. Thirdly, we've often got to repurpose money. If
we're going to talk about parity of esteem, if we're going to talk about, you
know, mental health having an investment standard, which means that we get the
same money as other parts of the health service, it's my job to be the advocate
for those patients to make sure when the growth money
is allocated, it goes to those health services,
not to the big shiny acute hospitals perhaps,
who shout loudest, but to those more vulnerable patients
who don't have that voice, and I should be their voice
arguing for the money.
Thanks, Tom.
And yeah, just to follow up as well,
I wanted to ask about, so where a program has worked
really well, like you talked about the Trailblazers
project is that something that we would look to roll out across Wandsworth
schools? Yes, that's the answer. By 2030 every single school in Wandsworth will be
covered but also we're going to consider reprecurring it at some point to get
better value for money to look after more children. Thank you.
Councillor Gussain. Thank you chair. I'd like to reassure Dr. Coffey that I thoroughly
approve of the ones with specific detail in this paper.
And the level of descriptive detail is fantastic.
And it may well be that the brief of the paper was to provide descriptive detail, but you
probably guess where I'm going with this already.
What is lacking is the outcome data for all of these various projects.
And you know, it's all about, as a clinician,
I'm sure you understand this yourself,
it's almost instinctive.
You sort of, you read about an intervention,
you know, your first question that sort of pops
into your mind is, does it work?
And you know, this is really important for a number of,
most importantly, it's absolutely crucial
for service users who need to know where to go
and what works for them.
But from my point of view as a counselor,
one of our primary responsibilities is to see if things are providing value for money to our residents.
And that, I don't think it's just this paper, this instance of it.
I think over a number of committees, for whatever reason, that data isn't coming to us in the volume that I think it really needs to.
And I'm wondering why that is and whether there can be a commitment to providing that
data because I absolutely approve of everything in this paper in terms of the intention behind
it and I think these are the right things to do.
But it's important to know whether they're having the desired effect and that will give
us something to scrutinize.
So yeah, I just wanted to make that general point.
Thanks.
Okay.
And just to answer, first of all, the narrative in the paper was written by Temi, not me.
I'm not a very good writer.
He's much better than I am.
We do have that data.
It would have made, obviously, the paper much longer.
So every single one of his reports has a performance approach.
And so therefore, I think what I can do either is send you – I'll get Temi, really – send
you after the meeting some data.
but Temi might want to come in just to support me here.
Yeah, I wouldn't mind coming in Tom.
There are sections where we've actually put some outcomes
that are readily available without increasing the numbers
of pages on the documents.
For example, on page 36,
we've got something about the PATS program
and about place to be around the outcomes achieved
because these services do use some evidence -based outcomes tool to measure,
and they would be included like in terms of their improvement in the individuals,
in the individuals or beneficiaries from the services.
I'm happy to look at the inclusion of some further outcome data where we do have them.
Just mindful, of course, that we want to keep this as succinct as possible at the same time.
But, Councillor Hussain, we'll definitely get you that data because we do have it.
And in fact, it's always presented at our joint campus transformation board with the
level of authority and our adult partnership group as well.
That would be greatly appreciated, thank you very much.
But I also don't see why that can't be incorporated more into these papers.
I think that perhaps the level of descriptive detail regarding the various initiatives could
be reduced somewhat because it is quite clear that everybody's doing great work.
But I think, yeah, more room could be created for the data in here as well.
But thanks very much.
I appreciate that.
And I thank you for your comments.
Thank you.
Yeah, that would be great if that could be noted for future reports.
And thanks very much, Tom.
And Councillor Corbelli.
Can I just ask a question about something that wasn't really clear to me.
I was looking at the key intervention to crisis family placement scheme.
And I thought that this was a really interesting initiative.
And it made perfect sense.
And it sounded like a really good way
of trying to tackle a lot of the criticisms
around treating mental health patients in general.
What I didn't really understand was,
are you seeing that this is an alternative to section?
Is this an alternative to a patient being section?
Because of course, sometimes.
No.
No.
No, no. So it's a model based in Milton Keynes. And it was under about five or six years ago,
written up. And then, so what it's meant to be, it's a family who are trained in looking
after patients in mental health crisis. So if there were a section, they have to go to,
you know, an appropriate place, you know, one section under the Mental Health Act. So
it's specifically for people who are not sectioned. It's for people who often are seen by the
crisis team. And they say, you know, this person is in crisis. They haven't got the
support around them, so we have to admit them.
But you know, there is a family now that got to know
over the last few months and years,
who perhaps they can be placed with that family
to avoid an admission.
Secondly, there's a group then,
and often this is how they get to know the family first,
who are in hospital.
And we're trying to get them out of hospital
as quick as we can,
but they haven't got a social structure or housing
to go home if they're not totally well,
but it can go to that family.
So it's people who are not on a section,
who are in a crisis who would otherwise be in hospital
who either avoided admission or expedited discharge.
Great, thanks for clarifying that point.
Great, thanks very much.
I'll go to Stephen Hickey then,
if we don't have any other questions.
Yeah, I just wanted to ask about something
which I don't think is in the paper, as I missed it,
which is about the state of play
in terms of inpatient beds and pressures thereon.
And the more general question linked to that
is there's clearly a lot of really good initiatives
described here in the community about trying to treat people
out of hospital, which is excellent.
But do you have overall evidence for whether or not
these programs are having an impact on the need
for inpatient beds?
So if the Mental Health Trust were here,
they'd probably have greater data than I have.
But I knew this question might come up,
so I just looked something up quickly.
So the only measure I've got which is a proxy measure,
so the trust monitors its inappropriate
out of area placements.
So these are patients who, you know,
they should really be within a trust facility.
So in the last 12 months, they've gone from 20
in March 24 to five in March 25.
So they've gone down 300 % or down by 15.
So that would show that, and I can't claim it's just these little programs, the whole
approach of trying to, how can we not put patients out of the area, because it's bad
financially, but also it's bad for families, bad for patients.
So we can keep them looked after in Wandsworth and in southwest London by having better community
interventions to avoid admissions to expedite discharges,
that will do both, save money
and improve inpatient experience.
Thank you Tom, and Steven if you wanted anything
in a more detailed nature, I'm sure we can get
the Mental Health Trust to provide that, thank you.
Okay, is the report noted for information?
Yeah, great, thanks everyone.
And now we're moving on to our penultimate paper.

6 Outturn Position for 2024/25 (Paper No. 25-230)

So this is our Outterm Position,
otherwise known previously as our budget monitoring report. This is a joint
report from Executive Director of Adult Social Care and Public Health. Sarah are
you able to introduce yourself and then a quick intro to the report. Sure.
Good afternoon, good evening, sorry councillors. I'm Sarah Evans, Director of
Business Resources in Adult Social Care and Public Health and this report sets
out the revenue out -term position for the areas within the committee for the
financial year 24 -25, and that's adult social care and public health and community safety.
Overall, the out term for the committee for 24 -25 is an overspend of 2 .7 million against a revenue budget of 102 .3 million.
And as we've discussed previously at the committee, budgets within adult social care and public health, and in particular,
the budgets for care services are the most challenged across all client groups.
Where we've experienced increases in demand and increases in care needs which is leading to
increases in fee rates required by the provider market and
As we've set out in the report the 25 26 budget does include growth
to address those demand and market pressures and
And which gives us a much stronger base to start 25 26
from. The report however does note that there are still some financial risks and
challenges that remain for social care in 2526 and these are being addressed
through the directorate transformation program transforming social care which
includes a range of work programs including demand management initiatives
to prevent reduce or delay the need for long -term care and support. I'll stop
there and myself and colleagues are happy to take any questions. Thank you
very much Sarah. We've got a question from Councillor Correlli to kick us off.
Can I ask you, you've just highlighted the point about the problems that you
have with the social care providers in general. You said the reporting
difficulties in maintaining financial sustainability which may create risks to
the stability of the local care market. Are you anticipating an overall
reduction in the number of providers available in the long term who are able to provide care
as part of the local care market.
If you are, can you tell us what impact that's going to have on Wandsworth?
Thanks Councillor Crivelli.
We've got our Director of Commission in here this evening, Rachel Sonney, who will take
that question.
Good evening.
Providers are quite challenged and there is,
we are seeing market pressures in terms of the cost of care,
the amount of workforce costs that providers have.
And we're trying to support providers as much as we can
with the right inflation, workforce support,
and working to co -design services with providers
so that ideally over the long term,
we can try and bring out efficiency together
in the way that we design and deliver services.
We've not had any contracts handed back
from our providers in Wandsworth.
We do have some services that are challenged
and providers who have highlighted
significant financial challenges,
and we are working to support them.
And we have tested our provider failure procedure,
where we're a provider to fail so that we can make the necessary contingency arrangements.
Clearly that's a last resort,
but it is a significantly challenging environment for providers. The key is how we work together
with our sector to try and avoid those things happening
and make suitable alternative arrangements in a well -planned way so that the impact on our residents is minimized.
Thank you, Rachel. That's really, really helpful. Have I got another question?
Cancer Cremity? Yeah, go ahead.
But one of the things that we talked about in commissioning was you've said in paragraph 17,
the director continues to implement demand management measures with the aim of preventing,
reducing or delaying the need for social care through the Transforming Social Care Program.
You appreciate the overspend in adult social care is 3 .316 million.
What sort of saving do you think you can make overall in relation to the overspend through
the Transforming Social Care Programme?
Thank you.
I guess in terms of this overspend, this is the out -turn for 24, 25.
And as I set out before, we have built in additional growth monies into the 25, 26 budget to take account of the pressures that we have experienced in terms of demands, complexity of need and market pressures.
But in terms of our demand management, our transforming social care program, in terms
of demand management, we do have a range of initiatives which are aimed at preventing,
reducing, or delaying need for social care.
And those initiatives include increasing reablement, increasing use of care technology.
And as part of that, we have built into the 25,
26 program a number of efficiencies around it.
And I've not brought the exact figure, but it's around 1 million pounds.
And they're split across demand management, so including reablement care technology.
And then some commissioning initiatives around mental health commissioning program and
supported housing to try to mitigate those pressures in the year.
I think Jeremy just wanted to come in briefly here as well.
Yes, yes, so I just wanted to emphasize the focus of a lot of Transforming Social Care Program.
It recognizes that we have an aging population and there is,
If we did nothing, there will be more need for care for residents in our borough.
So our focus is really on looking at how we can support our residents to stay healthier and more independent for longer.
So some of that's about much more long term earlier intervention so
that we're working with people long before we would otherwise have come into contact with them to keep them independent.
But of course then, where we are working with them and supporting them,
it might be the outcome is that they need less care or they're delayed.
The date that they start to need care is late and otherwise would have been.
So a large element of that work will result in us avoiding future costs, costs that would otherwise have been incurred.
And there's less scope for a saving from the base budget of our cost,
because we recognize that the population is growing.
And that will mean that we need to spend more money on care.
But then the other element is the work that Ms.
Rachel Sony talked about, our director of commissioning, which is work with our care market.
because we do need to build sustainable care provision and we recognize that our
care providers costs are increasing and we've got to work closely with that care
provider market locally. Thank you. Thank you. Are there any further questions from
committee members? Okay then. Is the report noted for information? Great. Thank you.

7 Work Programme (Paper No. 25-231)

Okay, so we're moving on to our final item here, which is a bit of a different item than we've had previously that marks the
conclusion of our democracy review in Wandsworth. So the report we've got here just briefly sets out the methodology
of looking at items of scrutiny in the future and this kind of changing approach that we're working with.
It includes a list of draft work program items throughout the year that will be discussed at a work planning meeting
that will be initially held with the chair, deputy chair, opposition speakers
and cabinet members. We've suggested a date of the 23rd of July and I know
Councillor Cravella you're just going to double check to see if that works well
for you. But we'd really welcome all committee members to feed in via
whichever side about kind of possible items that you might want to discuss in
more detail throughout the year. I think we're really really open to this being
I think really collaborative surface any topics that you feel either in the work program that you want to go into a little bit more detail.
We've had topics tonight like ADHD, youth offending, CAMS, anything like that.
Or if there are topics that we feel are missing in general and we'd like to delve into in a bit more detail.
I think we're really, really open to that.
So are there any initial questions on that going forward and from the committee members?
Sorry, do we have questions or are we going to talk about ideas now?
I think it probably makes sense because of the meeting to kind of give people a chance,
but if people do have initial ideas that, you know, from today or things that they want
to kind of mention that they're already thinking about, then that too.
Have you got something that you wanted to?
I was, I suppose it ties into the work program, yeah, thinking about digital inclusion and
how we could, yeah, sort of look in more depth at what we're already doing with re -enablement
and current digital inclusion program
and thinking about how we can better that.
Yeah.
Very good point.
Thanks.
I've just added that to the list around digital inclusion.
And I know, Steven, you asked a question around,
will the kind of information we consider
include input from service users, patients, and people
with lived experience?
And yeah, absolutely.
I think that's exactly why we want to change the way we're doing things so that it's much more informed with what people care about
What patients care about and what might be relevant that the council isn't focusing on so please feel free to feed those ideas
Directly to us ahead of that meeting if there's something that you'd like us to consider
Anything else before we close is there I have to do the form what is the report noted on that one? Yeah, okay?
Thank you, that now concludes this meeting.
Thank you for bearing with us in the heat.
And stay cool throughout the week.