Health and Care Scrutiny Committee - Monday, 15th April, 2024 7.30 pm
April 15, 2024 View on council website Watch video of meetingTranscript
a slight delay to starting the meeting. I'm Councillor Ji-Ranichoudri and I'm chairing tonight meeting. Please note that we are not expecting a fire alarm test this evening, so if the alarm is sounded, please follow my instruction and evacuate the building. This meeting is being webcast to allow those who cannot attend in person to follow the proceedings. Please, could I ask you to turn on your microphone when invited to speak and to remember to turn off your microphone when you have finished speaking. Please, could Committee Member and Officer introduce themselves starting on my right, Councillor.
- Joseph Croft, Councillor for St Mary's, and James's, and Vice Chair of this Committee.
- Finn Craig, Councillor Frost, and Ward.
- Councillor Trisha Clark, Teffler Park, Ward.
- John Spencer, Chief Operating Officer at Moorfields.
- Good evening, Sheila Adam, Chief Nurse at Moorfields.
- Clothes Ammit, Councillor for Holloway Ward.
- Councillor McKewill, Gunford, Tollington Ward.
- Councillor Bly, Hamdash, Harbeword, and I'm substituting for Councillor Caroline Russell.
- Thank you. John, please.
- Thank you.
- John, have you sent your answer to that of Social Care?
- Victoria Nesta, Deputy Director for Adult Social Care.
- Hi, Miriam Bullock, Assistant Director of Public Health.
- Thank you, thank you.
- We have received apology from Councillor Russell but substituting Councillor Benel Ditz, and also I receive an apology from Councillor Badger. Are there any declasional interests? Can we agree the minutes of the previous meeting?
- Thank you.
- Thank you.
- Chair Repur, I would like to welcome you all tonight meeting. Please, can presentation be kept to the point so committee member can focus on asking questions? Public question. We'll consider any question from the public after each agenda items. Sorry, just I'm coughing. Tonight we welcome Sheila Adams, Chief Nars, and John Spencer, Chief Operating Officer from Morfield, I hospital. Item 8, Morfield, I hospital, performance report, please.
- Thank you very much everyone, and good evening.
I'm going to start, and we're going to focus on quality elements
for our presentation at first,
and then John's going to pick up on performance
and the oral building as we move on.
I don't intend to go through slide by slide.
I recognize that you've all had the slides in advance
and will have a major reference to them.
I would just like to draw the committee's attention to our new website.
It's very new, and we're proud of it because it meets
AA accessibility ratings and is one of the things
that we've been wanting to do for some time.
So please do have a look, should you feel inclined.
I would then like to just take you down to our patient-led assessments
of the care environment.
You may or may not be aware of these.
They're something that was introduced a number of years ago,
but they are patients themselves, lead these,
and although we don't always score well in items like food,
for instance, on the ward, we do better than we had hoped
and expected in terms of dementia care and condition.
So once again, we are grateful to our patients
who help us to do that work and to improve.
Another area I'd just like to draw your attention to
is that we are using our data,
our anonymized data around patients who attend the organization
to look at areas of health inequalities and population health.
And if you look on slide six, one of the ways that we are doing that
is to understand why patients don't attend their appointments.
And we've been looking at different groups to see which groups
are particularly unlikely to attend or to DNA as we term it.
And in fact, what's of interest is that neither ethnicity nor
deprivation background tend to increase the likelihood of DNA,
but age does, and so the older our patients are,
the more likely it is that they'll find it difficult to attend.
And so we started to put some initiatives in place such as early calls.
We'd also like to talk to you a little bit about the single point of access.
John's going to talk in a little bit more detail about the model of care around that.
But basically what this is, is any referral,
any ophthalmic referral that comes in across North Central London
is made to one particular place, a one electronic referral system.
And we can then divvy out the care that each patient requires
according to different elements. And some of these will be around the length of the waiting list.
Some of these will be around distance, so how close it is to the patients.
And we brought all that data in and use it to work out what would be the best pathway
for each of the patient choice comes into it.
And one of the good things about it is that it does offer significant levels of patient choice
as well as a much more effective patient pathway.
What we can also do with that is use the information that we have as part of that
to identify where our referrals are coming from.
And when we plot that against a deprivation map, we can see
where there are areas of increased need or low levels of referral.
We can then start to investigate whether that's due to the fact that there, for instance,
isn't an optometrist or an optician close by, or whether it's the fact
that the population themselves might need additional education or outreach in terms of that.
So that's one of the ways that we are hoping to improve improvement as we move forward on this.
If we move on down through that, there's some examples on slide eight of the types of education
that we give for referring optometrists.
Again, I won't go into detail, but if anyone would like to know more, then please do ask.
And then on slide nine, I can see the slides are having trouble keeping up with me.
[ Inaudible Remark ]
I'm so sorry.
Well, I'd say keep going, keep moving on down.
[ Inaudible Remark ]
So the title is digital twin is the one I'm on at the moment,
although I've just passed improved video.
That's the one.
So digital twin is a simulation tool.
We can look at all the data of patient referrals and then use it to work out, if you like,
which element of a referral would give the patient the best alternative
for their clinic appointment.
And you can see if you look at the slides that patient preference, for instance,
can be brought into the model, and then we can look at whether that impact or not
on the speed of patient accessing an appointment.
And we then have also used some of that learning and made some surveys of patients
to ask them what particularly would influence their choice.
And so if you move to the next slide, which is called using ERS to support patient choice,
you can then see that when we sampled 50 patients, we asked them what it was
that would particularly influence their choice for cataract surgery.
And of these, 36% of patients continued with the first choice
that they had been offered by their optometrist referral.
But there were a number of other important variables for them.
And these were not always about choosing the shortest waiting times,
but might be about accessing expertise, so, for instance,
choosing more fields over another offer.
And so we can understand better how patients feel about accessing the services that they need.
If we move on to slide 11, one of the other areas I talked about was the need
for increased education.
So this slide is our Envoy's program.
And pictured our Dr. Roxanne Crossbinawobi and Tandai Gwen here,
who were leading this program.
What it is is an education program for social care staff.
And we invite them in to give them skills in terms of understanding eye care,
but also eye health.
And the ability of the staff then to protect the patients that they care for,
particularly the vulnerable patients, can be improved.
And we see an increase in confidence around things like eye drop installation
and managing monitoring of vision.
So that's another element. We've run three cohorts of course,
this is for our Envoy's, including over 100 care staff.
If we move on to slide 12, which is labeled our quality priorities for 24-25.
And we have just shared the quality priorities, which will be coming to you,
I believe, for the quality account sign-off.
There are a number of new quality priorities this year.
And some of them have been chosen, particularly by our patients
who have been consulted on these.
And that includes things like improving experience of patients
requiring transport.
If we move on then to the next slide, which is staff survey results.
And we just wanted to share with you that we've had a greatly improved engagement
this year by our staff in completing the staff survey.
So 66% of our staff took the chance to tell us how they felt.
And we have improved overall against six of the themes
and maintained our position against two of the themes
and deteriorated just slightly against one of the themes,
which is about having a voice that counts.
And so some of our work is particularly around shared decision-making with staff
and staff engagement overall.
If we move on to the slide on equality, diversity and inclusion,
these are areas of particular importance to us.
Around 51% of our staff are from a BME background.
And we have been working on actual plans to improve the level of inclusion
that staff feel and to improve our performance against DES and RES equality standards.
And so these are the work streams that we've got in place at the moment.
Again, we are particularly keen to make sure that staff feel
that we are working hard on this.
If we move on to the next slide, learning disability and autism training,
some of you may be aware of this as Oliver McGowan training.
It's received quite a lot of press, but more fields has always been
well ahead of the game on this.
And we've been giving staff learning disability
and autism training for a number of years.
We have about 90% of our staff overall who are trained in this.
And so we'll continue to work towards the Oliver McGowan level of standards,
which includes a two-tier approach.
And I think that's it from me.
I think that's all.
So I'll hand over to John for the pathway.
Thanks very much, Sheila.
So I'll hire up the slide.
I wanted to go to it, but I'll hire up the deck and talk about performance.
And we're meeting standards such as the A&E performance target
and diagnostic target and cancer target.
But the one that we've seen and we've got, we've met those last year.
The one we're seeing most improvements on this year is the elective target
for the number of proportional patients that have been treated within 18 weeks.
And we're up to about 83% against a 92% standard,
which still sounds like we've got some way to go.
And we have, but it proportionately compared to, I think, most of that.
And it just providers were in a better place.
And the reason for that is, really, is this model of care,
which we helped to develop within more fields.
But we've now managed to gain regional and national agreement
that this is the model of care to follow.
And so, really, what we're seeking to do here is to have the assessment process
that Sheila described so that we channel all referrals through a single front door
and provide a couple of levels of clinical triage so that we really make sure patients
are directed to the point of care that really most suits their requirements.
And in some cases, quite a number of cases don't need to enter into a hospital service.
And we're really sort of structuring both the back part of our service
and then the subsequent treatment options for the patients really around this model of care
and monitoring how well we can manage patients effectively in different points of the pathway
and where we need to develop services in order to continue that sort of improvement in this model of care.
So, moving on to the next slide, I think we've probably rehearsed before,
a significant outpatient specialty, anything we do to help manage patients either virtually
or to give them options to allow their conditions to be managed at home.
It really will have quite a big impact on the pressure that we're seeing within hospital services
and will give patients much better outcomes at much higher volumes.
This service was a service that we developed, which is one of the next slides.
We've got a 10-anywhere service which we developed which allows patients to attend A&E virtually
so they can have a triage rather than coming in physically into an A&E.
And that shows that about 20% of the patients who use this service are advised to attend in that day,
but a significant portion either can come in later in the week or don't need to come into hospital at all.
And we're now seeing a decent portion of about 20% of our patients who are accessing our services
through this digital route. We've still got face-to-face services available for those that are digitally excluded
from such a service or wish to attend in person, but it's very much there for those that choose to use it
and it has good success ratings.
We're starting to think about the benefits that our virtual services provide,
and we can see on the next slide the sort of saving we're getting in terms of CO2 emissions
and generally I think this is preventing trial and necessary travel around London.
We've gone to the next slide.
This is the single point of access that Sheila's describing and we're very keen to be commissioned
to run this single point of access certainly with an NCL and that's sort of subject to our current tender,
but eventually across London because we believe that we've developed a model which will allow us to provide that full package
for commissioners so that they can work out how to provide services and make sure that patients are directed to the right place
and that education is provided back to the referrer to a point out where referrals went,
optimal to help and learn for the future, how they may be amended.
I'm just going to the next slide.
We're starting to monitor a number of benefits at the single point of access.
Our triage time is right down from previously 11 days down to 1 so that emergency patients can be picked up within a matter of hours
and directed on to really urgent services where there's potential threat of them losing their sight.
But we're also starting to see a number of other benefits in terms of quality of the referral
and making sure that it ends up in the correct place.
And really, as Sheila said, bringing patient choice much more to the front of the pathway
so that patients have got actual choice in where they wish to be seen based on a number of criteria.
Our next slide shows our diagnostic hubs and the proportion of patients in the top bar that are able to be retained
from the left to the right within a diagnostic hub setting so that they don't need to attend the hospital itself.
They can be managed and they're much shorter pathway of around 40 or 40 minutes
as opposed to having to go and sit in an outpatient setting for a number of hours waiting for a series of tests.
And this is something we're going to keep monitoring to sort of increase the proportion of patients
that we can support through a diagnostic hub.
We're starting to look at other specialties other than MR and glaucoma where we started this
to see what the answer to the possible is across our entire sort of care portfolio.
Just on the next slide, our oral center is really coming out to the ground now.
So if you go to the Altson Pancras Hospital site, we're up to about level two now.
It's visibly rising out to the ground and we anticipate -- this was breaking ground in the picture,
but we anticipate getting to our topping out ceremony by December this year
and then we'll have a couple of years to develop the interior so that we're on track to open in late '27.
So very exciting and it's becoming a reality now from sort of concept as was a couple of years ago.
But we're not just focused on our oral.
On the next slide, you can see the presence that we've got across London and to Bedford.
So we continue to refine our site strategy focusing on both the improvements of the state
where we're committed to staying on a site, but also I think working out where patient flows
aren't optimal for patients.
And so when you go on to the next slide, we've got two examples of where we've opened new premises.
So at Brent Cross we've opened a longer, a sort of more permanent center at Brent Cross which replaces the old center
which will provide diagnostic support for patients in this region and quite significant volumes.
And then on the next slide, we've opened a hub at Stratford which is much more than diagnostic.
It also provides surgery which is a benefit for NCL patients because it frees up capacity as an unsight
so that Northeast patients can receive their surgery in the Northeast.
So this is a model that we probably envisage more of in the future where we start to condense a smaller number of sites
into a single center so offer a full ophthalmology treatment option for patients
so that they don't have to travel out of area to receive their surgery.
And when we combine that with the diagnostics, we're starting to work through the proportion of patients
that we can treat locally versus having to bring into the center of London to receive specialist care as our real.
So I'm very happy to pause there, just don't welcome any questions.
Thank you very much.
So we're very, very lucky, you know, in Edmonton, we've had more fields on our doorstep.
I've used it twice, about 12 years ago, my granddaughter going into A&E and having something removed from her eye
and then a couple of weeks ago, I went in in great discomfort because I had something in my eye
and I tried drops and everything and I got in, it was empty in A&E and I was really lucky, I got through triage really quickly
and I actually got this, it was an eyelash in my eye, I got it removed.
But I got the impression that I wouldn't have been, you know, I was especially treated especially well
that, you know, in other circumstances, it had been crowded, I wouldn't have been a priority, you know,
I don't know if you could clarify that, but I mean, I had an absolute ex-an-experience both times.
And so the other question is, you know, when we go to Ariel in King's Cross, will we have the similar sort of facilities to A&E to drop in
for those sort of, you know, not really emergency but, you know, just really discomfort cases?
So in answer to your question, yes, the facilities of an emergency point of view are at least like for like,
the capacity is slightly greater in Ariel limit is at City Road and actually our clinicians have worked with patients
to help us design our emergency flow within the new centre such that hopefully it's an improvement for patient experience on the current.
Our current facility isn't ideal, it's not fit for purpose, and we're not for the digital innovations that we put in prior to COVID,
we did have significant volumes of patients waiting for their treatment.
It's a bit better now because, as I say, sort of 20% of patients access us online, but we hope that the Ariel facility will provide a better patient experience
and a better flyer, I don't know if she has anything on to it.
Well, I was just going to say first of all, I'm very glad to hear you did get excellent care.
And it does hugely depend on timing as to how busy the A&E is.
We do intend to provide as good, if not, I think, better services when we move to Ariel.
But if your need is there, then you would be seen whether you had to wait slightly longer in busy times or not.
Sorry, I just have three quickies.
One, Western upholmic 15, because I see you're not in Westminster and there's a couple of boroughs around there that I think might just be Western upholmic,
but I wasn't sure how that fits with the bigger picture.
Second, when you looked at patient choice, was there a preferred location that was sort of coming up?
Because I would imagine a lot of people want to go to more fields.
And my third of more selfish one, I'm nearly 60.
I'm starting to see that 80% of over 60s live with sight loss.
What's the sort of breadth of that way? Does it include just wearing glasses?
Shall I take the last one first?
Yes, that includes a range of sight impairment.
From that kind of thing all the way up to a macular degeneration and other difficult things.
But yes, that's correct.
Well, it does make things, it makes life more difficult, doesn't it?
Do you want to answer the others?
I'll give the others a go.
I think when you look at the number of sites, so we provide about half of the ICA for London.
So in each ICB that we're, apart from southeast, we've got a presence in the other four ICBs
and we do about 20% of the work per southeast from our Croydon size or from City Road.
So that's where we get to the 50%.
But in most ICBs we have a significant other provider of healthcare from the NHS,
the West and I in the West be it Bart's embarking here in a red bridge in the East.
And so we try and work in partnership with those NHS providers.
And the single point of access is a good example of where we are not looking to take over all the referrals.
We are providing a service that then gives the patient choice between the different offerings that are available really.
So yeah, I think the NHS is working in a much more collegiate way post-COVID and we've provided mutual aid
for a number of patients from other trusts and we are absolutely seeking to give patients choice
and to work in partnership with other providers.
So hopefully that covers the first question.
So the single point of access is interesting because I think what we're trying to do is give sort of five options for the patients.
And so we're really assessing the reasons that the patients are choosing and we assumed distance would be a key factor.
But actually it is in some cases but not in all cases.
It depends on the patient and depends on their condition.
Some want the ease of access because they work in the day.
Others I think much more go off brand, you know, there are a variety of reasons.
No, we absolutely, you know, we're not looking to gain market share out of the single point of access.
We're looking to provide a service for London, bring consistency of referral, provide education to the referrers
and make sure the patients have genuine choice and that's available for them.
And the waiting times and various other success criteria are there for patients to allow them to have informed choice.
(inaudible)
It's in 45 minutes, which is very good PR because we were set for a five to six hour wait.
If you're out in under an hour, that feels like a win.
Sounds like a cunning plan.
Thank you.
It's a concern.
Great, thank you.
Just a couple questions of me for me.
The IONVO program is really positive and it kind of talks about engaging with staff in care homes.
I'm just wondering whether this program reaches out to other types of social care staff, whether that's agency or other groups.
We don't really differentiate.
If their staff who are regular, say they're regularly used by one particular care home
and the care home feels that it's appropriate for them to come on our course, then they would have a place.
I was just going to add that we also offer the IONVOIS course to some community staff as well.
And I guess just taking more broadly about adult social care.
If there was one thing that you could do to improve the relationship between visiting council and more fields to make caring for instance community better,
what would it be?
I think access to a range of social care staff who we could work with.
I think a more collaborative working relationship has been really, really beneficial.
On a slightly lesser note, we're very grateful to council a wolf who mended the pavements for us because we've had a number of patients actually trip on the way over.
But I think on the whole, it's about having a collaborative working relationship with social care staff particularly.
Yes, Councillor.
There's a great report, thank you, and I love that the care of what you're doing kind of comes through in all of the presentation.
So I wanted to ask, I've just got a couple of quick questions.
The patient led assessments, I was really interested in, I was just wondering sort of how many you sort of did.
And then also I missed a stat at the beginning, which was when you were saying about as people get older, they don't turn up for their appointments.
And just wanted you to remind me of how many that was, just because I'm thinking about that more broadly and what do we do with the aging population.
And, yeah, I think that's it.
Thank you. Then you'll see that variations in all outpatient appointment outcomes against age, you can then see that for each age group, you can get a sense of the number of appointments made but then the number of patient cancellations.
And the older the age group, the greater the number of patient cancellations, which again does make sense, but it's useful to see it. So 28% in greater than 85 years.
So that was that one. And then place assessments, I think.
So these are done on an annual basis and we choose three different sites out of all of our sites.
So this year we did city road, sintans, and I'm just trying to remember whether it was Stratford or Stratford as well.
And so Stratford and St. George's.
And what we do is there's a group of about three patients and our infection control matrix and our states team.
And we go with a quite lengthy checklist. And each of those categories that you see cleanliness food, each has a lengthy checklist.
And we look at each of the sites and compare what the checklist says there ought to be in the way of a standard.
So, for instance, in the dementia category, the fact that the differential between.
I don't know why I've chosen the loo seats, but the loo seat is dark and the rest of the loo is white.
And that's a really important differential so patients are aware of that.
So there are all sorts of things that we would then check against.
And the patients themselves have to agree that we meet the standard required rather than anything else.
So it's just the small numbers.
In terms of numbers of sites, yes.
Oh, number of patients. Yeah, it's just three patients who come around and do the assessments with us.
And in fact, some of them are our governors.
Okay.
I'll take you again.
Yeah, just the new sort of hubs in Stratford, Norway.
And you mentioned others places.
Yes.
Not a present, but part of our expansion of our emergency model is something that is something that we're looking at.
So we're considering whether we would have a small number of bookable slots so that if patients contacted our attend anywhere service and it was appropriate,
they could come to one of those sensors the next day to be seen rather than coming to our own in the middle of the night.
So that's something we're looking at in quite a limited manner for emergency patients.
Thank you. Any more questions?
Thank you. Just one thing to clarification.
I'm really sorry, but due to the coughing, I couldn't quite.
Would you mind introducing the question?
The reason behind because of the transport problem issues, the transport or because the older people may not manage support from the Kerala, manage something.
Yeah, I mean, there are multiple reasons.
What reason do you think about?
So I can't give you absolutes because we didn't actually delve down that deep into the data.
I think transport's infrequently, of course, sometimes it's late arrival because of transport, but rarely is it no arrival.
But I think the tendency is that it's sometimes just not being well enough to come.
Or as you say that the carer or your family member isn't available in order to support you.
I'll cut that back.
So when the oral sites up and running, you'll be in Camden. So you won't be coming to this committee anyway, you'll be going to Camden.
So we have our presence at Hoxton will remain at the Hoxton diagnostic centre until about 2030, I think, at present.
And then we would think about whether to renew that lease or move to an alternative premises, but I think that's probably the only space in the vicinity here.
Thank you.
Anybody else have any questions?
Okay.
Thank you.
Thank you.
Many thanks for coming to giving us here with us.
Thank you.
Thank you.
This item nine.
Scutiny review evidence review adult social care fund or Victoria and John.
Please.
Okay.
Shall I make a start chair?
Yeah.
So, as we draw to a conclusion of this year's screeching review, the purpose of the session today is to.
Try and provide a bit of a summary of the journey that hopefully we've taken on taking you on over the last few months with Victoria describing some of the impact of that work and the next steps in taking those developments.
So, if we remind ourselves of the purpose of the scrutiny review, as articulated in the review documentation, what we wanted to consider was how residents are able to access in this case, the adult social care front door.
So, if we go to the first slide, what we, what hopefully you've heard as we've gone through the process is back in November 22.
There was a real recognition that actually what was in place wasn't doing everything it needed to do to ensure that residents were getting a good experience, both in terms of accessing by telephone, but also by email and by letter.
So there were lots of indicators for us that things weren't working as well as they should do.
And a reflection of where that might, where some of those problems might have been, were linked to where it sat within the organization.
So, there were a number of actions that we took over that time to try and address those problems. So, the move to online referral forms, as we know, a lot of the activity that we've got comes from professionals rather than individuals.
So, trying to streamline those sorts of things, making sure that we had referral forms that were really clear and easy for professionals to use and provided the right amount of information and data to help make quick decisions.
Because actually what we noticed were people were being inundated with very random information that then had to be followed up by telephone call to find out what actually was being asked for.
Some of those really big backlogs were reduced quite quickly by introducing some of those things, so some of the big backlogs there that you'll see that we talked to.
But I think really importantly the shift for the access of the front door service moving back into adult social care, where we would have more of an opportunity to make sure the staff were allowing to the service that they were developing and evolving and training development with adult social care felt really important.
And so, that happened in August last year. Another really important thing and cancelers, you've raised that quite rightly, was some of the issues around the telephony and introducing a new telephony system that actually meant we could keep an eye on.
And Victoria again will talk to this a little bit, keep an eye on the numbers of people coming through how long they're waiting, the drop-off rates, all of those sorts of things, but it was really important and making sure you've got the right systems in place
to manage the front door of your service is very much particularly when it's phone based in this case, reliant on having a good system in place.
We talked about the staff moving across a really clear training and development program was put in place and actually what we started to develop in the winter of 23-24 was actually how we bring health and care staff, some of our housing staff together to start to really take
forward that idea of solving people's problems at the first point of contact. Actually, what we should see is the majority of people actually having that problem solved rather than actually having to be pulled into services and having huge assessments of the care and support.
And quite often, given the very high threshold, you need for adult social care, people wouldn't be eligible for that, so solving problems was really key.
And making sure that we had an integrate front door that was fit for purpose going forward, again, connected to what we were developing across Islington Borough Partnership, so with our mental health colleagues, with our primary care colleagues, with our community health colleagues,
and actually sector partners, so bringing all that together into one space, connecting up with some of our rapid response services, and then thinking about it in the longer term, actually, we've got really complicated needs.
How do we make sure that we respond to that? Not part of the front door, but actually it's making sure that everything fits together.
If we go to the, not the next slide, two slides forward, and the next one, that one, I'll hand you over to Victoria, because I think what's been really important for me and to give me and hopefully your assurances, making sure that we've got a clear dashboard of where we're starting to see performance
dashboard improvements in the activity that we've got at the front door of services, so Victoria's going to talk to you about that, but also the next steps in helping to evolve that, that hopefully we'll tie in with some of the recommendations that we've been talking about,
because actually this conversation has been really important, because you've had the opportunity to talk to partners and people who use services too, but Victoria over to you.
Thanks, John. Thanks for setting the scene there as well.
So in terms of our front door performance data, we've obviously over this period of time we've been looking at that, we've been looking at ways that we can ensure that we've got the data to hand.
And as John mentioned, the telephone, the new telephone system, the eight by eight cloud based system gives us much more information.
But first of all, our email backlog has reduced by 97%.
But alongside that reduction, we are now able to review and triage our emails much more efficiently dependent on the risk.
And dependent on risk emails have responded to within 14 days. So if there is a higher risk, we're responding on the day and we're able to do that now.
We're previously that was really difficult for us to do, but we're able to identify that risk now.
That includes our safeguarding referrals as well. We were struggling a little bit with our safeguarding referrals to identify those within an inbox.
But now that we've got the forms that allow us to do that, we can readily do that.
It also means that we've had the ability to capture data about the service to make improvements and understand the demographics of our service users or the people that are contacting us.
So we've got much improved data as well through this system.
And we've also seen an increased quality of the referrals and appropriate use of the service. So historically, we might have had emails where someone's bins haven't been emptied or housing repairs.
And we would they would just be in the inbox with everything else, which really wasn't helpful for us.
It wasn't helpful for our resident because we weren't giving them the right response in the right time frame.
So working on this system, we've managed to achieve all of that.
And it's, you know, it really is quite phenomenal. And it's remained steady as well.
We have very slight peaks and troughs that we will even out over time, but pretty much it's remaining steady.
We've removed and redirected unnecessary traffic from the service by an average of 28.5% per month.
So again, it's all those referrals that someone might have thought were for adult social care.
And they weren't. And so we've been able to move those out and make sure they're redirected in the right way.
And then we've got our core monitoring quality assurance framework.
So in February 2024, there were 289 phone calls to adult social, adult social care equating to an average of 14 calls per day.
The minimum wait time was zero seconds and the maximum wait time was 24 minutes.
The median wait time was zero seconds and the average wait time was one minute, 54 seconds.
75% of calls were answered in less than a minute.
So now we've got the data and we've seen improvements already.
We're now working on how do we use that data to make more improvements and improve those outcomes.
So, for example, we can now start to look at how we manage colleagues being available on the phone at peak time.
So we can start to judge when our peak time for phone calls are.
We can take some people off of those that email inbox and move them over to the phones that peak time and then move them back again.
Next slide, please. Thank you.
So I planned next steps. So our streamline triage process.
So implemented a tiered triage system to prioritise incoming requests based on urgency.
So we've already started that work through what we've done, but we're going to continue with that so we can really get good efficiency for our residents.
Assigned dedicated triage officers to ensure swift assessment and decision making.
And again, the reference I've already made is to flexing the time on the phones and the emails depending on those peak demand times.
We're looking at scripting for our access workers to ensure consistency.
So I think one of the things that's come up is about consistency of response.
So how do we use a series of key questions that would be completed electronically by members of the team to guide the contact pathway.
So a bit like not quite the same, but a bit like you would have if you call 999 and you're going through the triage questions.
Our access colleagues would be able to do that as well to really prioritise the work, but ensure some consistency and what we're asking and getting those responses that we need.
Enhanced communication channels. So this really is about whether we're using online phone.
Very, very rare now a letter, maybe a paper refer or comes through.
But thinking about how we really enhance those communication channels so they are accessible as possible for people.
We're looking at establishing a dedicated helpline for non urgent inquiries.
So the main phone line can focus on urgent cases.
And we're looking at introducing a web chat feature for quick online assistance.
So again, we recognise it's not everyone's cup of tea to be doing that.
But on our website, can we have something where there's the option to be able to do that?
And if we can do that, can we then take it into a phone call at that point where we think we can't resolve the query.
Accessible online resources, so a redesign of the Adult Social Care website to be more user friendly with clear navigation and plain language.
And develop a knowledge base of frequently asked questions and self help guides so they would then be published on the website and people can self serve as well.
So it would be much more accessible and they may be able to find out hopefully that information that they need without feeling like they need to pick up the phone.
And then standardised documentation, so create standardised assessment forms and templates for consistent record keeping.
Our character assessment is obviously standardised, but we've got some other forms that we need to standardise as well.
And implement electronic documentation to reduce paperwork and improve accessibility.
So we're possible that we all have everything stored on the system. It makes it much easier for our reporting. It makes it much easier for consistency.
Next slide, please, Sammy.
The Corporate Resident Experience Program.
So this slide is very, very technical. It's not actually my slide. It's come from Resident Experience Program.
So the Resident Experience programs have worked with us for a service review approach in Adult Social Care, and it's got three key phases to it.
And it's split into the discovery and future state analysis, which we've already done. We've worked with Resident Experience to do that.
And now we're moving on to the business case development and design approved and implementation.
So this is the next part that Resident Experience as a whole are doing with their business cases to say how are we going to support the various directorates and departments through that.
Next slide, please. So further development technology and tools. So this is our aspirational work that we've worked with Resident Experience to start thinking about how can we do this.
Accessibility tools, so use of accessibility testing tools on the website to ensure the website is accessible to all residents, including those with disabilities.
So a bit like with more fields talking about, you know, if you've got a visually impairment, what works for you, but also some easy read language.
Or, you know, do we need to use pictures for people with cognitive impairment or learning disability?
Our feedback and survey tools to provide feedback and survey tools to collect feedback from residents about their service experiences and make improvements accordingly.
So the current time we have an annual feedback survey.
But to look at how do we do that on a more regular basis? So we're getting that feedback from our residents. We do have, obviously, we have various forums that we engage with residents.
But is there something that we can do? From a resident's point of view, a bit more quick and dirty immediately at the time that they receive in the service so that we're not going back to them a year later and saying what was your experience like?
Online form builders to create user-friendly online forms for service requests for the feedback collection and other interactions. So again, very much thinking about the accessibility of this, but it's the technical knowledge and the software around building those forms.
Training and learning management systems to develop an online training modules to educate residents on using digital services effectively.
And the resident portal. So this one's really ambitious, but the potential option for residents to access their own records and make appointments with their social worker and communicate with the service.
And finally, desired outcomes and potential benefits. So we're looking for improved response times to residents, carers and professionals and reduced processing delays.
Enhanced the resident experience through accessible online content.
Efficient resource allocation due to streamline processes, for example, being able to monitor those phone calls and flexing colleagues across that time.
Enhanced overall resident experience with streamline communication and demonstrate a commitment to meeting resident needs efficiently and effectively.
And it will provide a more effective means for residents to access the support and services that they need.
That's it. Thank you.
Thank you, Victoria and John.
Yeah, I think we can start this customer. I think really nicely started the program to find out something is really nice.
Thank you, Councillor KA.
So it sounds fantastic and like that everything should be so much better. So thank you.
Oh, yeah, thank you very much, really good work. But I just want to raise this issue of the transition again, because there's no mention about in that report.
And it seems to be that a little bit of a vacuum.
And so it would be really good to know what you're going to be doing to improve the service for families and people moving from the young people services into adult social care.
Because one of the things that's come out of this scrutiny is the poor service going on to that particular group.
And you're doing a good job improving the service generally for residents.
That's one question. And the other question is the other thing that's been raised.
We've had residents in the scrutiny committee about the state of some of the companies running the domicine care.
So you're talking about the front door, but then once you've got through the front door, you've got to ensure that there's going to be really top-quack care.
So could you just give a little bit of an update on the companies that you're maybe not dealing with anymore?
So in terms of transitions, I think, yeah, absolutely right.
We haven't talked about transitions in this scrutiny review because it's not part of the front door as we would describe it in terms of what the scrutiny review was designed to look at.
But I think what's really important, though, is to say that the recognition from this thing and having conversations both with families of those children who may, over time, require further support as that young person moves into adulthood has absolutely been heard.
Those issues where actually that transition, if somebody is eligible to move into adult social care to people before you have to have incredibly high level of needs.
And these are the people you've got very high needs.
I mean, across just has not been as robust as it should be.
So in conversation with and working with children services, because this isn't something that adult social care obviously can do on their own, we have got a really clear program of work.
That has got additional resource attached to it, including additional capacity within both adults, children's and the program management team to support improvements along that journey.
And it's something that both the lead member for children services and adult services, a part of in terms of that conversation. And I think it would be an interesting piece of work for both children and adult scrutiny to potentially consider in more detail.
I don't know how that would operate in terms of joining up, but that could be something we could consider.
And we can give some information about how it works connected to our front door.
But it's a really deep and wide piece of work that connects to a lot of things that our children services colleagues and family are doing already, but also importantly what we're doing to help smooth that pathway and prepare young people for adulthood.
So making sure that they have the same life chances as much as possible as any other young person.
And I think there's always a risk that as children move through and become adults so that isn't supported in the same way.
In regards to the quality framework that we've got around the providers that we use in Islington. So what I would, I would hope, because actually there was a scrutiny review on this a couple of years ago, isn't there to look at domiciliary care providers.
And I think our local government association peer review that was carried out relatively recently found that we've got incredibly strong and incredibly strong infrastructure and making sure that we as a council are clear about the quality and consistency of the care that we provide.
There are always going to be individual and sadly individual cases where things don't work as robustly as they should do. And in those circumstances, we take the action that we need to take to ensure that the lessons from those alone in conjunction with the adult safeguarding board in Islington.
Islington's adult safeguarding board is chaired independently by Fiona Bateman as you know, who comes to this scrutiny committee and her observations about the infrastructure that we've got as an independent person that we have strong robust arrangements in place that give assurance not only to us as the council, but to that partnership that the people that we're supporting through our providers are of a high quality.
And I think there's triangulation of that with the care quality commission who have a statutory responsibility to ensure high quality care is provided across the country is the other evidence that we have that the providers that we work with are the providers that we should be working with.
I can provide you with the list of, if you're talking about Thomas Hillary care that of those providers that are part of our new contract framework that I can pass to the to the chair that's all published now went through.
And we're beginning implementation of that with the new providers as we speak.
So it's a big piece of work that that reduces our spot contracting arrangements, which sat very much in the gosh how many was it probably 50 providers and reduces that right down to small call of providers in our localities in our three localities
that gives us much a much stronger working relationship with those providers and actually they will be seen as partners with us with our enablement service with the integrated teams that we're developing.
So hopefully that gives you some assurance in that respect.
And just something that that I think we're all really proud of as well is the involvement, the co production without residents around the procurement process for the home care providers.
You know, we were talking with our residents, we were involving them in that human process.
And it was certainly something that, you know, we're really proud of but was recognized by the LGA as well as an exception piece of work.
Thank you. Thank you. Can I just say it would be really welcome if we could have that list.
Okay, yeah, thank you.
Great. Thank you.
So really positive stuff about the front door service and kind of the improvements being made here.
I'm wondering whether in maybe not the first scope, the second scope, whether you think there's any opportunity to start referring to some of the wider kind of charity spaces thinking about people coming in with.
Parkinson's or MS and maybe kind of signposting different services when they come to the door because I'm very conscious that when people have a range of opportunities to be supported, they do better.
Yeah, sure.
So, one of the things that we've been really conscious of is that we have this very rich and diverse community front view sector partners across using term were really fortunate.
And it is, it's quite a challenge for our frontline practitioners to really stay up to date with what's out there because things do change.
So we've got a number of things underway to support with that. So we've got a central point of access where we, they will speak with people perhaps before they need adult social care, but they can move people over to us as well to support with that.
So they would link people up with perhaps those more specialist organizations like Parkinson's.
Our practitioners themselves would be aware of, you know, all the major players, but can also, you know, access a directory of services.
And we've done a lot of promotion around that directory of services to make sure that our frontline practitioners can access that.
But they've all got, again, it's about this message about consistency that they've all got access to the same information.
A directory is quite challenging to maintain. It can become a full time job with contact details and, you know, who's active and who's not.
But we wanted to make sure that we had that to provide that consistency.
I think I was just sorry, because I think you had a presentation. Well, I know you had a presentation from Sarge in regards to the access links and hubs.
And I think that work particularly is going to make sure that we start to really coordinate the responses in those local areas to very much picking up your points.
Just a quick question and just to follow up. And I guess as our online offer became becomes more and more compelling with the opportunity here.
How do we make sure that those who aren't able to access online don't miss out on other opportunities to use things like direct mail or isn't in hubs to make sure that people can access the same opportunities that people who are online can as well.
Yeah, sure. So, so we look all the time up how we get those contacts into our service and primarily it's online or telephone.
So this was one of the things with the telephone access that we now that we've got a telephone system where we can check on what's happening.
This is where we can now flex where our colleagues are so we get an awful lot of demand via email and we need to be on top of that so we're not missing things.
We've improved our efficiency around that and, you know, checking on when things are risky or high priority.
But it's given us the ability to check at those peak times when phone calls are made to us so we can flex colleagues over to cover the phones so that phones remain an option.
And then, in addition to that, we've got obviously the access is in some hubs not our existing that hubs that we will, you know, we are in regular communication, they know how to contact us.
So if people rock up to one of those hubs, then they can send that contact through to us on their behalf as well.
In addition to that, we've really developed, I would say, over the last year, much closer working relationships with housing colleagues and a lot of people tend to come that room.
I think like you were saying earlier, Councillor Zameh, you know, we might people might not be self referring and actually they might be quite isolated, but housing colleagues are a great route into referral for us as well.
It was just a flag and I think which is something we should be proud of and then we talked about it here before, but when we did the Adult Social Care Survey this year, which is a national survey.
We saw an increase in the proportion of people who use services who find it easy to find information about services.
So we'd move from 63% the previous year to 70% this year, which although there's still room for improvement is still much higher than the London average, which is 65% and England average, which is 67%.
So it shows that I think people are reflecting back and telling us they're starting to see some of the differences, so hopefully, you know, it's a slice of an amendment in time, but I think it helps to give us an indication that things are improving.
Thank you, Councillor Jimmie.
Again, that was great and building on the conversation that we were talking about earlier.
I was surprised that only 2% actually kind of referred themselves.
So I think my next question is, there's like a lot of work that's been done in the process side and the efficiency side and the transformation and that's excellent.
And then, John, you keep saying, you know, you need to be at this particular threshold in order to get to adult social services.
I wonder whether or not we need to do something whereby we put ourselves in the shoes of the resident and look at the forms that are being filled in and actually sort of remind ourselves kind of what that threshold
actually is.
So I think, you know, our job is to talk to residents the whole time.
And actually, I'm not sure that I know what that threshold is all of the time.
And actually, when you talk about tenancy services, making referrals, like I know that we're probably all, you know, putting in casework and we know that some of that casework goes to tenancy services and they then make that recommendation.
But I think I don't think I'm sure of what that threshold is or what they're actually sort of filling in, if that makes sense.
So I just wonder if there's a small piece of work that maybe needs to be done kind of with us, kind of outside of the scrutiny group, so that we're all kind of refreshed.
Or it might just be that this is like my first year on this committee and I just need to do a little bit more homework.
No, not at all.
I think it's a really important question.
It's not that straightforward in our last Victoria to come in really briefly.
And I think it's something that we can help scrutiny committee and members to understand more.
But when we talk about thresholds, I suppose there's a bit about making sure that those people who absolutely need adult social care, those people absolutely need it as a finite resource.
But on the other side of it too, we also have a duty to prevent, produce, delay the need for adult social care.
So there's a combination of things.
So when I'm talking about thresholds, I'm talking about actually protecting the relatively small amount of resources we've got for those most vulnerable people in our communities, keeping them safe, keeping them independent, keeping them.
And we can talk about how we come to those sort of decisions, but actually, more importantly, in a sense, and this is about promoting people's independence, making sure that they're healthy and happy in their lives.
What is it that we can do?
Because actually getting to adult social care isn't the best, that's not what you're aiming for, is it?
You're aiming to be living independently in your own home with your family, your friends, your networks around you, and staying as healthy as possible for as long as possible.
It's what we all want for ourselves and our family and parents.
I just add to that, I think when we were first elected in children's services, they did a kind of a user story for us.
This is Jack, and this is what he needs, and these are sort of the services.
So I think this review has been excellent in terms of looking at the processes and the transformation that you're going through, and the stats are amazing.
But I almost wasn't aware of whether or not the next time we do a few things around kind of user cases, and this is John who might be experiencing this, and then the surface that they go to, or not, as the case may be.
So it's just given me an idea, because I was just thinking for the freshers fair, perhaps we should have some sort of pen profiles of people who are potentially our residents, and their level of need, and what we did to meet the need.
But also, we've obviously got an eligibility criteria under the Care Act, which is our statutory legislation, and that's what we assess people under.
So we could perhaps do, you know, a piece of work around that.
But like John says, the bit about the reduced delay prevent is really important.
So we would also alongside, you know, our access agencies and hubs colleagues, we've got our central point of access, we've got our access team.
So it's really important that we sign post people out, if, you know, if they're referred to us, and they're not eligible under the Care Act, it's, it's really important.
We sign post people to those other services that can support them, so that we're working in that strengths based way to say, what are those strengths around you?
What's that those networks around you that we can help you link into that you perhaps haven't got at the moment.
Yeah.
I just wanted to, I've asked this before, actually, because it is a topic that I'm really concerned about is, you know, if you've got someone that's receiving care at home, virtually they might have a fall, then they're receiving full-time care, they're taking into care.
And I just wanted, you know, the support to the families around the person that the Council are caring for, if you like.
I just wanted the families, the level of support that they have throughout that sort of was because it's a big step as Mitchell mentioned.
No, no one wants to go into care specifically, and some families face it very hard.
And also, some family members might become ill with themselves, but when they're looking after their loved ones, you know, so I just wonder what level support we have for the families.
So, we would always, when we're working with the person, we always look at who's around them because we want to identify, you know, in that strengths based approach, we want to understand that network around them that's going to support them.
And then we would offer to have those conversations and do a carer's assessment with them, identify what their caring role is, how we support them with that.
We have options around providing care and support to the carer through us, but also we've got the carers hub, we can link them into.
Sometimes it might be advice about, you know, do you think you ought to speak to your GP because it really sounds like emotionally you're struggling, you know, can you access some counseling services through the GP.
The carers hub provides some counseling services, it's time limited, but that might be somewhere we sign post people to.
And then, like you mentioned about the Parkinson's charities, so if someone's got a very specific condition, it might be that we refer them back to that to get that emotional support around that particular condition.
You know, we know for some families understanding dementia is really, really challenging, particularly when they see a real personality change in their loved one.
So we might suggest that they contact or we put them in contact with one of the dementia charities so they can get that emotional support and that understanding of the condition that their loved ones experiencing.
Thank you.
Okay.
It's very quick.
It's just going back to transition, and this might be something you do already, but, or it might be a quick fix.
I don't know.
When I'm transitioning young people to adult services, so young people with complex needs.
The first thing that happens when we start to do it is a disagreement between health care, social care and learning disability as to whose responsibility it is.
That will go on for some time.
I don't care whose responsibility it is, I just want it sorted as do the family.
And then eventually health care will take it, and then soon they turn 18, they say no, it wasn't us, it's adult social care, and that's where we get the three month gap, because health care say no, it's not us.
Adult social care haven't yet got them on the case loads to when the parents phone their phone, children services, asking for support and get told you'd be discharged, then they phone adult health care.
This has happened this year for one of my families, then they phone adult social care to be told no, we don't have you on a case load.
And if we could just sort it out earlier and stick with what's being agreed.
So there's something going wrong in that I think people are saying yes, we'll take it as adult health care, but might not be the person that is ultimately responsible for that decision.
And then later on that decision gets reversed, and that's where I think you get a bit.
I'm not the polite word, it just kind of falls to you, and therefore you look like it's your fault, but it wasn't.
If I just pick up this, make some of the complexities there in Victoria and some operational reflections too, so you're absolutely right, that there's real complexity between the funding routes between children services,
children's continue health care and continue adult, continue health care and probably got some of the terminology wrong.
But there are slightly different arrangements and different, back to the eligibility criteria for all of those things.
And that's why it becomes so incredibly important that the conversation with the young person and their family starts at a very formative age.
So the latest 14, in my opinion, so that's not where we're, you know, lots of local authorities really struggle to do it at that key stage.
And actually, you know, 14 to 16 is roughly in the space that people are looking, but I, you know, if you really want to get some of the conversation, you need to be doing it there.
And also, the mechanisms to think about the different eligibility criteria, when it's really complex, when health funding comes into it, the child's health needs, as you know, are really complicated, aren't they?
So, but actually, you might be entitled as a child, but you're not necessarily entitled as an adult, and that becomes quite difficult.
So, operationally, we are working with both children's and adult services, but not in isolation with our ICB colleague, our integrated care board colleague, so NHS in effect, to make sure that we start to line up some of the thinking around those mechanisms to try and smooth that out a bit, because you're right.
Otherwise, it's too, it's so late in the day over here, nobody's got time to plan anything, and you're trying to put something in at the last minute, if somebody isn't in education to the age of 24, for example, it's a drop-off point there, or if they come forward at 18, there's a risk of they're being a drop-off point there, but I don't know where there's something else you wanted to do.
Other thing that happens is then, they have to do the assessment all over again. Can you not just share the assessments? I mean, I suppose you can't, there's different criteria, but again, that sets you back another couple of months.
But you're right, there's, again, it's that opportunity, and that's why we talk a lot. I mean, sometimes it's easy to trip off the tongue about how we integrate the way that we work, but the reality is, is where we can, we don't want anybody repeating their story more than once.
And that, you know, that includes, from a children's services perspective through to adult services, not just with our health colleagues, so we're trying to make sure that not only are we setting up conversations that are meaningful at the right time for those individuals, but also our systems and processes start to marry up a bit.
So those things get automatically fed across into other systems, and systems are at a nightmare.
When it doesn't happen, they don't get incontinence pads, you know, it's a basic snap, and also you don't need to look at this, and adult social care, I think you only get only left for a day, and a lot of people need more than for a day.
Thank you. Thank you. Thank you, John.
We did a fantastic job. Just, my one question is how, as we discussed fast, as a committee, how we can monitor this one, as I kept, yeah, we were thinking that this one.
How can we monitor front door, like how many call we receive, what is the outcome as a counselor's good in the committee, how we can monitor this one that we are much lacking when we go to next time to the facing the community.
That means community people can say that we're doing a fantastic job.
When they're not complaining that we're going to receive a call, a counselor's called into five, one minute or something.
That means we have some kind of monitoring, or new program.
Okay, is it possible to add this or let me keep here?
Yeah, absolutely.
So, you know, we have to be really clear, and I think it's really important that we're clear as adult social care about what, you know, our front door so people aren't confused.
Unfortunately, there are so many single points of access, and that is something that we're looking to really streamline, but at the moment there does remain some confusion around that.
So, we're absolutely committed to ensuring that we're clear about when people come to us, when they phone us, what they'll get is a swift and high quality response that helps solve their problems at that first point of contact.
So, as part of that, and Victoria's articulated it, we've got the ability now to more accurately provide that level of data, both from a quantitative perspective, but more important, well, as importantly, a qualitative perspective.
And the outcomes of those conversations are really important, actually, what we should be seeing is people going,
Oh, actually, you've solved my problem. I've been connected to X, Y, and Z. Actually, what I don't need is you for the time being, but you're, you know, actually, you've supported me to sort of get back up on my feet and sustain things for a bit.
So, we can, I think it's part of the work that we're doing now to finalize that performance and quality framework, can look to incorporate elements of that, where it makes sense into the quarterly performance report that we provide, which is the next item on the agenda, I come incidentally. So, something that gives that sense to you as the board about, you know, the ongoing progress. Obviously, that's part of the scrutiny review recommendations are response to your recommendations if you decide to include the performance framework will reflect what that looks like, if that feels okay for you. Thank you. I think, like, the next item going to discuss so many things about this issue, I think better to, next, we can discuss the next item, which is our collection of the evidence gathering for our scrutiny review into the access has been circulated to the members tonight. We are looking at the team's idea for recommendation, but that recommendation will already circulated to the member officer outside the meeting committee and to having the next meeting. Okay, just a minute. Thanks for sending us this really or whatever we discuss this year and point by point. Thank you so much. It is a help us to gather our point and everything here. And now also, send us draft recommendation, like, this is a draft, like, we can now start discussing. And also, I would be grateful for everyone after discussing if you would like to add anything, if you have any idea or anything, please send an email to Samia and us here. And we can, I think we will finalize in the next meeting. Yeah, we'll finalize in the next meeting. And John and Victoria also help us to keep us, like, whoever is everything going to be feeding here. Thank you. Just a read point. I think bullet point three says bi-annually. And I know bi-annually sometimes can be twice a year or every other year. And I just wonder whether we could use twice a year just to be super clear. Just the last word on bullet point three, so those outcomes be reported to the committee bi-annually and I just wonder whether we could use twice a year instead of bi-annually just to be super clear. And now we can start a recommendation. First one is what is discussed is, I think everyone has an NHS, North Central, London, Integrated Care Board should work, which piece are the established worldwide protocol for access to primary care services, sitting out best practice in the terms of access and ensuring that patients have choice over whether the access service says online in person or over the phone, depending on their appearance. This should also consider relevant equality in relation to ensure that residents with disability have equal access to the service. >> I think we talked very briefly earlier about whether or not this could be more than a bar of white protocol and it could be a bar of white charter that GPs kind of signed up to, and perhaps we took a little bit of time to just brainstorm what we think that charter, might be. I mean, I was impressed with some of the stuff that Moorfield did, and just thought, actually, there are so many examples of best practice out there, which is you have an accessible website, you have patient reviews or something. But something that the good organisations would be very happy to sign up to, and those organisations that perhaps need to improve, could be encouraged, but I appreciate that this would be a big ask. But I think if Islington really wants to trail blaze, we could do this, and I think our residents would love it if we sort of said this is how we are going to bring people together. >> Thank you. I think although we don't have a direct control to the public as well, but as Islington, we will always fall forward, like we started fast 20 miles speed limit everyone following us. Why not? We start. What is the things best? They should follow us. Thank you. >> I agree, and I think the charter could just encompass what bullet point one encompasses, actually. That could be just simply as simple as that. The charter could encompass exactly what is stated in bullet point one, just simply that. >> Yeah. >> I would support the charter, because I think it makes it more approachable if you like to patients. It makes it more accountable, really. >> It's just one, who would draft our officers, or who would be responsible for drafting the charter? >> Officers are a good comes person. It should be drafted by the officer, and we can put our recommendation there. Something come. >> I just think it fits into sort of what's been mentioned, good practice, and it's written in such a way it's understandable to patients and accountability, really. >> I think the charter should reflect the point of the appointment and other thing. With that, we can add other things, if the officer can send us some draft, something, then we can add our point. >> Well, I mean, maybe we're getting a bit ahead of ourself. Maybe it's the first thing to do is maybe having a meeting with the organisations that this would kind of involve the integrated London integrated care board and just see whether or not they would be open to doing something like this, and then possibly the next step is sort of writing something together. >> I suppose, I mean, obviously I'm not responsible for primary care in this LinkedIn, so I think that feels probably a really sensible next step, because the recommendation and effect is that you feel that this would be a really good way to show a commitment to the set of things recognising that as a council. That's the responsibility, but actually then the ICB and the GP Federation can respond to that and suggest the best way to progress it, because it would be difficult, I think, to develop it from a council perspective, it would need to be developed and owned by the GP Federation's effect. >> Things like that, because of our time limit, we can suggest our point is we are ICB to adopt the charter and give us the feedback, this is our recommendation and they will make the charter and we will approve it for next meeting or something. Am I right? Is it okay? >> So we're agreeing bullet point one with the addition of the charter. >> Yeah. Thank you. And can we discuss now's second point that GP and Adult Social Care Review, their online materials to ensure jargon is not used and access is simple form a user perspective. >> Great. >> Okay. >> Thank you. >> I mean, have we all seen the form that one has to fill in? >> Two, I think it's just like that recommendation makes sure that that is accessible. The truth is right now, the third one is already we discussed, yeah, and we agreed that this will come back. And your user by annually rather than you should. Council, I'm going to say it's twice a year or something. Yeah. >> Sorry. Can I just check? So I know that's what we wrote in the recommendations earlier, but it sounded like it was something that officers wanted to include in the regular updates that you get of key performance indicators. So it was just to clarify really. >> Well, should we put as a minimum twice a year and then it gives us the opportunity because I'm not sure how we're not in a rhythm of reporting the information at the moment. So if we put as a minimum twice a year, then if we can, it will be, well, it would then move to four times a year if that's okay. [ Pause ] >> Yes, Chair, I would just add and improve the service for the transition of the people from the young people service into the adult social care service, which is so quite obviously being looked at, but we want to keep an eye on that. I just recommend the improvement in that service of transitioning from young people services to adult social care. >> Well, as I said, it will be a narrow response for this because obviously what you do is recommend and then we respond to it. Of course, I can provide that commitment and a brief pointer to where that work is happening with the views that both adult and children screening may want to hear some more about it over the course of next year. >> Yeah. >> We'll keep an eye on it, yeah. >> Thank you. [ Pause ] [ Pause ] >> To improve the resident experience of adult social care, I think that's covered, isn't it? So I think that's covered by that recommendation. So you review the training and guidance and consistency of services that I think that's good. [ Pause ] >> I suppose it's just because residents don't access their respite care through the front door. It's something that's set up as part of their care and support plan that they get. I suppose I'm just not from what I can see, but I don't know where. I mean, we can provide information to scrutiny on how respite services are accessed as a separate piece of information for your review. But it probably doesn't necessarily fit into this scrutiny review, but more than happy to bring information to you as a scrutiny committee on the respite offer, particularly part of your conversations of being about people struggling to access their respite. Because I would want to understand that as a separate viewer as members, individual members saying to me,Actually, Mrs. Whoever can't access their respite,
then we would investigate that and try and understand that and provide a response to you. So, probably maybe if we could think and look at the feedback that you've got about respite and then we can respond to that as a separate piece. I just didn't feel like it fitted with this. What is slightly concerning if people are not aware that they can have respite, you know, but I take what John says. I'm happy to go with that, you know, that we would keep an eye on that. [BLANKAUDIO] [BLANKAUDIO] [BLANKAUDIO] I think it was part of people didn't know the complaints process or didn't get a response from memory, from the focus groups. [BLANKAUDIO] Is that in relation to being able to get through to adult social care? Was that the complaint that people were concerned that when they couldn't get through they didn't know who to complain to? Yeah, so I think if we're clear that we want people to know how to let us know or complain or tell us there's a problem. And I think we should and absolutely should be able to respond to that and improve that if people are saying to us they're not sure what to do if they can't get out of us. I think that's really important, so maybe we just need to elaborate the recommendation you've described to say actually if people are unable to get out of adult social care, you know, they're on the phone too long or they're in your mouth not responding to or whatever that might be. That they know exactly who they need to contact to. [BLANKAUDIO] Yeah, absolutely. [BLANKAUDIO] [BLANKAUDIO] [BLANKAUDIO] Well, we publish our complaints and compliments information on the website. So we can point to some website. Yeah, yep. Yeah, of course, on a costly basis. So, you know, when your mind just goes completely blank. Yeah, so of course there are about all complaints about adult social care that come to us and then what we do with that information to help improve our services. So, yeah, we have that information if it's something you want to look at, but specifically we can answer, you know, this is an important thing here. [BLANKAUDIO] [BLANKAUDIO] [BLANKAUDIO] [BLANKAUDIO] [BLANKAUDIO] [BLANKAUDIO] Yeah, I mean, yeah, I actually thought this was going to be the final draft tonight, but you know, it's not the next meeting. [BLANKAUDIO] [BLANKAUDIO] [BLANKAUDIO] You know, because of time and we've got this, they've got the drug and alcohol coming up. I don't know how if we could do quickly, just do this, get this done quickly. No, yeah, okay. No, no, absolutely. Thank you very much. Victor is literally then hopefully you've all read the report. There's been very little change from last time, so Victor will just pick up any exceptions for you and take any questions. Thank you. So, yeah, just looking at the report, I think one of the areas that I would like to draw your attention to is the indicator for statutory reablement that monitors outcomes after a period of reablement, the service aims to reable people and promote their independence. A high percentage for this measure provides evidence of a good outcome in delay in dependency and supporting recovery for our residents. Of residents who receive reablement in quarter three, 72% were reabled and did not require long-term support from adult social care. No target has been set for this indicator as this is nearly reported. I think we've had it the last three reports. But the performance is below end of year performance from last year. So, the reason for this is our data is definitely much more robust this year as more people were receiving reablement compared to quarter three last year. In addition to that, we've opened up access to reablement. So, as we started off, we were really cherry-picking those people that we could immediately identify would really get good benefits from reablement. Once we've got that under our belt and we're getting good outcomes, we've increased the cohort of people that we will see through reablement. So, initially, it was all hospital discharge people. We've now included people from community routes and also quite significantly people with mental health problems as well. In addition to that, the level of residents needs that we are now seeing through reablement. So, again, initially, we might have been seeing people who needed support three times a day. We're now seeing people who need support maybe four times a day and some aspects of double-handed care. So, that's impacted on our outcomes. We do expect that to level off over time. But in addition to that, our quarter three performance is still similar to London performance and very slightly under England's the whole performance. So, we are still doing really well with that, but just that explanation about where we're not quite where we wanted to be with it. But overall, it's a good news story because we've opened up that capacity to more of our residents. And then finally, just to flag our safeguarding performance. So, this has been mentioned at last quarter. I discussed this. So, we are doing really well with our safeguarding performance data. We are keeping people safe, but we have had some challenges with receiving some data from our colleagues in the CNI in Camden and East London Trust. They had some challenges with a new electronic record system that went live. So, we've been working with them to figure out how we get that robust data from them. We're working really closely with them. They're developing a dashboard that's in its final stages now. And that dashboard will give better assurance of the data that's being collected as it's collected from the system. At the moment, it's collected via a very unwieldy spreadsheet, which isn't ideal for anyone. So, hence, they are going to pull that into a Power BI dashboard, but that data will literally drill down onto individuals. So, we are waiting for that from very minus quarter three for last quarter, waiting for that to go live. But, yes, we're still in lots of collaboration with our colleagues in CNI around their data that they're providing to us. So, just if there's any queries on any of that. Thank you. If any question to anyone. Okay. Any other questions? Just one question around on the safeguarding inquiries. Like, not flick it. How many was that? So, how many cases are we talking about that were raised? Do you have that information? I don't have that to hand. We've just got it as the percentage amount on here. But, yes, we can. We do have it as a whole number. And, it would just be of interest to know, I guess, are they? Are they all coming through kind of professional referrals, I guess, rather than family and friends? So, we do have that information as well. Yeah. Yeah. Thank you. Yes. Okay. Many times, John, in the picture, you have to come. Thank you. Thank you. Please come. I'm really sorry to put you at the same time. You can start now. Okay. Thanks very much for having me. I won't go through the paper in much detail because you've had it. It basically summarizes some of the treatment needs around drug and alcohol in Islington and the Ranger Services that we commission. I guess I particularly highlight some of the work that we've been doing and continue to do to try and make those services more accessible to more people. We've done a lot to improve pathways from criminal justice systems, settings into treatment pathways from health care and really invested in trying to reach more people through street outreach. We have some really great partnerships and we continue to build them, so we work really closely with our colleagues in community safety. We've established the combating drugs partnership and that includes some great work with the police and public health recently established a community of practice, which is paying dividends already in terms of improved visibility and relationships between our treatment providers and some of the other front facing services that work with residents who have high levels of need. So, for the work that we're going to do this year, we're establishing a drug and alcohol liaison team at the Whittington Hospital, which we hope will guide more people who are accessing the hospital services into drug and alcohol treatment where it's needed. We are working on a communication strategy to promote and engage more people around services and particularly looking at how we can work more effectively with our BCS and faith organisations. That's something we ought to be doing more of from a treatment perspective. We're going to do a deep dive into alcohol needs in the borough and we're going to undertake a piece of social research to understand naloxone and overdose prevention methods and how they're actually being taken up and used by people or not, we'll see about by people who use drugs. So, it's due specifically to understand the use of naloxone. So, naloxone is the overdose reversal medicine. We are issuing it to people who we think may need it, but we don't have a great insight into how it's actually being used in practice. So, we want to understand if people are accepting the medication and then would they use it in practice, you know? Exactly so, yes, exactly. Well, it does, but hopefully long enough for some sense of care to arrive, yes, yes. And that's probably enough to say the starting point I suppose, but we're really happy to take any questions that you may have or if there's anything I can cover in more detail. Good, thank you. We call it a clerk, I'm going to start. Thank you very much because, you know, this committee has been asking for a deep dive into drug and alcohol services. And this is a deep dive, it's really very detailed report. And I'm sorry that, you know, we've been left right to the end of this meeting for such a great piece of work. So, I just wanted to, you know, just right at the beginning, you know, page 484.1 drug and alcohol use associated with homelessness, including rough sleeping, contact with the criminal justice system and exploitation. And just to say that we have received additionally 637,000 pounds funding from the GLA to continue to fund the support team which provides intensive floating support to individuals with a history of rough sleeping to live independently. So just to add that, we're so very welcome, you know, that we are continuing this support. But the other points that I want to really stand out, it's really, you know, Islington has the highest prevalence of opiate use in London and the fifth in the country. You know, 21.5 per cent per thousand versus 10.9 per thousand in London as a whole, I mean, it's unbelievably high. And so it's critical, you know, this report is really critical. I do notice that the data is coming from like 2020, 2021, it's quite old data. So we haven't got the most up-to-date data. So that would be really welcome, you know. So we've also got the second highest rate of deaths in 2021, the second highest rate of deaths due to alcohol-related conditions in London and the second highest rate of alcohol-related hospital emissions in London. And, you know, that's incredibly worrying, you know, that we are so high. And, as I said, the data is old as well, so it's not totally reliable. It would be good to have more updated information. And then, you know, the other very concerning thing is the child safeguarding, you know, 51 children per thousand, children, eight, not seven living households where there's a parent that has drug or alcohol problems. And that's a huge amount, you know, that's Islington. And so it's really critical. I remember, you know, we were trying to go wrap round care for children in that situation. And I just wondered if you could give us any information on that, you know, because we wanted to sort of really look after those children to make sure that they didn't go into problems when they got older. I just wondered if you've got information on that as well. I might not be the best person to speak about children's social care services. From the drug and alcohol treatment perspective, we, Commissioner, are provided to run a offering family service, which they do. So that's the beneficiaries of that service or anyone who's affected by anyone else's drug and alcohol use. We have a young people service for young people who might be using drug or alcohol. And we know that parental or other familial use of drugs and alcohol is a risk factor for that in children, young people. So there are safeguarding considerations around that when seeing young people in the service or then. But in terms of the safeguarding around children specifically who are affected by drug or alcohol use, I am not the best officer to address those questions. I'm afraid, sorry, it's not services that I work with directly in public health. It's not ones that we can commission, perhaps that's something that we can take away and bring you some information on. Well, we're interested to know who does look after that side of things and it would make sense for you in public health to be liaising those people. Yes, yes, with children services, yes, absolutely. And certainly the service, if they do identify that there are children in the household, if there are family members who may be at risk, due to somebody's drug or alcohol use, then they are absolutely plugged in with those services and absolutely made those referrals. Yes, definitely. I'm speaking more as a, I suppose I'm here in my capacity as a commissioner of drug and alcohol services, but not the commissioner of those child services, that's what I meant to get across. But the services are by all means, link together, yes, absolutely. So, what about the question, you know, the rather frightening statistics about this instance position? Yeah, so what I will say around that data is that they are model estimates. Model estimates, the way that, and the way that this data has been prepared, it's quite a sophisticated technique that's been used, looking at lots of different data sources and bringing them together. When you do that kind of, when you follow that kind of methodology over quite small geographies, which London boroughs are in the context of this kind of work, there is the potential for inaccuracies to creep in. And whilst I would be confident that Islington's drug and alcohol use is high, relative to other London boroughs or, you know, other regions perhaps, I'm not sure that I would say absolutely with confidence that we are the highest and that it is indeed possible to differentiate those kind of margins between boroughs where levels of use are probably quite similar. So, I would support that drug and alcohol use here is probably high. I think it's probably comparable to boroughs who have a similar geography, and indeed we're quite similar really to a lot of our neighbours, whether I would say necessarily that we are absolutely the highest. I'm not sure that you could really make that judgement based on my understanding of the data and how it's been derived. But that is not to say that we don't have high level of need and we're really attempting to respond to that in the way that we are providing our services. You mentioned alcohol as well and high levels of admission due to alcohol-related conditions and deaths. That's why we want to do a deep drug and to alcohol-related health needs this year and that piece of work is forthcoming. We've done a local area profile committee's assessment around drug use and now we need to do the comparative piece of work around alcohol and some of those issues where we're going to draw out. As I mentioned we're trying to improve our pathways into drug and alcohol treatment from healthcare services and if we are an area that has high levels of presentation with alcohol-related conditions then we really need to step it up when it comes to being able to link people who are presenting with alcohol-related conditions to the treatment services that can help them with their alcohol use. Which the hospital is not necessarily the best place to do. It's about linking people to the community services. Thank you. Pleasure. Thank you. Are you happy or the question will do? Yeah, I'm happy. I take the data. I take it, we'll probably get more updated. Yes, absolutely. There's always a time lag and the data that you see there is actually the first prevalence. Prevalence estimates that we've received in I think seven years. It takes a really long time to pull that data together and the data that we do have which is more reliable and much more current is around access to treatment. So we get our numbers of people accessing treatment services. We get the numbers of people who are completing treatment successfully and that we feel that we can track and monitor much more closely because those are the services that we commission directly. So looking at those, there are numbers of people who are accessing support. We find is a really helpful measure for letting them know how the services are doing and how many people they're reaching. Thank you. So I'm just going to ask you a question about drug checking services, whether or not that's something that we as a council are lobbying for permission for and just a bit of context that's the opportunity for anyone to test the drugs that they've been, they've bought to see actually whether they are, whether they what they bought or there's something much nastier and it's kind of approach to help enable harm reduction in services. It's not something that we're lobbying for here. I think Bristol isn't it where a lot of that work is taking place. The work that we are doing to try and reduce the overdose risk is more around the harm reduction advice. It is issuing the locks own trying to understand if, as I mentioned, the piece of research you want to do is try and understand that that is having an impact and practice and trying to connect people to as many people to advice and services as possible. I think drug checking and its effectiveness, it remains to be seen. I think the program in Bristol is in its fairly early stages and I would want to feel assured that the people who are using that service are the same people who are at highest risk and I think that would help me understand whether I feel that that service is going to make a difference to the people who are most vulnerable and at greatest risk of overdose. The service in Bristol is pretty much its infancy but I know perhaps a bit more to that from the Netherlands and I was wondering whether we might be looking at a broader kind of evidence base for whether or not this kind of services is making an impact as well. I think it is good to take a broader view and to see what is working in different contexts definitely but something I would say about drug and alcohol use and services and interventions is that they are very context specific. So we would have to feel assured that drug taking practices in our contexts are sufficiently similar to those where those interventions have been taken place and have been applied. We have a lot of comparisons with approaches taken in the states and in Canada but the whole economy and social situation around drug and alcohol use in different environments can really influence what interventions we might apply. So absolutely yes we ought to be taking a broader view but we must consider whether there can be effective in an interesting context. What I observe on the streets visiting town is that people who are looking for drugs they are really desperate and I can't imagine them receiving their drugs and then going I must still get these drugs tested. I just can't imagine that because you can see the desperation it is right there on the streets and so the thing that I would hope is that our services that people get into them and then they get help with getting decent methadone and they get substitute drugs. That would be the pathway that I would like to see. The people who are getting help and I don't actually see it very realistic the drug testing idea. Yeah I have some sympathy with that and I think that's why we would want to understand before applying any kind of new intervention is this actually going to reach the people who need it most and on the people with really high levels of need and maybe desperate situation. Something that we have realised through our community of practice in its early stages is that some of our accommodation providers for example and some of our street outreach workers weren't aware that our drug treatment provider will offer same day assessment and same day prescribing for people where it's appropriate and through setting up that community of practice we've been able to improve awareness across some of the front facing services who work with these residents who have the greatest need. That same day assessment, same day prescribing is available and that's just through that partnership working we felt connect some people to that immediate treatment when they end up just because prescribing is one intervention it's not the bill and end up but as you highlight if people are in a particularly acute situation there getting that first assessment that prescription can help them stabilise and then engage with a longer term or substantial treatment offer so it's a really valuable part of the service. Thank you. So when you work with other kind of teams, so when I was reading through this I was thinking about working through, working with our housing partners and tenancy services, is there that good sort of working relationship because I think again when we're on the doorstep you know we're talking to a lot of residents who are either talking about the person next door who's you know I don't know anti-social behaviour etc etc you know and sometimes you want to sort of say well actually there are services if it's your neighbour you could be helping but actually you know we as councillors could be going to tenancy services and saying actually you know that the girl at 66 probably needs some help but I have never got a response back from anybody that has said actually we have referred them which is really interesting that you know we talk about the anti-social behaviour and mediation on you know all of the things that we can do to make things stop but I've never heard another team talk about the things that we can do to help Okay so we certainly do we certainly have forged really good connections with our providers of supported accommodation of temporary accommodation perhaps less so with our with our general housing providers perhaps and that that is something that we perhaps ought to do more about in terms of anti-social behaviour in the drug and alcohol element in some of those cases I was invited to speak to the policy and perform a scrutiny committee as part of their long investigation into anti-social behaviour and they were really interested to hear about the partnership relationships that service has but I think perhaps greater visibility in more connections with our general housing providers is something that we can look at Yeah because I think most of our you know state champions etc you know the state champions who know all of the things that are going on and you know where help could be provided because it's you know it's all currently so negative it's about stopping somebody rather than helping them and I just think I think you know some of the stuff that you outlined is like amazing and actually we could get people in more help but it needs to be more people helping doesn't it? Yes and greater awareness of the types of help that are available and how all my access it yes absolutely yes we are developing a communication and engagement strategy and yes that definitely will work into that but yeah yeah thank you thank you Hey guys I just want to pick up Casa Hamdash's point about the new sort of drugs that are coming out you know these I can't remember what you described what do you call them what synthetic that's it yeah you know that that's quite frightening isn't it that so we need to be always we always need to be sort of updating our services to deal with those things yeah yes no absolutely and the services is very good at keeping keeping themselves up to date and we get that guidance is issued nationally around new and emerging risks and all the services are very aware of those risks yes it is very concerning and this is one of the reasons why we're so keen to improve access to the service and outreach they're providing so even if somebody is not ready to you know start interrupt treatment we still have people out there who are able to advise about emerging risk you know be careful etc so yes having those opportunities to offer more people advice in a broader range of context even if they're not you know ready to engage with treatment that feels really important one of the things we're investing in this year is more peer-led work and more peer champions within the treatment service and again that's about improving those relationships and talking to a broader range of people so that we can share that kind of advice I think it's good news about winter and alcohol treatment now I'm just wondering about the just as I suppose this data or is there work going along the lines of people drifting in and out of prison with drug and alcohol is it would that be your remit or is that more wider sort of yes it depends what you mean we've definitely done a lot to try and improve the pathway from for people who leave prison with drug and alcohol needs improving their access to continuing that that treatment in the community and actually that's it that's a really key metric in the national strategy is improving those rates of continuity of care between prison and community services that's something that we've done an awful lot of work on and are really pleased she says touching with that our continuity of care rates are shown marked improvement in the last two quarters compared to where they were before we started investing in these pathways so yes thank you very thanks for coming here and really good to thank you my pleasure thanks for your questions thank you thank you item 13 is not here and is in the apology there's nothing to update from that now I think today is I'm going to go there next meeting there's no question there's a question I'll sort of come back to the minutes on the minutes about the hubs the free hubs that we're setting up in the borough we had to put a presentation at last meeting regarding the hubs I don't know if it was a misprint or it said the one in the north of the borough would be June 2025 it would be opening up would it be as late as that because the others are already premises that's quite a long way because I mean long wait for the others are set up ready so it's kind of concerning you want me to ask the question to the joint to give for it okay I can't say anything about yeah I think we can say as our older team they're doing fantastic job nodalize the chief executive doing fantastic job protecting our other people protecting a busy or new job we can say this kind of thing and also our officers they're doing fantastic job we can say and we are helping that we say thank you to everyone other than anything else yeah the meeting in the next meeting I think is the element of June and this meeting is important to we finalize our recommendation and everything and this year this is the next next meeting is the last meeting for next year and then we can choose that new topic and everything okay they are being no further business I declare this meeting closed this is time 10 to 10 many thanks I'm really happy to finish I'm really sorry I'm coughing I'm really sorry because it's nothing to do but visible the weather change [BLANKAUDIO]
Transcript
a slight delay to starting the meeting. I'm Councillor Ji-Ranichoudri and I'm chairing tonight meeting. Please note that we are not expecting a fire alarm test this evening, so if the alarm is sounded, please follow my instruction and evacuate the building. This meeting is being webcast to allow those who cannot attend in person to follow the proceedings. Please, could I ask you to turn on your microphone when invited to speak and to remember to turn off your microphone when you have finished speaking. Please, could Committee Member and Officer introduce themselves starting on my right, Councillor.
- Joseph Croft, Councillor for St Mary's, and James's, and Vice Chair of this Committee.
- Finn Craig, Councillor Frost, and Ward.
- Councillor Trisha Clark, Teffler Park, Ward.
- John Spencer, Chief Operating Officer at Moorfields.
- Good evening, Sheila Adam, Chief Nurse at Moorfields.
- Clothes Ammit, Councillor for Holloway Ward.
- Councillor McKewill, Gunford, Tollington Ward.
- Councillor Bly, Hamdash, Harby Ward, and I'm substituting the Council, Caroline Russell.
- Thank you, John, please.
- John, have you sent a letter of Adderal Social Care?
- Victorian Esther Deputy Director of Adderal Social Care.
- Hi, Miriam Bullockers, Assistant Director of Public Health.
- Thank you, thank you.
- We have received apology from Councillor Russell, but substitute, Councillor Bernal ditz, and also I receive an apology from Councillor Baz's. Declash, are there any declasional interests? Can we agree the minutes of the previous meeting?
- Yeah.
- Thank you, thank you. Chair Repur, I would like to welcome you all tonight meeting. Please, can presentation be kept to the point so committee member can focus on asking questions? Public question, we'll consider any question from the public after each agenda items. Sorry, just I'm coughing. Tonight we welcome Sheila Adams, Chief Nars, and John Spencer, chief operating officer from Morfield, I hospital. Item 8, Morfield, I hospital, performance report, please.
- Thank you very much everyone, and good evening.
I'm going to start, and we're going to focus on quality elements
for our presentation at first,
and then John's going to pick up on performance
and the oral building as we move on.
I don't intend to go through slide by slide.
I recognize that you've all had the slides in advance,
and we'll have a major reference to them.
I would just like to draw the committee's attention to our new website.
It's very new, and we're proud of it because it meets
AA accessibility ratings and is one of the things
that we've been wanting to do for some time.
So please do have a look, should you feel inclined.
I would then like to just take you down to our patient-led assessments
of the care environment.
You may or may not be aware of these.
They're something that was introduced a number of years ago,
but they are patients themselves, lead these,
and although we don't always score well in items like food,
for instance, on the ward, we do better than we had hoped
and expected in terms of dementia care and condition.
So once again, we are grateful to our patients
who help us to do that work and to improve.
Another area I'd just like to draw your attention to is that we are using our data,
our anonymized data around patients who attend the organization
to look at areas of health inequalities and population health.
And if you look on slide six, one of the ways that we are doing that
is to understand why patients don't attend their appointments.
And we've been looking at different groups to see which groups are particularly
unlikely to attend or to DNA as we term it.
And in fact, what's of interest is that neither ethnicity nor deprivation
background tend to increase the likelihood of DNA, but age does.
And so the older our patients are, the more likely it is that they'll find it difficult to attend.
And so we started to put some initiatives in place such as early calls.
We'd also like to talk to you a little bit about the single point of access.
John's going to talk in a little bit more detail about the model of care around that.
But basically what this is, is any referral, any ophthalmic referral that comes in
across North Central London is made to one particular place,
one electronic referral system.
And we can then divvy out the care that each patient requires according to different elements.
And some of these will be around the length of the waiting list.
Some of these will be around distance, so how close it is to the patients.
And we brought all that data in and use it to work out what would be the best pathway for each of the patient.
The patient choice comes into it, and one of the good things about it is that it does offer
significant levels of patient choice as well as a much more effective patient pathway.
What we can also do with that is use the information that we have as part of that to identify where our referrals are coming from.
And when we plot that against a deprivation map, we can see where there are areas of increased need or low levels of referral.
We can then start to investigate whether that's due to the fact that there, for instance, isn't an optometrist or an optician close by,
or whether it's the fact that the population themselves might need additional education or outreach in terms of that.
So that's one of the ways that we are hoping to improve improvement as we move forward on this.
If we move on down through that, there's some examples on slide eight of the types of education that we give for referring optometrists.
Again, I won't go into detail, but if anyone would like to know more, then please do ask.
And then on slide nine, I can see the slides are having trouble keeping up with me.
I'm so sorry. Well, I'd say keep going. Keep moving on down.
So the title is digital twins, the one I'm on at the moment, although I've just passed improved. There you go. That's the one.
So digital twin is a simulation tool. We can look at all the data of patient referrals and then use it to work out if you like,
which element of a referral would give the patient the best alternative for their clinic appointment.
And you can see if you look at the slides that patient preference, for instance, can be brought into the model and then we can look at whether that impacts or not on the speed of patient accessing an appointment.
And we then have also used some of that learning and made some surveys of patients to ask them what particularly would influence their choice.
And so if you move to the next slide, which is called using ERS to support patient choice, you can then see that when we sampled 50 patients, we asked them what it was that would particularly influence their choice for cataract surgery.
And of these 36% of patients continued with the first choice that they had been offered by their optometrist referral, but there were a number of other important variables for them.
And these were not always about choosing the shortest waiting times, but might be about accessing expertise. So, for instance, choosing more fields over another offer.
And so we can understand better how patients feel about accessing the services that they need.
And if we move on to slide 11, one of the other areas I talked about was the need to increase education. So this slide is our invoice program and pictured our Dr Roxanne Crossby Nuebi and Tandi Gwen here, who were leading this program.
What it is is an education program for social care staff, and we invite them in to give them skills in terms of understanding eye care, but also eye health.
And the ability of the staff then to protect the patients that they care for, particularly the vulnerable patients, can be improved.
And we see an increase in confidence around things like eye drop installation and managing monitoring of vision.
So that's another element. We've run three cohorts of this is for Ryan boys, including over 100 care staff.
If we move on to slide 12, which is labeled our quality priorities for 2425.
And we have just shared the quality priorities, which will be coming to you, I believe, for the quality account sign.
There are a number of new quality priorities this year, and some of them have been chosen, particularly by our patients who have been consulted on these, and that includes things like improving experience of patients, requiring transport.
If we move on then to the next slide, which is staff survey results, and we just wanted to share with you that we've had a greatly improved engagement this year by our staff in completing the staff survey.
66% of our staff took the chance to tell us how they felt, and we have improved overall against six of the themes, and maintained our position against two of the themes, and deteriorated just slightly against one of the themes, which is about having a voice that counts.
And so some of our work is particularly around shared decision making with staff and staff engagement overall.
If we move on to the slide on equality, diversity, and inclusion, these are areas of a particular importance to us.
Around 51% of our staff are from a BME background, and we have been working on actual plans to improve the level of inclusion that staff feel.
And to include, to improve our performance against DES and RES equality standards.
And so these are the work streams that we've got in place at the moment.
Again, we are particularly keen to make sure that staff feel that we are working hard on this.
If we move on to the next slide, learning disability and autism training, some of you may be aware of this as Oliver McGowan training.
It's received quite a lot of press, but more fields has always been well ahead of the game on this, and we've been giving staff learning disability and autism training for a number of years.
We have about 90% of our staff overall who are trained in this.
And so we'll continue to work towards the Oliver McGowan level of standards, which includes a two-tier approach.
And I think that's it from me.
So I'll hand over to John for the pathway.
Thanks very much, Sheila.
So higher up the slide, I wouldn't propose you to go to it, but higher up the deck talks about performance.
And we're meeting standards such as the A&E performance target and diagnostic target and cancer target.
But the one that we've seen, and we've got, we've met those last year, the one we're seeing most improvements on this year is the elective target for the number of proportion of patients that have been treated within 18 weeks.
And we're up to about 83% against a 92% standard, which still sounds like we've got some way to go, and we have, but it proportionately compared to, I think, most about, and it's just provided as we're in a better place.
And the reason for that is really is this model of care, which we help to develop within more fields, but we've now managed to gain regional and national agreement that this is the model of care to follow.
And so really what we're seeking to do here is to have this assessment process that Sheila described, so that we channel all referrals through a single front door and provide a couple of levels of clinical triage so that we really make sure patients are directed to the point of care
that really most suits their requirements, and in some cases quite a number of cases don't need to enter into a hospital service.
And we're really sort of structuring both the back part of our service and then the subsequent treatment options for the patients really around this model of care and monitoring how well we can manage patients effectively in different points of the pathway
and where we need to develop services in order to continue that sort of improvement in this model of care.
So moving on to the next slide, I think we've probably rehearsed before, a significant outpatient specialty, anything we do to help manage patients either virtually or to give them options to allow their conditions to be managed at home.
And really will have quite a big impact on the pressure that we're seeing within hospital services, and will give patients much better outcomes at much higher volumes.
This service was a service that we developed, which is one to the next side.
We've got a 10 to 10 anywhere service which we developed which allows patients to attend A&E virtually so they can have a triage rather than coming in physically into an A&E.
And that shows that about 20% of the patients who use this service are advised to attend in that day, but a significant portion either can come in later in the week or don't need to come into hospital at all.
And we're now seeing a decent portion of about 20% of our patients who are accessing our services through this digital route.
We've still got face-to-face services available for those that are digitally excluded from such a service or wish to attend in person, but it's very much there for those that choose to use it and it has good success ratings.
We're starting to think about the benefits that our virtual services provide and we can see on the next slide the sort of saving we're getting in terms of CO2 emissions.
And generally, I think it's just pretending to be preventing trial necessary travel around London.
We've gone to the next slide.
This is the single point of access that she was describing and we're very keen to be commissioned to run this single point of access certainly with an NCL and that's sort of subject to a current tender.
But eventually across London, because we believe that we've developed a model which will allow us to provide that full package for commissioners so that they can work out how to provide services and make sure that patients are directed to the right place.
And the education is provided back to the referrer to a point out where referrals went optimal to help and learn for the future, how they may be amended.
We've just gone to the next slide. We're starting to monitor a number of benefits at the single point of access.
Our triage time is right down from previously 11 days down to one so that emergency patients can be picked up within a matter of hours and directed on to really urgent services where there's potential threat of them losing their site.
But we're also starting to see a number of other other benefits in terms of quality of the referral and making sure that it ends up in the correct place.
And really, as Sheila said, bringing patient choice much more to the front of the pathway to the patients have got actual choice in where they wish to be seen based on a number of criteria.
Next slide shows our diagnostic hubs and the proportion of patients in the top bar that are able to be retained from the left to the right within a diagnostic hub setting so that they don't need to attend the hospital itself.
They can be managed and they're much shorter pathway of around 40 or 40 minutes as opposed to having to go and sit in an outpatient setting for a number of hours waiting for a series of tests.
And this is something we're going to keep monitoring to sort of increase the proportion of patients that we can support through a diagnostic hub.
We're starting to look at other specialties other than MR and glaucoma where we started this to see what the answer to the possible is across our entire sort of care portfolio.
Just on the next slide, our Royal Centre is really coming out to the ground now so if you go to the Altson Pancras Hospital site we're up to about level two now it's visibly rising out to the ground and we anticipate this was breaking ground in the picture,
but we anticipate getting to our topping out ceremony by December this year and then we'll have a couple of years to develop the interior so that we're on track to open in late late 27.
So very exciting and it's becoming a reality now from sort of concepts as was a couple of years ago.
But we're not just focused on our on the next slide.
You can see the presence that we've got across London and to Bedford so we continue to refine our site strategy and focusing on both the improvements at the state where we're committed to staying on the site but also I think working out where patient
flows aren't optimal for patients.
And so when you go on to the next slide and we've got two examples of where we've opened new premises.
So at Brent Cross we've opened a longer sort of more permanent centre at Brent Cross which replaces the old centre which will provide diagnostic support patients in this region and quite significant volumes.
And then on the next slide and we've opened a hub at Stratford and which is much more than diagnostic also provides surgery which is a benefit for NCL patients because it frees up capacity as an unsight so that and northeast patients can receive their surgery in the northeast.
This is a model that we probably envisage more of in the future where we start to condense a smaller number of sites into a single centre so offer a full ophthalmology treatment option for patients so that they don't have to travel out of area to receive their surgery.
And when we combine that with the diagnostics we're starting to work through the proportion of patients that we can treat locally versus having to bring into the centre of London to receive specialist care as our real.
I'm very happy to pause there. Just welcome any questions that any members may have.
Thank you very much so and we're very very lucky you know in Edmonton we've had more fills on our doorstep and I've used it twice about 12 years ago my granddaughter going into A&E and having something removed from her eye and then a couple of weeks ago I went in in great discomfort because I had something in my eye and I tried drops and everything and I got in it was empty in A&E and I was really lucky I got through triage really quickly
and I got actually got an eyelash in my eye got it removed but I got the impression that I wouldn't have been you know I was especially treated as treated especially well but you know in other circumstances it's been crowded I wouldn't have been a priority you know within I don't know if you clarify that but I mean treat I had an absolute ex and experience those times and so the other question is
you know when we go to Ariel in King's Cross will we have the similar sort of facilities to A&E to drop in and for those sort of you know not really emergency but you know just really discomfort.
So in answer to your question yes the facilities from an emergency point of view are at least like the like and the capacity is slightly greater in Ariel limit is at City Road and actually our clinicians have worked with patients to help us design our emergency flow within the new centre such that hopefully it's an improvement for patient experience on the current
Our current facility isn't ideal it's not fit for purpose and were it not for the digital innovations that we put it in prior to COVID we did have significant volumes of patients waiting for their treatment it's a bit better now because as I say sort of 20% of patients access
us online and but we hope that the aural facility will provide a better patient experience and better, better flow I don't know if you want to. Well I was just going to say first of all I'm very glad to hear you did get excellent care and it does hugely depend on timing as to how busy the A&E is we do intend to provide as good if not I think better services when we move to aural
but if if your need is there then then you would be seen whether you had to wait slightly longer in busy times or not.
So I just have three quickies one where does up on Western up home at 15 because I see you are not in Westminster and there's a couple of boroughs around there that I think might just be Western up family but wasn't sure how that fits with the bigger picture.
Second when you look at patient choice was there a preferred location that was sort of coming up because I would imagine a lot of people want to go to more fields.
And my third of more selfish one I'm nearly 60 I'm starting to see the 80% of over 60s live with sight loss. What's what's the sort of breadth of that way does it include just wearing glasses.
Should I take the last one first yes that that includes a range of sight impairment from from that that kind of thing all the way up to a macular degeneration and other you know difficult things but but yes that's correct.
Well, well it does it does make thing it makes life more difficult doesn't it.
Do you want to answer the others.
So I think when you look at the number of some so we provided about half of the I care for London so in each in each ICB that we're apart from southeast we've got a presence in the other four ICBs and we do about 20% of the work for south east from
east or from city road. So that's where we get to the 50% but in each most ICBs we have a significant other provider of health care from the NHS so be at the western eye in the west be it.
Bart's embarking here in a red bridge in the east and so we try and work in partnership with those NHS providers and the single point of access is a good example of where we are not looking to take over all the referrals we are providing a service that then gives the patient choice between the different
offerings that are relatable really so and so yeah I think the NHS is working in a much more collegiate way and post COVID and we provided mutual aid for a number of patients from other trusts and we are absolutely seeking to give patients choice and to work in partnership with the providers so hopefully that
covers the first question.
So the single point of access is interesting because I think what we're trying to do is give sort of five options for the for the patient and so and we're really assessing the reasons that the patients are choosing.
And we assumed distance would be a key factor but actually it is in some cases but not in all cases and it depends on the patient depends on their condition, some want the ease of access because they work in the day and others I think much more go off brand you know the variety of reasons.
No, no, no, we absolutely, you know, it's we're not looking to gain market share out of the single point of access we're looking to provide a service for London bring consistency of referral provide education to the referrers and make sure the patients have genuine choice and there's that's available for them and the waiting times and various other success criteria are there for patients to have informed choice.
Some 45 minutes, which is very good PR because we were set for a five to six hour way if you're out in under an hour that feels like a win.
Sounds like a cunning plan.
Great, thank you, just a couple questions of me for me. The ion for programs is really positive and it kind of talks about engaging with staff in care homes.
I'm just wondering whether this program reaches out to other types of social care staff, whether that's agency or other groups.
We don't really differentiate if if their staff who are regular say said they're regularly used by one particular care home and the care home feels that it's appropriate for them to come on our course then, then they they would have a place.
I was just going to add that we also offer the ion voice course to some community staff as well.
And I guess just taking more broadly about social care. And if there was one thing that you could do to improve the relationship between isn't in council and a more fields to make, you know, caring for instance community better what what would it be.
I think access to a range of social care staff who we could work with. I think a more collaborative working relationship has been really, really beneficial on a slightly lesser note.
And we're very grateful to council of wolf who mended the pavements for us because we'd had a number of our patients actually trip on on the way over.
But I think on the whole this is it's about having a collaborative working relationship with with social care staff particularly.
And there's great report. Thank you. And I, and I love that the care of what you're doing kind of comes through in in all of the presentation.
So I wanted to ask, I've just got a couple of quick questions. The patient led assessments is really interested in just wondering sort of how many you sort of did.
And then also I missed a start at the beginning, which was when you were saying about as people get older, they don't turn up for their appointments and just wanted you to remind me of how many that was just because I'm thinking about that more broadly
and what do we do before, you know, like the aging population. And yeah, I think that's it.
Thank you.
Then you'll see that variations in all outpatient appointment outcomes against age, you can then see that for each age group, you can get a sense of the number of appointments made but then the number of patient cancellations.
And the, the, the older the age group, the greater the number of patient cancellations, which again does make sense, but it's useful to see it. So, so 28% in greater than 85 years.
So that was that one. And then place assessments, I think.
So these are done on an annual basis and we choose three different sites out of all of our sites.
So this year we did city road sintans, and I'm just trying to remember whether it was Stratford or Stratford as well.
And so Stratford and St. George's.
And what we do is there's a group of about three patients and our infection control matrix and our state's team, and we go with a quite lengthy checklist.
And each of those categories that you see cleanliness food, each has a lengthy checklist.
And we look at each of the sites and, and compare what the checklist says there ought to be in the way of a standard.
So, for instance, in the dementia category, the fact that the, the differential between.
I don't know why I've chosen a loo seats, but, but the loo seat is dark and the rest of the loo is white.
And that's, that's a really important differential. So, so patients are aware of that.
So, so there are all sorts of things that we would then check against.
And the patients themselves have to agree that we meet the standard required rather than anything else.
So it's just the small numbers.
In terms of numbers of sites, yes.
Oh, number of patients? Yeah, it's, it's just three patients who come around and do the assessments with us.
And in fact, some of them are our governors.
Okay.
I'll say you again.
Yeah, just the, the new sort of hubs in Stratford, Broadway.
And you mentioned others places.
So, I think kind of walking centers. Can people just walk in there?
Not, not a present, but part of our expansion of our emergency model.
And it's something that, that is something that we're looking at.
So we're considering whether we would have a small number of bookable slots.
So that if patients contacted our attend anywhere service and it was appropriate,
they could come to one of those centers the next day to be seen,
rather than coming to our own in the middle of the night.
So that's something we're looking at in quite a limited manner for emergency patients.
Thank you. Any more questions?
Thank you. Just one thing to clarification.
The consultant actually asked the question that older people can solution is more due to transportation or due to lack of social service support.
Because you said older people get lots of consolidation from the older people.
I'm really sorry, but due to the coughing, I couldn't quite.
I'm sorry.
Would you mind repeating the question?
You know, the consultant asked the question about the older people.
The consolidation of the older people here also.
The reason behind because of the transport problem issue is transport or,
because the older people may not, may need support from the Kerala, may need support from something.
Yeah, I mean, there are multiple reasons.
What reason do you think about it?
So I can't give you absolutes because we didn't actually delve down that deep into the data.
I think transport infrequently, of course, sometimes it's late arrival because of transport, but rarely is it no arrival.
But I think the tendency is that it's sometimes just not being well enough to come.
Or as you say, that the carer or your family members aren't available in order to support you.
So.
So when you, when the oral sites up and running, and you'll be in Camden, so you won't be coming to this committee anyway, you'll be going to Camden.
So, so we'll have a, our presence at Hoxton will remain.
We're committed at the Hoxton diagnostic center until about 2030, I think, at present.
And then we would think about whether to renew that lease or move to an alternative premises.
But I think that's probably the only space in, in, in the vicinity here.
Thank you.
Any, any other questions?
Okay. Thank you.
Thank you.
Many thanks for coming to give us here with us.
Thank you.
Thank you.
This item nine, scooting review evidence review, adult social care, front door, Victoria and John, please come.
Thank you.
Sure.
Yeah.
So, as we draw to a conclusion of this year's screeching review, the purpose of the session today is to.
Try and provide a bit of a summary of the journey that hopefully we've taken on taking you on over the last few months.
With Victoria describing some of the impact of that work and the next steps in taking those developments.
So, if we remind ourselves of the purpose of the scrutiny review, as articulated in the review documentation, what we wanted to consider was how residents are able to access in this case, adult social, the adult social care front door.
So, if we go to the first slide, what we, what hopefully you've heard as we've gone through the process is back in November 22.
There was a real recognition that actually what was in place wasn't doing everything it needed to do to ensure that residents were getting a good experience.
Both in terms of accessing by telephone, but also by email and by letter. So, there were lots of indicators for us that things weren't working as well as they should do.
And a reflection of where that might, where some of those problems might have been, were linked to where it sat within the organization.
So, there were a number of actions that we took over that time to try and address those problems.
So, the move to online referral forms, as we know, a lot of the activity that we've got comes from professionals rather than individuals.
So, trying to streamline those sorts of things, making sure that we had referral forms that were really clear and easy for professionals to use and provided the right amount of information and data to help make quick decisions.
Because actually what we noticed were people were being inundated with very random information that then had to be followed up by telephone call to find out what actually was being asked for.
Some of those really big backlogs were reduced quite quickly by introducing some of those things.
So, some of the big backlogs there that you'll see that we talked to.
But I think really importantly the shift for the access of the front door service moving back into adult social care, where we would have more of an opportunity to make sure the staff were allowing to the service that they were developing and evolving and training development with adult social care felt really important.
And so that happened in August last year. Another really important thing, and the Councillors, you've raised that quite rightly, was some of the issues around the telephony and introducing a new telephony system that actually meant we could keep an eye on.
And Victoria, again, we'll talk to this a little bit, keep an eye on the numbers of people coming through how long they're waiting, the drop-off rates, all of those sorts of things, but it was really important.
And making sure you've got the right systems in place to manage the front door of your service is very much particularly when it's phone based, in this case, reliant on having a good system in place.
We talked about the staff moving across a really clear training and development program was put in place, and actually what we started to develop in the winter of 23, 24 was actually how we bring health and care staff, some of our housing staff together
to start to really take forward that idea of solving people's problems at the first point of contact.
Actually, what we should see is the majority of people actually having that problem solved, rather than actually having to be pulled into services and having huge assessments of the care and support.
And quite often, given the very high threshold, you need for adult social care, people wouldn't be eligible for that.
So solving problems was really key, and making sure that we had an integrated front door that was fit for purpose going forward, again, connected to what we were developing across Islington Borough Partnership.
So with our mental health colleagues, with our primary care colleagues, with our community health colleagues, voluntary sector partners.
So bringing all that together into one space, connecting it with some of our rapid response services, and then thinking about it in the longer term.
Actually, we've got really complicated needs.
How do we make sure that we respond to that?
Not part of the front door, but actually it's making sure that everything fits together.
If we go to the, not the next slide, two slides forward, and the next one, that one.
I'll hand you over to Victoria, because I think what's been really important for me and to give me and hopefully your assurances, making sure that we've got a clear dashboard of where we're starting to see.
Performance dashboard improvements in the activity that we've got at the front door of services.
So Victoria's going to talk to you about that, but also the next steps in helping to evolve that.
Hopefully we'll tie in with some of the recommendations that we've been talking about, because actually this conversation has been really important, because you've had the opportunity to talk to partners and people who use services too, but Victoria, over to you.
Thanks, John. Thanks for setting the scene there as well.
So in terms of our front door performance data, we've obviously over this period of time, we've been looking at that.
We've been looking at ways that we can ensure that we've got the data to hand.
As John mentioned, the telephone, the new telephone system, the eight by eight cloud based system gives us much more information.
But first of all, our email backlog has reduced by 97%.
But alongside that reduction, we are now able to review and triage our emails much more efficiently dependent on the risk.
And dependent on risk, emails have responded to within 14 days.
So if there is a higher risk, we're responding on the day and we're able to do that now where previously that was really difficult for us to do, but we're able to identify that risk now.
That includes our safeguarding referrals as well.
We were struggling a little bit with our safeguarding referrals to identify those within an inbox, but we've now now that we've got the forms that allow us to do that.
We can readily do that.
It also means that we've had the ability to capture data about the service to make improvements and understand the demographics of our service users are the people that are contacting us.
So we've got much improved data as well through this system.
And we've also seen an increased quality of the referrals and appropriate use of the service. So historically, we might have had emails where someone's bins haven't been emptied or housing repairs.
And we would they would just be in the inbox with everything else, which really wasn't helpful for us.
It wasn't helpful for our resident because we weren't giving them the right response in the right time frame.
So working on this system, we've managed to achieve all of that.
And it's, you know, it really is quite phenomenal and it's remained steady as well.
We have very slight peaks and troughs that we will even out over time, but pretty much it's remaining steady.
We've removed and redirected unnecessary traffic from the service by an average of 28.5% per month.
So again, it's all those referrals that someone might have thought were for adult social care.
And they weren't. And so we've been able to move those out and make sure they're redirected in the right way.
And then we've got our core monitoring quality assurance framework.
So in February 2024, there were 289 phone calls to adult social, adult social care equating to an average of 14 calls per day.
The minimum wait time was zero seconds and the maximum wait time was 24 minutes.
The median wait time was zero seconds and the average wait time was one minute, 54 seconds.
75% of calls were answered in less than a minute.
So now we've got the data and we've seen improvements already.
We're now working on how do we use that data to make more improvements and improve those outcomes.
So, for example, we can now start to look at how we manage colleagues being available on the phone at peak time.
So we can start to judge when our peak time for phone calls are.
We can take some people off of those email inbox and move them over to the phones for that peak time and then move them back again.
Next slide, please. Thank you.
So our planned next steps.
So our streamlined triage process.
So implemented a tiered triage system to prioritise incoming requests based on urgency.
So we've already started that work through what we've done, but we're going to continue with that so we can really get good efficiency for our residents.
Assigned dedicated triage officers to ensure swift assessment and decision making.
And again, the reference I've already made is to flexing the time on the phones and the emails, depending on those peak demand times.
We're looking at scripting for our access workers to ensure consistency.
So I think one of the things that's come up is about consistency of response.
So how do we use a series of key questions that would be completed electronically by members of the team to guide the contact pathway.
So a bit like, not quite the same, but a bit like you would have if you call 999 and you're going through the triage questions.
Our access colleagues would be able to do that as well to really prioritise the work, but ensure some consistency and what we're asking and getting those responses that we need.
Enhanced communication channels, so this really is about whether we're using online phone, very, very rare now a letter, maybe a paper refer or comes through.
But thinking about how we really enhance those communication channels, so they are accessible as possible for people.
We're looking at establishing a dedicated helpline for non-urgent inquiries, so the main phone line can focus on urgent cases.
And we're looking at introducing a web chat feature for quick online assistance.
So again, we recognise it's not everyone's cup of tea to be doing that.
But on our website, can we have something where there's the option to be able to do that?
And if we can do that, can we then take it into a phone call at that point where we think we can't resolve the query?
Accessible online resources, so a redesign of the Adult Social Care website to be more user friendly with clear navigation and plain language.
And develop a knowledge base of frequently asked questions and self-help guides, so they would then be published on the website and people can self-serve as well.
So it would be much more accessible and they may be able to find out, hopefully, that information that they need without feeling like they need to pick up the phone.
And then standardised documentation, so create standardised assessment forms and templates for consistent record keeping.
Our character assessment is obviously standardised, but we've got some other forms that we need to standardise as well and implement electronic documentation to reduce paperwork and improve accessibility.
So where possible that we all have everything stored on the system?
It makes it much easier for our reporting.
It makes it much easier for consistency.
Next slide, please, Sammy. The Corporate Resident Experience Program.
So this slide is very, very technical. It's not actually my slide, it's come from Resident Experience Program.
So the Resident Experience programs have worked with us for a service review approach in Adult Social Care, and it's got three key phases to it, and it's split into the discovery and future state analysis, which we've already done.
We've worked with Resident Experience to do that, and now we're moving on to the business case development and design approved and implementation.
So this is the next part that Resident Experience as a whole are doing with their business cases to say how are we going to support the various directorates and departments through that.
Next slide, please. So further development technology and tools. So this is our aspirational work that we've worked with Resident Experience to start thinking about how can we do this?
Accessibility tools, so use of accessibility testing tools on the website to ensure the website is accessible to all residents, including those with disabilities.
So a bit like with more fields talking about, you know, if you've got a visually impairment, what works for you, but also some easy read language, or, you know, do we need to use pictures for people with cognitive impairment or learning disability?
Our feedback and survey tools to provide feedback and survey tools to collect feedback from residents about their service experiences and make improvements accordingly.
So the current time we have an annual feedback survey.
But to look at how do we do that on a more regular basis? So we're getting that feedback from our residents. We do have, obviously, we have various forums that we engage with residents, but is there something that we can do?
From a resident's point of view, a bit more quick and dirty immediately at the time that they receive in the service, so that we're not going back to them a year later and saying what was your experience like?
Online form builders to create user-friendly online forms for service requests for the feedback collection and other interactions. So again, very much thinking about the accessibility of this, but it's the technical knowledge and the software around building those forms.
Training and learning management systems to develop an online training modules to educate residents on using digital services effectively.
And the resident portal. So this one's really ambitious, but the potential option for residents to access their own records and make appointments with their social worker and communicate with the service.
And finally, desired outcomes and potential benefits. So we're looking for improved response times to residents, carers and professionals and reduced processing delays.
Enhanced the resident experience through accessible online content.
Efficient resource allocation due to streamline processes, for example, being able to monitor those phone calls and flexing colleagues across that time.
Enhanced overall resident experience with streamline communication and demonstrate a commitment to meeting resident needs efficiently and effectively.
And it will provide a more effective means for residents to access the support and services that they need.
That's it. Thank you. Thank you, Victoria and John. Yeah, I think we can start this customer. I think really nicely started the program to find out something conclusion is really nice. Thank you.
Consular. Sounds fantastic. And like that, everything should be so much better. So thank you.
Oh, yeah, thank you very much. Really good work. But I just want to raise this issue of the transition again, because there's no mention about in that report.
And it seems to be that a little bit of a vacuum. And so it'd be really good to know what you're going to be doing to improve the service for families or people moving from the young people services into adult social care.
Because one of the things that's come out of this scrutiny is the, there's a poor service going on for that particular group.
And you're doing a good job improving service generally for residents. That's one question. And the other question is, the other thing that's been raised, we've had residents in the scrutiny committee about the, the, the state of some of the companies running the dumbest care.
And I just, you know, so you're talking about the front door, but then once you've got through the front door, you've got to ensure that there's going to be really top quick care.
So, could you just give a little bit of an update on the companies that you're making up, maybe not dealing with anyone?
So in terms of transitions, I think, yeah, you're absolutely right. We haven't talked about transitions in this scrutiny review, because it's not part of the front door as we would describe it in terms of what the scrutiny review was designed to look at.
But I think what's really important, though, is to say that the recognition from this thing and having conversations, both with families of those children who may, over time, require further support as that young person moves into adulthood has absolutely been heard.
Those issues where, actually, that transition, if somebody is eligible to move into adult social care, and to people who thought you have to have incredibly high level of needs, and these are the people who've got very high needs.
I mean, across just has not been as robust as it should be.
So in conversation with and working with children services, because this isn't something that adult social care obviously can do on their own.
We have got a really clear program of work that has got additional resource attached to it, including additional capacity within both adults, children's and the program management team to support improvements along that journey.
And it's something that both the lead member for children services and adult services, a part of in terms of that conversation. And I think it would be an interesting piece of work for both children and adults scrutiny to potentially consider in more detail.
I don't know how that would operate in terms of joining up, but that could be something we could consider. And we can give some information about how it works connected to our front door.
But it's a really deep and wide piece of work that connects to a lot of things that our children services colleagues and family are doing already, but also importantly what we're doing to help smooth that pathway and prepare young people for adulthood.
So making sure that they have the same life chances as much as possible as any other young person. And I think there's always a risk that as children move through and become adults, so that isn't supported in the same way.
In regards to the quality framework that we've got around the providers that we use in Islington. So what I would I would hope, because actually there was a scrutiny review on this a couple of years ago, isn't there to look at domiciliary care providers.
And I think our local government association peer review that was carried out relatively recently found that we've got incredibly strong and incredibly strong infrastructure and making sure that we as a council are clear about the quality and consistency of the care that we provide.
There are always going to be individual and sadly individual cases where things don't work as robustly as they should do. And in those circumstances, we take the action that we need to take to ensure that the lessons from those alone in conjunction with the adult safeguarding board in Islington.
Islington's adult safeguarding board is chaired independently by Fiona Bateman. As you know, he comes to this scrutiny committee and her observations about the infrastructure that we've got as an independent person that we have strong robust arrangements in place that give assurance, not only to us as the council, but to that partnership that the people that we're supporting through our providers are of a high quality.
And I think there's triangulation of that with the care quality commission who have a statutory responsibility to ensure high quality care is provided across the country is the other evidence that we have that the providers that we work with are the providers that we should be working with.
I can provide you with the list of if you're talking about Thomas Hillary care that of those providers that are part of our new contract framework that I can pass to the to the chair that's all published now went through.
And we're beginning implementation of that with the new providers as we speak.
So it's a big piece of work that that reduces our spot contracting arrangements which sat very much in the gosh, how many was it probably 50 providers and reduces that right down to small call of providers in our localities in our three localities
that gives us much a much stronger working relationship with those providers and actually they will be seen as partners with us with our enablement service with the integrated teams that we're developing.
So hopefully that gives you some assurance in that respect.
And just John something that that I think we're all really proud of as well is the involvement, the co-production without residents around the procurement process for the home care providers.
You know, we were talking with our residents, we were involving them in that human process.
And it was certainly something that, you know, we're really proud of but was recognized by the LGA as well as an exception piece of work.
Thank you. Thank you. Can I just say it would be really welcome if you could have that list.
Okay, yeah, please say John because thank you.
Councillor.
Great. Thank you.
So really positive stuff about the front door service and kind of the improvements being made here.
I'm wondering whether in maybe not the first scope, the second scope, whether you think there's any opportunity to start referring to some of the wider kind of charity spaces thinking about people coming in with.
Part concerns or MS and maybe kind of signposting different services when they come to the door because I'm very conscious that when people have a range of opportunities to be supported, they do better.
Yeah, sure.
So one of the things that we've been really conscious of is that we have this very rich and diverse community front view sector partners across using term were really fortunate.
And it's quite a challenge for our frontline practitioners to really stay up to date with what's out there because things do change.
So we've got a number of things underway to support with that.
So we've got a central point of access where we will speak with people perhaps before they need adult social care, but they can move people over to us as well to support with that.
So they would link people up with that perhaps those more specialist organizations like Parkinson's.
Our practitioners themselves would be aware of, you know, all the major players, but can also, you know, access a directory of services.
And we've done a lot of promotion around that directory of services to make sure that our frontline practitioners can access that.
But they've all got again, it's about this message about consistency that they've all got access to the same information.
A directory is quite challenging to maintain. It can become a full time job with contact details and, you know, who's active and who's not.
But we wanted to make sure that we had that to provide that consistency.
I think I was just going, sorry, because I think you had a presentation, well, I know you had a presentation from SARS in regards to the access links and hubs.
And I think that work particularly is going to make sure that we start to really coordinate the responses in those local areas to very much picking up your points.
I did want to flag that.
Just a quick question and just to follow up, and I guess as our online offer became becomes more and more compelling with the opportunity here.
How do we make sure that those who aren't able to access online don't miss out on other opportunities to use things like direct mail or isn't in hubs to make sure that people can access the same opportunities that people who are online can as well.
Yeah, sure. So, so we look all the time up how we get those contacts into our service and primarily it's online or telephone.
So this was one of the things with the telephone access that we now that we've got a telephone system where we can check on what's happening.
This is where we can now flex where our colleagues are. So we get an awful lot of demand via email and we need to be on top of that so we're not missing things.
We've improved our efficiency around that and, you know, checking on when things are risky or high priority.
But it's given us the ability to check at those peak times when phone calls are made to us so we can flex colleagues over to cover the phones so that phones remain an option.
And then, in addition to that, we've got obviously the access is in some hubs not our existing that hubs that we will, you know, we are in regular communication.
They know how to contact us. So if people rock up to one of those hubs, then they can send that contact through to us on their behalf as well.
In addition to that, we've really developed, I would say, over the last year, much closer work in relationships with housing colleagues and a lot of people tend to come that room.
I think like you were saying earlier, Councillor Zamit, you know, we might people might not be self referring and actually they might be quite isolated, but housing colleagues are a great route into referral for us as well.
It was just a flag and I think which is something we should be proud of and then we talked about it here before, but when we did the Adult Social Care Survey this year, which is a national survey.
We saw an increase in the proportion of people who use services who find it easy to find information about services.
So we'd move from 63% the previous year to 70% this year, which although there's still room for improvement is still much higher than the London average, which is 65% and England average, which is 67%.
So it shows that I think people are reflecting back and telling us they're starting to see some of the differences, so hopefully, you know, it's a slice of an amendment in time, but I think it helps to give us an indication that things are improving.
Thank you.
Councillor Dermot.
Again, that was great and building on the conversation that we were talking about earlier.
I was surprised that only 2% actually kind of referred themselves.
So I think my next question is, is this like a lot of work that's been done in the process side and the efficiency side and the transformation and that's excellent.
And then John, you keep saying, like, you know, like you need to be at this particular threshold in order to get to adult social services.
I sort of, I wonder whether or not we need to do something whereby we put ourselves in the shoes of the resident and look at the forms that are being filled in and actually sort of remind ourselves kind of what that threshold actually is.
So I think, you know, our job is to talk to residents the whole time.
And actually, I'm not sure that I know what that threshold is all of the time.
And actually, when you talk about tenancy services, making referrals, like I know that we're probably all, you know, putting in casework and we know that some of that casework goes to tenancy services and they then make that recommendation.
But I think I don't think I'm sure of what that threshold is or what they're actually sort of filling in if that makes sense.
So I just wonder if there's a small piece of work that maybe needs to be done kind of with us, kind of outside of the scrutiny group, so that we're all kind of refreshed.
Or it might just be that this is like my first year on this committee and I just need to do a little bit more homework.
No, not at all.
I think it's a really important question.
It's not that straightforward in our last Victoria to come in really briefly.
And I think it's something that we can help scrutiny committee and members to understand more.
But when we talk about thresholds, I suppose there's a bit about making sure that those people who absolutely need adult social care, those people absolutely need it as a finite resource.
But on the other side of it too, we also have a duty to prevent reduced delay, the need for adult social care.
So there's a combination of things.
So when I'm talking about thresholds, I'm talking about actually protecting the relatively small amount of resource that we've got for those most vulnerable people in our communities, keeping them safe, keeping them independent, keeping them.
And we can talk about how we come to those sort of decisions, but actually more importantly in this incident, this is about promoting people's independence, making sure that they're healthy and happy in their lives.
What is it that we can do?
Because actually getting to adult social care isn't the best, that's not what you're aiming for, is it?
You're aiming to be living independently in your own home with your family, your friends, your networks around you, and staying as healthy as possible for as long as possible.
It's what we all want for ourselves and our family and parents.
I just add to that, I think when we were first elected in Children's Services, they did a kind of a user story for us.
This is Jack and this is what he needs and these are sort of the services.
So I think this review has been excellent in terms of looking at the processes and the transformation that you're going through and the stats are amazing.
But I almost wasn't aware of whether or not the next time we do a few things around kind of user cases.
This is John who might be experiencing this and then the surface that they go to or not as the case may be.
So it's just given me an idea because I was just thinking for the freshers fair, perhaps we should have some sort of pen profiles of people who are potentially our residents and their level of need and what we did to meet the need.
But also we've obviously got an eligibility criteria under the care act, which is our statutory legislation and that's what we assess people under.
So we could perhaps do, you know, a piece of work around that.
But like John says, the bit about the reduced delay prevent is really important.
So we would also alongside, you know, our accesses and hubs colleagues.
We've got our central point of access.
We've got our access team.
So it's really important that we sign post people out. If, you know, if they're referred to us and they're not eligible under the care act, it's, it's really important.
We sign post people to those other services that can support them so that we're working in that strengths based way to say what are those strengths around you.
What's that those networks around you that we can help you link into that you perhaps haven't got at the moment.
Yeah.
I just wanted to, I've asked this before, actually, because it is a topic that I'm really concerned about is, you know, if you've got someone that's receiving care at home, virtually, that might have a fall, then they're receiving full time care.
They're taking into care.
And I just wanted to, you know, the support to the families around the person that the Council are caring for, if you like.
I just wonder, the families, the level of support that they have throughout that sort of, because it's a big step.
As Mitchell mentioned, no, no one wants to go into care specifically, and some families face it very hard.
And also some family members might become ill themselves, but when they're looking after their loved ones, you know, so I just wonder what level support we have for the families.
So, we would always, when we're working with the person, we always look at who's around them, because we want to identify, you know, in that strengths based approach, we want to understand that network around them that's going to support them.
And then we would offer to have those conversations and do a care assessment with them, identify what their caring role is, how we support them with that.
We have options around providing care and support to the carer through us, but also we've got the carers hub, we can link them into.
Sometimes it might be advice about, you know, do you think you ought to speak to your GP, because it really sounds like emotionally you're struggling, you know, can you access some counseling services through the GP.
The carers hub provides some counseling services, it's time limited, but that might be somewhere we sign post people to.
And then, like you mentioned about the Parkinson's Charities, so if someone's got a very specific condition, it might be that we refer them back to that to get that emotional support around that particular condition.
You know, we know for some families, understanding dementia is really, really challenging, particularly when they see a real personality change in their loved one.
So, we might suggest that they contact or we put them in contact with one of the dementia charities so they can get that emotional support and that understanding of the condition that their loved ones experiencing.
Thank you. Okay. I'm going to be very quick. It's just going back to transition, and this might be something you do already, but, or it might be a quick fix, I don't know.
When I'm transitioning young people to adult services, so young people with complex needs, the first thing that happens when we start to do it is a disagreement between healthcare, social care and learning disability as to whose responsibility it is.
That will go on for some time. I don't care whose responsibility it is, I just want it sorted as to the family.
And then, eventually healthcare will take it, and then, soon as they turn 18, they say no, it wasn't us, it's adult social care, and that's where we get the three month gap, because healthcare say no, it's not us.
Adult social care haven't yet got them on the case loads, so when the parents phone their phone, children services are asking for support and get told you'd be discharged.
Then they phone adult healthcare, this has happened this year for one of my families, then they phone adult social care to be told, no, we don't have you on our case load.
And if we could just sort it out earlier and stick with what's being agreed, so there's something going wrong in that I think people are saying, oh yes, we'll take it as adult healthcare, but might not be the person that is ultimately responsible for that decision.
And then, later on, that decision gets reversed, and that's where I think you get a bit, what's the polite word, which is kind of false to you, and therefore you look like it's your fault, but it wasn't.
If I just pick up, there's some complexities there, and some operational reflections too, so you're absolutely right, that there's real complexity between the funding routes, between children services, children's continue healthcare, and
continue healthcare, and probably got some of the terminology wrong, but there are slightly different arrangements and different, back to the eligibility criteria for all of those things.
And that's why it becomes so incredibly important that the conversation with the young person and their family starts at a very formative age, so the latest 14 in my opinion.
So, you know, that's not where we're, you know, lots of local authorities really struggle to do it at that key stage, and actually, you know, 14 to 16 is roughly in the space that people are looking, but I, you know, if you really want to get some of the conversation, what you need to be doing there.
And also, the mechanisms to think about the different eligibility criteria, when it's really complex, when health funding comes into it, the child's health needs, as you know, are really complicated, aren't they?
So, but actually, you might be entitled as a child, but you're not necessarily entitled as an adult, and that becomes quite difficult.
So, operationally, we are working with both children's and adult services, but not in isolation with our ICB colleague, our integrated care board colleague, so NHS in effect, to make sure that we start to line up some of the thinking around those mechanisms to try and smooth that out a bit, because you're right.
Otherwise, it's too, it's so late in the day over here, nobody's got time to plan anything, and you're trying to put something in at the last minute, if somebody, you know, isn't it an education to the age of 24, for example, it's a drop-off point there, or if they're, you know, come forward at 18, there's a risk of they're being a drop-off point there, but I don't know where there's something else you wanted to do.
Other thing that happens is then, they have to do the assessment all over again, can you not just share the assessments? I mean, I suppose you can't, there's different criteria, but again, that sets you back another couple of months.
But you're right, there's, again, it's that opportunity, and that's why we talk a lot. I mean, sometimes it's easy to trip off the tongue of that, talking about how we integrate the way that we work, but the reality is, is where we can, we don't want anybody repeating their story more than once.
And that, you know, that includes, from a children's services perspective, through to adult services, not just with our health colleagues.
So, we're trying to make sure that not only are we setting up conversations that are meaningful at the right time for those individuals, but also our systems and processes start to marry up a bit.
So, those things get automatically fed across into other systems or a nightmare.
When it doesn't happen, they don't get incontinence pads, you know, it's a basic snap, and also you don't need to look at this, and adult social care, I think you only have four a day, and a lot of people need more than four a day.
Thank you.
Thank you.
Thank you, John.
We did a fantastic job.
Just my one question is, how, as we discuss fast, as a committee, how we can monitor this one, as I kept, yeah, we were thinking that this one.
How can we monitor from the, like, how many coal we receive, what is the outcome, as a counselor is good in the committee, how we can monitor this one.
That we are much lacking.
When we go the next time to the facing the community, that means community people can say that we are doing a fantastic job.
When they're not complaining, we're going to receive the call.
The accounts are received according to five, one minute or something.
That means we have some kind of monitoring on your present.
Can you, is it possible that this one let me come here?
Yeah, absolutely.
So, you know, we have to be really clear, and I think it's really important that we're clear as adults social care about what, you know, our front door so people aren't confused.
Unfortunately, there are so many single points of access, and that is something that we're looking to really streamline, but at the moment there does remain some confusion around that.
We're absolutely committed to ensuring that we're clear about when people come to us, when they phone us, what they'll get is a swift and high quality response that helps solve their problems at that first point of contact.
So, as part of that, and Victoria's articulated it, we've got the ability now to more accurately provide that level of data, both from a quantitative perspective, but more important.
But as importantly, a qualitative perspective.
And the outcomes of those conversations are really important.
Actually, what we should be seeing is people going,
Oh, actually, you've solved my problem. I've been connected to X, Y, and Z. Actually, what I don't need is you for the time being, but you're, you know, actually you've supported me to sort of get back up on my feet and sustain things for a bit.
So, we can, I think it's part of the work that we're doing now to finalize that performance and quality framework. Can look to incorporate elements of that where it makes sense into the quarterly performance report that we provide, which is the next item on the agenda, I come incidentally. So, something that gives that sense to you as the board about, you know, the ongoing progress. Obviously, that's part of the scrutiny review recommendations are response to your recommendations if you decide to include the performance framework will reflect what that looks like, if that feels okay for you. Thank you. I think like the next item going to discuss so many things over this issue, I think better to, next, we can discuss the next item, which is our collection of the evidence gathering for our scrutiny review into the access has been circulated to the members tonight. We are looking at the team's idea for recommendation. The draft recommendation will already circulated to the member officer outside the meeting committee and to having the next meeting. Okay, just a minute. Thanks for sending us this really or whatever we discuss this year. I'm point by point, I'm really, thank you so much. It is a help us to gather our point and everything here. And now also send us draft recommendation, like this is a draft, like we can now start discussing and also I would be grateful for everyone after discussing if you would like to add anything. If you have any idea or anything, please send an email to Samia and us here, and we can, I think we will finalize in the next meeting. Yeah, we'll finalize in the next meeting. I'm John and Victoria also help us to keep us like I'm aware is everything going to be fitting here. Thank you. So just a we point, I think bullet point three says by nearly and I know by least sometimes can mean twice a year or every other year and I just wonder whether we could use twice a year just to be super clear. We just the last word on bullet point three so those outcomes be reported to the committee by only I just wonder whether we could use twice a year instead of by only just to be super clear. Yes. And now we can start a combination first one is what is discussed is that I think everyone has an NHS North central London integrated care board should work, which be so the established border wide protocol for access to primary care services sitting out best practice. In the terms of access and ensuring that fashion to have choice over whether the access service says online in person or over the phone, depending on their appearance. This should also consider relevant equality in preparation to ensure that resident with disability have equal access to the service. I think Council adjourned to start your point. Yeah, I think I think we talked kind of very briefly kind of earlier about whether or not it could whether or not this could be more than a bar a white protocol and it could be a bar a white charter that you know GPs kind of signed up to. And you know, perhaps we all took a little bit of time to you know just brainstorm what we think that charter kind of might be I mean I was, you know, I was impressed with some of the stuff that more fields. You know, and just thought actually there are so many kind of examples of best practice out there, which is, you know, you have an accessible website. You know, you have you have patient reviews or something, but you know, something that, you know, the good organizations, you know, would have very happy to sign up to and those organizations that perhaps are, you know, need to improve what could be encouraged. But I appreciate that this would be a big ask, but I think if isn't and really wants to trail blaze, you know, we, you know, we we could, you know, we could do this and I think our, our residents would love it if we, you know, sort of said this is, this is how we're going to bring people together. Thank you. I think like although we don't have a direct control to the public as the year, but as he's linked on, we will always fall for like we started fast 20 mile speed limit everyone following us. Why not we start. What is the things best. They should follow us. Thank you. Oh, yeah, I agree. And I think the charter could just encompass what bullet point one encompasses, actually. That could be do it just, you know, just simply as simple as that. The charter could encompass exactly what is stated in bullet point one. Just simply that. Yeah. I would support the charter because I think it makes it more approachable if you like to patients, you know, it makes it more accountable really. And there's just one, who would draft it or offices or who would be responsible for drafting the charter. Offices are a good comes person. Should be drafted by the officer and we can put our recommendation there, something. I just think it fits into the sort of what's been mentioned good practice. And it's, it's written in such a way. So it's understandable to patients and accountability really. I think I think the charter should reflect the point of the appointment and other thing with that, we can add other thing. If the officer can send us some draft something, then we can add our point. Well, I mean, maybe we're getting a bit ahead of ourself. Maybe it's, you know, the first thing to do is, is maybe having a meeting with like the organizations that this would kind of involved like the, you know, the integrated London integrated board and just see whether or not they would be open to doing something like this. And then possibly the next step is sort of writing something together. But I think, you know, I suppose, I mean, obviously, I'm not responsible for primary care in this LinkedIn. So I think that feels probably a really sensible next step because the recommendation and effect is that you feel that this would be a really good way to show a commitment to the set of things, recognizing that as a council. We don't have the responsibility, but actually then the ICB and the GP Federation can respond to that and suggest the best way to progress it because it would be difficult, I think, to develop it from a council perspective. It would need to be developed and owned by the GP Federation's effect. Things like that, because of our time limit, we can suggest our point is we are ICB to adopt the charter here and give us the feedback. This is our recommendation and they will make that charter and we will approve it for next meeting or something. My right room, is it okay? So we're agreeing bullet point one with the addition of the charter. Yeah. Thank you. And can we discuss now's second point that GP and adult social care review their online materials to ensure jargon is not used and access is simple form a use perspective user perspective. Great. I mean, have we all seen the phone that one has to fill in? We need to. I think it's just like that recommendation makes sure that is accessible. It's true is right now. Tarot is already we discussed. Yeah. And we agreed that this will come back and your is by annually rather than you should. Yeah. Sorry. Can I just check is. So I know that's what we wrote in the recommendations earlier, but it sounded like it was something that officers wanted to include in the regular updates that you get of key performance indicators. So it was just just to clarify really. Well, should we put as a minimum twice a year and then it gives us the opportunity because I'm not, I'm not sure how we're not in a, in a rhythm of reporting that the information at the moment. So if we put as a minimum twice a year, then if we can, it will be, well, it would then move to four times a year. If that's okay. Yes, sir. I would just add and improve the staff. Yes, sir. I would just add and improve the service of the, for the transition of people from the young people service into the adult social care service, which is so quite obviously being looked at, but we want to see that, you know, we want to keep an eye on that. We want to see that the service of transitioning from young people services to adult social care. Well, as I said, it will be a narrow response for this because obviously what you do is recommend and then we respond to it, but and of course I can provide that commitment and a brief pointer to where that work is happening with the view that both adult and children secretly may want to hear some more about it over the course of next year. We'll keep an eye on it, yeah. Thank you. Thank you. We've improved the resident experience. I think that's covered, isn't it? I think that's covered by that recommendation. So you review the training and guidance and consistency of services, I think that's good, that's good. I suppose it's just because residents don't access their respite care through the front door. It's something that's set up as part of the care and support plan that they get. I suppose I'm just not from what I can see, but I don't know where. I mean, I can, we can provide information to scrutiny on how respite services are accessed as a separate piece of information for your review, but it probably doesn't necessarily fit into this scrutiny review, but more than happy to bring information to you as a scrutiny committee on the respite offer, particularly part of your conversations have been about people struggling to access their respite because we would, you know, I would want to understand that as a separate, you know, if you were as members, individual members saying to me, actually Mrs. Whoever can't access a respite, then I, and we would investigate that and try and understand that and provide a response to you. So probably maybe if we could think, look at the feedback that you've got about respite and then we can respond to that as a separate piece, I just didn't feel like it fitted with this. [silence] It's slightly concerning if people are not aware that they can have respite, you know, but I take what John says, I'm happy to go with that, you know, that we would keep an eye on that. [silence] [silence] [silence] I think it was part, people didn't know the complaints process or didn't get a response from memory, from the focus groups. Was that in relation to, sorry, was that in relation to being able to get through to adult social care? Was that the complaint that people were concerned that when they couldn't get through, they didn't know who to complain to? Yeah, so I think if we're clear that that's, we want people to know how to let us know or complain or tell us there's a problem and we need to, I think we should and absolutely should be able to respond to that and improve that if people are saying to us, they're not sure what to do if they can't get out of us. I think that's really important, so maybe we just need to elaborate the recommendation you've described to say, actually, if people are unable to get out of adult social care, you know, they're on the phone too long or everything that's not responded to or whatever that might be, that they know exactly who they need to contact to. Yeah, absolutely. Well, we publish our complaints and compliments. So, we can point, yeah, of course, on a costly basis, so, you know, when your mind just goes completely blank. So, of course, there are about all complaints about adult social care that come to us and then what we do with that information to help improve our services. Yeah, we have that information if it's something you want to look at, but specifically we can answer, you know, this is an important thing here. [BLANKAUDIO] [BLANKAUDIO] [BLANKAUDIO] [BLANKAUDIO] [BLANKAUDIO] I mean, yeah, I actually thought this was going to be the final draft tonight, but, you know, if it's not the next meeting, yeah. [BLANKAUDIO] [BLANKAUDIO] [BLANKAUDIO] You know, because of time, and we've got this quite, they've got the drug and alcohol coming up. I don't know how, if we could do quickly, just do this, get this done quickly. No, yeah, okay. No, no, absolutely, thank you very much. Victor is literally then hopefully you've all read the report. There's been very little change from last time, so I think we'll just pick up any exceptions for you and take any questions. Thank you. So, yeah, just looking at the report, I think one of the areas that I would like to draw your attention to is the indicator for statutory reamement that monitors outcomes after a period of reamement. After a period of reamement, the service aims to reable people and promote their independence. A high percentage for this measure provides evidence of a good outcome in delay and dependency and supporting recovery for our residents. Of residents who receive reamement in quarter three, 72% were reabled and did not require long term support from adult social care. No target has been set for this indicator as this is newly reported. I think we've had it the last three reports. But the performance is below end of year performance from last year. So the reason for this is our data is definitely much more robust this year as more people receiving reabement compared to quarter three last year. In addition to that, we've opened up access to reablement. So as we started off, we were really cherry picking those people that we could immediately identify would really get good benefits from reablement. Once we've got that under our belt and we're getting good outcomes, we've increased the cohort of people that we will see through reabement. So initially, it was all hospital discharge people. We've now included people from community roots and also quite significantly people with mental health problems as well. In addition to that, the level of residence needs that we are now seeing through reablement. So again, initially, we might have been seeing people who needed support three times a day. We're now seeing people who need support maybe four times a day and some aspects of double handed care. So that's impacted on our outcomes. We do expect that to level off over time, but in addition to that, our quarter three performance is still similar to London performance and very slightly under England's the whole performance. So we are still doing really well with that, but just that explanation about where we're not quite where we wanted to be with it. But overall, it's a good news story because we've opened up that capacity to more of our residents. And then finally, just to flag our safeguarding performance. So this has been mentioned last quarter. I discussed this. So we are doing really well with our safeguarding performance data. We are keeping people safe. But we have had some challenges with receiving some data from our colleagues in the CNI in Camden Easton Trust. They had some challenges with a new electronic record system that went live. So we've been working with them to figure out how we get that robust data from them. We're working really closely with them. They're developing a dashboard that's in its final stages now, and that dashboard will give better assurance of the data that's being collected as it's collected from the system. At the moment, it's collected via a very unwieldy spreadsheet, which isn't ideal for anyone. So hence, they are going to pull that into a Power BI dashboard. But that data will literally drill down onto individuals. So we are waiting for that from very minus quarter three for last quarter, waiting for that to go live. But yes, we're still in lots of collaboration with our colleagues in CNI around their data that they're providing to us. So just if there's any queries on any of that. Thank you. If any question to anyone? Okay. Any other questions? Yes. I just want one question around on the safeguarding inquiries. Like, roughly, how many was that? So it's so how many cases are we talking about that were raised? Do you have that information? I don't have that to hand. We've just got it as the percentage amount on here. But yeah, we can. We do have it as a as a whole number. Yeah. And it would just be of interest to know, I guess, are they, are they all coming through kind of professional referrals, I guess, rather than family and friends. So, we do have that information as well. Yeah. Thank you. Yes. Okay. Many times, John, in the picture, you have to come. Thank you. Please come. I'm really sorry to use it last time. Sorry. Okay. Okay. You can start now. There we go. Okay. Thanks very much for having me. I won't go through the paper in much detail because you've had it. It basically summarizes some of the treatment needs around drug and alcohol in Islington and the range of services that we commission. I guess I particularly highlight some of the work that we've been doing and continue to do to try and make those services more accessible to more people. We've done a lot to improve pathways from criminal justice systems settings into treatment pathways from healthcare and really invested in trying to reach more people through street outreach. We have some really great partnerships and we continue to build them so we work really closely with our colleagues in community safety. We've established the combating drugs partnership and that includes some great work with the police and public health recently established a community of practice, which is paying dividends already in terms of improved visibility and relationships between our treatment providers and some of the other front facing services that work with residents who have high levels of need. So for the work that we're going to do this year, we're establishing a drug and alcohol liaison team at the Whittington Hospital, which we hope will guide more people who are access to hospital services into drug and alcohol treatment where it's needed. We are working on a communication strategy to promote and engage more people around services and particularly looking at how we can work more effectively with our BCS and faith organisations. That's something we ought to be doing more of from a treatment perspective. We're going to do a deep dive into alcohol needs in the borough and we're going to undertake a piece of social research to understand naloxone and overdose prevention methods and how they're actually being taken up and used by people or not, we'll see about by people who use drugs. So it's due specifically to understand the use of naloxone. So naloxone is the overdose reversal medicine. We are issuing it to people who we think may need it, but we don't have a great insight into how it's actually being used in practice. So we want to understand if people are accepting the medication and then would they use it in practice? Exactly so, yes, exactly. Well, it does, but hopefully long enough for sub-sands of care to arrive, yes, yes. And that's probably enough to say the starting point I suppose, but we're really happy to take any questions that you may have or if there's anything I can cover in more detail. Good, thank you. We can also look like we're going to start. Thank you very much because this committee has been asking for a deep dive into drug and alcohol services. And this is a deep dive, it's really very detailed report. And I'm sorry that we've been left right to the end of this meeting for such a great piece of work. So I just wanted to, you know, just right at the beginning, you know, page 484.1, drug and alcohol use associated with homelessness, including rough sleeping, contact with the criminal justice system and exploitation. And just to say that we have received additionally 637,000 pounds funding from the GLA to continue to fund the support team which provides intensive floating support to individuals with a history of rough sleeping to live independently. So just to add that, we're so very welcome, you know, that we are continuing this support. But the other points that really stand out, it's really, you know, Islington has the highest prevalence of opiate use in London and the fifth in the country, you know, 21.5% per thousand versus 10.9 per thousand in London as a whole, it's unbelievably high. And so it's critical, you know, this report is really critical. I do notice that the data is coming from like 2020, 2021, it's quite old data. So we haven't got the most up-to-date data, so that would be really welcome, you know. So we've also got the second highest rate of deaths in 2021, the second highest rate of deaths due to alcohol-related conditions in London, and the second highest rate of alcohol-related hospital emissions in London. And, you know, that's incredibly worrying, you know, that we are so high, and as I said, the data is old as well. So it's not totally reliable. It would be good to have more updated information. And then, you know, the other very concerning thing is the child safeguarding, you know, 51 children per thousand children, eight, not seven living households where there's a parent that has drug or alcohol problems. And that's a huge amount, you know, that's Islington. And so it's really critical. I remember, you know, we were trying to go wrap round care for children in that situation. And I just wondered if you could give us any information on that, you know, because we wanted to sort of really look after those children to make sure that they didn't go into problems when they got older. I just wondered if you've got information on that as well. I might not be the best person to speak about children's social care services. From the drug and alcohol treatment perspective, we are commissioner provided to run a offering family service, which they do. So that's the beneficiaries of that service or anyone who's affected by anyone else's drug and alcohol use. We have a young people service for young people who might be using drug or alcohol, and we know that parental or other familial use of drugs and alcohol is a risk factor for that. In children, young people, so there are safeguarding considerations around that when seeing young people in the service or extra for them. But in terms of the safeguarding around children specifically who are affected by drug and alcohol use, I am not the best officer to address those questions. I'm afraid, sorry, it's not services that I work with directly in public health. It's not ones that we can commission, perhaps that's something that we can take away and bring you some information on. Well, we're interested to know who does look after that side of things, and it would make sense for you in public health to be liaising those people. Yes, with children services, yes, absolutely, and certainly the service, if they do identify that there are children in the household, if they're family members who may be at risk, due to somebody's drug or alcohol use, then they are absolutely pandem with those services and absolutely made those referrals, yes, definitely. I'm speaking more as a, I suppose I'm here in my capacity as a commissioner of drug and alcohol services, but not the commissioner of those child services, that's what I meant to get across. But the services are, by all means, linked together, yes, absolutely. What about the question, rather frightening statistics about this instance position? Yeah, so what I will say around that data is that they are model estimates. Model estimates, the way that this data has been prepared, it's quite a sophisticated technique that's been used looking at lots of different data sources and bringing them together. When you do that kind of methodology, over quite small geographies, which London boroughs are in the context of this kind of work, there is the potential for inaccuracies to creep in, and whilst I would be confident that Islington's drug and alcohol use is high, relative to other London boroughs or other regions perhaps, I'm not sure that I would say absolutely with confidence that we are the highest, and that it is indeed possible to differentiate those kind of margins between boroughs where levels of use are probably quite similar. So I would support that drug and alcohol use here is probably high. I think it's probably comparable to boroughs who have a similar geography, and indeed we're quite similar really to a lot of our neighbours, whether I would say necessarily that we are absolutely the highest. I'm not sure that you could really make that judgement based on my understanding of the data and how it's been derived, but that is not to say that we don't have high level of need, and we're really attempting to respond to that in the way that we are providing our services. You mentioned alcohol as well, and high levels of admission due to alcohol related conditions and deaths. That's why we want to do a deep drug and to alcohol related health needs this year, and that piece of work is forthcoming. We've done a local area profile committee's assessment around drug use, and now we need to do the comparative piece of work around alcohol, and some of those issues where we're going to draw out. As I mentioned, we're trying to improve our pathways into drug and alcohol treatment from healthcare services, and if we are an area that has high levels of presentation with alcohol related conditions, then we really need to step it up when it comes to being able to link people who are presenting with alcohol related conditions to the treatment services that can help them with their alcohol use, which the hospital is not necessarily the best place to do. It's about linking people to the community services. Thank you. Pleasure. Thank you. Are you happy or the question will do? Yeah, I'm happy. I mean, I take the data, you know, I take it, we'll probably get more updated. Yes, absolutely. There's always a time lag, and the data that you see there is actually the first prevalence, prevalence estimates that we've received in, I think, seven years. It takes a really long time to pull that data together, and the data that we do have, which is more reliable and much more current, is around access to treatment. So we get our numbers of people accessing treatment services. We get the numbers of people who are completing treatment successfully, and that we feel that we can track and monitor much more closely because those are the services that we commissioned directly. So looking at those, the numbers of people who are accessing support, we find is a really helpful measure for letting them know how the services are doing and how many people they're reaching. Thank you. Yes, Councillor? Thank you. Thank you for this thorough report, and I know it's not long since you gave us a thorough report, but policy performance, so thank you very much. I was just reading about the sad news of four fatal overdoses near Harangay, via a synthetic opioid, and I'm very conscious that hearing is going to very much embrace the public health approach. So I'm just going to ask a question about drug checking services, whether or not that's something that we as a Council are lobbying for permission for, and just a bit of context that's the opportunity for anyone to test the drugs that they've been, they've bought to see actually whether they are, whether they bought or they're something much nastier, and it's kind of an approach to help enable harm reduction in services. It's not something that we're lobbying for here. I think Bristol isn't it where that work is taking place. The work that we are doing to try and reduce the overdose risk is more around the harm reduction advice. It is issuing a lot's own trying to understand if, as I mentioned a piece of research you want to do, is try and understand that that is having an impact in practice, and trying to connect people to as many people to advice and services as possible. I think drug checking and its effectiveness, it remains to be seen. I think the program in Bristol is in its fairly early stages, and I would want to feel assured that the people who are using that service are the same people who are at highest risk, and I think that would help me understand whether I feel that that service is going to make a difference to the people who are most vulnerable and at greatest risk of overdose. The service in Bristol is pretty much in its infancy, but I know perhaps a bit more to that from the Netherlands, and I was wondering whether we might be looking at a broader evidence base for whether or not this kind of services is making an impact as well. Yeah, I think it is good to take a broader view and to see what's working in different contexts definitely, but something I would say about drug and alcohol use and services and interventions is that they are very context specific. So we would have to feel assured that drug taking practices in our contexts are sufficiently similar to those where those interventions have been taken place and have been applied. People draw a lot of comparisons with approaches taken in states and in Canada, but the whole economy and social situation around drug and alcohol use in different environments can really influence what interventions we might apply. So, absolutely, yes, we ought to be taking a broader view, but we must consider whether there can be effective in its mental context. But can I just pick up that? Because what I observe on the streets visiting town is that people who are looking for drugs, they're really desperate and that you can't imagine them receiving their drugs and then going,I must still get these drugs tested.
I just can't imagine that because you can see the desperation, it's right there on the streets. And so the thing that I would hope is that our services, the people get into them and then they get help with getting decent methadone and they get substitute drugs. That would be the pathway that I would like to see. The people who were getting help and I don't actually see it very realistic, the drug testing idea. Yeah, I have some sympathy with that and I think that's why we would want to understand before applying any kind of new intervention. Is this actually going to reach the people who need it most and on the people with really high levels of need and in a maybe desperate situation? Something that we have realised through our community of practices in its early stages is that some of our accommodation providers, for example, and some of our street outreach workers weren't aware that our drug treatment provider will offer same-day assessment and same-day prescribing for people where it's appropriate and through setting up that community of practice, we've been able to improve awareness across some of the front-facing services who work with these residents who have the greatest need. That same-day assessment, same-day prescribing is available and that's just through that partnership working. We've helped connect some people to that immediate treatment when the end gets just because prescribing is one intervention. It's not the bill and end all, but as you highlight, if people are in a particularly acute situation there, getting that first assessment, that prescription can help them stabilise and then engage with a longer term or substantial treatment offer. It's a really valuable part of the service. Thank you. When you work with other teams, when I was reading through this, I was thinking about working with our housing partners and tenancy services, is there that good sort of working relationship? Because I think, again, when we're on the doorstep, we're talking to a lot of residents who are either talking about the person next door, who's anti-social behaviour, et cetera, et cetera. Sometimes you want to sort of say,Well, actually, there are services. If it's your neighbour, you could be helping.
But actually, we as Councillors could be going to tenancy services and saying that the girl at 66 probably needs some help. But I've never got a response back from anybody that has said,Actually, we have referred them.
Which is really interesting that we talk about the anti-social behaviour and mediation on all of the things that we can do to make things stop. But I've never heard another team talk about the things that we can do to help. Okay, so we certainly have forged really good connections with our providers of supported accommodation, of temporary accommodation. Perhaps less so with our general housing providers, perhaps, and that is something that we perhaps ought to do more about. In terms of anti-social behaviour and the drug and alcohol element in some of those cases, I was invited to speak to the policy and perform an scrutiny committee as part of their long investigation into anti-social behaviour. And they were really interested to hear about the partnership relationships that the service has. But I think perhaps greater visibility and more connections with our general housing providers is something that we could look at. Yeah, because I think most of our estate champions, the estate champions who know all of the things that are going on and where help could be provided. Because it's all currently so negative. It's about stopping somebody rather than helping them. I think some of the stuff that you outlined is amazing, and actually we could get people in more help. Yes, of course. But it needs to be more people helping, doesn't it? Yes, and greater awareness of the types of help that are available and how or might access it. Yes, absolutely. Yes, we are developing a communication and engagement strategy. And yes, that's definitely what we work into. Yeah, thank you. Thank you. Any ideas? I just want to pick up Council Hamdash's point about the new sort of drugs that are coming out. You know these, I can't remember what you described, what do you call them? Synthetic, yeah, that's quite frightening, isn't it? So we need to be sort of updating our services to deal with those things. Yes, no, absolutely. The service is very good at keeping themselves up to date. And we get that guidance is issued nationally around new and emerging risks. And all the services are very aware of those risks. Yes, it is very concerning. And this is one of the reasons why we are so keen to improve access to the service, to improve outreach that they are providing, so even if somebody is not ready to start interrupt treatment, we still have people out there who are able to advise about emerging risks, you know, be careful and et cetera. So, yes, having those opportunities to offer more people advice in a broader range of context, even if they are not ready to engage with treatment, that feels really important. One of the things we are investing in this year is more peer-led work and more peer champions within the treatment service. And again, that's about improving those relationships, talking to a broader range of people so that we can share that kind of advice. There's some good news about Wynton, an alcohol treatment now. I just wonder about the, I suppose there's data or is there work going along the lines of people drifting in and out of prison, who are driving an alcohol? Would that be your remit or was that more wider? Sort of. Yes, it depends on what you mean. We've definitely done a lot to try and improve the pathway for people who leave prison with drug and alcohol needs, improving their access to continuing that treatment in the community. And actually, that's a really key metric in the national strategy, is improving those rates of continuity of care between prison and community services. That's something that we've done an awful lot of work on. And I'm really pleased, she says, touching with that our continuity of care rates are shown marked improvement in the last two quarters compared to where they were before we started investing in these pathways. So, yes. Thank you. Many thanks for coming here and really good. Thank you. My pleasure. Thanks for your questions. Thank you. Thank you. Thank you. Item 13 is not here, and is in the apology. There is nothing to update from that. Now, I think today is going to go there. Next meeting, there's no question. Any airway, any question, anything to airway? There's a question, I've sort of gone back to the minutes. On the minutes about the hubs, the free hubs that we're setting up in the borough. We had to put a presentation at last meeting regarding the hubs. I don't know if it was a misprint, or it said the one in the north of the borough would be June 2025, it would be opening up. Would it be as late as that, because the others are all ready? They're struggling with the... Permises? It could be. That's the last one to do. It's quite a long way. I mean, long wait for the others to sit up, ready. So, it's kind of concerning. Do you want me to ask the question to the John to give? (Inaudible) Okay. Do I ask John to clarify this question? Okay. Thank you. John, who's asked? Can't say anything about... Yeah. This is between... (Inaudible) Yeah. I think we can say, as our old team, they're doing a fantastic job. Nodilised, exuitive, doing a fantastic job. Protecting our other people. Protecting our own job. We can say this kind of thing. And also, our officers, they're doing a fantastic job, we can say. And we are helping that. We'll say thank you to everyone, other than anything else. We can say this kind of thing. (Inaudible) The next meeting, I think, is the 11th of June. And this meeting is important to finalize our recommendation and everything. And this year, this next meeting is the last meeting for next year. And then we can choose that new topic and everything. Okay. There are being no further business. I declare this meeting closed. This is time 10 to 10. Many thanks. I'm really happy to finish. I'm really sorry, I'm coughing. I'm really sorry because it's nothing to do but preserve the wider change. [BLANK_AUDIO]
AI Generated
Summary
The Committee received presentations on the performance of Moorfields Eye Hospital, the Council’s Access to Adult Social Care (ASC) services, its new Access Islington Hubs, and the range of support provided for people who use drugs or alcohol. The Committee also received the quarter 3 performance report for Adult Social Care.
Moorfields Eye Hospital
Councillor Chowdhury thanked the Hospital for its new, more accessible website, and noted that the Hospital had scored highly in its recent Patient-led Assessment of the Care Environment (PLACE)) inspections, receiving good scores for the condition and appearance of its buildings and its dementia care. Councillor Clarke asked about the Single Point of Access (SPoA) system for referrals. The Hospital explained that the system had been in place since July 2023, and it helped to ensure that patients could choose the clinic that best met their needs, taking into account factors like waiting times, outcomes, and travel time. The Hospital was also trialling a new digital twin
system, which provided real-time recommendations for referrals based on various factors, including patient preference. It was noted that the Hospital's new Stratford hub was helping to reduce waiting times for residents in Islington.
Access to ASC
The Committee considered a report on the performance of the ASC front door. The Committee was pleased to hear that the e-mail backlog had been reduced by 97%, and that the average wait time for calls to the service was 1 minute and 54 seconds.
Councillor Burgess asked about the transition from Children’s Services to Adult Services. John Everson, Director of Adult Social Care, explained that the Council was working with Children’s Services to ensure a smooth transition for young people with high levels of need, and that a program of work was in place to address any issues.
Councillor Zammit asked about the support available for people with complex needs. Victoria Nestor, Deputy Director Adult Social Care, explained that the Council had a directory of services that could be accessed by frontline practitioners to signpost people with conditions like Parkinson’s and MS to specialist organisations.
Councillor Ward asked about the Council’s work to make sure that people who could not access online services did not miss out. Ms Nestor explained that the Council was working to ensure that phones remained an option for residents, and was also working with housing colleagues to help residents to access the service.
Access Islington Hubs
The Committee received a presentation on the Access Islington Hubs initiative.
Councillor Craig asked about the work that the Hubs were doing with other organisations in the borough. Manny Lewis, Assistant Director of Resident Experience, explained that the Hubs were working closely with a range of partners, including Bright Lives Coaching, the Single Homeless Project, Citizens Advice Bureau, Islington Mind, and Bet No More. He also explained that the Council was working with voluntary and community sector groups, such as Help on Your Doorstep and Age UK, to develop the Hub offer.
Councillor Zammit asked whether the Hubs would be linked to community centres. Mr Lewis explained that he was working on a separate project looking at how community centres and voluntary and community sector groups could offer advice and support to residents in one place.
Councillor Gilgunn asked whether constituents should be referred to the Hubs. Mr Lewis explained that the Hubs were open to referrals from anywhere, including councillors, and that it was hoped that the Hubs could help to resolve issues swiftly.
Councillor Clarke asked how the Hubs would work in connection with referrals to the ASC access team. Mr Lewis explained that the existing phone number for access to ASC was still operating, and that the Hubs had been introduced to give people an opportunity for face-to-face contact with someone if they had struggled to get help elsewhere.
Councillor Ward asked how the Hubs were monitoring outcomes. Mr Lewis explained that the most important feedback was from residents, who really valued the service, and that staff often reported that they were enjoying their work. He said that the Council was exploring ways in which it could use technology to monitor outcomes, such as a system that tracked individuals across different Council services.
Overview of Addiction Services
The Committee considered a report on the range of services provided for people who use drugs or alcohol.
Councillor Chowdhury expressed concern about the high prevalence of opiate use in Islington. Miriam Bullock, Director of Public Health, explained that Islington was designated as a priority area by the Office for Health Improvement and Disparities (OHID) and was therefore receiving additional funding to tackle drug and alcohol use in the Borough.
Councillor Craig asked whether the Council was lobbying for drug-checking services. Ms Bullock explained that the Council was not currently lobbying for this, as it was not clear that such a service would be effective in Islington.
Councillor Zammit asked about the Council’s work with housing partners to help people who use drugs or alcohol. Ms Bullock explained that the Council was working to improve links with general housing providers.
Councillor Hamdache asked about the challenges posed by new synthetic drugs. Ms Bullock explained that the Council was working to raise awareness of these risks, and was investing in peer-led work to help to reach people who might not be in contact with treatment services.
Councillor Gilgunn asked about work to improve continuity of care for people leaving prison. Ms Bullock explained that the Council had invested in a number of roles to improve treatment pathways from the Criminal Justice System, including prison link workers, and was also funding the SWIM program, which provided structured support for men of Black African and Black Caribbean heritage.
Quarter 3 Performance Report - Adult Social Care
The Committee considered the Quarter 3 performance report for ASC. It was noted that the target for the proportion of service users who have received at least one review had been met, and that performance on the number of new admissions to nursing or residential care homes had been better than the previous year.
Councillor Zammit asked about the performance on the safeguarding indicators. Ms Nestor explained that there had been some challenges with data collection from Camden and Islington NHS Foundation Trust (C&I), due to the introduction of a new electronic patient record system, but that the Trust and the Council were working to address these challenges. She said that a new dashboard was being developed to improve data quality and provide better assurance.
Scrutiny Review
The Committee reviewed the draft recommendations for the scrutiny review into access to GP services and ASC. Following discussions, the Committee agreed to finalize the report and recommendations at the next meeting. The key issues to be resolved related to:
- Whether the Committee should receive a report on performance related to access and outcomes for ASC twice a year.
- Whether a borough wide charter on access to primary care services should be developed, in addition to a protocol.
- Whether the Committee should receive an update on work to review the transition from Children’s services to Adult services.
- Whether a recommendation should be made on access to the same GP.
- Whether the Committee should receive an update on the Council’s provision of respite care.
- How the Committee could best monitor complaints relating to access to ASC.
Executive Member Update
The Committee agreed to defer this item to the next meeting.
Attendees
Documents
- HSC April Moorfields Presentation
- Agenda frontsheet 15th-Apr-2024 19.30 Health and Care Scrutiny Committee agenda
- Overview of Addiction Services
- Minutes 04032024 Health and Care Scrutiny Committee
- Q3 ASC Scrutiny Performance Report
- Islington Drug and Alcohol Local Area Profile 2023
- Public reports pack 15th-Apr-2024 19.30 Health and Care Scrutiny Committee reports pack
- Printed minutes 15th-Apr-2024 19.30 Health and Care Scrutiny Committee minutes