Transcript

that we are not expecting a fire alarm test this evening. So if the fire 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, St. Mary's and St. James's, and vice chair of this committee.
• Janet Burgess, Councillor for Junction Ward.
• Councillor Tricia Clark, Topham Park Ward.
• Councillor McGill-Gunt, Holland Ward.
• Dr. Liz McGrath, clinical director for Islington Borough-based mental health services and their substance misuse services.
• Hello, I'm Prosper Mafo, managing director for the Islington Division in North London Mental Health Trust with Liz. Thank you.
• Councillor Bnay Hamdas, Highbury.
• Hi, I'm Councillor Phil Williamson, and I am the executive member for health and social care in Islington.
• Jodie Pilling, the director of strategic commissioning and investment in the council.
• Hello, Nicky Ralph, assistant director for age-well commissioning in adult social care in the council.
• My name is Ian Swift, director of housing operations at Islington Council.
• It's called Cladham Housing, where I work.
• Previous meeting of the health, well-being, adult social care committee, held on 16th September, 2024.
• Thank you, thank you. I agree to vary the order of business this evening. We will take item B2, the Camden and Islington Mental Health Trust annual performance update, as the first item, as we have external guests for this item. Public question. We will consider any question from the public after each agenda item. Item B, B2, Camden and Islington Mental Health Trust performance report. I believe Mafu and others will be here. Please, I'll be grateful. Please keep your presentation on the brief summary, focusing on the main point here, what is the main outcome and good thing. And yeah, then we will ask, because I believe every member, they read your presentation. Thank you very much for coming here. Please.
• Thank you for inviting us to this committee. The last time we were here was in October, 2023. And at that meeting, we gave you an update around our partnership between Camden and Islington NHS Foundation Trust and Bannett Enfield and Haringey. And today, I will give you a bit more update around how that partnership is progressing and also to give you an overview around our performance as a trust over the last 12 months and the steps that we are taking, what challenges we face within our organisation, but also just share a little bit around some of the opportunities that we have around our community mental health transformation, some of the state's transformation work that has happened over the last few years, all really aimed at improving access to our services, experience, and outcome of Islington residents. As an organisation, we've got three divisions. So we've got our hospital services. We've got services in Camden, as well as services in Islington. So the services in Camden and Islington are mainly community services. But we do have a shared hospital base. And we are also working in partnership with Bannett Enfield and Haringey. So it is possible to see some of our Islington patients being admitted to a bed in Bannett Enfield and Haringey if there is vacancies over there. In regards to our North London Mental Health Partnership, we're hoping to move into becoming a single organisation. So we won't have Camden and Islington, Bannett Enfield, and Haringey. The organisation will become North London NHS Foundation Trust. And we hope that that would happen from the 1st of November. And that's all subject to final sign-off from the Secretary of State for Health and Social Care. I've given an overview around the performance. And I'm not going to go through the whole indicators. But really, the performance report is based on planned care indicators. So that's our community mental health services that we work in partnership with London Borough of Islington as part of the 1675 agreement. We work with various VCS organisations within our community teams. So there are some indicators for that sort of planned care services, such as looking at people that have had two plus contacts, people that have been seen in talking therapies, or memory services for older adults, or services for our perinatal services. But there's also some indicators in that report which really covers the unplanned care pathway. This is where we look at people that present to our hospital liaison services, such as the Whittington Royal Free Hospital, other hospitals. There's also indicators around our crisis mental health services, how we're responding to people in 24 hours, our length of stay, if people ended up being admitted to our mental health ward, how long do they stay in our hospitals. That's all the indicators that we monitor. We do also monitor people that may be admitted. We would call that inappropriately to out of area placements. So that's people who are admitted out of area, because we haven't got enough beds within the local area. And that excludes people who may be admitted in out of area placement, because they are off safeguarding reasons, and they need to be admitted to other hospitals. And one of the other indicators that is around when people leave our hospital, during that critical time, having been in hospital possibly for weeks or months, having to make sure that we do what we call a 72 hour follow up, just as a safety call to people. So within these indicators, you will see there are some areas where we are not quite meeting the expected target. But I'm encouraged that we are moving in the right direction. So for us, this isn't just about the numbers. It's actually about the quality of care that people receive. So that example about 72 hour follow up is a safety indicator for us. So it's not just about how many people have we followed up within 72 hours. It's how many people have we kept safe after being discharged from hospital. The key areas that we are really focusing on, and we want to see some improvement, is the number of women accessing our perinatal mental health services. Our target is to get to 10% in terms of that access in March 2025. At the moment, we are around just 8%. And what we want to see is that being sustained and improved going forward. The memory services is another area that is of particular interest for us. We want to see people receiving a diagnosis within six weeks of accessing our memory services. So that could be dementia or other cognitive impairments that people present as they access our services. So that's the performance report. But we continue with our community transformation program. And just to say that one of the key areas that we are focusing on is that dialogue plus, which is a care plan. Basically what it is is it's a care plan. It's an assessment tool which looks at the wider determinants of health. So when people come into our services, other than the medical, we are interested in accommodation and other things, such as relationships, finances, employment. So that dialogue plus will then help us to develop a care plan for individuals. And that's really part of our community transformation. And there's a number of other programs very targeted to specific specialty areas, such as looking at younger adults who are 18 to 25, or eating disorder services, or older adults' personality disorder services, and our community mental health rehabilitation services. But I also wish just to give a brief update on our partnership working, our employment services that are commissioned by the London Borough of Islington that work in collaboration with our community mental health services to enable people to go back into employment. And that service is working very well. We also have a service that's commissioned between Compton and Islington and the GP Federation, which focuses on providing physical health checks for people with serious mental illness. And that service is running very well, which shows how great a partnership we've got with those organizations. And as I pointed out, we have a section 75 agreement between the London Borough of Islington and Compton and Islington. So we do have social workers employed by the London Borough of Islington who work collaboratively in partnership with us within our mental health teams and leadership. And thank you very much for colleagues in this room that are enabling that to happen. And just to say, we've got our new mental health facility, the High Gates Mental Health Centre, which opened around March this year. And we've got capacity of about single and suite rooms for service users. And it's one that we think is really helping to improve the experience of people who come into our inpatient services. And also, we've got Lowther Road, which is our community mental health services, which opened around the same time as High Gate. And I'm pleased to say that the community services that are based there are having a good experience of being in that building. And certainly, the feedback that we receive from people who use our services has been positive since Lowther Road has opened. Other services include our crisis mental health crisis assessment service, which is the mental health A&E, if you want to call it, where people, instead of going to Accident and Emergency Department, they could come to High Gate Mental Health Centre, where they could walk into a mental health service and receive an assessment and support. And what we are seeing is actually by having that MHCAS service, we've halved perhaps the number of people that present to Accident and Emergency. There's also other updates which I won't go into the detail around the police 136 line, the NHS 111, which you may have seen recently in the news, and how important that particular service is. And our challenges will remain around the prevalence of mental health, as well as autism and ADHD, the waiting times for that. And of course, we're doing some work around that as a system to try and make sure that we reach the waiting times for people that need to have those assessments. And as I pointed out, the waiting times for dementia, we are aiming to do that within six weeks in terms of assessments. However, our 18 weeks target and the improvement around that shows that we are moving in the right direction. And like many organisations, recruitment remains one of our challenges. And we've seen that when we do work with our partners, the Health and Social Care Academy, and coming up with new initiatives and trying to recruit people into some of those entry level roles, we're able to achieve some success, as we've done in our IACT mental health services. Thank you very much. Thank you for your presentation. Are there any questions? Thank you. Thank you. Just looking at the new KPIs for talking therapies, I think it's going to be a big challenge for lots of services I've seen across London anyway. It sounds like a great idea to have a joint managing director and an operations manager overseeing that. Can I ask, is that strategically across BEH, NCL, CNI, or how does that look like? And is the idea to standardise practice and share best practice, I guess, in terms of what works at one and apply that across? Thank you. Yes, it is across our partnership with BEH. So the managing director, who has responsibility for common services, also has responsibility for all, and the same as the operational manager. And really, the aim is to make sure that we have more consistent practice across, and that we can also learn from our partners in the northern barriers. And one other thing on the perinatal side of things, I notice it talks about women accessing perinatal services. Do you include other birthing people, partners of birthing people that could count towards that uptick in terms of access and receiving support for a mental health problem within those services? Is that part of a partner's assessment or anything like that? Because I know other services have noticed that post-pandemic, everyone's coming back, and they missed out on accessing support in the birth. So their partner had a child, and they're now getting problems as a result of that. So I wonder whether that could be included in some of the work that they're doing there, if not already. Yeah, so my understanding is this is specifically for those women that obviously use our services, and that's what this particular KPI is pointing to. Thank you. Councillor Rogers. Thank you, Chair. Thank you for the presentations. Very good. Three points. I think only one of them is a question. Firstly, I went to the opening of the new facility up at the Whittington, and it is stunning. Really, it's wonderful. Great job there. Secondly, I share-- it's a bit clumsy-- Dementia-Friendly Islington Partner Network. Oh, it doesn't run off the time very easily. We had a meeting today, and we had a usual input from one of your people talking about the memory service. And she said that in Canton and Islington, unlike everywhere else, when someone is diagnosed, they stay in the service. Now, I didn't know this was unique to our part of the world. That is why they have such a big caseload, because everywhere else, apparently, they are passed on to other services, but your memory service keeps them. And apparently, NHS England went to visit them recently and learned about this model. And also, the fact that they interact so much with the partnership and all the people in it that now this is going to be used as the template for other places in the country. So I think that's a real success for Canton and Islington and all of us. I don't think we sort of shout enough about the good work we do. So well done for that. So the third thing, which is probably a question, is that the representative from Whittington Hospital said that it was about people dying at home. So in Islington, only 56% of people with dementia pass away at home, compared to 70% in the rest of England, meaning many spend their last days in hospital. And this is quite a stark figure, isn't it? And it's great that Ian Swift is here as well. So he might have something to say about the suitability of housing. I wondered if it was because the housing we have isn't suitable to give support at home. But that's a pretty stark figure, isn't it? So thanks. Chair. Yeah, thank you. I must admit I've not had that statistic in something that I would need to look into to try and understand. Yeah, I think we all need to look at that, don't we? Because that's, you know, 14% difference is big. OK. Thanks. I don't know why social care would be interesting to understand a bit more. Because we do have teams that go, you know, obviously where people have. And thank you very much for your feedback. Thank you. Thank you, Councillor Clark. Oh, thank you. Yeah. So thanks for giving us all this information and data. To pick up on talking therapies on page four, you've got two-- I'm surprised that-- so someone who is able to have talking therapies, they only get two appointments. Is that right? Maybe I've read that wrong. It's not right. OK. And so there's a target rate of 50% success, is there? It seems quite low, target rate. And so I just wonder why you've got such a low target for that, talking therapies. And then I just want to know, what form do they take with talking therapies? And how do people qualify for them, you know, to get them? And then I just got another question. Can I ask that as well, Chair? Yeah, so my question is on page 11, Lowther Road, Islington, Clozapine, and Depo, Kilinic. It's the first time since I've been on the committee that I've seen mention of the Clozapine and Depo, Kilinic. And when I look up Clozapine, it's quite a serious drug. It may cause drowsiness, blurred vision, convulsions, seizures, or to have trouble with thinking or controlling body movements, which may lead to falls. And so I'd just like to know when that would be used. So they're my questions. Thank you. Thank you. Thank you. So in terms of the target and the recovery rates, that's a national figure, so it's not a local figure. In terms of what people might get, so there are the IAP talking therapies, but also we have other psychological therapies which are provided in different parts of our service. In IAP, it's primarily CBT focused interpersonal therapy that's provided as well. But within our other services, so wider within our personality disorder service, within our eating disorders pathway, so there will be other therapies that are kind of more specific to those particular diagnoses. So those talking therapies, in IAP that are made, that's mainly briefer 6, 12 sessions with therapy services where it could be a year, depending on. And then we also have post-traumatic stress disorder service, for example, where, again, there will be different therapies, so trauma focused therapy. So there are lots of talking therapies, it's just that I know that you know from your own experience that we have psychol-- Yeah, to your second question with my nursing hat on around clozapine. Yeah, so clozapine wouldn't be one of the first line anti-psychotic medications adjusted to a number of other medications. And then they would go for clozapine. But there are also some safety precautions attached to clozapine, so only need for that particular medication. Thank you for that. So do you have any sort of statistics on-- because when you look it up, it's like it was banned in Europe, and sometimes people die on it. I just wondered, did you have any sort of-- so you've got dying on it, for example. I'm not aware, certainly kind of thinking of our detoxes in the last year. There was one incident where someone-- of everyone, one where they kind of had a negative reaction and had to be monitored firstly to monitor them after they've had the clozapine. But you know, it's prosperously, and it really is kind of balancing that up with people's quality of life when other treatments haven't had any impact. Thank you. Thank you. Councillor Gooligan. Yeah, just following on from Councillor Burgess, a question about dementia. I just wonder, the support service, I mean, often, in case where there's dementia, often people looking after people with dementia fall ill themselves, and it can be such a strain on them. I just wonder what backup, what support both Camden and Islington offer, and I wonder if the amalgamation with the boroughs, could that be strengthened? I mean, is that going to-- what's the long-term policy around that? Because it's family members that suffer as well during dementia. I'll just comment on-- I think we've been working with our partners in Islington around the dementia strategy, which is currently in development, but also there was another earlier strategy around the carer strategy, and so we worked together involved and we're working partnership with AGU Care. Yeah, also just to say that internally we do have, like within our services, we have carers groups and by the links to some wider partners. And actually, in terms of the sort of wider partnership as well, there was a focus on that older people's pathway and good practice and actually some across the partnership. >> Thank you. Councillor Hamilton. >> Great, thank you. I think it was about 15 years ago when I used to work for Mental Health Foundation Trust, and I remember back then how difficult and strange sometimes resources were and I'm conscious that things haven't got any better. So, I want to say first of all, I think there's some really impressive results under difficult circumstances. And, you know, in that intermittent period, we had a lot of talk from government about parity of esteem and about making sure that mental health services were treated on an equal footing with physical health. Do you think we've gotten any closer to that? Do you think funding remains an issue for mental health trusts? >> I think a lot of effort has been put in to try and enable that parity of esteem between physical health and mental health, and I'm pleased to say that some of the work that we do with our physical health nurses that work with the GP Federation have been really positive and well received by people who use our services as well as our GP Federation. We do also have a physical health clinic, so we spoke about the Depo Clinic and the Clozapine Clinic, but we also run some physical health checks within our own organizations. I think a lot of work has happened. However, I say there's still a lot to be done, but I'm pleased that as NCL there's a lot of focus around long-term conditions and how we might be able to support people. But within our own local partnership, we're working very closely with London Borough of Islington, the Whittington Hospital, talking about the integrated front door and how we enable people that use those services, community health services, to also access mental health services and vice versa. So I think there's something, again, around we need to work more collaboratively, either with the GP Federation and other local partners. But I would say -- >> Just to add that in the last three, four years, there has been additional investment into mental health services that, you know, we haven't seen for quite some time, which has, you know, kind of we have been able to take on additional staff of, you know, obviously there is, like you all know, the challenges in Islington and the complex three years that we've had for quite some time, which is positive. >> Great, thank you. I mean, yes, one of my unrealised dreams was to become a counsellor with an S rather than a counsellor with a C. But I think I remember one of the barriers under the austerity years for me was the reduction in the system psychologist place and how much harder it became to find a clinical psychologist place. And I know staffing has been mentioned in one of the barriers. And is the pipeline getting any better for finding mental health staff or is there still big problems? >> I mean, I think there is still a challenge, but what has happened, again, in the last few years is kind of there being kind of developing additional rules because you mentioned that's some kind of psychology pathway, there's now something called a clinical associate psychologist that sits somewhere, that is a career path that sits somewhere in between the assistant psychologist where, which wasn't really a career path, and the clinical psychologist, which was quite a small cohort of people. And I have to say our clinical associate psychologists that are working with me are amazing. We do sadly lose quite a few of them to then clinical psychology, but they are, you know, real, I think we are attracting people that we didn't attract previously. And recruitment, yes, is a challenge, you know, as people move on. But there are other rules that have been developed, like kind of mental health practitioner rules, et cetera, that we improved. >> Thank you. I have just one question, because I used to work in the voluntary sector, and there was a stigma within the BME community about the mental health that we want to discuss with each other. Do you think, because I was talking about 15 years ago in the voluntary sector, this was that, what is the situation now? Do you think people in the BME community are more open to discuss this kind of thing, or still stigmatize that? >> I mean, again, it is something that continues to be an issue that we continue to work on. We're working with system partners. We're always kind of trying to, I think there's something coming up quite soon, you know, around our equalities and how we can engage populations that we, you know, that might, that actually we're more challenged in terms of supporting people to access our services, so there has been a lot of work, I think, in the lift in Islington in the very near future, where that is the main topic that we're looking at again. And there's something else that I thought I've lost. We also have different roles, again, talking about, you know, one of the roles that we've got now, this sort of population health nurses that have gone in, that have worked, working in our core mental health teams, being part of their role is to sort of case find and engage with different communities and kind of work with them to the best way that we might engage people that don't show up at our services. Anything you wanted to add? >> Thank you, and just to add to what Lisa said, and we have been having discussions around how we might be able to work more collaboratively with our homeless services, Rapsleeper services within the local borough, and we are also engaging with other partners such as Islington Faith Forum. And we know that there's a lot of work that they do around working with people who perhaps won't come through the mainstream way of being referred to our services, because perhaps they haven't got GP registration or maybe not quite trusting of our services. Or maybe as services we haven't quite reached out to those people with multiple disadvantages. >> Thank you. Thank you. Many thanks for coming here and doing your report. And please could we note the report? Yeah. Thank you. Many thanks for coming. [ Pause ] >> Thank you. Now we're going to go to the P1, Scootin' Review Adult Social Care Accommodation and Witness Evidence. Ian Hsu to present. Ian, you come up here. And just I wanted to ask about the ability of the accommodation for the aging population in the next 10 years. I noticed that the presentation was very generic. Would you be able to provide the committee with a bit more information on accommodation available for elderly, older people? And also just explain on your report that some one point is like on the adult social care, because they don't have need identified some adult. Yeah. Because they need assessment is not a care act, is not identified. Can you clarify that? Yeah. That means we can do understand more about that. Yeah. And also the housing. What kind of accommodation available for older people? Yeah. And this kind of thing we are looking for. Thank you. >> Okay. I'll cover the services for elderly people. As you've asked me to. So in Islington, Islington Council does not have any sheltered accommodation for elderly people. They're managed by the housing associations. There's around about 900 properties, sheltered accommodation. They're not always the easiest to allocate, because people would prefer independent living. So in the general needs accommodation. So some of the schemes that we have, sometimes they have for elderly people have high void rates, because of the perhaps the expectations of living when your elderly is not going to live in a sheltered housing scheme with other elderly people that they wish to maintain their independence as long as they can. We've arranged for a housing association to come and talk to you about your next session on the work of housing associations around elderly and other needs. In terms of the housing register people, it's on the housing register that pensioners are very small in numbers compared to the vast majority of the housing register being the younger population. And it's fair to say when we liaise with housing associations that some are thinking of remodelling some of their sheltered housing, because it's no longer accommodation that they think in the next 10 years, 30 years would be suitable for that generation's needs. So that's something that we work in partnership with housing associations on. Does that answer your question on elderly living? >> Yes, some kind of, because our understanding is like the people who are adults who take a first is you are looking forward to living within the family or something. Then it needs to be called shelter accommodation. There is no shelter accommodation. Then extra care, then care home, then extra care home, some kind of this kind of accommodation. Just want to know that what kind of accommodation is available in Islington and what the need in future for our older people or something. >> So it's very high and likely that Islington Council and partner housing associations will be building sheltered housing in the future. If you look at the way that the housing business is going in terms of the anchors of this world and the handovers who are merging together to form larger organisations, the provision of new sheltered housing for elderly people is not really at the forefront of the priorities for Islington Council's housing departments because the priorities are elsewhere in terms of numeric financial challenges and the phenomenal need for other forms of accommodation. We do have a successful right size moves approach which is moving people from larger accommodation to smaller accommodation and that does over 100 moves a year and that's really beneficial to elderly people who can move from a three bedroom property, get paid a large amount of money, have the removals paid for but still live in a one bedroom flat with independence or support going in from adult social care or from family and friends. So that is a successful approach. Members around the room are also aware of the Seaside and Countries Home Initiative where people may live in Islington or will live in Islington but no longer want to live in Islington or want to move to potential sheltered housing on the coast of Surrey, Sussex, Kent, Essex areas which is the old GLA sheltered housing that was transferred to housing authorities in the 80s and that option remains available for elderly people as well and we do try to facilitate that as much as we can. Also we try to facilitate mutual exchanges so people can move from a larger property to a smaller property and tenant moves the other way and that's highly successful. The likelihood of Islington Council housing the apartment building extra care for elderly people is probably not going to happen, I need to be honest with you, one because the priorities are greater in other areas in terms of homelessness, families in overcrowded accommodation, far outweigh our post bag. Everybody that we deal with from our housing department is, our families are single people under the age of retirement age that are desperate for accommodation today and not wanting sheltered housing or extra care if I'm honest with you and your post bags will tell you that from the dialogue you have with your local communities. With regards to housing associations, housing associations are like the council is struggling to develop because of the inflation in building materials, also because obviously land availability in Islington isn't great and you do need a large footprint for a extra care sheltered unit for elderly people compared to building other types of accommodation. >> Do you want to go through the presentation? >> Yeah, I'll quickly go through it because I know it contains some issues which is mainly around partnership work rather than the details of how we're going to build sheltered housing because, if I'm going to be honest with you, I don't think the council has a plan for that from a housing perspective because of the severe budget cuts that we're facing in other areas because of homes that's going through the roof and everything else. So it's fair to say that the Homes and Neighbourhood Service has a brilliant partnership work with adult social care, the health sector, public health, the GPs and that was really a wraparound support service that we provide to those individuals and we're trying to build a single front door for service provision going forward in the future with health. Adult social care. We're one of the few councils, the only council in England to operate a duty to prevent framework which any organisation can refer somebody in if they're concerned about homelessness, the health industries in Islington doing that really well, the hospitals, etcetera. We have a brilliant partnership work about discharge from hospitals, as was mentioned before, fantastic partnership work with Prosper. The hospitals will tell you we discharge everybody with the exception of anybody that's got a physical disability and that becomes difficult because at that point in time they're needing a discharge from hospital. We very rarely have disabled properties available for those individuals which prolongs their stay in hospital which is not good but we need to be honest and transparent. Probably 98% of hospital discharges are highly effective. The 2% that are not are because of the physical disabilities of the individual, nothing else. With regards to the work that we're doing we have excellent work with adult social care and the health industry around the cuckooing of vulnerable individuals of where we protect that vulnerable person and move them out of the accommodation and then undertake eviction proceedings and secure that property. We'll never move the vulnerable person back to that accommodation but that's an effective partnership work because 29% of residents that are accessing housing now have got multiple complex needs so that may be mental health with a combined substance misuse or undiagnosed health conditions as well because of their vulnerabilities. So that's what I need to be honest with you, the vulnerabilities of our citizens under pensionable age is enormous within Islington and it's growing because of the cost of living crisis, poverty, the housing crisis that residents are facing. We have a good working relationship around data and adaptations. We meet daily with adult social care and the hospitals to plan ahead of our work so we can undertake the work that is required. I think it is important that you do understand as elected members that homelessness is going through the roof, 1,600 households in temporary accommodation, the largest we've ever had. Of those, which is really important for this committee to understand, 721 of those are single adults with multiple complex needs who are living potentially in temporary accommodation inside of Islington or outside of Islington but do not qualify for a Mental Health Care Act assessment service. So they could have a mental health breakdown, they could have substance misuse but they don't qualify for an adult social care package. So that's where it's really important for housing, adult social care and health organisations to work together to plan a better future for those individuals. So you can clearly see almost 50% of our homelessness issues now are single people with multiple complex needs and it's that that we need to address as a council and health to ensure that they have better quality lives in the future. As I've already said, 29% of people coming through that front door now is homeless. We get about 4,000 to 5,000 homeless applications a year. Almost a third of them now have got complex needs that need some form of not just accommodation but need accommodation and support provided by Islington Council. That isn't provided by adult social care but it is provided by the housing department to those individuals. Sometimes members in this room know that that support breaks down and that they cause antisocial behaviour for the wider community and members in this room have liaised with me on a regular basis about what are we doing about that individual that's causing disruption to the wider community or to that scheme that they're living in. And that's a difficult balancing act to potentially evict a vulnerable person to move them back into supported housing to then move them back into general needs accommodation. We have 18 people sleeping on the streets at the moment of Islington which is, you know, 18 too many, let's be honest. All of them with multiple complex needs, not all of them are Islington residents but are currently staying in Islington. And that's where it's important as part of the work that we're doing around the health, wraparound support for those individuals, getting them accommodated, getting them support, linking in with public health and planning what we need to do in the future with those individuals. Homelessness has increased 35% in the last 12 months, it's one of the biggest rises this country has ever faced. The country's got more people in temporary accommodation than we've ever had in our history and you've got more people sleeping on the streets in London than has ever existed. Combined with Islington being a difficult place to live or to find accommodation, the average rent now at £2,500 a month and the average property value is now almost £690,000. So people are struggling and that's adding to the vulnerability of the individuals. Because if you're a looked after care person that's transitioning from looked after children to adulthood, there is very limited prospects of that individual being housed, other than within social housing. And the problem is social housing nettings is reducing. We need to be honest about that because of the right to buy, you know, 59 properties have been bought in the last 12 months through the right to buy. But more importantly, people can't afford to move anymore and that's why it's important to undertake those planned moves through downsizing with our communities that we are working on. Only 11% of people that come through as homeless and in employment, so you can clearly see there's a massive poverty gap now that's adding to those vulnerabilities of the individuals within society that we do need to protect. We have an arrangement with adult social care that they have a quota of 15 properties. Each year they are allowed to allocate whoever they wish to to those properties to help those individuals to come out and perhaps looked after care provision within adult social care or some form of accommodation that's needed to allow them to manage in the future. It's fair to say that not all of those properties are used on an annual basis because the need may not be there from those individuals and sometimes it will be. The council has built two schemes, supported housing scheme in partnership with adult social care, et cetera, at Beaumont Rice and Rosehip, formerly known as Windsor Street. And we are commissioning 14 support services to allow people to remain in the home, to give the support where they want to live. They do want to live independently, they do not want to live in sheltered housing. However, on the flip side of all of that, it's fair to say only 1,143 council tenants receive an adult social care package of support. That's only 4% of all of your council tenants and that is something that perhaps you need to think about further because rather than building sheltered housing, et cetera, they don't want to move to. Could we do more with the existing people in our stock? Because we have got an aged profile for some of our communities but we've also got an unbalanced communities of elderly people living next to young people and the young people disturbing the elderly people by just living. And we need to be honest on playing Xboxes and other games that they play as young people irritating an old age pensioner because they can hear somebody enjoying themselves or shouting. So it's kind of like trying to build that support within our communities. So a third of all care packages within adult social care are within council accommodation and that needs to be further looked at. Bearing in mind 40% of all housing in Islington is social housing, could additional care packages be provided within society that we currently manage? Other issues that you need to be aware of is that Islington is the 10th largest landlord of social housing of a council in the country. We have the 7th highest amount of homeless applications in London and we're trying our best to meet the vulnerable needs of individuals within our existing general needs stock and not providing hostile type of accommodation because of the expense of that. We have Alton Stacey streets as you know for rough sleepers, we're about to open another scheme for complex single individuals, the St John's mansions in the new year which is really required by a lot of the younger middle aged people in Islington who get 24 hours 7 days a week support. We have a housing first scheme where basically one officer will support only 5 residents in general needs home in Islington council stock to ensure that those people can survive in the future and that's really important. We are doing a restructure which has started so one officer will only manage a patch of 561 properties to get to know the communities better, change the way they've been managing our services. That is the kind of like this presentation that I need to talk to you about partnership and it is important for me to emphasize that a true partnership built on equals between us, CANDI, a hospital, public health, adult care and housing. We don't always get it right but we do put the residents at the heart of everything that we do. Happy to answer any questions that you may have. Thank you, just a few questions from me, thank you for the comprehensive report. I want to start with them a little bit local, so in Highbury I'm aware of Crowfield House which I think is largely for over 50s and I'm wondering about that kind of model of housing where we provide specific blocks for specific age groups. How is that working, is that working well and is there any tendency to genericise these properties because Crowfield feels less over 50 than it used to be, is that the impact you're right to buy? It's difficult because somebody who's 55 isn't actually old are they? And they'll then introduce their partner who has a child that may be 14 and then everybody says but there's somebody living in that property that isn't over 55 and that then causes me management headaches if I'm going to be honest with you. So we do need to look at that management framework for the over 50s because there's a few of the schemes dotted around that probably 20, 30 years ago served a purpose but society's changed and the needs have changed as well so we do need to perhaps think of that in partnership with this committee and adult social care and health and truthfully it does need to be reviewed. That sounds like a helpful point for our report so thank you. Crossing over into new builds which I understand is something you need to go back on, I'm wondering how well we're delivering against the target of 10% of homes being accessible in our new builds so I'd be interested, I'd also be conscious that because for so many years properties weren't delivered at that level there's almost a need to over deliver on that percentage because gosh knows the 60s developers love putting stairs when they don't belong so I'm just wondering how we're doing. For Islington Council's new builds service they are delivering on that 10% scheme just down the road from here Dix & Clark Court has got four two-bay driven ground floor wheelchair accessible properties which is pretty good and so that is working successfully. In addition to that as you know we're buying 397 x-ray to buy properties and some of those are having adaptations provided to meet the individual needs of those individuals as well. One final one and I definitely hear that perhaps sheltered accommodation might not be part of Islington's thinking right now in housing development but I've always been very inspired by the Netherlands and some of the stuff that's happening there with intergenerational living and it does kind of seem some of the kind of very forward thinking kind of you know community building that might address some of the needs that we're thinking about. Has the council ever done any scoping on intergenerational living or was it something that they might start to consider? It's been raised before I think by you in housing committee and we said that we would investigate that going forward as part of our strategic work. I think I need to be honest and frank with the committee that the priority at the moment within housing is to meet the impossible need of the homelessness households. And we had 1100 people in temporary accommodation this time last year, we've now got nearly 1700 households in temporary accommodation so our focus is what on earth can we do to build a better future for those people because 50% of those people are living outside of Islington. But I think you are right, we need to consider other strategic approaches and not write anything off the table but to consider them when we pull back to this committee in the future. I'm picking up the temporary accommodation point, I mean Islington is doing pretty well and the figures, it's incredible how well we're doing compared to the rest of London for example regarding the cost of it, it's so expensive. It would be really good to find a way to stop us having to pay so much money to private landlords in temporary accommodation, that's one point I want to make. But I was surprised, I didn't know that we weren't calling people intentionally homeless anymore, I learnt that from this report, I was wondering if that is one of the reasons that the homeless figures are going through the roof as you said. I've had cases where I've said to people 'no you mustn't leave because you'll be intentionally homeless' so how does that work, is it increasing the numbers of homeless but also if someone decides 'I don't like my neighbours, I want to leave' and they can go to the 222 and declare themselves as wanting to move. Also I just wanted to check, you mentioned the rough sleepers are not all from Islington so are we obliged to house them if they're not from Islington or to help? That's obviously going to help them but to be liaised with the grow that they come from. That's a few of my questions and just one clarification on this page here where it says there are 70, this type of emergency accommodation is notoriously overcrowded, expensive and unsuitable, that's the B&Bs, hostels and all that. Then it says Islington's figures are zero, this is under current national and local trends, does that mean we have, I can't understand why Islington's figures are zero? Okay, so working backwards I'm sure I'll forget some questions. So the use of bed and breakfast hotels has exploded by about 600% over the last three years because of the lack of alternative accommodation. A lot of that is in London but also it's a national issue now. We have a culture, values within Islington that believes that a person, family living in bed and breakfast accommodation isn't suitable for them so we will try everything in our powers not to place them in bed and breakfast accommodation or a hotel. It's fair to say a person fleeing domestic abuse or somebody phoning in my service tonight has to be placed within accommodation as a matter of emergency who may have to place them in the travel lodge or Premier Inn but that's only for tonight and we'll try to get them out of the accommodation tomorrow and provide them with a proper property, i.e. self-contained that can cook, clean etc in that property. So that's why we're at zero. If you compare it say with Brent, Brent's got 750 households in bed and breakfast accommodation, we've got none today's date so that's part and parcel values, culture etc. In terms of the overspends of homelessness, everywhere is having overspends. The average overspend now in London by councils is £20 million. We are £2.25 million overspends within our temporary accommodation and a lot of that is because of the vulnerabilities of the individuals that you cannot place them in accommodation that is going to be putting them at risk in the future. So we have to work with those individuals with health, public health and GPs etc to make them safe. We do have quality standards as you know and we're one of the few councils in the country to have quality standards throughout some accommodation so we insist that they have cots in rooms for babies etc and we go way beyond what is the norm. In terms of people making themselves intentionally homeless, if I'm going to be honest with you, there's only less than 10 households a year over the last 3 years since I've been here. They've been classified as intentionally homeless. We still have an accommodation need and rather than transfer that accommodation need to adult social care or children's services we say we will provide you with private rents accommodation. You need to move to that private rents accommodation and that may be in Arangay, it may be in Brighton, it may be in Hackney but you're not going to get council accommodation. The people we do accept as priority need, not intentionally homeless, will one day get housed in council accommodation. The average weight now in London is about 5-10 years in temporary accommodation so you can imagine being a vulnerable adult in temporary accommodation for 5-10 years. The average weight in Islington is 62 weeks so we are pretty good for that. Does that answer your question? I wonder who monitors that? Is it the prison service or is it Islington's responsibility? So that would be Islington's responsibility. So on the early release programme they've got all that press coverage recently of vulnerable people coming out of prison etc. We based a staff member from my service in the probation office to make sure everybody that was leaving prison had an accommodation and support package for those individuals and tried not to re-offend. Because a lot of the people in prisons are vulnerable and coming out they're still vulnerable because the supporting prisons are perhaps not as what they should be. So in terms of prisons that's how it works. In terms of the home office, as you know we have two home office hotels. In Islington we do an upstream prevention work. My team go into those hotels even though the home office has a support package we advise them. Once you have the right to remain in the country, 70% of people in the hotels have the right to remain. Nearly 700 individuals have been granted status to remain in the country. None of those have gone to live on the streets which is really good and we're proud of that. The hospitals as I say, nobody goes and sleeps on the streets from the hospitals. We do have difficulties, we need to be honest and transparent on physical disabilities because of lack of accommodation as Councillor Benali said before. But that's the only issue that we have. Similar to do with Rough Sleeping, I was just wondering is there any list of charities, organisations that we've got in Islington that offer people Rough Sleeping like a day centre if you like that can have a shower, have a cup of tea, have something to eat. I don't know how many registered charities have we got or organised. I know we've got outreach for the homeless and I just wonder how it all works. So Islington Council has a really effective partnership with our Foreign Service sector homeless agencies. We have a Homelessness Prevention Rough Sleeping forum that's chaired by Islington Law Centre that's attended by statutory agencies. So Prosper will go all the way to Sydenham's Advice Bureau, to Streets Kitchen etc. So we do have an effective working relationship with the voluntary sector, third sector around that Street Kitchen is very supportive of our work and we're very supportive of their work. Shelter from the Storm likewise etc. Union Chapel works with us on homelessness etc. What we can do if the committee wants is to provide you with a list of the partner agencies that effectively works with us to address the needs of vulnerable people in Islington. So it's not just Rough Sleeping but other agencies that we work with to stop people descending into chaos. We can certainly provide that to the committee tomorrow, that's not a problem. Thank you, thank you again. Just as I understood from you that the shelter accommodation is not viable for your partner's housing position and because of the funding was withdrawn from us, no support services. What do you think within the next 10 years, what is our population for older people next year? Because even the older people have gone up and the school is closing. What is your prediction for the next 10 years for our older people? It's like, if you think of elderly people, they don't want to move from the accommodation they're in. Whatever you think, they don't. They want to stay where they are. If it's in a three bedroomed house, I've been here for 40 years, I'm not moving out. I want you to provide aid adaptations to me so I can go up the stairs, if it's a house, I want you to do the adaptations to my room to allow me to stay in a community where I'm a valuable member of that community and they generally believe that. And services will be brought to them in that existing accommodation. We try everything to move people. We're trying to move people to Monmouthshire and Herefordshire this week and we're failing but we will try because that's what that resident wants. So we're much more resident led rather than being funding led or being strategic led as we said before. It's around each individual person's needs. The problem is, elderly people are settled in the environment that they're in and whatever you all think, they don't want to move. I have an experience with Council Benali over some cases of constituency work. It's really difficult. They shouldn't be living in that accommodation for their own well-being but that's what they want and we then provide that services of wrapping around them. Thank you and if anyone has any questions, I think many thanks for coming here. Thank you. Thank you. And now I think our persons report public health. Jonathan is here. Jonathan, would you like to come here? Please, please. Thank you, Chair. Often I find everyone's read the paper so I'm not sure whether or not people want me to give an overview or just to... Just go through a brief one and where the important talk went. Okay, so thank you so much. So remember we report a bit later than others because lots of this data comes through national data sources and I always also say that we choose the data because it's something that we can report quarterly. It doesn't necessarily mean there are other things which are really important but which we just don't get with that sort of frequency and that's why we also bring an annual report to this committee which we're currently working on which gives you an overview about much wider performance. So this relates to quarter four, so that's going all the way back to January and March of this year and it just highlights progress against a number of indicators. So just to give you sort of a brief overview, we continue to hold the line on vaccination rates. They're not going up but they're not going down. Some of the vaccinations are beginning to improve a bit, so first doses of measles months have increased by about 5% over the last year and a half. That's quite important because there is measles circulating in the community now, not at very high levels but it is circulating. That's really the first time it's happened in probably a generation I would think that we've had that and that's definitely because of lower vaccination levels in the community so it's a big focus but you might want to ask me a little bit more about that. We're really pleased to be helping some of our young families in sort of greater financial need for the Healthy Start scheme so that gives people access to help with funding of money for fruit and vegetables and milk and if you're a pregnant woman, multivitamins as well which is very good for you in pregnancy. We continue to have a really strong stop smoking offer, in fact looking now we can say for the year 23/24 we saw more people coming through the service and more people successfully quitting and that's really important and we're very excited about the smoke-free generation proposed coming through National which I think will give us a major opportunity to do more. We are seeing a really big increase in the numbers of people receiving their NHS health checks so that's obviously about sort of testing or finding out people's risk which is linked with early risk of cardiovascular disease or diabetes and that's a very important offer. We're also seeing a very big expansion in the numbers of people coming into and staying in drug and alcohol treatment and the overall figures don't necessarily quite give the volume of numbers of new people coming in but we're essentially seeing an increase of something like I think in the last previous financial year I think we've had about 550, 600 people come into drug and alcohol so for the most recent year it's about 900. And within that we're seeing a very definite shift, so numbers of people with opiates, so heroin and crack cocaine use which is probably the most addictive, generally some of the most addictive we've got. We've doubled the number of new people coming to the service so two years ago we had about 110 people coming to the service, the most recent year we had just over 200 and that's very purposeful in terms of where we're reaching in. And we've also seen a huge increase in the number of people coming in through prison. Now people coming through prison sometimes are more complex than others but not always but it's really important again about helping to interrupt those cycles of criminal behaviour or people getting into trouble, going into prison, helping to come back out of prison and also really helping to address issues in the community around some of the factors associated with that so we've seen quite a big increase in complexity. So the thing which is frustrating for us although I think in that context is sort of more understandable is that the number of people successfully leaving the service with having completed drug and alcohol treatment and having stopped use of drug and alcohol hasn't really shifted in the last year. So we've got more people in treatment, the number of people coming in that have recovered, we're roughly seeing the same. Now some of that is because of the complexity, some of it is because actually we're seeing more people coming in with hair in, opiate and crack cocaine use. Those are people often on long term treatment so they're not people that leave the service, they're people that stay in the service and we can give them opiate substitution therapies treatment which is very successful in terms of helping them to manage their conditions. It significantly reduces any sort of drug and alcohol use, has a whole range of social, economic and housing benefits attached to that. And we continue to see a very strong offer about long acting reversible contraception through our sexual health services which have got one of the highest levels of uptake of long acting reversible contraception in the country. Thank you. Any questions? Great, thank you. So really helpful report as ever. I was very interested about the section on drug and alcohol services and I'm very conscious that there's a really good plan there about what the service can do to help meet the targets of people completing the course. That's not necessarily the best measure entirely of that. I'm just wondering, I know the report very much focuses on what the service can do itself but I'm just wondering whether some of the pressures that we've just heard about are also impacting completion rates, whether that's temporary accommodation rates, the rising rates of homelessness. I wonder whether there's just something in the report about trying to acknowledge that we're working in a harder context because surely when people are dealing with all of these things like the cost of living crisis it's harder to recover. Characteristically I could give you a one word answer which would be yes. But however, I suppose for me one of the things that we absolutely observe is that the same factors which drive homelessness are very similar to the kind of factors that drive problem drug and alcohol use, particularly more visible. One of the key things that we've been investing in and working very strongly is about much more outreach into the community and I think that's really important that actually the practicalities of delivering services is that you do need to help people to come into services but you've got to be where people are. So we've got a lot more community treatment outreach, we're working in some areas where we know there are clusters of need and help so if it's Archway or Finsbury Park and doing that sort of work, working much more closely with community safety and the police. And some of that is just about the fact that it's about acting together where those kind of issues come up. Often you know you can have issues around anti-social behaviour or criminal activity which comes up now but actually what we're trying to do is to broaden what we can offer to people who are currently homeless or on the streets in outreach. Some of that is about very practical clinical support so can we get them into a service if people in temporary accommodation hospitals actually now will begin to go out and we can initiate treatment. We don't do it very often, it's for people who really struggle to come in. We've got a more diffuse offer so we've got long acting sort of treatment so people don't necessarily have to come in every day for methadone for people who've got issues etc. So we're actively engaging in that sort of need, we're not shying away from it and we're very practical but you're absolutely right it does make it so much more difficult for people experiencing drug and alcohol problems to successfully stop. It makes it much more complex for us and it has wider community pressures as well. I don't know if it's worth adding a bit of context, I think it was only last week that I visited the drug and alcohol service and there were a couple of things that really struck me about it and one was the general view that if somebody comes and they fail in their treatment that isn't the end of the journey, that's just the start and so their general view is it's got to be welcoming and a happy place. If they're not ready they will come back again and again because you can't force somebody to give up drug and alcohols until they're ready and mentally in the place to do it. The other thing is there is a lot of partnership working starting to happen with Whittington and UCLH around having specialist nurses within the hospital so that treatment can start if somebody presents it with an issue that they've come up with, a related but not directly related issue so that can start there. But it means also people start having a good experience of the service so that when they're ready they know it exists, they know they can come back, they know they're not going to be judged and so then you hopefully get better success rates. It's really good news about the numbers of people getting into this to get help, it's really good. I just wondered if you had to recruit more staff or whether you had enough and how do you reach people coming out of prison because Ian Swift talked about having someone sitting in with the probation service. How do you, do you have anyone working in prisons or how do you capture those people, not capture them you know but encourage them? Terrible. Yeah so there are my questions. Thank you, so yes we have invested in new staff, I think we're very fortunate that we've been able to recruit, there's a big workforce pressures across the country, we are working with other councils in north central London and the NHS to actively develop future workforce career models for those staff. It's a very interesting area to work in, people are very interested but there's massive shortages so that's really important. One of the things which happens in the short term is that we've had a series of basically, we knew that we were going to get increases in funding but it was sort of quite often notified very late on in years and sometimes quite provisional so if we weren't getting more people into service we would risk losing some grant, we're not going to lose grant because we've got loads more people in already. So all of those are practical things but yeah we've been very very fortunate in terms of being able to bring more staff in. Importantly some of those new staff roles are very much working within the criminal justice system and within prisons as well so we, again it's a bit like with A&E, we've got to get the right people in to raise the profile of the service. If you're being seen in probation, if you're in the prison, it raises the profile about drug and alcohol use that there were services in the community that could meet those needs and actually we then have people in those services who can make contact with people who are within the criminal justice system and then can actively get them to community treatment. It's not exactly the same as capturing them but we do do at the gate meetings so if we know that someone's coming out on a particular day we have people who will go and meet them, hopefully they know them in the prison already and they can then help to get them into community service. And we also have, because we know that particularly men from black heritage communities are over-represented in the criminal justice system linked to drug and problem alcohol use and under-represented in treatment services, we've got a very specific project called Support When It Matters or SWIM that actively go into prisons, create the relationships with prison health services and the prison to identify issues, make relationships with the prisoners whilst they're receiving treatment, sometimes identify people not getting treatment in prison who should have the treatment and then when they're being released, we'll navigate them, be their sort of colleague or guide to get them into community treatment services. Sorry. A number of times with pregnant women quitting smoking. I just wonder, one observation I've had is there doesn't seem to be many, thankfully, younger people smoking compared to when I was young and many of us were young and I just wonder is that a pattern or is there a generation thing where smoking is seen as probably an older generation thing or have you noticed your findings? Is there any findings to back that up? Your observations are completely correct. We've seen an absolutely dramatic drop in smoking starts amongst young people and young adults and that's typically where about 90% of people who start smoking do it sort of in their teenage years or very early 20s. The numbers are too small in the surveys to really be able to say for any one particular borough what the proportions look like but within London I think it's now, I think amongst 16 to 24 year olds I want to say, I'm probably going to give you the wrong figure, it's probably as low as about 4 to 5%. It's really rather low now. I could be wrong on that. I will probably need to go back and check but it is dramatically lower and you're absolutely right. There was a generation effect. So one of the key groups that we're actually trying to proactively reach and one of the reasons why health checks starting at 40 and it's linked and it's really powerful is a sort of a 40 to 55 age group who are still smoking and that we don't, we see quite a number of services but when you look at the population there's a lot of smokers still in that age group and they must have come through all the big smoke-free legislation. There's been a lot of free legislation changes in the noughties and all the other sort of things and they're still smoking. My assumption is they're still smoking but they haven't got ill yet which tends to be the next thing which then pushes people to think about stopping smoking. So we're trying to be more proactive about how we reach those groups. Another group coincidentally that we're also just beginning to develop some innovative work for is actually people with drug and alcohol use problems because actually there's a very high level of smoking within those populations. So we're looking at new ways in which we can also deliver stop smoking support to them because otherwise they tend to get completely overlooked against their other needs. Thank you. Just if anyone else has a question? Sorry, can I just follow on from that regarding drinking? Again it's another generation thing I guess. I think binge drinking amongst the young, I don't know whether it's as far as showing up, 30 or 30 plus, it seems to have been increased and by that I mean it's not really, it's drinking to get drunk I suppose. Drinking at the weekend, young people tend to have shots, quite a lot of shots, well not shorts, drinking alcohol but shots and that seems to be, I think that in years to come that'll probably be an issue as well. I just wonder is there any research not just in Islington but elsewhere do you know? Because I think it is quite harmful. So binge drinking, I mean it's probably more of a phenomenon amongst some of our younger adults but it knows no age I think would also be one of the things I would also say about it. So yes it does potentially increase risk. There's a whole load of issues of potential risk that you might have an accident, you can have acute intoxication, so other reasons why we've got people in A&E who can intervene etc and it does potentially set up a longer term problem. Interesting though if you look at any people who don't drink, the younger generation actually got a higher proportion of people who do not drink at all compared to previous generations and actually compared to the rest of the population as well. So it doesn't mean that there isn't the problem and issue about people drinking too much at any age and particularly some of the extra risks attached to binge drinking but actually when we look at our younger adults they were actually less likely to drink than other age groups and certainly the generations before them. Thank you. I've got two questions. One is immunization is similar. Is there any reason why we can't increase this one? Let's continue quarter one, two, three just similar. Is there staff shortage or campaign or something reason behind this we can't increase this one? Second question is quit smoking. Do you have any data that people quit smoking then back to smoke again smoking? From my experience I did a project when I was to work in the voluntary sector. People quit after two to three months they back again smoking. Do you have any kind of data that reflect this one? So our vaccination levels remain stubbornly where they are, not for want of trying. So I think in the report we described some of the recent work that's been carried out. I think that in particular there was a big call recall effort. Now call recall is basically you review general practice records to see who's got a record of an immunization and who hasn't and then you proactively follow up the people that haven't had the immunization. It seems to be done very much within GP practices in Islington. It's more likely to be done by groups like the GP Federation now. Experiences is what I would describe as hard yards. People have got a view as to whether or not they want their children vaccinated. The general trend is the younger and the earlier the vaccination the more likely the take up and as you go through the age range, particularly once you reach school, it becomes very difficult to persuade people to have their vaccinations. The sort of insights that we've got around that are really twofold. It's not that people want to get vaccinated, it's more about the factors that are in play and which are different I think from like when I was coordinating immunizations like 20 years ago. Firstly is that I think now parents view it as being much more of their duty to ask questions about things, not to simply accept the fact of vaccination or indeed any intervention. It's good parents to ask the questions and sort of wanting to understand from general practitioners or health visitors or other people in the community about what's going on. The other factor which seems to come in is also people worry about the number of vaccinations that their children have. So we've got a much bigger vaccination schedule now than we used to have. It covers many more infectious diseases and there's sort of a concern that that then has that that increases the risk of the potential for adverse events or harms etc. Now to be frank from the scientific point of view that just doesn't hold, it's not accurate. The vaccinations leave your body, they just train your body to respond to the presence of a virus or that you're infected that you can fight off etc. But that's the concern that people have. So some of that is about understanding what the concerns are so we can better address those issues. There is a London wide resource which has just been developed called why I chose vaccination and it's not just aimed at childhood vaccinations, it's aimed at vaccinations across all the age ranges. So whether it's about flu and COVID vaccination being offered at the moment or the new RSV for older people and we're just beginning to use some of that to begin to roll out messages. And what that works on is about people's lived experience within the community about why they've chosen to have vaccinations for themselves or for their children. And when I do training for people who do vaccinations, one of the key things I always say, think about why you got vaccinated. When you were a child, did you get vaccinated? Because you've got to understand for yourself what was going on in terms of how you confidently address that. So there's a lot of work going on but we are holding the line. One thing which is obviously going on underneath is we've seen the most gigantic change in our young population at the current time in Islington and we know our birth rate is going down and down and down at the moment. But what's happening within that is there's a lot of mobility so people who do get vaccinated actually leave the borough before we start counting them in these statistics. But also we know that the proportion, the numbers of babies born in our most deprived areas is not going down. Now to be clear, most people in our most deprived areas get vaccinated but we know it's more difficult. You're going to be more time poor, you might have more issues about accessing general practice, you might have a bigger family and we know the bigger families, it tends to be more difficult to get vaccinations. So we're holding the line where the population is actually probably saying that we could otherwise be seeing a falling immunisation rate. Sadly we're not alone in this, so the rest of London and inner London are working very hard on this but we're simply not seeing any shifts happening in London. So I think it's really, really important we continue that insight about what makes a difference for residents, continue to work with GPs and the NHS about how we really develop that offer. We've got a very good trained workforce in early years in all of our children's centres who can talk about immunisations and advocate for it and we just have to keep on keeping on. Because it remains one of the most beneficial things that we can do and one of the most protective things that we can do for our population. In terms of smoking reaction, we do do follow up past the first 12 to 16 weeks when we see people who don't have those figures to hand. You're absolutely right, people do relapse. We talk about drug and alcohol, people do that. We could be talking about food and people going to us, they relapse, that's obviously what happens. But generally the more time you help people to quit, go from that cycle, you will get to a position over time where people are more likely to have stopped. We can see that in population figures, we can see that in terms of experience. So it's always a case of we've got really good services, have very positive feedback from residents, very accessible. And there's always a sense that if you need to come back to the service, come back to the service because we're there to help again. But I'll see if I can find any local figures. Just going back to the substance misuse, because Ian Swift was talking about how he's housing people on estates. Often they're vulnerable, they have issues and often substance misuse issues and it causes sometimes problems on estates. I just wondered, do you work with Ian Swift or the housing team to do outreach to those people on estates that maybe could use the services that we're providing? On characteristics, yeah, I could give you another single word answer, which would be yes. It's really important we do that, the housing completely understand that you can get social disturbances, other social disturbances in the neighbourhood. One of the most powerful things we can do to support people who have got a drug and alcohol problem use is actually to get stable accommodation for them. So much else builds on that, they're going to be more likely to engage in treatment, they're going to be more likely to successfully stay in treatment. From a really practical point of view, you know where they are in terms of being able to offer help and support where things are going wrong, being able to make contact with them. Really important that we do that, we've got some very strong examples, also about where people being exploited in those kind of situations, so 'cookering' as Ian talked about. And there we've got really practical examples about how our clinical services engage in problem solving with agencies about how you best intervene and proactively help those individuals. in those circumstances. Thank you, thank you Jonathan, that is a very good, really nice report and everything. Thank you for coming here, many thanks for that. And now we have a work programme. Do committee members have any comment about the work programme? Thank you. Next one, who's coming next? We're yet to confirm, yeah, we've got to confirm. I'll let you know as soon as I find out. I'm going to talk to John and find out the way, how we can shape that. That's good, and I'll talk to you about that. Thank you. The next meeting of the Health and Wellbeing Adult Committee on the 11th of November. I think we are making records that we're finishing before 10 o'clock. There being no further business, I declare the meeting closed. The time is quarter past nine. [end of transcript]