Transcript

Good evening, and welcome to the Health and Adult Scootinies 2020 meeting. My name is Councillor Muhammad Balaluddin, and I will be chairing this meeting today. Only member and person attend can be vote and does not include the co-optees. The meeting is being recorded for the council website for the public viewing. If there is any technical issue, I will decide how the meeting should be continued after taking the advice from the officer. Can I remind member should only speak on my direction and ensure to speak clearly into the microphone. Please have your phone on silent. Member, officer, speaker, who are only online, can you keep microphone on mute, except when they are speaking. If member, officer, online wish to speak, please use your raise hand function. Before we move into the apology, I want to remind member and speaker that we are for the period from now until the by-election take place 12 September. Therefore, you must not discuss or involve any election issue or party political content and strictly close to the matter set out the discussion. Justina, have you any apology today? No, chair. Other than Councillor Mark Francis has indicated that he is online today. Thank you. Can I ask just to note that Councillor Abdul-Marnain is a member of the health and adult school and sub-committee replace the Councillor Kavirishan. Thank you. Yes, chair. No, chair. The minute from the last meeting, 4th of June, 2020, were have been sent. Can the committee member confirm these are the true and accurate record? Thank you. The action log has also been circulated in the agenda pack from the last meeting. We respond from the service. We are receive all but one response and officer are following are from the outstanding one. Do member have any comment or any we can move on? Yes, Councillor Mark Francis. Thank you, chair. Can I just double check? I didn't quite catch that. This is the action log. Thank you. Thank you. Yes. Yeah. Yeah. Is that right? Yeah. Can I can I just raise a couple of points? First of all, on the performance data. So I really appreciate the information that the officers are provided us with around performance. It's really helpful to see that. So I've been having a look at it. And one of the things I just wanted to understand is how these performance measures correlate to the key performance measures that we see in this strategic plan. So obviously, the vast majority of these are not in the strategic plan, but there are a couple that are. And one of those, particularly from last year, is around permanent admissions to residential and nursing home. And so I just wanted to just if wondered if there's anyone from the team who's available this evening who can just draw out that where we are in terms of that KPI in particular, which is, I think, one of the few that are not on that weren't on target last year for adults, health and well-being. Thank you, chair. I'm sorry. Apologies for me personally, that I'm not able to join you in the room tonight. Any officer will be respond from the mod. Okay, sorry. Anyone respond from the mod? Thanks. Yeah. So I can respond to Councillor Francis and just to introduce Cody, Georgia Chimbani, who's the permanent corporate director of health and adult social care, but it's only her second day, so I can just say a little bit about this. So this was an indicator that we used last year, and it was about permanent admissions to residential and nursing home care. And one of the reasons why we used that measure was because what we are trying to do is we are trying to promote independence rather than people going into residential nursing care and becoming more dependent. So this was a measure, when we reflected on this measure what it is, there are some factors around the trends in this which are not in our control, so it's related to the demand for social care and the complexity of residents that we need to support. We can do what we can, looking at each care package, to really think through what is best for the individual, but we're not using this measure this year as one of the strategic plan measures because we're really focusing on those measures that we have control over. We are still tracking it and still monitoring it, but the actual measure that we're using this year is actually quality of life for people who are using our adult social care services, so that's the kind of context of that indicator. Just to add, it is a measure that is a national indicator, so all local authorities are required to keep a track on any admissions into residential care. So as Shermina said, although we are driving towards reducing people in care homes, because actually that's not the best place for people, the best place for people at home, and only when people's needs get very, very complex should they then go into a care home, we will still keep an eye on it because actually it is an indicator of how well we're promoting people's independence as well. Thank you to the officers for that response. So I understand that now and I think that makes a lot of sense why that one's not there. I think the team will understand that when a measure is read at the end of year and isn't then being used again, that's one of the reasons that prompted that question, but that's a really helpful and fair explanation. I wondered if it might be helpful for us as a committee to be notified of those. There's a lot of measures here and I asked for them and that's exactly what we wanted to see, but which of those are going to be included in the key performance measures for the strategic plan? That's the first thing. Second thing I wanted to just to highlight from within this performance report as well is on the third page of the performance indicator report around occupational therapy. So I saw that there's some talk in the narrative as well around average number of days to complete an OT assessment or reassessment and then there's a range of different data in there from 22, 23, 23, 24 and you can see how that's coming down, but then what I couldn't see is how that correlates to the next column, which talks about long term OT. I didn't really follow that if I'm honest. I can see that it says 11 days for an OT assessment across the range of the service, but I couldn't really follow how this relates to each of the different elements of the service, for example housing OT, that sort of thing. So it would be helpful just to get a little bit more of an explanation around that, but just also to say that if that's the performance data and it's come down from what was 30 days a couple of years ago to now an average of 11 days in May, then that's really good performance and just to feed that back to the team as well. Thank you. Okay, thank you Mark. Thank you very much. Can I formally welcome Jessica Chu who is taking over the Nicola Lawrence, Nicola Lawrence is our HealthWatch cover 100 co-op TF. HealthWatch cover 100 is important to stakeholder and to bring the resident well on the health and care issue. Thank you very much. Sorry, Jessica Chu. Our next agenda is to introduce yourself and declare if you have any DPI, starting from myself, Councillor Bela Luz, nothing to declare. Thank you Chair. Good evening everyone. Councillor Iqbal Hussain. I have nothing to declare, thanks. Thank you, Chair. Councillor Baudrilli Choudry. Nothing to declare, thank you. Councillor. Yeah. Jessica Chu. Iqbal Hussain. Nothing to declare, thank you. Councillor Sabina Khan. Nothing to declare. Councillor Amy Lee. Nothing to declare. Good evening everyone. Councillor Manan. Nothing to declare. Anyone? Councillor Francis. No DPI's. Thank you. Our first item this evening is important area for the council and our service user resident, which is looking at our council adult social care service preparation for the forthcoming care quality commission inspection today. I am aware that we have not had a CQC inspection for adult social care for over a decade now, so it will be a useful learning. I am also aware that this is committee and did receive presentation for adult social care last year on the initial preparation, so it will be useful to understand the progress and any feedback or improvement in sight or they may have received or observed CQC inspection as statedly and for adult social care, ensuring that service is meeting compliant and quality of care. We want to know and understand any area for the improvement, any ongoing concern and pressure and how to mitigate as the best as you can to avoid the negative outcome. Can I welcome Councillor Gulam Kibriya Choudhary, cabinet member health and wellbeing and social care and also welcome Georgiad Cimbani, our new corporate director for health and adult social care and also welcome Margit Young, our new director. Can I welcome Emily Fian, the program manager for adult and social care improvement. We will have to up to ten minute provide high level overview and then we will open to our member questions. Now, I will hand over to our cabinet member, Councillor Kibriya Choudhary, please. Thank you. Thank you, Mr Chair. Good evening all and thank you again for choosing this agenda. It is very important for us. This administration prides ourselves on our commitment to caring for adult residents who need support. We provide high quality care which meets our duties under the Care Act. Our residents decide their own goals. We support them to be independent but stay connected to their families and friends. We also recognise that we have a diverse body of residents. Our care is culturally sensitive so that our residents feel at home even if they attend day care services or move into residential care. The last government began a process of inspection. The Care Quality Commission CQC carries out the inspections. We expect the CQC to come to Tower Hamlets within the next year. We have been preparing for this inspection for over a year. Yes, this is because we want to pass the inspection but it is also because we want to have high quality, excellent service even when the inspectors are not around. As a part of our preparation, we had, as members know, a PR review in January

1. The result of this review came to this body in June and are summed up in this report for convenience. Officers have been working very hard on assembling documents, reviewing our policies and practices and preparing our staff for this preparation. Details of what we have been doing and what we still have to do are given in this report. I thank all of the officers in adult social care for the parts they have played in getting us ready and we want to assure that any assessment of us should be a positive one. Today our officers are here. If you have any questions, any clarification, they will clarify, they will answer. Thank you. Our next speaker will be a request to Emily, please. So in your papers, I believe you have the presentation entitled Adult Social Care, Care Quality Commission Inspection Preparation. I know you will have lots of questions and things that you want to ask and discuss, but I will just briefly refer you to some of the key things in there that might help the discussion. I should start by introducing myself. I lead on adult social care inspection preparation, but also improvement and transformation within adult social care. So the Care Quality Commission Inspection, or CQC as we know it has, as Councillor Choudry has outlined, it's a new regime. There were no inspections until January this year and it's expected that all local authorities will be inspected by the end of December next year, 2025. And at the end of the inspection we'll get a published report which will grade us as outstanding, good, requires improvement or inadequate. So the framework for us to be assessed has four kind of themes under it. Working with people, how we provide support, so very much looking at things like commission provision and also partnerships is included here. Safety and how we safeguard people and our leadership. So that's the kind of lens through which they're looking at what we do. In terms of the inspection activity and what it consists of, there are a number of different things that happen. So the traditional inspectors coming on site for a site visit kind of aspect is there, but that tends to be the kind of last thing that is part of the inspection. And prior to that we need to submit quite a large number of documents and data. They'll look at our website, they'll talk to providers and other key people in the community. They might talk to carers and voluntary sector, for example. And we submit a self-assessment that sort of sets out briefly our kind of summary of where we think we're doing well and not so well. We also submit 50 actual cases. That gives you a flavour of some of the different things that the inspection consists of and the many things that they'll take into account when they're making those judgments. In terms of our preparation, there are really three things that are top priority things for us and they are the things that CQC have said that they require us to do. That's why they're top priority. So the self-assessment and the good news is that we have a self-assessment is in place and it's being regularly reviewed and updated. The information return and essentially we have the documents against that that I would expect to be in place by now and the ones that we don't have when we're notified, we know we can get them. The case tracking, so this is the 50 cases. We have 50 cases. They're always changing because they have to be very up to date and there's all sorts of other reasons. So we keep those up to date. So we have our 50 cases that we're happy and ready to share. And then our other preparations are to do with having a clear plan for the point at which we're told now we're being inspected and who's going to do what and we've got that in place. And we're also doing various things to talk to people and brief people, whether that be staff, partners, the individuals whose cases are going to be put forward, members, a range of different audiences for that kind of engagement. And that is being delivered as we speak and we'll go into a different higher sort of level of that once we are notified. In terms of other things, we are also looking at our documentation more generally just to ensure that all of our policies and procedures and things are up to date. Just to mention that we also had a peer review. I think the previous director of adult social care, Kato Driscoll, spoke to you about, I think the chair referred to it earlier, came to scrutiny to talk about this a little while back. Well, we had that in January and a peer review is basically like a kind of mock inspection and it was a really positive experience and the feedback from the peer review was extremely positive. There were many strengths identified that we identified with and particularly things around our workforce and how committed they are and how positive they are and how knowledgeable experience our staff are, our partnerships being strong and the way we work with our communities and know our communities well was also a strength as well as just some of the resources we have that other boroughs don't necessarily have like the Independence Living Hub and the Carers, the strength of our Carers Centre. There were of course some areas of focus and it wouldn't be a successful peer review if we didn't have those. So things like making more use of our data, ensuring that people don't become dependent on social care, particularly where they actually have low needs and then there would be other ways of them being supported and empowered and a better understanding of user satisfaction. So those things that came out of the peer review were very much taken forward into our self-assessment and the remaining slides that you've got in your pack where it says theme 1, theme 2, theme 3, these are partly based on what came out of the peer review but also our own kind of assessment of our areas of strength and areas of focus. Obviously there isn't time to talk through all of those and you may have particular ones that you wanted to ask questions on but just perhaps to draw your attention to a few key things. So in terms of our strengths based approach that was something that they particularly pulled out as being very positive in a peer review and that we think is a big strength of us and involving the user voice also very positive. In terms of areas of focus under theme 1 we have things like the way we use technology and the fact that there's more opportunities around that and also more opportunities to utilise direct payments. In terms of theme 2 which is really about the provision, the commission provision law, so people are actually very positive about our provision and we know that from our surveys and the feedback that we get and our workforce is actually very stable, that's both the workforce in the council and the wider workforce compared to other places. But there are some areas of focus for example our housing with care strategy enables us to better meet match the kind of needs of our population with the housing with care options that we have on offer. And then the things I'd draw your attention to in terms of theme 3, ensuring safety, are that safeguarding is most definitely our top priority and unlike some boroughs we do have no safeguarding or deprivation of living to safeguard waiting lists. So it is something that not only us within the council but we work very closely with partners to ensure is our top priority. But there are areas that we need to work on such as mental capacity. Sorry, only one minute left please. Thank you. In terms of the last theme then which is leadership we feel we have very ambitious leaders in Tower Hamlets and we have effective governance that we continue to review and streamline when we need to and we have very strong commitments on equalities and our diverse workforce and we also have a strong learning and culture offer. But our areas of focus on the theme 4 are again using our data better as I mentioned earlier and delivering our new workforce strategy as well as improving how we reflect more on the feedback that we get. Thank you, thank you very much. Do member have any question or any comment starting from Amy, Councillor Abdul-Mannan, Councillor Badourwal and Councillor Iqbalujian? Thank you. I think I've got a few but I'll just start with, so it does mention the final slide but last time we did, as you said we've had a presentation before, last time we did it was a lot about building, I think that's the language you're using, building all of this work into ongoing work so it's not a separate project it's just part of what you do on a daily basis. There has obviously been some staffing changes since then so I just wondered if we could get a bit of an update on that progress in that sense and I do have others but I think it's best to come back to me. Yes, there have been some staffing changes, I am one of them and I just want to give assurance that the plan that we have in Tower Hamlets, given today's day two, but of what I hear of it, it's a really good plan. I was in Suffolk in my previous role, we were one of the five national pilot sites and based on what we did this sounds like a very, very robust plan and also given that we undertook our pilot inspection that was about September last year, we've done a huge amount of work in terms of integrating it into business as usual and I think one of the key things is, although we clearly have Emily who's the programme manager, she's very much integrated into operations, she's working very closely with operational staff, our interim director of adult social care is leading this work but couldn't be here, our principal social worker, so we have a very, very good strong team operationally because actually CQC or no CQC, this is the right thing to do, so we are continuing. So even if something happened and we didn't get an inspection call for maybe 18 months or so, we still would continue with this work but it is the right thing to do. Thank you. Thank you. Our next question will be Councillor Botul talk, please. Thank you, Chair. Thank you. Good evening. Thank you for your presentation. My question is how can you assure us on the steps that have been taken to improve the user satisfaction and ensure that all eligible individuals who are part of that service that they are receiving, they are getting the right support they need on a daily basis? Thank you. Okay. So in terms of user satisfaction, I think the work that we've been doing particularly lately in light of sort of identifying that this was something we wanted to work on was making sure that we're asking people more what they think and making sure that their net feeds into, as Georgia mentioned, it feeds into our existing operations and our existing plans. So we have a team who regularly call people for feedback on what social workers have been doing as well as the feedback that social workers would ask for. We also have a kind of like an online platform and people can call as well as a way of feeding back any time on adult social care and we promote that via kind of most of our mechanisms of communication have that as part of them. So yeah, so we make sure that that is regularly looked at and feeds into our improvement plans and if we identify that there's a particular trend with lots of people saying a particular thing, then we make sure that we kind of adapt. So the plan that Georgia referred to, it's not kind of set in stone, it moves as it needs to to meet what people are saying. So, yeah. I missed one line to it. Is it normal to be 10 years for a CQC to come in? Ten years, that's a decade. So we've had and had anything in between. So no, no, it's not 10 years. So we have off stage four children, CQC, this is something completely new. So we've not had regulation like this ever in terms of adult social care. The last we had was probably, goodness, 15, maybe 20 years ago when we had local authority inspection teams, it was very different. So this is something new and that's why when I described initially earlier, I described how in my previous role, we were part of a pilot site. That was a new, it was new legislation that was brought in under the health and care legislation that the government, the previous government brought in and the pilot sites were asked to pilot as a way of trying to test out this framework, which is now being rolled out now. Yes. Okay, thank you very much. Our next question will be asked by Councillor Sabina Han. Hi, hello. So I've got two questions. One is to ask how can you give assurance that patients when they get discharged from hospitals, especially mentally, mental health, health patients, that they're safe in the community in terms of housing and they've got somewhere to go to and they're not just, you know, discharged. And the second is about housing as well. Like what specific initiative you have or inspection you've done on housing with care strategy that, like that, that they target and meet the residents need, communities need housing and care? If I jump in and based on my two days knowledge and then colleagues can support. So we work in Tell Hamlets, we work very closely in terms of mental health or hospital discharge, we work very closely with health colleagues. So as you are leaving hospital, you are seen by different professionals as part of that. There's also as part of that discharge an agreement in terms of maybe who the lead professional might be. So for instance, it may be a district nurse or it may be a social worker, it may be an occupational therapist, who will then in a sense almost kind of follow you into the community and do a follow up with you. And that's one of the ways in which we are reassured in terms of making sure that people's needs are met. So that's part of what we do in terms of mental health is quite similar. We work with the mental health trust again and actually we have at the moment we have a model of working where our social workers sit in the mental health team, we have integrated teams, we've got integrated teams with the mental health team. So that means that instead of having a separate team for social workers that sits in the local authority, a separate team for maybe mental health nurses, they all work together and then actually can work with the person together rather than divide. When you are working with a person you can't say well this is your physical health, this is your mental health, this is this. We are all individuals aren't you and you want people to look at all your needs in totality and that's one of the ways in which we reassure ourselves in terms of making sure about that. And then I think you asked Councillor Khan about housing, do you think you asked? Okay I know that we are working quite closely with housing colleagues but I'm not sure if we've got a housing strategy because part of what we always try to do in adult social care is, and you can maybe fill in the blanks Shoman and Emily, is to be sure that we have a strategy because what we want to do is not just work, provide housing just in the here and now, it's also about people's long term needs because you want housing, you want to work with housing so that they recognise that people will get older, so you want what we describe as homeschool lives that are easy to adapt so that people don't have to move when they get to a certain age and it's important that we work with housing to be able to say in 10 years time this is what we are going to need and actually what are you going to do to support us. But also things like making sure that people are supported to continue to maintain their tendencies, so those are some things we would do, and then Shoman or Emily you can fill in that there. Yep, so there is a housing with care strategy that I understand was recently agreed at cabinet, it sets out our plans to ensure that our future housing with care options better meet the needs of our population, so some of the things that includes for example are ensuring that we actually have increased provision of extra care and therefore less provision of residential care because that would better meet the needs of our population but as Georgia has said it's a long term strategy because this is basically we are working as Georgia said with housing, we are making sure that we are part of the capital delivery plan to ensure that if we need to identify sites for this we can identify sites for new types of accommodation etcetera, so yes there is a strategy and it's very much not only looking at our population now and what we know the needs are now but as Georgia said looking at what we know about what the population is likely to be like in future and what those needs will be and how we can ensure that best fit with what we have available to what people actually need and want and enables them to be more independent. I think the other thing I'd say just to respond to the hospital discharge point in addition to what Georgia said is that one of the things we're working to do and I think we're again sort of ahead of some other boroughs in this respect is to build the process of discharge from hospital much earlier and to get more and more occupational therapists and others into the hospital early so that really preparation for discharge from hospital happens from day one and so there's an exciting piece of work that we're doing around that that yeah we hope we'll soon have some positive evidence to show how effective that's been in supporting people better. Thank you, thank you very much, thank you. Our next question will be for Councillor Abdul-Mannan. Thank you chair, how does our adult social care framework ensure that the needs of our unpaid carers are adequately assessed and supported and the follow-up is also what specific measures are in place to prevent dependency on social care for individual with low needs. Thank you. Thank you Abdul-Mannan, is it good questions because we always prefer the prevention is better than and we always try our best to get the service in home and we always prefer for unpaid carer if and we will lose their issues and their concern, it is our priority as well, thank you. Thank you, thank you very much and the next question will be Jessica. Thank you chair, I just wanted to follow on from Councillor Chaudhary's query about the feedback and you mentioned that you gather feedback through calling the service users and their families, I wondered if there were any other mechanisms kind of because there is a potential that the feedback could be skewed if you are just calling from the service and whether you work with any other organisations to collect the feedback and then I also wanted to ask about, it seems very data driven which is fantastic, your strategy, but I wondered if there are any plans in place to actually, how you can effectively use the data to kind of improve the services and whether you will capture the data later down the lines again and it is not just a snapshot piece of data and you will, following all these improvements, will, are the plans to evaluate and capture data, sorry that was three questions, everyone, thank you. So I will, you asked three questions, I was trying to think what the questions are, the data driven, so the different methods of getting feedback from residents or service users, we have a number of methods and of course Emily you may want to jump in after I have spoken, it is constantly evolving, if I am honest it is not something that as local authorities, certainly as adult social care, we were particularly good at and actually from my perspective I think in Tower Hamlets we are actually a little bit ahead of other local authorities, it might not sound like it because it sounds very basic, but in a lot of places getting feedback is almost non-existent, so yes I think there is always the risk with any feedback, whatever feedback it could always be flawed, but we are constantly trying to find ways of evolving so that we have a number of different ways of actually, this is triangulating, but that is work in progress and what we want to do is to take our time to develop that so that it becomes sustainable because as Councillor Lee said, we want something that is sustainable and it is the right thing to do because actually this is what we want to do in adult social care, not just because CQC are coming. And then I think you asked the question around feeling quite data driven, I think that is a good challenge, it does feel like that and the reason it probably feels that way is because CQC themselves are very data driven, so while in adult social care we are very good at almost looking at outcomes, you do this, what is the outcome for somebody, CQC will say what does the data say, show us the numbers and show us this, so we have almost had to just change the way which we think as adult social care departments to try to make sure that when CQC come, because what they will say is, for instance you asked a question Councillor Mannan about carers, they will say what are you providing for carers, we will say this is what we provide and they will say how do you know that that is making an impact and we need to be able to provide the data to demonstrate that that is making an impact. So that's why, apologies it may feel quite data driven but we are trying to balance the data and the outcomes. And sorry I think you had a third question. It was around how you are using the data to improve the service, pre and post CQC inspection. Yes, I was just to say that as part of the preparation for the adult social care inspection, in public health we worked with adult social care and we did quite an in depth needs assessment to make the best use of all the data that we had. One of the key things that we did was we linked some of the adult, we looked at the adult social care client group and we looked at them from a health perspective looking at aligning it with GP data so we could see that a lot of the clients have multiple morbidity, you know like diabetes, long term conditions. We also established things such as their use of services and one of the surprising things we found was that although this is a group that has a lot of health conditions, they were not accessing general practice as much as we would expect them to do. So that was kind of an insight that we got but that is by bringing, as Giorgio was saying, we need to look at the whole person. So you know obviously in the council we look at them from the perspective of their use of adult social care services but it's really important for us to triangulate that with the health data as well and that access data. So that's the kind of journey that we are on and it's been actually a really good partnership between adult social care and public health in the council. Just to add to that, so there is a service user survey, that's the title of it and a carer's survey undertaken sort of nationally and we partake in that so that's slightly different than anything that we would do ourselves. Also just to be clear that the team that I mentioned that do the calling, they are not an operational social work team so they have a level, admittedly they are still calling from the council, but they have a level of independence so it's not like someone only being asked by their own social worker for example what they thought of it. We also have for example for carers, the carers centre do their own survey in addition to getting people to respond to the national carers survey and we very much work with the carers centre to address, we have an action plan that comes out of that and the carers survey to address the kind of things that come out of that. So yes we do do that. The other thing is we often work with groups like REAL, the Disabled People's Organisation and for example they have recently done some work with us about co-production and how we co-produce and provided us a lot of feedback that was very independent because they were doing it as REAL rather than as the council and so we got a lot of good feedback from that which we're responding to and yes and within the plan that I mentioned earlier the kind of improvement and transformation elements of the plan are all linked to data and when we look at our transformation board the question we always want to ask is what is the data telling us first and that includes the data in terms of the feedback data, so the kind of soft data as well as the hard data before we move on to okay like what are we doing and how is it progressing. Thank you Chair. I have two questions. The first question is in the process of preparing for the inspection, QC inspection, what in your judgement what is the most challenging area or gap you have identified and if so how is the leadership in terms of preparing to address potential gap identified in governance and ensure that the service meet the required standard demanded by QC? Okay, I don't know if it's necessarily the biggest challenge but I think the thing I'd highlight is that there's a lot of, so when I mentioned about the cases and the 50 cases that are put forward to CQC, actually they have to have had particular actions within the last six months to be valid for CQC and because we don't know when we're going to be inspected then it means that there's always cases which have to come off the list of cases that we're putting forward, so the process of, because we don't just put any case forward, we ordered them very thoroughly and we moderate that and we obviously talk to the person who's drawing on care and support and check how they feel and that they're happy for their case to be put forward to CQC and what that means for them. So doing all that work around those cases and then having to keep those up to date regularly is quite a challenge but we have successfully managed to do that but there's a lot of work involved in doing that and I'd say it's just the kind of not knowing when CQC are going to be notifying us that makes that a challenge. Thank you very much. Our next question will be asked by Councillor Marks and Francis. Thank you, Chair. Thank you for the presentation and it's really good and it's a great reflection on the work across the whole directorate that there's so much positive reflections from the peer review. Inevitably, we're going to focus on the slightly more challenging aspects of this and the first thing to say is that obviously this is a peer review, it's not about the satisfaction itself and so the language can sometimes be a little bit more generous and slightly less direct than it might be in an inspection. So one of the things that is drawn out is around the satisfaction as Councillor Churchill has mentioned. So my first question is really just what do you understand from where you've described it in the slide here, is it to have a better understanding of user satisfaction? What do you think that the inspection team was really saying then? Well, I think in terms of the peer review, I think it was simply that we need to find opportunities to ask the question more. I think that was the biggest thing that it came down to and I'll say sort of since the peer review we have found many more opportunities to do that and we've got lots of rich understandings from that and we've made plans and improvements off the back of those, whether that be kind of small improvements or fed it into our ongoing kind of improvement plans. So I say that's the biggest thing is that we need to kind of ask the question more and ask for feedback more. Can I just add, Councillor Francis, it is as Emily's described, asking the question more. You get an answer but I think from a peer review and a CQC perspective, what then do you do with those answers? Because the real test of good user satisfaction is being able to take what you are given and being able to demonstrate that it's actually having an impact in terms of shaping or influencing the surface through crop production and various other ways. So that's I think our challenge for us to be able to, we've made a good start, we're hearing and getting the feedback but I think the biggest challenge is what do we then do because you want to be able to say actually as a result of this feedback, this has changed for the better within the service. Thank you. Thanks, so I really agree with that. When I look at the, go back to the, not this presentation but the summary that I think was, I don't know if that was drawn up for DLT or CLT or someone from the peer review. So it says a better understanding of user satisfaction as the views of service users and carers were mixed and I think that's a, you know, that is, that is, there's more in there than we're kind of, than we're seeing here. So I mean I really agree that it's about, it's what you then do with it, there's no point kind of getting those views back if you don't take any action. But I just, so what I couldn't see is how those sort of, that aspiration to reintroduce satisfaction measures more obviously into performance management is then reflected in that whole schedule of performance measures that we were, that we were also given and I talked about at the start of that. So I appreciate that these two things are sort of slightly overlapping and this piece of work is, is at this point in time like the measures for 2024/25 are set in train, but are additional performance measures going to be introduced over the course of this year or at the start of next year to better, to make sure that we are better understanding and acknowledging the kind of the mixed perceptions of service. I don't know if we necessarily want to introduce new performance measures. I don't know, Councillor Francis, it's probably from my perspective too early to tell, but what I would like to do certainly over the next couple of weeks is say maybe we already have the indicators, it's just a question of maybe how we're using that data. So for instance if we're measuring use of satisfaction, in my view we need to be measuring it at various, in various areas within the service rather than maybe for instance traditionally we'd like to just measure it, it's quite easy to measure in our customer service centre because, you know, but that's where people come in, you know, in terms of the phone call. But we're not particularly good at possibly measuring it down, I don't know, a few months down the line when somebody has a service and a package of care and we've known them for a long period of time. So maybe we want a mixture but so I would say it's too early to say in terms of whether we want new measures but I can certainly give my assurance that we will be reviewing what we've got and it may be we need new ones or it may be the ones we have are already sufficient. That's really helpful and it would also be good if we could just draw out from those performance measures that are in place for the current year which of those are satisfaction. So I think there's been within this authority in general terms there's been a bit of a move away from perception based performance measures, not just in the last year or so but I think probably over the last decade and I think, you know, there's some debate about why that's happened and whether that's right or wrong but it would be useful just to know exactly what's there and what I guess what the feedback on that is. Can I just add one extra thing to this? So obviously like this is an inspection of ourselves but in some ways the people's perceptions of the survey is through the services that we commission and so one of the other things that's in the action log that we asked for is what ratings are CQC given to people that we are commissioning services from? So particularly nursing homes and home care, just to focus on those. So I went through the list earlier of those that we were provided with that are kind of based in Tower Hamlets and I know are providing service within Tower Hamlets. So at least one of those nursing homes is down as requiring improvement and several of the home care agencies are also down as requiring improvement. And obviously in the education field we've literally just in the last 24 hours had an announcement that we're moving away from one word, two word judgments following inspections but nevertheless that's kind of what we've got here to base that we can kind of base our own perceptions of the quality of service on at the moment. And there are obviously reports that underlie those as well which explain the reasons why CQC reached those judgments. So my final question is how do we factor in or how do we demonstrate, how are we preparing to demonstrate what we are doing to try to make sure that those we commission services from are also making progress on achieving improvements where they need to. And I should say there are lots that are rated good and some that are even outstanding as well and that's brilliant. I'll start and then I'll hand over to Emily. So as part of the inspection process CQC are very keen to separate ratings for care providers and ratings for local authorities because the two, although they may be similarities, they are, it's a very different framework. So that's the first thing to say. However, having said that, because we commission care providers you could argue that we are in a sense joined at the hip so it becomes quite difficult to separate that. From a local authority perspective what CQC will be looking at is in terms of our statutory responsibilities as a local authority, in terms of ensuring that people's needs are met, people have good quality care. They will want us to be able to evidence that in any number of ways because they'll ask the question how do you work with your providers, how do you ensure yourselves, what happens when you have safe guardings in care homes and so forth and it's for us to be able to demonstrate what we have in terms of a framework or services that we have which I know from a Tao Hamless perspective is fairly robust in terms of the support that we provide to be able to do that. There is also, I think CQC also recognised that from a provider perspective as a local authority we can do what we can but at the end of the day they are still independent autonomous businesses so they still have a responsibility themselves even with the support that we provide to make sure that they do what they can do in terms of providing good quality care. So I don't know if that answers your question Councillor Francis but I suppose what I was trying to demonstrate is the two are separate but because we commission, as you rightfully said, they will be looking at that aspect but they also recognise that providers do have a responsibility as independent businesses to be able to ensure that they do all they can to improve the quality of care. Emilia is there anything you want to add? Just to add that because a provider is in the borough doesn't necessarily mean that we commission them or use their services of course. So it's important not to conflate the two because who we commission and who happens to be in our borough are two different things. And also just to say that we do have a good record however of supporting providers, commission providers, non-commission providers and those that are in our borough and we have in the past supported providers to improve their CQC ratings, well improve their service which has therefore improved their CQC ratings and we continue to do that. We provide a range of different training and engagement and with some providers we work on kind of action plans to support them to improve. But as George said I would go back to the point that there are limits to that and our focus has to be on the services that we commission being of the quality that we would expect for our residents. Thank you very much, thank you. Sorry we can't take any more questions, we have to move to the next agenda. Our second item is this evening focusing on the sexual and reproductive health service. It is important matter from a public health point of view and one whose support prevention of sexual transmitted infection and included HIV provide education and awareness. It provide access to concerned support and vulnerable population early detection and treatment, mental health and emotional support and reduce inequalities. We know that the media has picked up our concern in sexually transmitted disease such as gonorrhea and chlamydia being in the increase. Can I welcome back to the council, Councillor Kibriya Chaudhry, also can I welcome Liam Crosby, Associate Director of Public Health and Adult and also can I welcome Andrew Liam, Consultant of HIV, Sexual Health and All Sexual Health Service, Bath and Health NHS Trust. Following our speaker I have also asked to hear from some of our frontline charitable service. Can I also welcome Lian Toji, project manager for working with Beyond on the state charity doing some work. So welcome. Now I can hand over to the Councillor Kibriya Chaudhry please. Thank you. Thank you Mr Chair. This administration is proud of the sexual and reproductive health services we offer. Our work is a great example of how this council works with local expert partners. We work with neighbouring councils so that we can achieve best value for money. We work with health service providers so that residents can access service in and we are developing our online service to help us keep within our budget and because it offers a convenient service for many of our residents. We don't have a single clinic or even a series of clinic issue clinics. We offer services through GP surgeries and pharmacies as well as through specialist centres in different parts of Tower Hamlets and beyond. We reach out to young people and to vulnerable groups with such a range of different services reaching out to our communities in so many different ways. We have to obtain feedback from service users in different ways too. We run mystery shopping exercises and many kinds of questionnaire. We monitor statistics closely so that we can vary our service to meet challenging needs. We want to do more with challenges we face and the areas of improvement we want to explore and set out in today's report. I want to add that our officers are aware of the recent outbreak of the new variant of AMPOCs in the Democratic Republic of Congo. I am pleased to say that at the moment there is no cause of concern but we are keeping in touch with the UK Health Security Agency and will take any action they recommend. I thank the officers, particularly Dr Suman Banerjee and Liam Crosby for their works on this service in terms of preparing this presentation and throughout the year. Thank you, Mr Chair. If members have any queries and any questions, our team will help. They will respond to this. Thank you. My name is Liam Crosby. I'm one of the Associate Directors of Public Health. I lead on healthy adults. I'm going to talk quite high level through some of the information that's in your pack because I do want to give time. We were joined by Dr Andy Williams who is one of the consultants in our specialist sexual health service and also by Tanya Percy who is the service manager there. I want to give time for them to talk as well. I'm just going to talk briefly through what we know about need in Tarhamas for these services then about the range of services we have put in place and about where we're going next with them and then Andy and Tanya are going to talk more about All East which is our specialist service that we have locally. We have a very young and a very sexually active population and what that means is that we have lots of people who have high levels of sexual and reproductive health need and actually we've got a very engaged population as well. We've got lots of people who are really engaging with thinking about what they need from sexual health and from reproductive health as well. Some of that comes out in some of what we see in terms of public health data. We have got increases recently in rates of sexually transmitted infections. That's to do with those population issues that we've talked about particularly gonorrhea which is of some concern at the moment due to antibiotic resistance. We've also got lots of success stories. HIV is a particular example of this where we've seen sharp falls since 2015 in the rates of new diagnoses of HIV and that's particularly the case among gay and bisexual men who have sex with men largely to do with rollout of preventative medication for other reasons as well. Some challenges there in most recent data is that we are seeing some indication there might be an increase among some other population groups. On reproductive health side, this is a really important topic because behind all of these numbers are people who are thinking about their own families and their own plans with their life really. Again, some successes here. We've seen rates of abortion in Tower Hamlets fall quite a bit but we know there is still more we can be doing particularly around making sure that all parts of our community have a full range of contraception choices that we need. Those are some of the issues that face our community. We've got more information in your pack about the range of services that we provide but as you can tell it's really important for us to take a whole life course approach here. People start to think about sexual and reproductive health quite early so we need services for young people and we have those in our Safe East service which is a very targeted tool. Health service does lots there as well, our school nursing service. Then we've got our specialist service which includes our centre of excellence which is right next door in the Ambrose-Kring Centre but also delivery in Myland Hospital. But as well as that we really have a range of services that get these needs close to where people are, close to people's lives so in GP practices, in pharmacies and that's in order to make sure we've got the wide range of different options for people in terms of how they engage with this and actually I'm sure Andy will talk about this more but we're very lucky to have sort of a very leading service that does lots of engagement with those other services as well and helps for example GPs to deliver quality sexual reproductive health. There's more information in your pack that I won't dwell on now about each of those things but essentially we have seen during the pandemic there was a dip in the rates of which these services were used as people were for a number of reasons but we're kind of seeing that return back to where it was pre-pandemic now and both our in-clinic services and our online services have very high rates of user satisfaction so people who report high rates of satisfaction with them. This chart that I'm showing here is quite important because this just shows how demand has changed over time. So this graph that you're seeing right now is the number of consultations for STI testing but I could show you a similar graph for a range of things that our clinics deal with from sort of cases around sexual exploitation or domestic violence coming up or reproductive health and contraception and it also is a similar thing which as you can see is kind of a gradual increase and a particular increase since around 2016/17 and this is really good news because what this means is that our residents are taking more interest in their sexual reproductive health and are feeling able to access clinics so it's a really good thing but it is also a challenge that we have to meet because the funding we have to meet that increased need and increased demand hasn't increased so actually since 2013 we have done a huge amount of transformation working with our clinical services and with other services and as a result of that transformation we've actually reduced the amount we spend on these services on sexual reproductive health by about two million pounds a year. I think that's one of the kind of big sort of transformational successes we can talk about in local government where it's one of the big successes and you can see more breakdown here of what that means we now spend but what this does mean is that we kind of now are at a point with these services where given the increased demand we don't really have much well any wiggle room really and especially as well Andy I'm sure Andy will talk about this more but the demand that we now do see is increasingly complex so as I spoke well that includes things around safeguarding it includes a number of issues. I want to stop talking so that I can bring in Andy and Tania but just to think about some of the challenges just to say we are collaborating on this area with others across North East London so that includes our services but also includes other boroughs to make sure that we're aligning what we're doing and that we are we have a good strategic approach to the challenges that we definitely face so we've recently brought a section reproductive health strategy to the health and well-being board which was approved by our health and well-being board in July and that focuses on some of the partnership actions we need to take in four priority areas that you can see on this slide everything right through from sort of promoting good understanding of health and section reproductive health to enable healthy relationships through some of the issues around making sure we're tackling those STI challenges that we have and ensuring action on HIV as well and there's more information in your packet what the actions were taken locally but I'm going to stop talking there and I think Andy was going to say a few words. Yeah I am hopefully everyone can hear me I can only see Tania and Mark if one of you could give me a thumbs up if you can hear me. Thank you yeah so hello everyone good evening thanks for having us here thanks to Shoman Banerjee and Liam Crosby for the invite to be here so I'm Andy Williams consultant in sexual health and HIV and clinical lead for sexual health services across the boroughs of Tower Hamlets, Newham and Waltham Forest and I work with Tania Percy who's the service manager across the same boroughs with the same service so this presentation is gone. Do you want me to share my own? I can bring it back sorry. Thank you. Thanks Liam. Are the slides moving if I move them forward or in a few minutes? I think I'll move them so you can do the next one. Thanks very much okay next slide please. Okay so this is going to talk about a bit of background about what we provide and what we were commissioned to provide so the commissioning arranged was in 2017 and All East who's led by Bart's Health were commissioned to provide specific work packages for sexual health and if we just quickly walk through them the main work package is integrated sexual health services so that's the main bulk of work that is provided within clinical service. Work package two is as Liam alluded to outreach from our service into primary care and pharmacies writing of something called PGDs which is patient group directives so that pharmacies and other providers can provide contraception or STI treatment at the point of presentation. We also provide other work packages which I won't go through in detail but effectively allowing us to provide outreach to certain areas to see young people in not Tower Hamlets but in Newham and then work package three is really sort of innovative work package allowing us to respond to need at the time so things that have happened as a result of work package three are for instance we provide chem sex work to local populations who present with that to STI services. For note there is also a separate contract for community women's health services that doesn't fall under our own contract so seeing patients who require menopause intervention termination of pregnancy FGM and also the new women's health hub pilot which will probably be on your radar. Next slide please. So briefly about our services in case you aren't already aware so we're located right next door to you so we're in the Umbras King Centre just at the junction of Mount Terrace and Turner Street and patients historically prior to the pandemic had limited options to be able to get into the service it was largely a walk-in service with some online availability and you may have heard through previous presentations over the years or even seen patients queued around the block and there was kind of quite a stigmatised approach and that's just the expectation of what sexual health patients had to go through. The pandemic changed healthcare in all sorts of different ways and one of the ways it did that was allow us to make innovative ePathways that have been very very successful and you've heard about something called Sexual Health London which is the ePathway for simple asymptomatic straightforward patients and those patients now no longer should come to STI services they should be self-managed through those pathways and we see the more complicated patients in clinic. We provide a range of all sorts of treatments which are listed here for your interest. PrEP is pre-exposure prophylaxis for HIV and PEP is post-exposure so PrEP is something that didn't exist prior to the pandemic so it's the ability to give patients HIV medication to prevent them becoming HIV positive so you identify patients who are likely to be at risk. That's been extremely successful in the gay and bisexual men community but less so in other communities and as Liam has alluded to the challenges now are getting PrEP into migrant and heterosexual populations who have very very low PrEP awareness as opposed to the other populations that are very very aware. LARC is long-acting reversible contraception and I think Tower Hamlets are to be congratulated on the maintenance of LARC through the pandemic. We stand apart from the rest of London where patients are struggling to get contraceptive appointments and treatments and if you look at the LARC data for your own residence it has been maintained and increased through the pandemic largely due to the work that has been done by our service and others so thanks to everyone that supported that. We also work with a group of clinical psychologists who work for risk reduction and ongoing psychosexual needs and there is huge psychosexual need within Tower Hamlets both for men and for women and we run joint clinics with medics and psychologists seeing those patients. We are providing peripatetic offer of interventions so what that means is going outside of the clinics or seeing patients within other locations that may be mental health services that may be going into maternity services so offering women who have just had babies what kind of contraception they may need going forward and obviously within the borough something that is extremely important and right at the bottom of this slide but it comes at the top of every consultation is how we interact with patients from a language point of view and that informs everything that we do. Next slide please. Just briefly so you can see where we locate so within the borough of Tower Hamlets we are mainly based at the Ambrose King Centre in the west of the borough. We have a site at Mile End Hospital and you can see the other sites that we operate through Waltham Forest and Newham. Just for interest oh sorry previous slide sorry the main other centre other than the Ambrose King Centre is SLG so that is the Sir Ludwig Goodman Centre which is the old athletes health centre from the Olympic village and that is in the north of Newham. Next slide thanks. So Ambrose King Centre just for knowledge is open Monday to Saturday so it is open a full day on Saturday it opens four evenings a week so just to benchmark us with other outpatient services it is extremely unusual for outpatient services to open in the evenings and at the weekends and that is obviously part of a parcel of our offer to ensure that there is access for our patients all of the time. We operate over two floors of the building with various clinics operating in specialist rooms and the HIV clinic for our local area is in the basement of the same building and again that is extremely important and different to what has happened around the country not just looking at London but around the country as part of the Health and Social Care Act and the tendering process that happened. HIV clinics were split geographically from from sexual health clinics which has had clinically disastrous consequences but ours is co-located thankfully. Patients can book online and via the call centre and they can walk in for certain presentations so we see certain presentations for walk ins and I think part and parcel of that is that we know that there are certain patients that we absolutely have to see and part of the work that we do in terms of access is ensuring that those patients can get into the building. Next slide please. So I've mentioned this already the varying staff so it's a mixture of nurses, doctors and other health professionals I think different to lots of healthcare providers. We're most analogous to emergency departments where the nurses are very experienced nurse practitioners who can see lots of presentations and lots of the presentations they see don't require medical input and then the medics are saved for the complicated presentations or the safeguarding issues et cetera. Next slide. Okay this is just again I'm not going to walk you through this in detail but this is just to show you where we sit within Barts Health so you can see me in the sort of middle of the slide and I have varying people who lead for the different sites that we run and then we report into a structure called SHARD and have a divisional director and then the nursing and managerial structure. One minute left please. Okay next slide please. I won't go through this if I've only got a minute left but it's there for your information to read it's just to highlight the complexity of patients that present to us and what we then do with those. Next slide. We're extremely concerned with inequalities and I think EMBOCs has been mentioned already so the types of patients that we see are marginalised, disenfranchised in healthcare, don't approach other healthcare providers so part and parcel of not just the clinical care that we provide is ensuring that those patients are engaged in care and I've mentioned already targeting certain populations who are at risk and I think I've heard mentioned during the CQC session earlier around prevention being much more important or already something that we're extremely keen on both in vaccination and pre-exposure prophylaxis. Next slide. And in terms of what next I think you know it's important to say in this audience that the work that has been done through the service is enabled through the collaborative commissioning approach that we have so we're grateful to commissioners not from just from Tower Hamlets but from the other three London, the two London boroughs with which we work and there's a shared vision in terms of what we're trying to provide. I mean let's be honest the cash envelope is strapped and the clinical presentations are becoming more complex. We see gonorrhea rates at a level not seen since the Second World War, syphilis rates highest in the generation and teenage pregnancy rates that are rising so I think let's you know let's be honest about what we're dealing with and we are totally aware of the cash strapped situation that everybody is in but because of the relationship we have with our commissioners and the honest relationship that we have we're focused on public health need and ensuring that we're working together to work on the same goals. We're also working with third sector and making every contract count that's what that acronym means and I think that there is a move to working less in silo and more across boroughs in an integrated way so we're working with other North London boroughs to share the approach to improve the offer to patients. I'll stop there and happy to take questions. Thank you very much. Thank you and our next speaker Lynn the project manager project manager for the door to hope and working with the beyond state your time will be three to four minutes please. Okay good evening everyone so my name is Lynn I'm the manager for the door of hope project and we work with only within Tower Hamlets but we work with women selling sex. We call it survival sex because we find that the majority of women have been forced for one reason or another into that position. It's mainly on street selling but we do work with some women who also are off street selling. So we have three elements to our support one is outreach second is one to one support and the third is drop-ins and in each of those particular forms of support we give out sexual health packs and our sexual health packs are basically condoms lubrication and some like basic advice which we get from Ambrose King actually those little kind of leaflets. So I did look at some stats actually so in the last quarter we saw on outreach we saw 28 women and we gave out sorry my eyesight's really poor at the moment I've got to so excuse me and we gave out I think it was 57 sexual health packs. In the last month we've already seen that number of women so as somebody was saying there is an increase the number of women who are coming back onto the streets has increased and this is probably when Covid struck that women weren't allowed to go on the streets so much so they were in different premises but we're seeing that you know within the last four weeks we've seen 27 women on outreach which is a lot. So we give out quite significant numbers of condoms for each one we give out at least 8 to 10 condoms but they tend to want more than one pack. So I'm just giving you this kind of background knowledge because it's I think that this kind of the support that we offer is essential in terms of sexual health. If you go to one to one support we have probably have about 28 women and we have three support workers and we're always giving out condoms. Alongside we give out needles as well and we also encourage hepatitis testing. So the last form of support is drop-ins and again we take lots of condoms along and we take information along but that doesn't mean to say that it always works and it doesn't mean to say that the women will go and get tested you know but we do offer support for them to go and get tested and we go to Ambrose King and there is the clinic S which they can just drop into but I think that they find above all there's a bit of a stigma because they are selling sex or sex working but we support them with that and on the whole I think that the women are really responsible about what they do. One of the things I wanted to mention because we do always talk about the women and their sexual health but I wanted to maybe put a bit of emphasis on the men also who are buying because you know I don't know that we actually think about that so much, where they're getting their information from, you know what they actually know about testing, what they can do in terms of precaution. So I just wanted to put that in there as well because I do think it's something that the information should be made more accessible, I'm not sure how but I just like that to be considered really. Also in terms of the information for women I think it needs to be a bit more accessible because women, particularly women who are starting to sell may not know what is available to them and actually my experience of Ambrose King is that it's really really excellent you know and I don't think the women have ever complained about it but actually if you don't know that that exists and you've got to walk in there for the first time how is that actually going to be for you. So one of the things I was thinking about is how we make that information more accessible and years ago we started talking about domestic violence and putting information into toilets in all different languages so that people who went into toilets could see that this was available to them. Some people may not even know what a sexually transmitted disease is, they may not realise what it is, how it manifests, so all that information I think is essential, putting it in places where you know they have the time to be able to read it and maybe consider it. Also videos for people with a learning disability, people who don't actually find the written words so great, make some videos, get that out there. The other thing that I wanted to mention actually was also about the self-testing which I think we recently had some training from Ambrose King and it was great. The thing about the self-testing is I don't think enough people know about it so the particular group of women that I'm talking about, how would they get to know about that? How would they feel confident about it? And we're talking about women who also take substances, have a lot going on in their life, they may have mental health issues and actually they may want to do the test but they may not get it together to send it back. But if you went into hostels and actually showed people in hostels how they could help to get that sent back or residential units or whatever it might be, I think that that could make a difference. I think that would make it easier for some of the women who really find it quite difficult to actually even book an appointment at Ambrose King. One minute left please. Okay, I'm just keeping it on the real level because you have to go online to book the appointments, some women can't do that. It's okay if we're supporting them because we can do that for them but we know that there's women out there who are not visible who won't be able to do that. So I've gone on a bit of a tangent there but actually it's just about making it more accessible for women and more visible and also for men too. I've only got one minute so I don't know what else I wanted to say actually. In terms of, yeah, I think that the feedback that we get from the women about the services are really good. I just think that we need more, maybe more of them. I know it's difficult because it comes down to funding at the end of the day but making them more accessible maybe, I don't know, going into the hostels, going into the different places. And for us as a service, you know, we struggle a lot to get things like, basic things like lube or condoms and stuff like that. So if there was some way where we could get more of that and more information, that would be brilliant. And also not just my service but the homelessness services within Tower Hamlets, so the SORT team when they're out on outreach and, you know, mental health services, different services really I think. Sorry, I feel like I garbled that out a bit there but open to questions. Thank you very much. Do members have any questions? One second. One second. Thank you. On one of the presentation I've read there's 26 pharmacies there for residents to take support for sexual health related treatments. Could you tell me, like, how do you advertise it and how do residents know? Because I didn't know myself until I read that, that there's available. And does it cost for residents to get treatment on the sexual health? So that's one of them. And the other one is this, I've read there's like demographic inequalities but it doesn't go into details. What kind of, could you give me a breakdown of that please? Thank you. So, yeah, sexual health in pharmacies is really important and this is one of the things about taking these services as close to people as we can and giving people a range of options for how they access these services. Yes, the things that we offer there are free to residents so we offer testing for some STIs, especially chlamydia, and also we offer condoms as well and emergency contraception, the morning after pill. We have a particularly strong offer here in Tower Hamlets, we offer the morning after pill regardless of age, most of the places have an age restriction on that and all of that is free for residents so that's quite strong. In terms of how it's advertised, I mean, local pharmacies will advertise those services themselves and also are working closely as part of, more and more closely actually with GPs in their areas to make sure that through GPs as well people are aware of that so if someone might go and some, if they need the morning after pill or something, they can be directed in that way. And your second question was about some of the more, some of the demographic inequalities. So the main population groups that have the greatest need in terms of sexual and reproductive health tend to be gay and bisexual and other men who have sex with men. Some particular minority ethnic groups, so for example the rates are actually much higher among young people as well so those are some of the groups that we see in general have the higher rate of sexual and reproductive health need. Thank you. Our next question we ask Amy. It's good to know it's free and I think it needs to be advertised more because people just go into booths and elsewhere or to get contraception and morning after pills so I think it would be really good to find out. I've changed two GPs recently in the last five years and I haven't seen a single advertisement about that so from my personal experience so I think there needs to be more work on it. Next question. Thank you, thanks chair. Just to say thank you to everyone for their presentations, it's really really interesting and it really does sound like there's a lot of good work going on especially if I could say that for Ambrose King it sounds fantastic. But I wanted to ask about education and SRE because obviously you'll be aware that some rather irresponsible people have chosen to make SRE a fairly grotesque political football in recent years and months and essentially my question is are we seeing any, is that hindering our ability at all to deliver a really robust education, sexual education and relationship education because I think you know what I'm talking about, what I'm getting at and some of the stuff that's been said about this kind of education particularly when it comes to issues surrounding the LGBTQ+ community, some really irresponsible and disgusting stuff being said in the media online by politicians unfortunately and yeah it's just a question about whether we are seeing any sort of blowback from that in a sense on the ground. So I can just add in terms of adults because I just cover adults, in terms of children, young people, I don't know if you have anything, but in terms of adults what I would say is we've got quite, most people who need sexual reproductive services in the LGBTQ+ community who need them the most are accessing them quite well but we know there are some sort of smaller groups within that who may have struggled to have reasons why they don't want to come forward and so we do partner a lot with lots of voluntary sector organisations to make sure we're reaching some of them so we have partnerships with for example the Love Tank we commissioned, the local organisation Positive East who do lots and lots of engagement with some of those patients, I don't know if you want to add anything to that? I don't think I've got much to add except to say that our Healthy Lives team which sits in the Children's Directorate do a lot of work in this area and they have some very clear principles about how they take this forward. In terms of their current experience I don't, we understand, appreciate what you're saying. Can I just come in on that, okay so Andy Williams here. So just really appreciate the Councillor raising that, it's extremely important and heartening to hear you raise that in this forum so thank you for saying that. From our own service we through work package to go out to educate GPs and pharmacists as mentioned but the person who leads that work package has also been asked to educate school nurses so I'm sure some of this conversation will come up within her work with them. Thank you. Our next question will be from the other one now. Given the rising incident of serious STIs, particularly among the vulnerable groups, what plan are in place to address this alarming trend and how will you measure the effectiveness? Thank you. So in terms of the plan to address the increase in STIs, so that is what is set out in the strategy that was brought to the Health and Wellbeing Board and as I mentioned it has those, it takes that whole four dimension approach. So first of all looking at how do we inform people and make sure people understand about sexual reproductive health need and enable people to have the best reproductive health, fulfilling sexual relationships that they can. We know we are doing lots in all of this and everything I presented really in terms of the most effective interventions so making sure people access sexual health, they can get tested if there's treatment that they can be given that they get that promptly. We follow people up to make sure that any partners they might have can be followed up and that they can be brought to treatment as well. So that's all set out in the strategy and it's quite a broad question, sorry I'm slightly struggling to answer it but I think as I set out on the slide one of the most important things is about making sure we have the wide range of services that reach people at whatever stage they are in life, at whatever stage they are in their sexual reproductive health journey, making those services where they best need them. That's kind of a key part of it as well. One of our questions on this, my colleague mentioned Sabrina that one of the ways of doing this is encouraging people like local advertising within the town halls or other things like that so people are more aware of it and that's what I was hoping you would be taking on that initiative. Okay in terms of communications, Andy and Tanya I don't know if you want to come in on that because our services do a lot of work in terms of that, both in terms of some of the outreach that we mentioned but also in terms of website and promotion of that website so I don't know if you wanted to come in on that Andy? Yeah I mean to go back to the first part of the question I think clinically I guess what you're talking about is rising rates in certain populations and what are we doing about that so I think work with local commissioners and Director of Public Health is around vaccination so ensuring that there's vaccination for the vaccinations that we can vaccinate against so specifically hepatitis, embox, HPV, human papillomavirus so in terms of prevention rather than allowing patients to get infections and there's also around work to look at high-risk populations and target them to get them into clinics so we text them, ensure that they book follow-up appointments so those that have already had an STI we know that they're at high risk of having another one and then the other part of that is outreach so going to venues or areas where we know that the people who have infections are likely to be and targeting them in terms of education and giving them testing kits so there's a sort of multi-pronged approach in terms of targeting those people. We have an outreach package so making people who are aware and there's been a few mentions of publicity and awareness and I guess you have to target people who are at risk and we're not looking at targeting every single member of the population so perhaps people haven't seen it but we're looking obviously for individuals and I'll let Tanya come in more about comms and promotionism and more her back. Hello everybody, yes so we're trying hard we've just redeveloped our website so you can choose whatever language you want it to be presented in and we try and keep that as fresh as possible and make that really easy to navigate around the system to get the information that you might be seeking. We also have a Twitter feed that we use quite a lot and we also have other platforms that we use depending on what outreach we're actually doing so we hone all our information on what we plan to do on that particular event if it's an outreach or if we're going to a freshers fair or something like that then we put the information together that way so there are various different ways that information is sent out to everybody including leaflets but we try to kind of be away from leaflets because once they're printed they're kind of out of date so we try to go on platforms and things like that and we rely on third parties also to advertise our services and what we tend to be doing for outreach et cetera. Hope that answers your question. Thank you yes thank you cheers. Thank you very much thank you. Our next question will be our Councillor it Balasi. Thank you Chair. Your good care model based on four components one of them is accessible so my question is what do we do ensure care for those to improve accessibility for those suffer from STI particularly in the people in Asian background they don't want to be seen or known they're culturally sensitive so what special action plan do you have to ensure the UI? I'll come in on that in terms of the general picture so again this comes back to making sure we have the range of options we know that different people will want to access sexual health services in different ways and for different particular needs as well so some people who might want to have a routine checkup where they might not have an STI or they might but they might want to get a checkup they might want to do that anonymously from their own home so we have an online service that they can do that without having to go into a clinic if that's preferable for them and some people we know might prefer to go to a local pharmacy or to their GP so we provide there as well and I think it's really important to say so we do look at the data in terms of who are accessing these different services and actually one of the quite important things is for some of those newer services like the online service and the diversity of who's using those services is increasing all the time so more and more Bengali people using those services more and more Bengali people we know use the pharmaceuticals the local pharmacy services as well so having those range of options is very important. In terms of the specifics at all least Andy do you want to add anything? Yeah thanks Liam I guess one thing is around the branding of Ambrose King Centre so I've worked in the Ambrose King Centre since 2007 and it's been there an extremely long time in fact I think it's our centenary the building centenary coming up in a couple of years and then there were conversations a couple of years ago which will certainly be part of this group around the moving of the Ambrose King Centre or moving of sexual health services away from this part of Whitechapel to another because that building wasn't owned by Bart's anymore we've been given a reprieve on that so we've got an extra decade in that building but the reason I'm raising all of this is it's extremely well known in the local community so the local Bengali community know what the Ambrose King Centre is and they know what's come there for so we're not short of local people and word of mouth spreading about what we do there so I think our challenge is often that the people who work there aren't often Bengali speaking so it's about communicating with people in a way that is culturally sensitive and appropriate about the needs of those people and understanding the relationships within that with which they are in. Thank you our next question we have Councillor Bodrul Chaudry. Thank you sir thank you to Councillor Chaudry for the presentation and the offices just before I come into the question obviously most of us know that we have a very young population youngest population growth in the land itself and a lot of students here we've got few few universities here so this and it's nice to see streets of growth doing some excellent work I think you're best in the Docklands now before you were based in Bromley by boat many years ago. Oh you're in Chatham yes yes so my question to you to the lead member of the offices what steps have been taken to ensure that these clinics that we are talking about can meet the increased demand of the service that you provide especially in light of the national crisis that we have recruiting nurses it's a big issue you're facing at the moment if you could give us some feedback on that thank you. Yeah so again I think the challenge here is about as I set out we have an increasing demand for sexual health services and we have less and less resource with which to meet it so the challenge is about making sure we meet this demand in the most efficient way so some of the things we do and we should be very successful have been about establishing new ways of meeting some of that demand for more cost effectively so we've got an online service which now this year I think saw over 30,000 STIs and that means that a lot of the much more simple consultations can be done through there and that makes more space available in the clinic so if people have got no symptoms if they need an STI check they can get it via that online service rather than going into clinic what that does mean the flip side of that is that actually lots of the activity that is seen in clinic is increasingly complicated so they might have issues they might have more than one STI they might have other issues going on whether that's around a number of issues they might be dealing with around domestic violence around sexual exploitation lots of different issues which I'm sure Andy can go into a lot more detail about but that's part of the answer to the question about how do we meet this increase in demand and continue to do so. Andy do you want to come in? Yeah I think it's a challenge isn't it and I think the challenge for the NHS as a whole everyone's on their knees in terms of access and demand and making sure that the right people are in the right place at the right time seen by the right person so I don't have an easy answer to your question but I think in terms of what we have done is about look at our workforce and is so if you look at a group of you mentioned nurses if you look at a group of workforce like the nurses they come in bands so the bands that generally see complicated patients as a band 7 nurse so in old money that would be called as award sister so someone who's kind of senior and experienced and we have a number of band 7 nurses who can see those patients but sometimes you need more nurses than you know so if you get a couple of you could get two or three band fives for the salary of a band 7 so you have to be innovative about the way that you structure your workforce so maybe if we employed a few and what has happened is we've where we've had a band 7 vacancy employed two or three band fives such that they can churn through some of the less complicated patients that then allow space and capacity for some of the more complicated patients to see be seen it's not easy but it's about constantly reviewing your workforce it's constantly reviewing people's job plans managing people's leave their sickness ensuring you've got staff on the floor to see patients it's a huge challenge listen and let's not underestimate it demand is through the roof but it's about making sure that patients are seen in the right place at the right time and as your third presenter spoke about specific population in terms of sex workers we have specific clinics for sex workers at certain times sex workers are welcoming the clinic at any one time but they are one group of patients who have huge need in amongst very many others Just to reiterate what Leanne was saying at the beginning which is about the national policy and how inevitably for populations like us creates real pressures and if we hadn't put in some of the things that we put in it's a significant financial pressure so we have to continue innovating as Andy was saying that it's not it's important not to underestimate the pressure we're all trying to manage Thank you very much thank you for your time and thank you very much for your presentation and thank you for your hard working we move forward to our next agenda Our next agenda is smoking session we have had a number of initiative over the year to encourage people to stop smoking and breaking the habit smoking is addicted and we know from public health evidence that is the destroyed life through the disease like heart disease issues such as cough and for the lung cancer I am pleased we have I am pleased we have this on the agenda as we know smoking particularly in the east and communicative was very much in social activity can I welcome back to our cabinet member Councillor Chaudhry and also we have also have the Shamsiya Begum Shamsiya Begum one man specialist stop smoking service manager white interactive Hamlet Saida Begum Begum community to work with the East London Foundation Trust I hand over to the Councillor Kivya Chaudhry thank you Thank you Mr Chair this is a good news report I want to thank officers for preparing such an informative report the rates of smoking have reduced in Tower Hamlets and this will limit rates of illness and death from smoking related causes however all those smoking rates are roughly similar to rates across London the number of deaths from smoking related causes is still higher than the London average officers have provided useful statistics in their presentation we now know that the new government intends to continue or even surpass the work begun by the last government to make England a smoke free zone we have received funding to build on our successful work of the last decade and expand our successful cessation services which are carried out direct and with specialist partners one of the reason for our success is that we target a range of groups our service is accessible and inclusive we collect a range of statistics from our different activities and this from the main part of the feedback which helps us keep our services relevant and successful officers have set out the details of our cessation services in this presentation we look forward to hearing your questions and any clarification thank you Okay thank you so I'm going to start off again and then I'm going to bring in Shamsiya and Saeeda in a little bit so as the Councillor says this is a success story in Tower Hamlets as it is elsewhere so we've seen sharp reductions in rates of smoking a decade ago it was over 20% one in five of our residents and now it's down to 12% but we still have a long way to go so we know that despite that we still have rates of mortality around 200 per 100,000 and that every single one of those people are someone who might have had a heart attack might have had a cancer or something and their family will also have been affected by that and that could have been prevented by the most impactful public health intervention we have which is enabling people to stop smoking so that's why this is still a really important agenda for us to work on in Tower Hamlets we do, sorry I'm just trying to share the right presentation, we know that there are also a few particular population groups where rates of smoking are much higher so among people who are in routine and manual occupations and they're much higher than in other parts of the population also people who are in touch with mental health services or people who are in touch with substance misuse services as well and what that means is that this is a big source of health inequalities and that's another reason why we are very keen to, because not only is this affecting our residents and their families but it's affecting them unequally so we want to achieve smoke free 2030, we want by 2030 we want the rates of smoking in Tower Hamlets to be less than 5% and that's the ambition we're working towards but that's going to mean we need to sort of speed up our action on this across all the domains of tobacco control so the MPOWER framework on the screen is the WHO's approach to this and really in Tower Hamlets we have a role in all of this so we work with trading standards who are working very proactively on controlling the availability of tobacco and other products so they enforce limits on sales for example underage sales and on how these products are advertised as well and they also enforce other smoke free agendas as well. But what we're focusing on today in this session is around supporting people to quit. This is really important because we know that if people are provided with the specialist behavioural support that our smoking cessation services provide then they are three times as likely to quit as someone who just tries to quit on their own and these services are more and more important now because as we've had the success in smoking rates coming down the smoking rates that are left, the smokers who are left are some of the ones who have the most entrenched addiction and who need the most support to quit. I'm just going to quickly highlight that some of the, so yeah Shamsia and Saeed are going to talk more in a minute about the details of our services that we provide but just to let you know that this is an area where we do very well in Tower Hamlets, the two charts here, the red bars are Tower Hamlets and right on the left hand side so showing we've got the highest numbers of people who quit every year in the last year with the support of our specialist services. These are people who have successfully quit for four weeks and that's like the standard measure that's used because there's lots of evidence that if you can quit for four weeks then you're five times as likely to continue to quit in the long term. And because we have, so last year we supported 1500 people to quit smoking, 1510 and what that means is that we've got a very sort of cost effective service where the cost per quit is one of the lowest costs in London. And because essentially of that success there is some detail in your pack about what we're planning to do with additional funding so colleague councillors will have seen that this is a big priority for the new government as it was for the last government as well. There is a real push for trying to make action and trying to get to that smoke free 2030 across the country and one of the things that's happened is that for this year there's been made some available additional funding and we are planning to use that to build on the success we've already had, to extend the services we've already got but also to do some more targeted work with some of the groups that I mentioned where we know there is particularly high rates of smoking so mental health and people who use substance abuse services, people who experience homelessness as well. I'm going to hand over to Shamsia now to talk a bit about the Quit Right Tar Hamlet service which is our community specialist stop smoking service. Thank you Liam and thank you Shoman and Liam for inviting me here today to present a good news story. So I've been working on the Tower Hamlets project for over 20 years now. I started as a researcher in smokeless tobacco and now I manage the specialist stop smoking service. In 2020, Queen Mary University of London was commissioned to provide the stop smoking service alongside the prime supplier model. So the prime supplier model has four components and I think Liam is going to talk a bit more about that later on. So we provided the specialist tobacco service for many years and now we've been given more responsibility, can you go back to the other slide? So we've been given responsibility of social marketing and training and subcontracting pharmacies and overall service management. So all of those things we do in partnership with public health. So we have KPIs minimum 1,275 and the maximum 1,500 per annum and as mentioned we achieved in the last financial year 1,510. We're a culturally sensitive service and based on evidence and our performance is very, very strong across North East London. Thank you. So the service, so what does it involve? So when somebody is referred to the service they come from GP practices, secondary care, direct referrals. So GPs would send direct referrals to the service, walk-ins, self-referrals. We have a telephone helpline that people can call. So once they come through, they come through to admin, they are triaged into an eight-week treatment programme with one of our five advisors. The eight-week treatment programme is a combination of weekly telephone, text, face-to-face contact with an advisor. It involves medication as well. The medication is nicotine replacement therapy, electronic cigarettes and now soon to be varenicline and cytosine which is offered by our in-house doctor. So you have behavioural support and you have weekly contact with an advisor who delivers this behavioural support and also medication. This then doubles your chances of quitting. We have client-focused tips, coaching techniques and we have postgraduate psychologists that work with us and become advisors within the service that provide occasional CBT techniques as well. So we have quite a lot of expertise. We also provide carbon monoxide testing to verify a person's quit attempt and also a quit outcome. So we can measure if somebody's completed the four-week quit outcome using a carbon monoxide breath test. So we have quite a variation of support. It's tailored to the patient. Not everybody will have the same support. There is a baseline support but people might want an e-cigarette or they might want nicotine patches and guns at the same time. So it's sort of worked through with the advisor on what the best method of support is. You've also got people that don't really want that weekly support. So this is where we signed up with the Swap to Stop Scheme, the government programme where free vapes are offered to smokers on a self-service basis or through the service and they have a light touch approach within the service. So I'll explain a little bit further. We also provide pan and smokeless tobacco support and we've been doing that for quite a long time. We're sort of renowned sort of across England to providing support to smokeless tobacco users, people who chew pan, particularly within the Bangladeshi community. We use nicotine replacement therapy to replace the tobacco addiction. Our service is culturally sensitive. We provide language support and we also provide same gender advisors if needed. Thank you. So the clinics, we provide in-person sessions. We're based at Two Stainers Road, the health and lifestyle research unit. We're open Monday to Friday, 9am to five ad hoc evening and weekend appointments are available based on hybrid and flexible working among our staff. We have regular face-to-face or telephone support offered at 15GP practices. In-person sessions are at Mission, Limehouse, Blythe Hill and Gough Walk. Now we're new to subcontracting and we've subcontracted 14 pharmacy sites in Tower Hamlet. They cover the eight primary care networks. So we're sort of working in a locality-based way with our pharmacies and with our GP practices and family hubs. So this is a way we sort of target hard to reach groups. We also have a partnership with Barts. On a Monday and Thursday we have an advisor doing inpatient work. They pick up patients who have been in hospital for two weeks and then they carry them over to our community service. So it's the same advisor following up with the support upon discharge. We also have in the town hall from two to four thirty every Wednesday. We have an advisor here. This service is now going to be sort of appointment based. So one of the upcoming events for us this year is the Stoptober campaign. So this is the marketing and social marketing aspect of the work that we do. We will be running five outreach stores within the borough. These include East London Mosque, local markets and Blackwall Depot. This is a targeted approach to communities with a higher prevalence of smoking, particularly those of an Asian ethnicity, those that are 35 to 54 year old, particularly male smokers. Then also E2 and E3 postcodes are going to be targeted with this work. We're also doing a big push with the Swap to Stop offer on Vapes through the Stoptober campaign to increase the number of sign ups within the service. We've got some successful clients and video case studies and we're utilising a behaviour change approach through our marketing and campaigns messaging. And our final slide. Now so I mentioned the Swap to Stop and this is a Tri-Borough initiative that we're part of. Queen Mary also provides Newham and Waltham Forest Stop smoking services. We went for a Tri-Borough approach. We have five thousand Vapes allocated to Tower Hamlet, eleven hundred people have already used Vapes and fifty five percent of them have quit. The scheme encourages thousands of smokers in Tower Hamlets to swap cigarettes for Vapes and to reduce smoking rates in Tower Hamlets. We know that e-cigarettes are popular. Eleven percent took it up in 2019. Now we've got 67 percent of our service users in 23 that have used it and more people are preferring the Vape, particularly through the website where we offer a self-service portal where people can order the Vapes and we then do the follow up after we get their details. So it's making it easy for smokers to switch and we're getting people who won't normally come to the service, you know, picking up the advisor support or maybe they want NRT as well or some just want to follow up at four weeks. So this is in line with the flexible approach that the government had and it's all evidence based and I'm happy to sort of, you know, answer any questions and, you know, thank you for the opportunity to speak here. Thank you very much. Thank you very much for your presentation. Do members have any questions? Sorry, chair. We also have Saeeda Begum here from East London Foundation Trust to talk a little bit about the service. Do you want that now or now? Hi, everyone. I'm Saeeda. Can you hear me? Yeah, sorry. So I'm the community tobacco dependency lead for ELFT, so East London Foundation Trust. So that means I manage all the community clinics within London and Luton, that's under ELFT and it's all for the SMI population. So the SMI stands for Severely Mentally Ill, so these are the kind of patients that we see on a regular basis. So our clinics, the one in Tower Hamlets that we have, we see the SMI population. So there is a striking difference between the proportion of people who smoke with SMI compared to the general population. So 12% of the general population are smokers, whereas 40% of the SMI population are smokers. And also people that are diagnosed with schizophrenia or any psychiatric disorders like bipolar, 60% to 70% of that population are smokers. So what our service offers, so we cover Tower Hamlets, Newham, Seton Hackney and Luton, but we're in partnership with Shanti's team, Quit Right Tower Hamlets. So we do two community clinics in person. Tuesdays is in Old Montague Street in Whitechapel. Wednesdays we have a clinic at Stainers Road. And then Thursdays we do a virtual clinic for those that are physically impaired or have work commitments or like anxiety and they can't leave the house. So what it looks like, what we offer is first they get referred into our service, usually from other community psychological services. We first do an initial assessment with them with one of our smoking advisors. We then offer them 12-week behavioural support combined with the nicotine replacement therapies and/or vapes. Their quit outcome is recorded on week four and week 12 on pharma outcomes. The patient is discharged at week 12, but because this is the SMI population, if they require more support, we can give up to 16 weeks. And then if after the 16 weeks they still want more support, we refer them to Shanti's team at Quit Right Tower Hamlets. So we know that with the SMI population, they're three times more likely to successfully quit smoking if they're professional and combined with the nicotine replacement therapy and/or vapes. So just the last financial year was the first year we piloted this clinic in Tower Hamlets and we managed to see 63 SMI patients, 32 of which were supported with vapes and NRTs and 11 of them were confirmed to quit. So with the SMI population, it's more complex. We have to give bespoke tailored treatment. Their appointments usually last longer, they're more flexible, we have more cancellations, so the treatment programme lasts longer and it has to be tailored to the individual's needs. They can have learning difficulties or if they have things like anxiety, we might have to meet them in a separate location. So we have various resources available for those needs of those patients. Because we cover trust-wide, the next data about the ethnic group is the majority of the population is white and then it's the black and African, Caribbean, black and British community, Asian or Asian British and then mixed. But as you can see, nearly half of each of those populations were able to quit. We have done feedback with all our patients and nearly all of them voted that they found this service very useful. And my last slide is about the innovative ideas that we have been doing. So we deliver level 1 and level 2 tobacco dependency training which is specialised in mental health. We deliver it to all staff in the community. We now have virtual clinics on Thursdays which we didn't have before for those that cannot attend in person and NRTs can be picked up by the next of kin. And we've started Just Ask campaign which we are putting out in all community services to encourage staff to screen more patients because if we don't know their smoking status, then we cannot offer them treatment. That's all from me. Thank you. Thank you very much. Thank you for your presentation and I'm sorry for the inconvenience. I would like to request for a member when you ask any question, very short and when you respond the question, please, short. First I would like to ask to the Councillor Abdul-Mondam, please, for your question. Thank you, Chair. Thanks for your presentations. My question is that a lot of biking shops are opening throughout East London and youngsters are basically giving up their smoking and going to biking and what are we doing to stop the biking as well? And also my second question to the Chair, I've seen it myself as well, how are we producing the cigarettes that the youngsters take in these days? They're probably not coming from directly on the shelf but I've seen it, people in the market and things like that are selling it, the Eastern European secrets, they're cheap, youngsters are buying it so therefore we're not, it's like prevention is better than a cure. Are we aware of it and if we are aware of it, how are we going to police it to make sure it doesn't go out of control? Thank you. Yeah, thank you, very good point. So where we're trying to, the line we need to draw up balance with vapes nationally is that vapes obviously are, if people are smoking cigarettes we do recommend them to try to switch to vapes because there's a lot of evidence that that's a lot less bad for them but as you've said, we don't want then for people who don't smoke at all to start taking up vapes and that is what we're seeing across the country, lots of young people starting to take up vapes. But that's the line we're trying to balance. In terms of what we're doing about it, so lots of the wider tobacco control measures we have in place, we are focusing also on vapes so as I mentioned our trading, we work very closely in public health with trading standards and with those teams so they will enforce, they have quite a lot of powers of what they can enforce in terms of vapes being sold. For example there are regulations about the size of vape that can be sold so if there was any with too big a volume, too much nicotine contained then they can enforce that, they can take action against the vendors who are selling that. In terms of some of the illicit cigarettes that you mentioned, some of the cigarettes being sold illegally on the markets, again we work with trading standards, we fund a thing called Operation Stromboli where they do go around the borough seizing any of those illegal cigarettes so that's some of the actions we take in those wider ways to control both tobacco and vapes. Just the last thing to say on vapes is that we are working with Safe East who is our children and young people's health and wellbeing service at the moment. We're working with them and they're going to be planning a campaign locally around vapes and around trying to dissuade young people from starting to smoke vapes and some of the reasons why it's not a good idea to start. Can I just add that we are kind of really pushing against the tide here because we're well aware that the producers of vapes who are tobacco companies as well are actively promoting vapes to children and young people and I think the national push to address that and how that is enforced is going to be important because as we know, I can't remember if young people have tried vapes and there's also the additional issue of unregulated masks, it's a real challenging issue for us and nationally as well. Can I just have a follow up question? One of the things I've noticed is when it comes to the weekend, Friday and Saturday, youngsters are not smokers before but they are as a trend. It's like a designer label thing you have to worry about. It's just encouraging, pushing them to and you see on the street, 16, 17, 18, 19 years old, and I was thinking is that a new trend or something? Are they aware of the health hazard that also calls? And it is a worrying thing because it is a new thing but it's been out for a few years now and how we're going to manage it is a difficult thing and one youngster takes it, another one encourages them all. You should take it. Do you understand? We've all been youngsters but how do you police this? How do you send the message? Look, what you're doing is wrong and I think there should be some sort of educational system we should put in place to make sure that the children are aware this is not the right way to go. So if I could add to what Liam and Shomin have been saying and your concerns about young people taking up, there is a lot of curiosity among teenagers to using disposable vapes and we hope that the vaping and tobacco bill will basically ban disposable vapes. There are some very good charities and organisations that are working with young people who are vaping, one of them CGL and also Safies that we work with in Tower Hamlets. So we support anyone over the age of 12 to give up nicotine so it could be somebody using a nicotine vape but we can support them to quit. There's also Safies that work with substances that are being added to the vape so there's a lot of work going on with young people and it's also something that the enforcement and trading standards need to sort of focus on in terms of illicit vapes and tobacco. But I do believe that the vape and tobacco bill will sort of put a stop to that. I mean it's very optimistic but it will put a stop to those disposable vapes and it will be regulated better. Thank you. Our next speaker, Councillor Sabina Hunt, please. I'm going to be very quick. Thank you for staying up to the end. You guys were here the first. I just want to congratulate Zaida for getting 11 SMI to quit. It's a hard job and also you are training mental health nurses and things. So I just want to ask you, you said about Just Ask campaign. How successful, how do you know it's been effective and successful? How do you measure it? Thank you for your question. So the way we measure the success rates is by referral numbers. So quarterly we do reports about if the referral numbers have increased and in turn if we see more patients in terms of initial assessments and then quit rates. So since the Just Ask campaign came out, which was only the last campaign, so this is for Tower Hamlets, Newham and across London, the referral rates have increased. Every bar is different but for Tower Hamlets it's about 10 per cent. So it's about getting that out more and then when we do training sessions to be able to have that posted out. So it's all about outreach, who we can connect with and how we can deliver that information. I think it's fantastic, the Just Ask programme, and it's very obvious. This is just East London Foundation Trust. I think one of the areas where I think there needs to be development is through the role of the NHS in promoting helping people stop smoking and one of the things that can be improved is actually the recording of smoking status for people who go into Barts for instance or go into our Trusts because you have people who are going there for reasons that are related to smoking and it's really important that they get the support that they need to stop and we know that the funding into the kind of hospital based smoking services has not been consistent. It has been a little bit more over the past years but it's always, I think as you all know Saeeda, it's not consistent, it's not long term funding but it's actually something that will obviously improve the wellbeing of residents but also save costs in the longer term and also thinking about. Thank you. Our next question will be Jessica. Thank you Geoff. Thank you so much for the presentation. I think it's great work. You can obviously see that it's been such a good success and you've got really good outcomes from it. I was wondering whether you've ever previously or currently whether you do kind of peer support because you are so successful and you have had people go through the programme who are very positive about the programme. Have you considered doing peer support? Have you tried it previously or peer groups or anything like that? We do group sessions if there is a demand for it but in terms of peer support or buddying up. So when we have a client that comes in, they will sort of bring in family members or sort of give up as a group. If we find somebody that's a bit reluctant to sign up, for example at Stocktober campaign, somebody's a bit reluctant, we would invite them to have a look at how a session takes place to see what's on offer and then they try some of that, to try the process and they do sign up. In terms of peer support we also get successful clients to do case studies for promotional campaigns and also people come in during with us reflecting on the service and talking about what we could do to improve. So it's a very open service and in terms of, you know, people are most welcome to sort of come and sit in on sessions. I hope that answered your question. I can add a little bit about ELFT as well. So we do have a pilot on peer support workers. It's currently in Newham and sitting Hackney and we're trying to bring that into Tower Hamlets. So it's a service user, previous service user with lived experience that comes on and then they help the patients go through the 12-week treatment programme. So they would meet them weekly outside of our sessions and encourage them to pick up the NRTs or vapes or attend their appointments and deal with other complex cases they might be going through and then signposting them to the relevant services that they need. Thank you. Thank you. Our next question will be Councillor Motrutodi. Thank you, Chair. Thank you for your presentation. My question - before I come into the question, I've just noticed that the surgeries that you run are all based in E1 postcodes. Just a suggestion, maybe you could use the idea store in Poplar to cover that side of the borough because we do have 20 wards here. So you're just based in one side of our borough. And my question to you, obviously you're doing a great job of this, how are you ensuring that the smoking cessation service effectively reach out to the BAME groups, the community and especially pregnant women, individuals with varieties of mental health issues, if you could give us some insights into that. Thank you. So in terms of sort of coverage of the borough, I mentioned we have 14 pharmacies that are spread across townhamlets from the Isle of Dogs to the north. We have family hubs as well, so we have to have presence at all of the family hubs that cover the borough. In terms of the GP practices that I mentioned, there are a total of 15. The ones that you're right, the ones that we're currently doing face-to-face at are E1 based, but the ones that are part of the 15 are remote, so we do have quite a good coverage. Pre-covid we had 22 GP practices, so post-covid it's been really quite tricky to do a hybrid model of the service because you have to honour human resources and work policy in terms of hybrid work and remote working, so we try to cater that for the service users as well. It's a mix of telephone and face-to-face, so that's one part. In terms of the target groups, how we get people coming into the service, so the majority of our referrals are coming through GP practices, so we get a lot of people with underlying health conditions, mental health, so the way we've got severe mental health and mental health patients coming in, anyone with mild anxiety or depression is classed under the mental health category, so we do get secondary care referrals as well, people who have been in hospital, so that's where some of the cohort comes through, and also Tower Hamlets being almost 50% Bangladeshi, most of our clients are from the Bangladeshi community, Bangladeshi men. We're also looking at getting more routine and manual workers, so those are our largest population that we serve. And in terms of mental health, we work with ELFT, we have Salida coming in once a week, but she targets more of the specialist side of the mental health and more flexibility in terms of the length of the programme they have. Yeah, so how we target our mental health patients is we usually, a lot of them come from inpatient wards first, which we also cover, we do inpatients and community, so they start off as an inpatient and then once they get discharged we follow them and continue their care into the community, so that's all sorts of complex cases and everyone that's either been sectioned or willingly gone into an inpatient setting. And then we also partner with all community services that are under psychological services, so they send all their referrals to us or we go and visit and do presentations and do opportunistic referrals where we go to their existing appointments like the clothing pin clinic or other things that they go to and then sign them up that way. So that's how we kind of target all the mental health population in Talhamlets. Thanks. Yes, just to add to what the colleague is saying. My name is Muthir Rahman, I'm a Public Health Programme Officer, I work for Showman and GLEAC team and this is my fantastic partner. I'm working here for over 20 years for Stop the Smoking service, I have a little bit of experience. One colleague mentioned the one thing I would like to add, we run a four campaign throughout the year, so when we see any specific gap, for example Stop the Smoking campaign, as Samsha mentioned, we are targeting E2 and E3, so from the JSN data shows that there's two areas, there are some people that don't access the service. So throughout our campaign we target those areas. We run four campaigns throughout the year, New Year campaign, No Smoking Day, Pre-Ramadan and Stop the Smoking. This campaign is and every time we try to target very specific group, that's why we try to cover the holistic way and for that I believe strongly that we are number one in London. Thank you. Okay, thank you very much, thank you very much for your presentation and thank you very much for your hard working and thank you for your coming and if you don't mind you can feel free to go now and we move on to our next agenda. Okay, thank you. Our next agenda is a work programme. This is the proposed work programme in the Agenda Pack. We would have to complete two meetings by the end of tonight and we have three meetings left remaining. The work programme has been established by the scrutiny member lead work programme development session on 19 June. As we only have the limited meeting, we used to prioritisation process which you can find in this current scrutiny toolkit. The overall work programme will be going to OSE on 10 September 2024 for the committee and comment and agree. The work programme is flexible so if key issue to need to come and this committee I will take under consideration. Do member any comment, happy to agree to move on? Thank you. Justina, can you make a note and confirm that member are happy to agree to work programme 2024 to 2025? Before we move to close this meeting, I have some update for share under AOB. We had a really good briefing session from Sumon and his team and help in the inequalities in the adult social care joint strategy needs assessment. I would like to thank Sumon and Liam for his hard working and going forward it will be helpful to have more brief like this where it is feasible. You should all have to send by the official by email and can I suggest you review this as it will be put into our committee to work. Next update there is a scrutiny performance training tomorrow which will be chaired by the OSE chair but is open to all members across the scrutiny committee. Can you try and attend? This will be relevant to our work, particularly as we have asked the performance monitoring update from the service. As published, the member of bulleting a few weeks back, our corporate director of the resourcing is putting some cement around the budget. Can I encourage to all attend this session? Budget is important consideration for aspect. Scrutiny works as our committee, particularly as the budget scrutiny happened earlier where the executive said their plan for our budget. Final update from me as that is the part of our policy development focus. I want us to carry out to deep and up to local maternity service and support for a new mother. This will be outside of the normal committee meeting so can you make our sleep available for the evidence session which are to be confirmed. I am politely requesting all my committee colleagues, particularly female colleagues, to assist me with his review as there will be a focus women experience which will be sensitive. As part of our evidence gathering there will be some seat visit being planned to go with relevant service so it would be helpful to have support from my female committee colleagues. I want us to all think about what we want from the scope on his issue, turn on focus and who you might wish to attend. Can you please provide your input in writing to Pulu who will help draft of the scope. Our next subcommittee meeting on the 5th of November 2004 so with no other business discussed I will call this meeting to close. Thank you very much for your time and thank you very much for your attention and good evening all. Thank you. This has to be AOB. I would like to request the meeting is closed now. No, the meeting is not closed because you have not given AOB. The chair has just closed it. The chair is giving his entry on the updates.