Transcript

Good evening and welcome to the first health and adult school community meeting for this municipal year. My name is Councillor Muhammad Bella-Ludin and I will be chairing this meeting today. Member have joined us both in person and some joining online. Only member and person attend can be both and does not include the cup of tea. This meeting is being recorded for the council website for public viewing. If there are any technical issue I will decide if and how the meeting should continue after taking advice from officer. Member should only speak on my direction in short to speak clearly into the microphone. Please have your phone on silent. People online can your keep microphone on mute except when speaking. If member and officer online wish to speak please raise your hand function. Before we move on to the apology I want to remind member and speaker that for the period time from now until election take place, 4th of July, therefore you must not discuss involved any election issue or party political content and stick closely to the matter set out the discussion. Justine, have you got any apology tonight? Yes chair, I have apologies sent by Councillor Kabir-Hussain. Councillor Kabir is chairing the general purposes committee so he has sent his apologies. Jessica Chu, the new health watch representative has sent her apologies and Matthew Adrian who is online is attending on her behalf and also co-op tea Assan Ali has sent his apologies. Thank you very much. Thank you Justine. For the introduction of Jessica from health watch tower Hamlet co-op member, Jessica has sent her apology and so he will not able to come tonight. We do a member Matthew Adrian, the service director of tower Hamlet who will be joining the online. Can you member and introduce yourself any declared DPI's starting from myself, Councillor Vellalodin nothing to declare and I would like to request from the mayor I check. Hello everyone, my name is Councillor Hamand Mayor, nothing to declare. Councillor Amy Lee, nothing to declare. Good evening chair, good evening to you all. Councillor Boru Choudry, nothing to declare, thank you. Sorry chair, Councillor Edward Hussain, I have nothing to declare, thank you. Councillor Mark Francis from Bo Eastwood, nothing to declare. Officer please. Justine Bridgeman, democratic services officer, nothing to declare. Philip Meer, senior strategy and policy officer, nothing to declare. Please kindly introduce yourself with the online. Matthew Adrian, health thoughts tower Hamlet, nothing to declare. Good evening Fiona Peskitt, director of strategy and integration at the Royal London, nothing to declare, thank you. Okay, thank you very much, thank you. I would like to request to the office of... Okay, our next agenda is the vice chair nomination from the municipal year 2024-25, do you have any nomination? Thank you chair, I would like to nominate Councillor Iqbal Senbai for that post. Any seconder? Thank you chair, I would like to second that, thank you. Any more than any nomination? Okay, thank you very much. Thank you. Justine, can you please note that Iqbal Senbai is appointed vice chair for the 2024-25 please? Yes chair noted. Okay, thank you very much, thank you. Our next item is noting of health and adult scrutiny subcommittee term of reference, our first item on the agenda is noting of the term of reference, justine can you introduce the report please? Thank you. Thank you chair, this is a standard report which outlines the terms of reference, the quorum number, the membership, the dates of meetings for the health and adult scrutiny subcommittee meetings for municipal year 2024-25. I am asking, we are asking, if the terms of reference are to be noted in appendices 1-3 and also if you can agree the start time of 6.30, thank you chair. Thank you very much. Do you have any comment or any question from our member? I am happy to agree with this chair. Okay, thank you very much. If there is no comment from the subcommittee, justine, can you please note the term of reference and set out the report please? Okay, our next agenda is annual JOSIC update, at the last OSC meeting 2021, 21st of May, the committee agreed that the following Councillor from health and scrutiny subcommittee will be representing from Tower Hamlet on the inner north east London joint overview health and scrutiny, myself as the chair, Councillor Muhammad Ali, Councillor Harony and Councillor Amy. Our next item is the subcommittee was not, okay, the subcommittee was not, the action plan respond progress on the work force across health and care sector, the subcommittee was not able to review the last meeting and we must have the worst right how the action plan has either meet or not meet the scrutiny report recommendation. Can I welcome to the, can I welcome to the Garrett Noble, deputy director of work force programme, NHS north east London, part of the health and care partnership who will speak to the item. Now I would like to welcome to the Garrett, Garrett will be five minute presentation please. Thank you. Okay, thank you chair. Just want to run through, so obviously this report is a update on the action plan response to work force shortage across the health and care sector and the recommendations that were made. I'm not going to run through every single update that we've got, but I just want to point out some of the really good work that's been happening in terms of things that we've done with Tower Hamlets in terms of promoting career ambassadors programmes that we've done throughout north east London really to support and get access for young people especially to enter into the workforce. Just want to highlight as well that our work force strategy for north east London was signed off in January 2024, in the next two quarters we'll be looking at a delivery plan specifically for how we attract, retain, lead and innovate to deliver the workforce across north east London. I think certainly in terms of Tower Hamlets we are from the IC integrated care board, we are talking with Tower Hamlets together to try and establish what will be, what best is done at a local level, Tower Hamlets level and actually what can be scaled up in terms of work force supply for the whole boroughs in north east London. I think in terms of recommendation five we've got some really good examples of works that we've done with Tower Hamlets training hub and also through Tower Hamlets together and with BART really to support education programmes for our local population really to enter and access the workforce within north east London. In terms of how we work with QMUL really to support medical education I think this process is now being looked at in terms of the introduction of a medical degree apprenticeship really to look at how we can sustain and draw from our local population really to build that medical degree apprenticeship within north east London and we will be meeting with regional colleagues to work out how we're best placed to do that and really for the benefit of the system. And just really to flag the last two elements we have a programme that runs across T levels which obviously are placed in BTEC national and really looking at how we got our young 16 to 18 year olds primarily through that kind of programme and also into employment and apprenticeships within our organisations and again we're co-ordinating with all kind of health care providers and social care providers across north east London. So that's really all I want to say I'm happy to take questions from the panel now. Thank you very much, thank you, remember if you have got any question or any comment? Councillor Mike Francis. Thank you chair, thank you for that update so I wasn't on the committee when it carried out this investigation and made these recommendations but I was on overview and scrutiny committee when there was some discussion about some of the recommendations and the kind of corporate view on them. So one of those that I think has had some discussion is around whether there's something more that Town Hamlets Council itself can do to incentivise people to work in the NHS national care sectors and there's been talk around parking, council tax and housing. So I just wondered if we can probe those just a little bit more just in terms of the actions so I think I can't see because I've got a black and white version and I don't have my laptop so I'm assuming this is an amber one on recommendation six. So I just wondered historically we have had quite a few housing allocations being allocated to key workers, there's a key worker element stream within the choice based letting scheme at the moment so I just wondered if I can ask around that one first of all, do we think that we're able to move forward on any part of the agenda, move that recommendation forward to deliver on that in terms of housing? I think in terms of that I think it's a complicated issue in terms of moving forward that in terms of recruitment, in terms of cost of living. I think that we will need to do more work on that really almost how do you actually then divide out who actually accesses that key worker housing? One of the interesting conversations that we've had with some of our kind of people directors about who that would be accessible for and we talk very much about our shortage professions both across health and care but actually there is a whole need in terms of housing for a lot of our kind of support workers, health care support workers moving forward so I think there is more work to be done on that and to clarify really who is holding that particular piece of work because it's a multi-agency factor, I think health care and social care can sort of save the demand but then how do we move that forward to actually bring this, this is the offer moving forward so I think there's a considerable amount of work for that. What I would say is that is a key determinant of us being able to recruit and especially from our local population moving forward as well. Thanks, that's really helpful and I really do understand the challenges and I can see it from the other side as well it's not tied to accommodation particularly if it's shared ownership and you know it's not like somebody who's a nurse one day in this trust is not entitled to apply for a promotion to be a nurse in a different trust as well so I really do understand that there's a I guess there's another side to this and we need to control it nevertheless I used to within a block in my ward used to have a high priority of lettings used to go to tenants who were working within the NHS and that's an example of something that was happening kind of 10-15 years ago so just yeah it would be useful to get a little bit more of an update on where we are with that. So just the other question is around council tax and council tax support so obviously I guess since this was written or since this recommendation was made the mayor has introduced or the full council has introduced the scheme to subsidize or to offer some relief from the increase in council tax for people earning up to £50,000 or some households earning up to £50,000 so this seems to be quite don't want to be misinterpreted but quite pretty much a knock back to say that there's no possibility of any kind of specific relief for people working in the NHS and I just wondered whether there's more is there something else that underpins this like are there figures that show the hit to our council tax income stream that might come from that I mean this seems to me like a reasonable proposition it's not going to cost the earth and we're not tied to it forever so I was quite surprised to see that it's basically a no. Thank you any more question any any question any comment councilor Badrurhan may I've got the one question to get it now how is the North East London people have people and workforce tragedy been received by different stakeholder okay I receive I repeat my question again how how has the North East London people and workforce strategy been received by different stakeholder can I can I repeat that again the strategy has been received well by stakeholders we did an awful lot of stakeholder engagement we did a place event in St Hammers with local people I I think our key element is how we deliver that strategy now and deliver on the kind of main themes on it but the strategy has been very well received in terms of the principles that we want to open up opportunities to our local residents to come and work in our services thank you very much thank you any more question councilor Badrurhan yes yes thank you chair good evening thank you I raised this question that last year when I was part of this committee the consultation you did North East London whatever it's a very big area how many people or have you got any figures that you can show us or some data that got consulted in Tower Hamlet itself because we're just getting some figures overall but North East London the trust is huge area it covers and I I did ask that question last time we went to some figures how many residents in Tower Hamlet itself was consulted on that consultation and one more thing if I may add chair I'll come back afterwards please thank you thank you chair yes please yes so I think in terms of that we we've got figures that we did through our kind of health watch consultants with our with our kind of big conversation in terms of our strategy so we I can certainly get those for you in terms of the event that we've we've done here a face-to-face event but also in terms of questionnaires that we've done with residents we did an event here in Tower Hamlet where we had 35 to 40 local residents that came and sort of discussed strategy moving forward but I can give you we can we can supply the details of the consultation that we did with Health Watch but also through our big conversation thank you chair one more thing as I was the scrutiny chair for education for the last couple of years so I visited a lot of schools one school I went with my colleague and co-optee members central so they were waiting for work experience with the NHS and they didn't get a response within it took them almost two years no response I can see it's been added to this note here a written response to the work experience waiting time for central foundation girls school to be returned to the subcommittee for review so it was shocking to hear when I went to visit there that people who are willing to come into the profession are not being given access or any response and they waited almost two years for work experience and they had no response from the trust thank you we are working collectively I understand that challenge we are working collectively to sort of develop new models of work experience as well because we know there is an absolute huge demand for that moving forward and we are working with our providers to make sure that we can try and meet that demand okay thank you very much thank you get any any more questions thanks I don't have a question I have a reflection on the so I'm happy to wait until afterwards or say it now I don't know when's this the best time okay thank you so thanks for this I think this is this is really good I understand the importance of this piece of work so I do think you know like it's difficult when you're a counselor because you have homeless families coming to you all the time you have overcrowded families coming to you all the time those in medical need coming to you all the time in your advice surgery or emailing or phoning and you know we're as a housing authority we are rationing a scarce resource nevertheless I think that in some ways we have to make sure that key workers are fully prioritized within housing allocation scheme so there is a there is a category I think within the choice based lettering scheme at the moment but I don't it's difficult really to judge its value when without some data so I think I would ask that maybe if we could have a bit of an update on the numbers of housing allocations that have gone to key workers in each say of the last four years that might be helpful in terms of us having taken a view on the kind of the value of the action that that is here and the council tax one I'm going to ask the lead member in a minute okay thank you very much thank you thank you guys I'm extremely grateful to you for your time to come thank you for your speaking to us tonight we are really value your input my reflection are that their community will continue okay my reflection are that the community will be continued to face challenge and we are currently don't have any workforce then structural and we are still playing playing catch-up it is important that we are continuing to monitor the situation throughout this year the health and well-being in our resident and I am important one of the with the council play and significant role thank you very much for your time before we can go to our next agenda I will explain the minute for the last meeting 18th of April 2024 have been sent can you the committee member confirm these are the true and accurate record is okay thank you very much thank you our next item is one second yeah if it's okay can I ask do you do matters arising from the minutes right now or do you wait for those until the end you can do now please yeah thanks so I'm reading through these minutes the main focus is on the presentation from the NHS about maternity services like last time around and I understand from the conversation before the meeting that there was actually also testimony from women who'd had some difficult experiences of maternity services and that we know from from what our constituents say frequently that while the service is often good it is also sometimes not good as well and so it's really important the scrutiny challenge session that happened around it the recommendations that were made on it I just wondered if any of the members of the committee who were on it at the time had any reflections on on that and or is this a piece of work that you would envisage us following up on over the course of the next 12 months because I think you know the government's the CQC's inspection is one thing we shouldn't be just kind of trailing in its wake we should be kind of wanting to see what the further the signs of progress are thank you thank you very much thank you okay our second item on the agenda is the cabinet member and corporate director achievement and reflection of priority as a council as a council we are the responsibility for the adults social care and it is important to service area for our resident can I welcome to the councilor gulam kibria chaudhuri cabinet member for health and well-being and social care and and som bien rg acting and corporate director for health and adults social care councilor chaudhuri can you introduce the item highlighted any priority for this year so one please do edit that cabinet member to comment thank you I would like to I would like to allow to ten minute for the provider or be when I will move the member to question I would like to hand over the glomkibria to for your presentation please thank you chair congratulations for your new role as a chair for health and adult couldn't care scrutiny subcommittee I hope under your leadership we will achieve great success and uphold the highest standard best of luck in your new responsibilities mr chair this report presents our many reflections and achievements for 2022 to 2023 including our work with people our cqc readiness activities and the completion of the new adult social care js and joint strategic need assessment this paper also outlines our priorities moving forward for 2024 to 2025 including the cqc inspection improvement and future implementation I will now hand over to shuman benerjee acting corporate director health and adult social care who will go into this thank you mr chair great thanks very much councilor thank you chair so what we what we were planning to do for this session is to talk a bit about actually what we're doing in the council and then we were going to move on to the different elements of the health and care system so we can we can do the council bit first if that's and then take questions or we can do all of it and then take questions afterwards okay thank you very much for your presentation now I will take the questions thank you I can you presentation first then you can take the question okay great so what we're going to do is we're going to talk through some of the health and care issues from the council perspective we're then going to get we have a number of senior leaders with us talking about the integrated care board talking about gp practices primary care the hospitals and the mental health trust and then we're going to talk about our partnerships so I'm just going to kick off talking a little bit about from the council perspective what the key achievements and reflections are from this year so I just wanted to start off with just a little bit about the context in which we're all working in as a health and care system we've recently refreshed all the data around health and well-being in Tower Hamlets what we're seeing is that you know we have a highest population growth in London we are seeing widening health inequalities we are seeing lower healthy life expectancy particularly in women we have the most and this is really relevant to our services we have the highest population turnover in London and we are seeing the health impacts of increased homelessness the housing crisis overcrowding we have very high levels of substance misuse the impacts of insecure employment and also impacts from crime and people's sense of safety we have the impacts of covid particularly on the health and care services and the pressures that's that's created and as as we were saying before we have workforce pressures and gaps in the in the and recruitment issues in the health sector but also particularly the care sector so we will be bringing more data to future scrutiny meetings but that is the kind of context that we're working in just moving on to from the council perspective the health and adult social care directorate it has three elements to it one are the operational adult social care services then there's the commissioning relating particularly to adult social care and then there is also public health so one of the key things that we we've taken forward this year particularly in preparation for the adult social care CQC review is that we've done a needs assessment around adult social care because what we really wanted to understand is why what is driving the increased demand for adult social care in the borough and what we're finding is that in the under 65 populations we're seeing increasing numbers coming into adult social care and then in the over 65 we're not seeing increased numbers but we are seeing significantly increased complexity which which reflects that in our borough we have fewer number of older people but they are significantly they have significantly poorer health so that is a backdrop for the rising demand in adult social care and a lot of the I mean one of the biggest priorities is how do we deal with the funding pressures around adult social care so that is a really key focus for us and the transformation around adult social care we're also a priority is preparing for the adult social care CQC inspection other boroughs across London have had their inspections this could happen at any time we have prepared by by taking forward an LGA peer review which was which was really positive sorry oh sorry ADAS peer review and so that was largely positive that's something we we we will probably bring back to scrutiny but happy to take questions on that a key other area of commissioning has been home care it's really positive that 86% of people say that they have positive experiences of home care we have commissioned a new model we're towards the end of that procurement and it's going to be really important to make sure that that transition goes smoothly and we continue to have really good satisfaction for the service another key area is housing with care so this is really fundamental to our approach to adult social care in which we want to move away from dependency more people going to nursing homes or residential homes and being as independent for as long as possible so it's it's how we develop the housing that supports that we are the first stage of a capital project which is developing a culturally sensitive extra care home and that is in progress the other really key thing that we're taking forward is what we call tech enabled care so this is how we use technology to really support people's independence but also to reduce unit costs in adult social care so it's a really important element of how we deal with the rising costs of adult social care so those are the sort of key things around the most vulnerable communities in our in our borough in addition in terms of public health we we're really mindful that we need to do more to build prevention into all the pathways across the health and care system really focusing on adult social care and prevention over the coming year we're framing our how we think about prevention in terms of what we call the vital five so the vital five are those things that people can change that have the biggest impact on their health so they're doing pretty straightforward things smoking obesity particularly blood pressure blood pressure there's about 20 000 people who have undiagnosed blood pressure and also about three to four thousand people who have undiagnosed diabetes in the borough so it's how do we work across all settings not in health not just health and care settings to identify and support people with with high blood pressure we have a program of health checks that we got some funding from the department of health to progress that in workplaces as well so that's something we'll be taking forward this year but the other two elements of the vital five are promote good promoting mental health good mental health and then also a sensible alcohol use of alcohol it's really there's a really surprising statistic which is that we have the highest level of alcohol related admissions in the borough even though a substantial proportion of our population don't drink so that that is something that we really want to understand a lot better this year so those are those are some of the things in relation to the services that we commissioned within the council i'm just going to move on now to charlotte who's going to talk about the northeast london perspective and the integrated care board and their priorities so charlotte thank you very much over them thank you thank you very much before you can i can take the house of correction to our member is okay before go member member have you do member have any question yes counselor thank you chair he mentioned we have high number of diabetes and high blood pressure in a people have in the borough do you know what the key issue behind is there any any work has been done to identify the key issues that to that high number of diabetic blood pressure yeah thanks so um in terms of um the the reasons why people don't get their blood pressure checked um it's because but first of all you may have high blood pressure but not be aware of it it's not just in tower hamlet that you have high levels of an undiagnosed blood pressure but there may be um issues about um uh you know so we have a program in which we invite everyone over the age of 45 to come and get a health check uh we have reasonably good uptake but about 30 percent don't um don't come and get their health check it's often men um who who who don't take it up as much um but also uh what we what what we want to do is to be able to use settings apart from healthcare settings for people to access um checks because uh whilst we know that you know people will go to their gps to to have these checks there's lots of if we if we go to for instance a faith setting we have done some clinics in faith settings and we found that you know your significant proportion of people have high blood pressure and they don't they don't know that they've got high blood pressure so i think there's a lot of um issues around awareness um around why um people don't access these checks and remain undiagnosed and so we actually need to increase the information and the implications of um you know of of some of these risk factors for health uh so that so that's that's some of the reasons um why we're seeing you know people don't actually get diagnosed similarly with diabetes what we do know is if you do get into primary care and you do get really good you get really good um uh support and treatment and management of your blood pressure of your diabetes if you go if you get access to primary care um but the issue is about getting getting getting that access yeah so so those are some of the issues thank you thank you very much any more question anyone yes counselor starting from councilor haroon well thank you thank you chair i just want to ask please if you can you know the substance misuse obviously we can we are worried about this this is growing do you have any figures of the percentage of the youth who are involved in this sort of activities and what sort of remedies are they available great thanks um so we we have done um a needs assessment around substance misuse um this year because we have established what we call the combating drugs partnership um and what what that has shown is that we have significantly higher levels of substance misuse um in the borough in actual fact the the age profile of people with substance misuse is actually growing older so it's a different um you know if you compare about the the services that we need to provide now compared to 10 years ago that's that's continually changing the real concern at the moment particularly with young people is are the new synthetic um substances which are becoming increasingly available so synthetic opioids like um fentanyl nitosine those that that's one area of concern there's also a concern about vaping and substances which are for instance really high strength cannabis um for and actually recently it's not in London not in Tower Hamlets but in southeast London um you know 14 15 year olds were hospitalized because they were using vapes which had like significant synthetic substances in so this isn't this is this is a really high risk area for us um and we want to make sure that we are informing schools informing the public about the risks and are able to address this as a as a drugs partnership so those are the sorts of things and the other thing to say is that we are recommissioning our substance misuse services for both young people currently and over the coming year where you'll be um recommissioning our substance misuse um service okay thank you very much next question will be asked uh counselor yeah uh and then we'll react to that yeah a little bit thank you for explaining nicely and i just want to ask you that with the nhs recovery and workforce under significant pressure especially in urgent care what specific strategy have you implemented to manage those pressure great thanks i can take the question now but we will be talking about that in the next presentation so it may be better to yeah we'll be talking about that a lot because it's a really important issue okay okay next question we've got counselor amy thank you chair um can i just ask a little bit about ccc inspection um because what you're saying uh priorities is streamline this activity into business as usual which makes a lot of sense but can you just say a little bit more about how that's actually going to happen as we go along and how you're bringing staff along with you with that was that about the cqc oh cqc inspection readiness thank you so much um so yeah i think that's a really helpful question because um i think what what we've seen um over the last year is lots of activity around inspection readiness so really understanding what the care quality commission assessment framework says and a self-assessment of where we feel our strengths and areas of development are in relation to that and what that has proven to be is quite a labor intensive piece of work but actually a really helpful framework in which to understand um how we're performing um what where we are at now is that we have completed a self-assessment of our of our current position so we're really clear about our strengths and areas for development we've had um a london adas peer review that's given us feedback around our strengths and areas of development as well which was a really helpful way for us to check out our perspective and where we thought we were and and and get an objective perspective on that which was really helpful um so really what we're considering approaching now is utilizing much of the infrastructure that we've set up over the last year so one part of that is our joint quality and improvement board that warrick and i jointly chair which oversees not only our performance in terms of the work that we do directly with people um but also has a really overarching forward plan that's looking at different areas of quality and improvement um so we don't really necessarily need something separate to that the work that we're doing from as part of our wider improvement and transformation program and we're going to review it within that context because this journey is really about um for all for all councils um about that continuous improvement in services residents experience and outcomes of the work that we do um so really that's our bread and butter and we don't really want to kind of look at that in the context of only cqc we want to look at that as this is what we're doing every day we're striving for that so we have um a rotational arrangement of the quality and improvement board a finance board for adult social care but also a project board so we we are streamlining what we did do separately into those functions yeah thank you thank you everyone next question react council but we'll show the please thank you thank you chair uh thank you dr bernardy um just a quick question i think i remember you just mentioned about the youth population that we have in tarahamut growing obviously i think we're the most growing borough in the country what do you have in place to combat this obviously you will have a lot of pressure on the services that we provide thank you thank you thanks um i'll just sorry i think one of the um just in terms of our demographics i think that what what one of the trends that we're seeing is that um the as we're saying that the demand for adult social care is actually increasing in the kind of middle-aged populations and because that's a large population that is putting demand on adult social care services so that is a particular feature of our population because of the higher proportion of you know that population particularly you know sections of that population is starting to grow older we also know that because of the um the poorer health in deprived areas um deprived communities in the borough people actually get get long-term conditions earlier in their lives so that is that is one of the drivers um of of demand on our services um not just in adult social care but across the system but is that was that the question you had council yes so what i what do you have in place obviously it's going to have a lot of effect on the services that we provide to young people yeah so so i think i think so one of the implications of the younger population um are issues around that are particularly associated with a younger population relate to issues like sexual health substance misuse mental health particularly um in men there are some really significant issues so um so obviously how we um think about our substance misuse services is going to be really important um sexual health is it is another area sexual health and contraception um so we have public health investment in that we are recommissioning the services but in actual fact the public health grant doesn't increase in line with the with the population so we're increasingly increasing pressures on that so we're looking at how we provide that services in a different way we have an e-platform so people can access sort of sexual health support in that way um so those are those are the some of the things but i think one of the biggest areas of concern um relates to mental health mental health um particularly i mean in children young people um and those and severe mental illness which we will hear about but those are some of the concerns that we have that particularly relate to having a younger population so hopefully that addresses the question is that yeah okay thank you very much thank you do uh do remember have any question from online or no counselor my Francis okay ask any question or anything i don't have any questions at this point i'm looking through the CQC report for the lead member's information okay last one okay thank you very much thank you thank you very much uh for your presentation counselor Choudry and uh Shuman and officer for your overview and adult social care and then important there is that we have digging all that population with living complex health and problem and growing demand adult social care often regularly pressure and this is can impact how service is delivered thank you very much for your time and thank you very much for your coming we can move move our next item our next item 5.3 tower hundred together board and partner reflection to the 2023 and 24 priority 2024 to 25 we have number area represented and i am pleased to welcome taller poem sorry my pronunciation very bad tolerance only chief participate and place officer northeast London and care board or Neil Ashman chief executive at the birth NHS trust Royal London and Milan hospital Richard Richard executive director from the intermediate care and deputy chief executive London foundation of trust Jainab Aryan co GP care group so welcome all also a robot a clinic director primary care and finally work with Tom said don't join with the joint director of integrated commissioning so welcome all Charlotte can you go fast and speak to the item for five minutes can join up robot go next and maybe between you can speak for about five minutes we will then pause and take some questions from the member for the about 10 minutes now I'd like to request to them so tall or please start I'll let you start five minutes thank you thank you chair and good evening everyone and so I'll be brief because there's quite a few presentations to come and it's and we'll need to have some leave some time for questions so this is a view from the integrated care board which covers northeast London so beyond our hamlets the the eight local authority areas from city of London through to havering as showman is said we're working in a very pressured environment high levels of demand and need and significant financial constraints so looking back over the year just passed them this is a bit of a view from northeast London with a focus on terror Hamlet and we are developing a financial strategy across integrate the integrated care system which recognizes those significant pressures and what we need to do not just now in the short term and bit into the longer term but also as part of that really focusing on our recovery so financial sustainability and also making sure that we've got place-based budgets to work around which will be introduced from next month we've been working with local residents the big conversations being mentioned already as has the northeast London people and workforce strategy those are significant milestones in our work to make sure that we have the right capacity in place for the future there was a previous mention of urgent and emergency care and as a system across northeast London we've moved out of tier one which is the tier where you get the most support from NHS England around urgent emergency care which does reflect some improved performance but having said that our priorities for the year ahead do include continuing to sustain improvement in urgent and emergency care as has been highlighted that's quite a complex area that covers trying to engage people to make sure they're using primary and community services so that's GP's and pharmacies that they restrict where possible so use those services so that they don't need to have access to our hospital environments but where they do that they get the best experience as seen quickly are able to be seen through the hospital and are able to be discharged wherever possible back home which helps with pressures on adult social care and making sure that we are supporting people with through reablement for example the other areas that we're working on as priorities for the year going forward are implementing our commissioning approach really focusing on how do we focus on health improvement not just responding to ill health developing our integrated neighborhood teams we asked a question earlier about how are we thinking about population growth and making sure that we're responding effectively some of that is about the models of care and health that we're using some of that is around earlier intervention the vital five that Shoma mentioned really focusing on primary care and how we join up so that people have a better experience of our local services and hopefully bring care closer to home as has been mentioned there's not only rapid and significant population growth in Tower Hamlets but also in Newham and Barking Dagenham where we will see ineffective population growth the size of a large London borough joining northeast London so over 450,000 people joining this area which is a significant additional growth in demand and that's why it's so important that we think ahead about the model of care that we need particularly focusing on growing demand that we're seeing throughout the system through the local authority but also through our health services on demand for children young people and their families with special education needs and disabilities and how do we respond in a way that again responds to the demand but also gives people that sort of personalised bespoke care as we can we as we've already said there are ongoing pressures and challenges that high level of demand and it's everywhere you look we have still as we highlighted in last year's presentation limited access to capital funding which can help us through some of these challenges and just a recognition that not only is the NHS under funding pressure clearly you will be feeling that in local government as well but our other partners including the voluntary community and social enterprise sector who are on the call are also facing significant financial pressures and I'll hand over at this point to Roberto who's online our lead for primary care. Thanks Charlotte so this year and and last year really has been about access because we know how difficult it has been for many residents for seeking primary care as we've been discussing on this call. Just to frame our presentation slide some of the transformation is being delivered at practice level some of the transformation is being delivered at primary care networks commonly referred to as PCN level and that's a group of around four to six practices collaborating together to support patients in a local way and some of the transformation is being delivered at borough level so a key focus for us has been around access in general and in the round so a large area of work has gone into how we support patients that are digitally excluded so we're happy to report that every practice in the borough now has a digital exclusion policy which is updated annually we've been thinking about access particularly for young people ensuring that young people have access to information and healthcare we've implemented a number of different schemes such as pride in practice which has supported LGBT plus residents and every practice has taken part in those training sessions to ensure that primary care is more accessible for this cohort of residents in addition across all practices we are developing cloud-based telephony and that supports patients with calling practices where they can't access digital and allows a number of different functionality areas so for example it provides practices with real-time data monitoring on the number of patients waiting in a queue and the average call length times as well as allowing for callback functionality specifically to support access we've also implemented acute respiratory illness hubs this winter and delivered 2632 additional appointments to support people with respiratory illnesses January through to March thanks to additional funding that was made available to primary care and throughout the year at 2023 2024 we've delivered an additional 20,000 appointments after hours so these are appointments typically that happen between 6 30 and 8 or at the weekend to support residents to have access to primary care at more at a wider scheme of hours available a key focus is also working with our secondary care partners to think about how we reduce some of the friction when patients move between care settings going forward we're looking at how we deliver same-day urgent care to patients across the borough it's really really important for us to improve access and availability for primary care when patients need it and reduce system pressure across our eds and our utcs our emergency departments and our urgent treatment centers and continuing to support children and young people to have access to health care via a distribution of leaflet to all 14 year olds across the borough an ongoing commitment to support the primary and secondary care interface as well as making sure that we're communicating clearly with residents about how to seek help particularly at winter and signposting to other services which are available including pharmacy and self-care and also keeping on the horizon the British Medical Association is currently balloting its members for industrial action and how we can best support access to primary care through that the pressures and challenges I think we've discussed at this meeting previously but as colleagues have mentioned rapid population growth a huge turnover of patients a workforce crisis of GPs and nurses particularly exacerbated by the cost of living crisis large waiting lists in hospitals issues with access to primary care and revenue implications for practices and building new health centres I don't know Jo if there's anything you wanted to add? No I think that's a thorough run through I think we've brought detailed presentations to previous committees where we've gone through all this in quite a lot of detail so hopefully that covers everything great I think so we'll move on to Fiona now thank you hope you can hear me okay I'm not sure if my camera's working or not I can't see myself so just on reflections and achievements I think a lot of what Roberto's just mentioned does obviously apply to us ourselves at the Royal London and Mile End but we're looking to really reflect on how we continue to work collaboratively and focus on our partnership with provider partners in Tower Hamlets and with our community engagement and how we can ensure that we're designing services for the future with our community co-designing alongside with us as has been discussed workforce remains a significant pressure for us particularly around urgent care but what we are very proud of is some of the new models of care that we've put into place during sort of 2023 2024 in respect of a woman's hub down at Mile End our children's hospital at home is established now in Tower Hamlets and is leading the way some of the some of our models of care are being looked at from other sort of outer Northeast London boroughs and also our virtual board for respiratory and frailty pathways we're determined also to continue to push forward with our diagnostic centre at Mile End and we're hoping for progress on that during 2024/25 our priorities though for 2024/25 do remain improving our patient flow wherever possible as has been mentioned we are focused on our waiting list and how we can reduce those as quickly as we can as well as within 2024/25 meeting our constitutional standards from an ongoing precious perspective again workforce retention and recruitment locally and committing to our workforce's well-being is is going to be our priority and our challenge moving forward we it was mentioned earlier about our focus is very much on service users with mental health requirements and how we can ensure that the pathway is as smooth as possible for for those service users and their families one minute left please one minute left thank you sorry and just very quickly we came just to ask last month talking about our maternity care and we are determined to ensure that we continue to hear the voices of our community to shape our service and improve wherever possible um thank you thank you very much thank you do uh do member have any question starting from councilor we'd like to hear from the foundation trust first and then we actually just have two items to go through east london foundation trust and very briefly i was going to talk about the partnership but we can make that brief uh thank you chair i will be very brief i'll just pull out three things we're really proud of and a couple of things that are real pressures for us at the moment um you'll see on the list on the left at one one one crisis line rollout which is a real achievement it's a service we provide from myland hospital just down the road it opens towards the tail end of the last financial year this service enables anybody to dial one one one and press two and get straight through to a mental health professional 24 hours a day if they are in crisis we provide this service across northeast london as i say just down the road really really proud of that service we're also really proud over the last year to have opened up a children's uh home treatment team uh in tower hamlets um supporting children and young people with mental health conditions at home as an alternative to hospital again operating 24 hours a day and providing much needed support for our children young people who are in crisis and then finally our primary care talking therapy services for people with anxiety and depression um we've got one of the best performing teams i would say in the country in tower hamlets for the level of service that we're able to provide for our local residents a couple of the things which are on our worry list at the moment uh or our issues that we're focusing on huge pressure on our crisis and inpatient services for adults in particular um it's we're not unique in town hamlets it is true across northeast london and london in general but we've heard already from fiona the example of people with mental health conditions having to wait in the emergency department at the royal london that is an effect of pressure on our inpatient services more generally as of this morning we've got 120 beds down the road at mile end as of this morning 23 of those beds were occupied by people who are clinically ready for discharge so 20 percent the large majority of those are people who have a housing problem the number of people who are being admitted to our wards who are no fixed abode at the point of admission or who become no fixed abode during the course of their admission has increased dramatically in the context of the cost of living crisis we don't pretend there's any simple answers to this but it is a real issue and people being in a hospital bed when they don't need to be um the second thing i would say which is a significant issue for us is the really significant growth in referrals for people with a neurodiverse condition as seeking assessment so adults and children in fact with suspected autism and adhd we have really significant numbers of people waiting for assessment in our neurodiversity services there isn't really any significant national policy or any source of funding for this area we are working with our partners across northeast london to try to find solutions to reduce the weightiness by working together and working more effectively um but but it but it is an issue to bring to the committee's attention and i'll stop there and pass over to quirk thank you and i'll be brief um but just to say that you've heard from colleagues in the room and online um all of whom come together to work in partnership to tower hamlets together and that includes the council as well and tower hamlets together is how we plan and deliver our health and social care services together so that we make sure we're joined up in how we do that and how we improve the outcomes for our residents um actually includes partners who haven't been part of the presentation so health watch who are online and gp care group community and voluntary sector and we have a really strong community voice input into the partnership as well um we work together through the tower hamlets together board which is a sub group of the health and well-being board but actually the partnership is beyond that the partnership really is about how our frontline staff work across organizations together so it goes beyond the work that we do in the board hopefully you've heard from the the um presentations this evening how important it is that we work together as a system to support our residents the slide that you've got in your pack gives you a bit more detail about how we do that it sets out the the vision and the mission that we have and it sets out the outcomes framework that we work with which is a framework we've developed with residents and it also sets out on the right hand column there the seven priorities that we've identified we need to work together on there's clearly a lot of work that happens within organizations as you've heard but these seven priorities are the ones where we think we really need to focus on working together as a system and we review these on an annual basis so i was going to go through them but given the time i won't but happy to take any questions on them thank you very much thank you speaker uh your summary or overview now do uh do member have any question from starting from our room by comfortable counter amy yes go ahead please yeah thank you um thank you for that i'm going to come straight back to you if that's okay just to ask about um the one one one the crisis line um you're right that's it's a huge achievement um it's it's a it's a big deal to be able to do that so smoothly but my question is what happens after that um essentially i would be interested to see if there's any sort of data on once these people make that phone call where do they go afterwards is that leading to opening a new pathway for them where they get referred somewhere or is it a phone call because i'm sure you're more than aware that they can as as big of an achievement as it is can be a lot of criticism of these kind of uh crisis lines uh unfortunately um and the advice that they actually offer and give to people in crisis isn't always appropriate that's quite a common thing unfortunately um and i have to say that that does apply to to clft as well um so my question is what is actually happening after that initial phone call are we seeing those people being given um the right guidance and the right support to access the services that they need or is it you know is there any data on it does it result in further phone calls is it a complete step back from the service after that what's happening as a result of that increased access to speaking to a professional like that if that so thanks for the question i actually spent the whole afternoon with the team on friday and they're a fantastic team of clinicians who take in the region of 150 calls a day across 24 hours and i mean the answer to your question is obviously dependent on the individual who makes the call but certainly when i was there they spent a lot of time navigating the system on behalf of people who call to get them to the right place which could be into a community mental health team it could be into the home treatment team it could be to the emergency department we actually have facilities on site for people to come down to have face-to-face assessments if they're not known to services and the team are concerned about a risk they also visit people at home so there's a whole range of different interventions which um which are available and the there's a whole load it's obviously only been going for a couple of months but because we it's all managed via a system called adastra we have loads and loads of data which we're just getting our heads around which tell us precisely the answer to the source of questions that you pose so where do people end up so we have all of that thank you next question will be asked the extended access provision that was mentioned by dr roberto was it yeah okay obviously it's a it's a growing service and how would we sort of make sure that it's in we are on top of it in in the future obviously there's a lot of pressure on that service out of ours provision that has been provided was it if i remember sorry it was 20 000 after hours appointment that was delivered last year is there something we have as backup or something in the pipeline that we could do more in that sector thank you thank you okay thank you next counselor who's going to ask to take the response do you want us to respond to that now sorry yes thank you very much go ahead oh sorry yeah the extended access provision is the um 630 to 8 pm on weekdays and the nine to five on saturday's so the way that is funded is as it's based on the list size to the number of registered patients so if there is an increase in list size then the funding increases accordingly so the number of hours is calculated based on on the patient population so that's how the the number of hours available to pay would increase in line with any list size increase so that's particularly for extended hours which is what the question was about that's saturday's and weekday evenings out of hours is something else that that's kind of beyond which is overnight 8 p.m to 8 a.m okay thank you very much next case your counselor thanks thanks for those presentations and the lead members um setting the scene as well so look this is helpful for me coming back to the committee for the first time in four years to have a a bit of a kind of a uh immersion into into everything that's that's going on and where people feel that there's progress and that's really encouraging and genuinely i really do understand the pressures that are on the nhs as well as on the council's own own side of things so it's going to take me a little while to get up to speed to understand the new things and some of the new language and some of the new terminology but one of the things that i think is really important is that we focus our attention where we can as a committee where we can add the most value and we can't add value on all of these different aspects of the health system um in the course of a four-year term let alone in in the course of a one or two years that we've got left here so i think that's something that we need to reflect on as a committee when we talk about our work plan as well but i wanted to ask um now just as a as an opening question so you're entitled as health professionals as local government officers to kind of put the best uh picture present the best picture to us and then to remind us of the context that you're operating in and that your colleagues are operating in as well um but this is about us understanding what the challenges are and where things aren't working as well as they as they need to as well um and i think we've heard a lot about what's going well or what's new or what we hope to change and all of that and we haven't heard quite so much in terms of what um what what we need to do better do differently or what we're really worried about um in terms of service delivery and especially when we're talking about delivery service delivery for vulnerable people so at the outset i think we were told um about the the cqc are coming there's going to be the inspection and we were told that um there's been we've done a self-assessment and uh ad us of the association of directors of adult social services have done a peer review as well so i just wondered if the team feel able to say anything about what they what whether any particular challenges were identified in that and what action has been taken so far to try to address those great uh thanks very much counselor um if you want to come back and talk about the sort of high level findings and then that's probably something that i want to add to that as well thank you um so your question was around what were the kind of learning that's come out of the self-assessment what are some of the real real tangible things that we're looking at as areas for development is that right yeah um so i think the the peer review is really helpful um just to check that we really are getting it right in terms of understanding what is a challenge i would say that in terms of the feedback from the peer review and i'm more than happy um to to kind of come and share something a bit more um around this and our self-assessment indeed we did bring a presentation on this before when we just started really doing our self-assessment but we're a bit more along the line now um but some of the things that come out was um in terms of strengths was around our committed and passionate workforce our strong partnerships with health that there was a golden thread from the strategic plan in the work that we were doing that we had uh really supported our staff but we had really knowledgeable and experienced staff and we had a really strong culture of reflective learning and it also um celebrated some of the services that we've got around our carer service our independent living hub our jet employment support and how hamlet's connect um some of the areas that they felt were opportunities for development was in particular in relation to continuing health care funding um how we work with partners to ensure that residents can access what they're entitled to and we've started to look at some work across uh the service on how we ensure that we are um improving our performance around referring people for continuing health care assessments there has been some work happening across northeast london on this particularly our joint funding policies as well um so we're working in partnership with our northeast london colleagues to try and navigate that at the moment um and one of the other areas was a better understanding um of user satisfaction around the services that we're providing um particularly the views of users and carers and what we've done in relation to that is developed um i mentioned uh to counselor lee earlier on around our quality joint quality and improvement board um so we've introduced a new quality assurance framework um which has sought to implement much more robust assurance processes around people's experience and outcomes as a result of their intervention from adult social care so what we've done what we've done is an increased level of auditing of casework but also included within that not only opportunities to seek verbal feedback from people with lived experience of accessing social care but also doing reflective pieces of work with practitioners so that we can embed the learning from that from people's experience we're also doing a piece of work specifically with the carer center because we know that perhaps their experience when they're cared for is being assessed is not always as good as what we would like so we're doing some work around that as well to improve their their experience and we're going to do a kind of joint event with carers and social care staff so we recognize that we've got some areas of development um we recognize that we've got some work to do but we do have plans around them and happy to share anything more on that yeah so that's all come from madhouse as well that's come from them and of course alongside that we've got our own improvement and transformation program wider program some of which you would have um be aware of so some of the technology enabled care work that that shoman mentioned the housing with care and we've also been doing improvements to our mosaic system as well just to just to add a little bit to that cancer you asked kind of what are the issues that that we're facing so i think across the health and care system um there remain the issues about a joined up system which actually played out when we did the needs assessment around adult social care because what we found was that a significant proportion of people in adult social care who have long-term conditions were not accessing primary care we don't really know why that is because you'd expect them to be accessing primary care at a higher level but those are some of the issues of join join up the other bit that came out of the review was the linkage of data across systems both sort of operationally and from a commissioning perspective so we still do have these issues in which individuals continually have to repeat the information they've got bits of the system can't see what's happening in other bits of the system so i think that is those sort of infrastructure join up issues are still remain unresolved and can be solved by sort of data governance and in better infrastructure but that certainly is a challenge for us across the system thanks can i come come back on that i'll try and be as quick as i can and thanks that's um there's a lot of assurance there there is a lot of assurance um but obviously we've seen this council and other councils not just um find the individual care settings or individuals home care providers are problematic for for users but you know there's something more fundamental so that's what i believe that we have to press you on a bit harder um so um i guess first a couple of things like it'd be useful to see for us to see even if it's unrestricted papers what the self-assessment said and what the adas peer review said um i think it's also really useful for us to um to try to to get a bit more in terms of the metrics so we we or the overview and scrutiny committee sees some key performance data in relation to uh adult social care not much you know there's all sorts of other things that are in there as well so it'd be useful for us to know what are the other um kpis that you see that don't make it into those that are published in the cabinet papers as well um and then the final thing is so the last time i was on this committee followed um a period where we'd seen a number of um care settings be turn out to be a requiring improvement at the very least and then some of those didn't um end up continuing so it would just be useful for us to have to to know whether um uh if you could actually provide us with a summary of what cqc says about those care settings that we that we use where we place people and um whether there's any kind of concerns that we have and again if that's something that needs to be provided to us as restricted information for the moment then that'd be really good but one of the things certainly in my experience as a counselor have often residents who come to me who have elderly parents going into settings and the you know these are people that have been very independent for 80-odd years and obviously it's a massive upheaval and a shock and it's a shock to their family members as well however in the past i think those settings haven't always been what we would want to see our own parents or loved ones in thanks that's really helpful okay thank you very much thank you our next our next member may feel in the online piece thank you chair um just one last question regarding or two questions on acute care so this is about workforce and retention so what are your current workforce retention rates and how do they compare to national averages and the second question is what pacific programs or incentives are in place to recruit locally and support the well-being of staff thank you sherman thank you chair and thanks adrian um sorry thank you matthew sorry um i don't have the detail regarding the retention uh percentages but i can certainly come back to you um and the committee tomorrow that's no problem um with regards to um what we're doing in respect of local recruitment is we're working closely with the council on how we can raise awareness of careers clinical and non-clinical at the royal london and myland and trying to promote wherever possible we're also part of the scheme where we're where we've been successful in recruiting um uh women um from the community into non-clinical careers um and we are up for an award called the mj award um so that's good news um from a well-being perspective we have been working um to establish a team it is a small team i i can't say it's not um but we have well-being hubs um in place at the at myland hospital and the world london hospital which provides um respite and a an area for relaxation for staff um we're also um with the small team working with um our clinical teams to take time out um and um have time to talk and listening events to understand what the issues are so for example the cost of living is is a theme that comes up currently um so so it's how do we um provide that council to staff and um wherever possible point them in the direction that that might be a help of help to them um happy to to discuss this at further length if that would be helpful with you thanks thank you okay thank you very much thank you next question ask myself the worst is tragedy are being employed to manage the high level of demand throughout the system okay yeah is that for me thank you but you've heard quite a bit from partners around the table around some of the strategies that we're using um certainly one of the things is really modeling what the future demand looks like as well because the population growth is not just happening in the past if we were where it's happening in the future so thinking about what some of our models of care would be those include um i mean showman mentioned the vital five it's really important that we do focus on that in early intervention prevention whether that's primary and secondary prevention to make sure that we're where possible avoiding people becoming um well um we are trying to do things as close to people's home as possible so this work on integrated neighborhood teams and joining up the capacity we have in a stretch system it's really important that we work together and where possible integrate think about the things that we can do together showman mentioned showing thinking about infrastructure as well as actual service delivery um we are also um thinking about our sort of asks around capital so i mentioned we are um what we consider to have lower levels of capital um and we are lobbying and advocating for additional capital for northeast london um bearing in mind the importance of estate and the use of our capital to delivery of services um the work on communications with our local residents is also really important so some of our campaigns we've just had a significant campaign on immunization and vaccination for example um that sort of again that early intervention is really important and making sure that local people know where to go when to get the right care in the right place is really important that can sometimes sound quite straightforward but obviously it's very complex with the diversity of communities and making sure that people understand the system we have as richard mentioned um some of the work of the one-on-one crisis responses about navigating people through what is quite a complex um system um i guess the other thing we're trying to do across northeast london is think about um where we've got variation between different um local authority areas or between different services how we can reduce that level of variation and learn from each other it's a huge amount of expertise um knowledge and skills across our sectors and across within individual sectors so making sure that we're learning to all those elements come together to help us address demand but some of it comes back to enabling people to live healthier lives from the get-go so that work with children young people which hasn't featured heavily on the agenda tonight is really really important and then we're working to sort of improve that um those healthier starts for children and young people okay thank you very much once again thanks to all our partner this evening outlining your reflection achievement and set in seating our priority for this year it is important to important that we continue to foster a strong working relationship with our partner listening to you give the gives me the hope that we are putting our resident need first and this is the really important i also thanks we can stretch the also and collaborate joint resource and the intelligence i think i think it will be useful for the committee for also understand how are the involving and the decision with key plan commissioning and serve the improvement thank you very much for your time and thank you very much for your coming we can move forward our next agenda our next agenda is 5.4 scrutiny report review and empowering disabled resident and accessible sport and fitness interview now i i would like to welcome to our colleague council Ahmad han commission please come to come thank you counselor han i will give you three to five minutes to provide your overview and your presentation and ask member for any comment thank you very much i you can start here thank you chair good evening everyone uh this scrutiny review session report set out the reason for the scrutiny review who who was invited and involved with the review identified key finding and set out the recommendation within the reports as a previous chair of the health and other scrutiny subcommittee i commissioned a scrutiny review review to exam examine people with that disability those with living in longer terms ill health condition level of excess on sports and exercise provision in the borough i and colleague on the health scrutiny subcommittee a number of borough leisure center we visited when it was over operations under gla examine how to organize it and provide the access to the residents and disability or living with a long term ill health condition within this process i am grateful to our disabled people network older people reference group who provided us with their view at a residence engagement sessions and i pleased to have included some of their contribution within this report i held to i held two evidence gathering session on 15th of february and 4th of march where the subcommittee had from the range of witness including real disabled people coach balanced sports community association ability view alternative movement and other council councils leisure in-house teams reason reason for the scrutiny review was that we wanted to understand the understanding the specific barrier for those group when they're trying to access the sports and exercise provision under the main challenge in promoting promoting in exclusiveness and participations in the sport and exercise groups method to improve accessibility to the leisure and facility for this group explore the consider ability availability and capacity adopted of sports program for this group how we can improve enhance the awareness and educations on the importance of the inclusion of sports and exercise program key finding and the recommendation the subcommittee made six recommendations within the report focusing on improving disability representation improving data for the better intelligence and leading decision making improving the forms and campaigns for these groups creating a platform for this group to be able to influence and shape the policies and hold to account the service work with the partners such as NHS for referral and creating transitional agreement moving on to the mainstream facilities subject to any proposed revisions by this subcommittee i will take as i will take to ask the chair and member of the subcommittee to agree this report and sign off on the report once the subcommittee agree and report report the next step will be will be for the service to provide a response in the form of a an action plan on to the scrutiny recommendations which will be then go to cabinet for final sign off thank you for hearing me out and i look forward to see the progress of the recommendation for this report thank you chair i was just going to say thank you um to you councillor for all your hard work um um as chair and on this report and obviously thank you to you as well um it it was uh in terms of the site visits and the work and the conversations that we had it's it's it's clearly a really important issue and i'm really pleased to see something like this is going to go forward um and i believe now that in terms of the new ledger service there is now a disability membership there were some questions around that previously um so that is a positive i'm pleased to see that that has happened thank you thank you um yes well done councillor this is a really good piece of work and it's really well evidenced the recommendations are really well evidenced as well so well done to you to everyone that was involved in it and to the team who's uh who's drafted um what lies beneath the recommendation so i was really impressed to see the extent to which um you and your colleagues went out and sought um testimony from those who both provide the service but also who are users of the service as well and amongst them ability bow which i think is one of the which is a which is a great organization trying to help um those with physical disabilities to um both to recover um and uh and also to enjoy physical activity so really impressed with that i guess the proof of like the value of it is in how the mayor and his team respond to it but i'm sure that there's plenty in there that they can that they can respond positively to thank you thank you thank you chair and uh colleague councillor the chair ex-chair of this committee i was lucky enough to be the vice chair and we worked on a lot of things we visited a lot of places so it's nice to uh obviously things will move on hopefully because the the facilities has come in house from gll so hopefully we'll get this done as soon as possible uh it's a it's always been a pleasure being around you and uh everyone who was part of that committee thank you once again thank you any more any question no can you remember any agree the report yes yes everyone is okay yeah thank you dustina can you make a note of this pleasure of this minute okay thank you thank you councillor for your time and for your coming i'm extremely grateful to you too for your presentation thank you thank you chair thank you everyone for listening me before we move the oab and the close this meeting i wanted to give you committee member the opportunity to comment or making suggestions or topic or issue that the hex the could consider for his work program if you can set out what and why we want to go fast or shall i just call your name and you can make your suggestion oac will be holding a member working okay make any suggestion yeah thank you uh council amy highlighted something uh the dis disability membership it's it's yes so it's ongoing hopefully they can get the facilities in time for those you know people who have been left out for a number of years so if that could be noted thank you thank you um for future planning yeah um so we've had the presentation from the cabinet member and from showman um which talks about their priorities between 24 25 i think we should really go heavily based off those priorities because that is the work that's going to be happening going forward um so i'm thinking particularly uh well based on this free community care we've now got date of april 2025 for that we haven't really been able to discuss that much and that has been pushed back um the housing with care strategy um and we've just we have discussed this before um although the dates blow into one i can't remember the last time we discussed combating drugs but if they are going to do a new review then i think that should definitely come back um so i would say we should try and align with the priorities that have been set out and then we're going to be able to have more opportunities to hate from the cabinet member as well okay thank you very much thank you very much for your suggestion and obviously that will be noted thank you that's fine thank you um so i i agree i agree with those um so one of these is around um the uh reinstatement of free home care and care and community settings and so preparedness i guess for that is important i think it's also important for us to maybe spend a little bit of time reflecting on the uh the experience of some of those people the challenges that some people have had with those um with their bills and in all honesty to have um to see whether there's any contribution we can make as a committee to what happens to that that's debt right now that's debt that is sitting there um owed to this authority and there's no budget for anything else obviously people were expecting that the free home care would come in last april 23 so how people have been dealing with that is is is definitely something that we should look at i'd like to add two other things as well so one of them is around um so over over time like our community care settings will always change that's inevitable but there was a bit of an acceleration in the in the changes and in terms of provision a few years ago um in relation i think particularly for um day centers for um people with physical disabilities mental health um uh problems as well so i just wondered whether there's um whether we could look at look at that at some point maybe not immediately but it's a bit further down the line and then the final one so i kind of alluded to that earlier which was about the um uh some of the care settings that we have so it probably goes alongside what uh counselor lee was just saying there about the housing housing and care strategy um but yeah where where it would be useful for me both to understand where care where where the cqc and the council rate care in those settings but also what is the future of some of those settings which perhaps are getting a little bit tired now and the final thing is i think just to reiterate a point i made earlier i think we should always be looking at metrics in one some way shape or form in this committee not just having presentations okay one more thing that was highlighted by i forgot someone sitting on the right just there uh autism and ahd which has a long waiting list in the borough so i would be very happy i'll be grateful in uh to the chair and everyone here if that could be noted and highlighted because i visited few places with the deputy mayor when i was the chair of the education committee and i've heard some horror stories you know it's not nice some of these people who we are elected to serve are going 10 20 miles out of the borough to get service thank you okay thank you very much thank you very much for your suggestion and thank you very much your comment and officer will be noted ose will be holding a member war program development workshop on 19th of june 2024 from six to nine which i will be attending and i'm happy to feedback your suggestions from this committee the council health and adult and social care leadership term has offered to provide us a briefing session on the latest data around the health and equalities this is the important for our committee and it will be useful for us as we are considered different issue in this year once that is the date has been agreed for look will be sent the detailed through can member get back the get back and follow as soon as possible either there will be in the attendance the service will be the service will have put a lot of time in preparing this for us and so i think we need to encourage good attendance finally there is any other business to discuss no i have one which will be useful for this committee so sorry which one no committee it's not no so with no other business to discuss i call this meeting to close thank you for your thank you for your time and thank you for your coming thank you and good good evening all thank you