Transcript

[Applause] >> Good evening and welcome to the Health and Wellbeing Board meeting. My name is Councillor Gulam Kibriya Choudhury, Cabinet Member for Health, Wellbeing and Social Care and I will be chairing this evening's meeting. This meeting is being filmed for the public website. Those participating in the meeting will be included in the footage should a technical error occur that prevents remote attendees from participating. I will decide if and how the meeting should proceed after taking advice from officers. I would remind members of the meeting to only speak on my direction and to engage and speak clearly into their microphones to ensure that their contribution can be properly recorded. Participants please have your mobile phone etc. on silent and virtual participants keep microphones on mute except when speaking. When those in physical attendance have their microphones turned on only when speaking. If those joining remotely wish to speak please use the raised hand function. Please do not use the remote meeting chat function as it will not be seen by those of us in the physical meeting. It's very important finally I would remind all members and stakeholders and other participants that this meeting is taking place within the formal pre-election or for the period leading up to the election taking place on 4th July. You are therefore reminded that discussion must not involve any election issues or party political content and must take closely to the matter set out for discussion. We received apologies from Neil Ashman, the Vice Chair of the Board, from Charlotte Pomerie from the North East London Integrated Care Board and Councillor Kabir Ahmed. Thank you, I call the board members to please declare whether they have any disclosable pecuniary interest and indicate the agenda item number, title of report to which the interest relates given explanation for each declaration. Minutes of the previous meetings and matters arising. Can we agree the meetings of the meeting of the board on 16th April 2024, members please? Now today's meeting, our first agenda item is sexual and reproductive health strategy 2024 to 2029. The board is to receive a presentation on the sexual and reproductive health strategy 2024 to 2029. As this report was not published five clear working days prior to the meeting, I would ask the board to note and agree the reasons for urgency as set out at the top of the report. Does the board agree the reasons for urgency first? Now I can invite Subjit Sanghera, Public Health Program Lead and Liam Crosby, Associate Director of Public Health to introduce themselves and then start us and present this item. He will have seven minutes to present before we open for members' question and any clarification. Thank you.

Thank you. I'm just setting the context because Liam isn't here today. So this is -- so as Subjit will say, sexual health in town is a particular issue. We have very high rates of sexually transmitted infections. But the organisations that provide sexual health services provide them across north east London as a whole, not just in town Hamlets. So north east London, both the ICB and public health departments across north east London have collaborated to develop a strategy and what Subjit is going to talk about is actually the elements of that strategy and how that will particularly impact on town and its residents and the work we've done with town and its residents. So I'm just going to pass on to Subjit. Thank you. So I'm going to talk -- just to give you a bit of context about what I'm going to talk about and Shonan's already spoken about this. So I'm going to give you an overview of some of the sexual reproductive health needs in town Hamlets in particular. And then also talk about the reasons why it's important for us to have a joint strategy across north east London for sexual reproductive health and then talk about the processes we took to develop the strategy and then some of the key aims and objectives and priorities for action and then a proposal for how we review the strategy and get the support of the health and well-being board for this. Next slide, please. So just to say -- could you put it on slideshow, please? Could you put it on slideshow? So just to let you know about the sexual reproductive health needs in town Hamlets, so the chart at the bottom on the left-hand side shows you our sexually transmitted infection diagnosis rates. So as you can see, the light blue line actually shows you that we've got high levels of STIs, sexually transmitted infections in town Hamlets compared to London average and England average. So it shows you that we've got a significant issue in town Hamlets and some of that is around because we've got a very young population compared to other boroughs across London for example and England but also because we've got a high proportion of people that are gay, bisexual and men who have sex with men. So that's driving those high rates of new infections and also re-infections as well. And then also for contraception, so for females, we know that -- so because coils and implants are the most reliable, cost-effective form of contraception for females, but we have a low rate of this in sort of GP practices so we know that sometimes national surveys have showed that actually women prefer to have access to contraception locally from their GPs so we know that our rates are particularly low and that's something that we would like to address going forward so there's some unmet need there that we need to address. Next slide, please. So in terms of the sexual and reproductive health landscape, we know that there are key enablers so it's quite a complex system so for example when we're looking at commissioning responsibilities of sexual and reproductive health, we can see that there are core sort of mandated areas of delivery for commissioning so for example in the local authority we commission sexual health services and also across NHS England they commission other forms of contraception but also other things like cervical screening for women and in the ICB, so in the integrated care board, they commission a number of services so some of that is around community gynae, gynae provision and also vasectomies and maternity care as well and abortion services as well. So it makes it quite complicated because there's lots of different organisations that do the commissioning around sexual reproductive health. On the other side, we have a number of partners that deliver sexual reproductive health as well and some of them are for example Bart's Health, GPs, community pharmacists as well and also voluntary sector organisations as well. So really from a resident's perspective, a person who's accessing services, it can be quite confusing and complex and then from a commissioning perspective it can also be quite complex and fragmented as well. So the idea of the strategy is to make sure we have a collaborative approach where we have good outcomes for our residents around sexual reproductive health across North East London. So the importance of having a strategy across North East London. So what we want to do is really we have, having a strategy, we've got an opportunity here to have a new vision across North East London which is around sort of shaping sexual reproductive health services, so working, making sure that our services are working collaboratively. So we have an opportunity to collectively address sexually transmitted infections, the high rates of transmitted infections and also to address the inequalities around reproductive health for women and girls. It's also about providing opportunities to build sort of seamless care pathways. As I said before, things are quite fragmented at the moment so it's thinking about how we can provide joint care and commission services in a different way. And also it's an opportunity for us to really make impactful outcomes around addressing stigma, particularly stigma around STI infections and also HIV as well. So what we've got is we've got a selection of actions that we want to do to implement the strategy and some of those are on a North East London level where we've done quite a bit of extensive consultation with stakeholders and partners about developing the action plan and priorities for the strategy. And also we've developed a local action plan which we've done some resident engagement on as well to make sure we've got the right actions in place. Thank you, next slide. So what the vision is and where we want to get to is we want to make sure that our residents have healthy, fulfilling relationships and informed about what choices and have choices. And then also the other part of it is around having good quality services as well that are equitable and they're accessible for people, our residents. Next slide please. So how the strategy was developed. So across North East London we have eight boroughs that have set the vision with our partners. So we ran a number of events where we engaged with stakeholders to think about what that vision looks like. And then just to say a bit about the strategy, it's a five-year strategy, we're hoping to launch it in September this year. And like I said before, each borough will have an action plan to address. So sorry, some of these priorities, the four priority areas within the strategy. So one is around healthy, fulfilling relationships, and the other one is around good reproductive health across the life course. So we're looking at sort of thinking about integrated pathways for, for example, women accessing contraception, but also menopausal support as well, and then also priority areas around high quality STI testing as well, so making sure it's accessible for groups that don't normally access STI testing. And then also thinking about HIV prevention as well, looking at how we move towards zero transmission, but also support people that are living with HIV. I'm not going to go into all these details, because I think it's a repeat, but this is just to say that this gives them sort of an idea about the aims and outcomes and the key success measures that we'll be measuring for the strategy. So I think we can skip this bit, the next few slides. This is just about what we're doing in Tower Hamlets, our action plan for Tower Hamlets around the priority areas, and we have a local steering group, it's called the Sexual and Reproductive Health Partnership group. So it's made up of a number of providers, including representatives from community pharmacy, primary care, our VORG group and also public health colleagues, and the voluntary sector as well, and also youth services are involved in that as well. So we've developed the action plan for Tower Hamlets in consultation with these groups. They will oversee the implementation of the action plan, so we will be meeting quarterly to review where we are and where we need to go to get to. Thank you. And then just around the governance process for the strategy, so the blue box just shows how we'd want to consult and have the health and wellbeing board review what we've delivered, so the annual action plan. And then across north-east London, so working quite closely with other partners, so having a partnership group there that will oversee the north-east London action plan. And then a local sexual health strategy steering group as well. Any questions? It was just a highlight, just to bring to the board, that subject was talking about how the commissioning landscape for this is a little bit fragmented, which relates to when public health came to the council. Some elements of sexual health came into the council, but other elements stayed within the ICB. So one of those key areas is termination of pregnancy services, which are commissioned by the integrated care board, but obviously there needs to be integration between our sexual health services and those services. Some of the gynecology services such as menopause services and those sorts of services are commissioned in the NHS, and we have kind of significant commissioning in the local authority. So one of the key discussions is about how we work together as commissioners in partnership across the integrated care boards, and that's one of the things that we're trying to drive here, which is aligned commissioning across the system. So that has been a challenge. Before members, colleagues come in, I have a few questions to you. Of the Serbia respondents and focus group participants, do you have any sense of how many or from how much our own local community was engaged? Second one, why are there any core issues with existing service or needed improvements that service users identified through our consultation work? And you also mentioned in your presentation about stigma, has the NIL made any commitment in this strategy to addressing stigma and access BME and Muslim communities? Because this is an issue particularly relevant to our residents. Thank you. So your first question about the engagement. So we ran a survey right at the beginning of before we developed the priority areas asking residents. So we had about 100 responses from Tower Hamlets residents asking about whether they felt the priorities that we were looking at were the right priorities, and we also picked up on some access issues with our sexual health service and also GP services as well, which we've embedded into the action plan for not just North East London but for Tower Hamlets in particular as well. We've also committed to doing, as part of the strategy, as part of the action plan for the strategy, we've committed to doing an annual review for access issues, so making sure that we're getting service user feedback on a regular basis about their views about whether they're able to access services in a timely way. Does that answer that question? Sorry, I've forgotten the second question. So some of the existing issues have been around access. We know things have changed a lot since COVID, where a lot of things had to be done, or lots of consultations have been done remotely. Some of that has carried on. And they actually don't at the moment offer a walk in service, but are working towards going back to offering a walk in service, but offering it in a different way compared to how it was delivered in the past to make it more effective. The other thing I would say, but is actually working quite well in Tower Hamlets, is that pathway between, for example, abortion services and maternity services. So we've got, for example, our specialist sexual health service providing training to staff that work in maternity services, so they are able to offer contraception for when, for example, a woman's just had a baby or has had an abortion. So our abortion rates actually are a lot better than the other North East London boroughs. So that's a success story, but we want to continue and expand and develop that further. And then stigma, yeah, so issues around stigma for sexual health, reproductive health, and HIV is an issue. It's an issue across the board, but also particularly in North East London. So as part of the action plan, we're working particularly, so on a London-wide level, there's an intervention called the Fast Track Cities, which is around HIV prevention. So they've allocated some funding to have some GP champions. So we're doing some work quite closely, so we've got a GP champion in Tower Hamlets. So we're developing some work as part of the strategy action plan to engage faith leaders around how we address issues around stigma and also community as well. So we've got some community engagement interventions as well, where we're using coproduction techniques to work with the community about raising awareness around sexual and reproductive health. Thank you, Chair. I think you've asked a couple of the questions I was going to ask. But anyway, thank you very much for the presentation. I'll touch on a few things in terms of the last point, the stigma aspect of it. I think this is one of those things which is, you know, when it comes to community, especially in Tower Hamlets, is a stigma. How have you, in terms of, you know, you said about becoming health champions, in terms of maybe reaching out more towards local organisations, faith groups, et cetera, things like that, to address in terms of the importance of this, firstly, and also in terms of the strategy that you have, you know, it is a barrier. So in terms of how, you know, to have more of a, you know, breakdown into how we break those barriers in terms of, because usually some of the service that we have already in terms of the GEPs, et cetera, in my experience, you know, people are not really in terms of comfortable in those surroundings. So basically these kind of things needs to be more localised in terms of women's group or male's group, basically, where they feel comfortable discussing this, because in terms of GEPs, like, you know, I don't think in terms of my feedback and in terms of interaction, these, you know, we don't really get the true reflection. And lastly, in terms of the data that you have, do you have a bit more in terms of breakdown of different sections of which particular group are mainly affected, and, you know, and that will help us maybe focus in more how to really put resources where it matters when it comes to dealing with things like this. Thank you. Okay. So going back to the stigma issue, how are we going to be addressing that? So we've done some, so as part of the consultation with local residents around our action plan for Tower Hamlets, we engaged specific key groups that work with our populations. So through the CVS, there's a flourishing communities project. So we've engaged them and they will be our partners in delivering the action plan. So they've engaged local women, local residents, particularly Somali communities and also Muslim communities as well, sorry, Somali communities and Bengali communities. So we're doing some work with them. So some of that work is going to be around co-production and we're doing sort of, we're starting off thinking about sort of myth busting kind of exercises and co-production about how we deliver the message around stigma and how we address the message, sorry, around stigma. So one area, another organisation that we're working with is Sister Circle. So they work across North East London, but do lots of work in Tower Hamlets and they're based in Tower Hamlets as well. So we're doing, we will be doing some work and they're part of actually our Tower Hamlets partnership group as well. Does that answer your question? And then the other thing around data. So another thing we're working on in public health is we're doing a needs assessment piece of work. So really trying to identify where the needs are around number one sexually transmitted infections and then also about where women aren't, females aren't using contraception and really targeting work in particular areas. So we know, for example, we have a map that we've developed closely working with our health intelligence team about where people aren't accessing sexual health services or online services. So we've got to the point where we can actually say that actually we know that there's certain community groups, for example, Bengali groups, Asian groups that aren't accessing services, so we are thinking about how we might do targeted work and in which areas we might do that. But we haven't finalised that yet, so in the process of doing that. I think you've already touched on it, so I just wanted more information. It's about the co-production event, the focus, whether really focused around Muslim communities' needs during the co-production, that's my first one. And the second one is about what accounting does this strategy have on culturally sensitive when it comes to the BAME community and so on. Yeah, so the co-production item, sorry, what was the question? Sorry. The focus, during the co-production, were there any focus on BAME or Muslim communities? So we haven't started that work yet, but that's on our action plan to start that in September. So as I said before, we're working with the CVS, who are running specific projects for women in particular, so that work will be around identifying what the needs are and then working with the communities to think about how we address some of those issues. And they've got a cohort of health champions that we will use to deliver messages around what their choices are, but also about how to access services. Does that answer your question? Yeah, thank you, I mean, I appreciate the work the CVS does, I think they do brilliant work. I think it's about reaching out to the faith groups as well, so I think there needs to be some kind of work around faith organisations as well. Thank you. Thank you, Emily. Thank you for that, it's really, it's a really good plan and it's really important, I think, to discuss it here, and I think we're focusing on the right issue, I think this is a really, what other councils have raised, I think is actually quite spot on in specific Talhamlet's terms, and what you raised about faith groups I think is really, really important, but what I'm thinking, I don't know whether, Siobhan I don't know whether this might be one for both of you, but there's obviously a role for the council here as part of this, to be part of this work, so I'd just be interested to hear what's already happening and what more the council can do, because that actually, that area, that's probably something the council is actually probably in a really good place to support with in reaching out to those groups, so I'd just be interested to hear about what's going on there. I don't know how much, I know you might have already had a long list of things. I can just kick off on that, I think the council has a really core part, obviously we are the commissioners of significant sexual health services, but we also, in terms of the networks that the council has access to, those are really fundamental in terms of, particularly when you think about stigma and how we address stigma, but also information as well, so I think that bit is really important. The other bit is thinking through, in terms of the actual services that the council provides in which sexual health may be a real issue. We've done work with the learning disability services in the past and that's been, that's really highlighted a lot of issues that people face, people with disabilities, so some of the services that we commission, adult social care etc, that's a real opportunity to ensure that we're embedding sexual health into those pathways, so those are some of the opportunities within the council. Just to add to that as well, we have a small working group that's looking specifically at young people's needs, so we're working very closely with, for example Kelly Duggan, who's the lead for youth's areas of work, so what we're doing with that core piece of work is we're kind of like starting off with what young people say their needs are, so we're running a survey to find out what's the quality of provision in schools, what they're learning about in schools, and then from that we will work with our stakeholders to think about actually are there other things we need to prioritise and even making sure that our schools have the right training and skill set to deliver good RSE education in schools but also training our youth workers as well, who work with young people around healthy relationships and where people access support. Thank you, Chair. My question is, it could be some of them partially answered, but I just want to clear it up. Since it is a rather sensitive subject, we're talking about how do you sort of communicate with those who are not willingly or they're difficult to reach people, some individuals or some communities that are hard to reach, do you apply any special way of reaching them rather than the usual way? Thank you. So as part of the action plan, we're doing a bit of a review on our most vulnerable groups who don't normally use services, so, for example, people that live in hostels or homeless settings, asylum seekers as well. We've already run, in May, we ran something in our hostels with asylum seekers, offering STI testing and support in terms of education through our GP champion, so we're hoping to continue that work but also to gain some insights around how people who don't normally access their services or actively go into services, how they would prefer to receive services. The specialist sexual health service that we commission, they have an outreach part of their service, so we'll be working closely with them to make sure that they're tailoring their support and interventions to where the gaps are into our hamlets. Finally, how effective do you think the services are, which you just mentioned? At the moment, probably, I think there's always room to do better, and I think we will run a robust evaluation and review of what's going on, existingly, and where the gaps are, and then work with our service providers to ensure that those gaps are filled and, you know, we improve on what we're doing. Hi, very interesting report, I've got a couple of questions, I think a lot of the questions that you've answered has touched on a lot of this. I'm more interested in the co-production, I'm just wondering how housing providers have fed into this, have you worked, are they engaged, because a lot of the housing associations have more or less, all of them have a community arm, which provides and works with a lot of the community, and a lot of them work with fairly hard-to-reach communities, which are the very people who may not respond to any consultation service. I think that would be, if you haven't already, then maybe that's probably a good group of people to work with in terms of to get a better representation of what the scale of the issue is. And then a question on data, you may have touched on it already, I may have missed it, apologies if I have, in terms of responses, what was the response rate from the BAME Muslim Somali community, and if it was low, I think one of the charts showed that there was a high demand or high issue amongst that community, how would we ascertain that, if the responses were low? Housing associations, I'd admit that we haven't worked with them in the past, and I think that is a group that we would really think about and be keen to work with, so yeah, that would be an action for us to think about who we engage, and we have a communities team in public health, so we will certainly reach out to them and make the appropriate links and actually also invite them to our local partnership group. And then the other thing around data, what was the response rate amongst the BAME Muslim community? So overall we had, there were about a hundred responses from Tower Hamlets residents, at the top of my head I don't have the breakdown of which minority group they were from, yeah, I think I need to go back and check and I can get that data to you. It would be interesting to know because the percentage breakdown of the population, we'll see if that data and response reflects that, because any strategy you want to make as accurate as possible, so the data is quite important I suppose. Yeah. Thank you, Chair, thank you, there's two things to note really, obviously around the stigma I sort of talked about already, but just as a quick story, there was a resident who spoke to me about sexual health clinics last year actually, just by chance, and what they mentioned was that they were from the Bengali community, they said they won't go to any locally once again just due to they don't want a sea body in the area, so I suppose it comes back to that belief in how do we, it seems like a bigger piece than just getting people screened or getting people to access services, it's actually changing people's perception from a young age based on their religion, so on and so forth, so it sounds like a very, very big thing to do. I know we want to engage with faith groups, so on and so forth, but it just feels like it's a much bigger issue, because it seems a note, it's not something to do, but yeah, just something to be aware of, because I think there's a lot of people who might use services, but they're not using the borough, so are we gathering that data, is it coming back to us? Secondly, I notice on the chart around the new STI diagnosis rates on page 73, there was a big spike in 2019, just wondering if you know what the reason was for that? So I'll take the last question first, because I remember that more, so we had COVID, so we know that's when COVID happened, our sexual health services, like other services, were suspended, there was only urgent remote access, so that's where we see that, and then coming back when everything opened, we saw a spike in people testing and then being diagnosed with STIs, so that's the reason for that spike there. Your other question around, sorry, it wasn't really a question, just something to know about, and finally around, I know you mentioned about housing organisations, but also to take into account the homelessness organisations as well, when we do that, if possible, but like I said, it's just around the fact of, you know, we can do all this work, I know we're talking about having towards zero for HIV as well, but once again, due to the way the borough seems to work, there's a lot of movement, that's going to be very difficult to achieve as well, so like I said, just want to note that down rather than anything else. Just a response from that, I know it wasn't a question, but I think that's the whole idea of us working collaboratively across boroughs, so for example our sexual health service is not just about Tower Hamlets, because we know that actually some people would prefer to access services in a different way, or access services face to face, but not in Tower Hamlets, because of confidentiality, so that's why we work collaboratively, and we have a joint contract with Newham, for example. I suppose really what I'm trying to say is how do we get those people back to use services in Tower Hamlets as well really, so that's the piece I'm talking about. They may still use it in Nel, but you know, you want people to try and use the borough services as much as possible if we can, but I appreciate what you're saying. And some of that is around branding as well, so we're working with the provider to make services more appropriate for people and culturally sensitive as well. Thank you. Thank you for bringing this strategy to our Council, even if it is later than we would have liked. I have spent months now working with officers to prepare to tender our next joint sexual health services contract with Newham, Red Breeze and Waltham Forest, so I know first how important it is that the North East London boroughs have a unified set of our goals when it comes to ensuring that our residents have easy access to quality STI, sexual transmit infection treatment, and other sexual health services. I know that my residents use treatment services across the city for reasons of privacy and convenience, and this strategy gives confidence that those residents will receive the highest quality of care. Thank you once again. Thanks. Now I ask the Board, do you accept the recommendation for this strategy? Agreed here? Thank you. Now we move on. Our next is a very important one, updated scent improvement. The Board is to receive the presentation on the updated scent improvement as this report was not published five clear working days prior to the meeting. I would ask the Board -- that's fine. That's fine. Now I invite Steve Ruddy, Corporate Director of Children's Services, to present this item. He will have seven minutes to present as usual, and we'll open up our members for questions and any clarification. Thank you. Thank you, Chair, and I appreciate the opportunity to present this to the Board, and apologies, I'm not there in person. Hopefully you will have seen the slide set that was circulated through the papers, but if we go on to slide one. So we're just going to go through quite quickly just talking about our current position around SEND, particularly with our view to our inspection that will be due quite soon, and I just wanted to reiterate the point that the inspection is of the local area system, so that's health, education, social care, so it's a partnership inspection. We have been, as a partnership, working really hard, but you'll see in the slides there's also some additional work that we need to do, so I'm going to briefly cover an update on the written statement of action, our current challenges, the difference we're making for young people and families, the preparation for inspection, and then a couple of lines around our key workstreams. So if we go to the next slide, you may recall colleagues that we had an inspection back in 2021, which resulted in a written statement of action. It's positive to report that our engagement with DFE and NHS England Advisors has recognised the improvement. You may also know there was a peer review back in October 23 that again recognised some of the improvements, so I think that it's really encouraging to know on that slide things like the relationship with young people and families, the autism targets being exceeded, and also the good progress on therapies, but as we've noted there, we do need to further embed and evidence our approach to co-production and build support and challenge through the inclusion framework. So that's the specifics related to those areas from the written statement of action. If we go on to current challenges, you may recall our last meeting, we looked at the SEN and inclusion draft strategy and we talked a little bit about these issues and the level of demand and you reflected back some of your experiences as well, but in terms of the figures you can see 184% growth in EHCPs since 2020, so large rise in demand. We are delivering improvement in terms of our timeliness there, but you can see a large rise in demand that all colleagues across education, social care and health systems will be feeding back if you talk to them about SEN. We've recognised though whilst we're improving in terms of our response to that demand, we know that the quality of our work as a partnership around education, health and care plans needs to improve and that's certainly an area of focus. There has been also a sustained rise in demand for autism diagnostic assessment, you can see there we're now running at 60 referrals a month compared to 20 pre-COVID period. If we continue on to the next slide, just some other challenges, we do have a shortfall in specialist education places so obviously a lot of young people with additional needs have SEN support in schools, some of them have additional support and some are going into special schools and unfortunately when we can't meet that within the borough they do have to go outside the borough so our work around sufficiency is really trying to tackle that, but there is a large rise in demand which we know is both a national and a local problem. I've got some issues around our data systems which we're working on as a partnership and we know that in terms of everyone's understanding of the offer across our partners, professionals, parent, carers, we know that that's something that we are working on and school readiness is certainly impacted and we're seeing more and more and colleagues on the Health and Wellbeing Board will be aware of this, that those who work in early years both in education and also in health will see the additional needs that those young people are bringing in terms of particularly communication and language. The next slide is what sort of difference are we making, so there's some real positive trends here which is really important to recognise, so the timeliness of education and needs assessments and plans has improved so you can see there 63% against a national average of 49%, average waiting times for diagnostic assessment has significantly improved again 88 weeks which is performed above national average, waiting times for under five speech and language significantly reduced from 35 down to 10 weeks and some of the engagement with young people and families is improved as well, parent, carer for a massive membership there up from 85 to 245, so some of the engagement work is improved. The next slide is about inspection then, so getting ready for inspection, we're doing all the things you would expect, so we have an inspection readiness group, we have a lead officer, we're looking at the thing which is the Annex A which is all the information requirements that we're going to have to have ready for when the inspection lands, we're developing our self-evaluation and that certainly will be circulated across the partnership and it's currently in draft with our external consultant but that self-evaluation document is being prepared and we'll be doing a summary document of it and I think as the previous presentation highlighted, important that we work regionally on this so we're a part of a North East London inspection readiness group and it's very difficult to predict when the inspection is going to land on us but it could be that or the big social care inspection, my reading of conversations with offset is that send inspection is more likely to be with us in the next few months than the social care inspection but we're doing all the stuff to ensure we're ready for it. The next slide, again just a reminder, the SCN and Inclusion Strategy that came to this meeting and appreciate all your feedback on that and we've been consulting widely on that, the consultation finishes on the 12th of June and then the inclusion framework which is being developed linked obviously to that strategy, what's really key is as a system, if we don't improve our inclusion framework and develop it with schools to support more young people in mainstream then that just does what I described earlier, it just pushes more and more children to require special school places, additional support and maybe even be placed out of borough with specialist provision and what we really want to do is keep young people in their local community supported in their local school but that inclusion framework is being developed through the summer and be tested with schools in the autumn. The next slide is our delivering better value work which this is a national programme of work particularly targeted at those local authority areas with a high level of increased demand around SCN and also where that's affecting the area council and partners significantly financially so we've successfully been awarded a delivering better value grant and we've got a number of work streams, the SEND front door, the inclusion framework and SCN support levels, a review of the banding arrangements and also a new participation and co-production officer to support with parents and carers so that programme will now roll out, now I've got the grant money. And the final slide is the work we're doing on SEND sufficiency so as I said there's a significant shortfall now in provision because of that increased demand we're projecting looking forward we could need up to an additional 260 places in specialist placements within the next ten years and that's effectively if we don't change our model and our system. Those areas are in terms of the increased need, the most prevalent are speech language communication, autism, social emotional and mental health. We are going to pilot a specialist additional resource provision ARPs, this is working in partnership with some of our primary schools, it's something I've seen work particularly well in other places where you've got additional support for those young people in a specialist resource within primary school and also we're developing one in secondary in partnership with schools and that's about ensuring young people are on site in mainstream and for some of their lessons are in the specialist resource but for the rest of the day are part of the wider mainstream school. We're developing a new autism resource base at one of our primaries and also we've identified a secondary school to develop an autism resource base because of the level of demand and also we're doing additional work with Phoenix Special School to support the wider system and also looking post 16 and post 19 at that provision and how Phoenix specialist provision can support that as well. So I think my overall message is that across the system in education, health and social care services and our colleagues in local authority have worked really hard to deliver that improvement but the test, the SEND inspection test is very rigorous and we need to make sure as a system that we're ready to cope with that. Thank you. Thank you Steve. Before coming my colleagues and members I have two questions to you. Obviously the lack of appropriate speciality education institutions is a problem that cannot be addressed overnight. With that said, are we aware of any wider London plan to invest in this sort of institution that we could participate in? And second one, I did not see anything in this process about updating or evaluating safeguarding procedures. I have received lot of calls from residents about the difficulties they have reporting poor treatment of their SEND children by staff as have many of my colleagues as well. Has any work been done to address this problem? Thank you Steve. Thank you for those questions Chair. I mean there is a wider London network on SEND and what was really positive that our young persons group in Tower Hamlet actually presented to that group. The London Y group which is really positive showing how locally our young people can influence decision making and practice. So that's really important. There's obviously government and the DfE have run a number of phases in terms of additional free school capacity and we're really lucky that a couple of months ago we were notified that there will be an additional free school in the borough and SEMH free school. But I think one of the things we will need to keep track on is you'll be aware from the reporting on the birth rates both in our borough and the wider London. It's a bit more acute in wider boroughs in terms of the fall in birth rate which might actually release some education estate potentially to create some additional provision. But I think our plan really at the minute is to ensure that that inclusion framework and inclusive practice really happens in mainstream school. So young people get really early support in their early years so they can remain in mainstream education. And the second question about safeguarding it's a really important point and there's been a refresh of the sort of working together, the guidance around how we operate children's safeguarding as a system and certainly within our children's safeguarding board bringing in a bigger focus on education and SEM and also children who are miseducation is a really important priority for the safeguarding board and certainly myself with the Deputy Mayor have been engaging more recently with parents who have flagged issues and certainly we are looking into those. Thank you. Thank you members. Please do members have any question? Thank you Councillor Rahim. Thank you Chair. Once again I think some of the questions I was going to ask you've already asked. But anyway a couple of thank you very much Steve for that presentation. A couple of things in terms of you said there was high demands in terms of referrals. How much of that is having impact on basically the whole procedures basically going forward? And as you know and also you've highlighted in terms of and I think recently there was a report out I can't remember the name of the report in terms of how it highlighted the impact of not diagnosing these kind of treatments early and how that could have an impact going basically having a big impact if that is not does that early diagnostic not being carried out. How confident are you and are we as a council that we are on top of this? And finally basically in terms of the inspection how confident are we are you and are we as a council that where we are on top of things and going forward in regards to the inspection. Thank you. Thank you. Thank you for those questions. I think that there is a reality which is the rising demand both for assessments for education, health and care plans and the rising demand for support and services to support our young people. That is definitely having an impact on timeliness and certainly we've seen that and it was certainly a feature of the last inspection. So that is a reality and we are as a partnership investing and this council has put additional investment last year into the SCN team to ensure that the staff have got reasonable case loads and can respond in time but I think that is why the challenge is a system wide issue that it is putting pressure across the whole system in terms of both schools and then our health services and we have seen that certainly in terms of waiting times for those assessments and diagnosis and then securing the support as a consequence of those assessments. We are definitely seeing some real challenges there and real delay. I think the key is that early help, early diagnosis and ensuring that preschool period across within early years and also with our colleagues health visitors, midwifery service, ensuring that we are identifying any delays early on with our young people to get that support in because there will be young people that as a consequence of us not getting that early assessment and early diagnosis and putting the right sport in place that when they are getting into school and at that point they are requiring additional support that maybe they wouldn't have had we got in earlier. So that is the reality. I guess underpinning a lot of that is yes resource and investment but also the workforce challenge as well. So both across the council, education and our health partners there is a workforce challenge there and making sure we can retain, recruit the right number of staff to meet the level of demand and the question is the big question on inspection. We are certainly in a much better place than we were at the last inspection in 2021 and the peer review last year said that and the feedback we have just had from the NHS England and DFE leads that work with us, their feedback is we are in a stronger place. The challenge is that it is a really long and detailed inspection and one of the things that we know does influence that significantly is that important relationship with parents which is why all that work engaging with parents and listening to parents and doing co-production is really important. Councillor, do you have any supplementary questions? Thank you very much for that Steve and just in terms of going back to the referrals and the waiting list, is there, and again this is coming from a conversation with a colleague who actually works up north, there was huge waiting lists over there and in terms of basically is it a matter of just not having enough staff or is it any other factors that is having an impact and is it something that we looked at if we can maybe get more staff or is it the whole process that we have. What is it that we can pinpoint and say this is what is happening, this is the problem and if we can actually look towards tackling that hands on. Does that make sense? Yeah that's a really good question. I think there's two sides to it really which is going back to the point about early diagnosis and support being really important and ensuring that there are more young people that actually with, and again we need to support our early years and schools colleagues, that with the right level of support and investment that those young people can flourish with a level of additional support and therefore not require an education, health and care assessment and a plan and that assessment and the resulting plan and the work around it puts additional pressure both on the social care system, the health system and the education system. So I guess there's a way of that early investment and early recognition of some support being required is like your investor save bit of the equation but then actually where young people definitely do need assessment diagnosis and therapies then yes there is a reality there which is the level of demand is being impacted by the simple volume of capacity but I think there is regional variation and I guess just flagging in the slides there we have seen some improvement there. When you look at the period of waiting you would say well actually we've gone with 63% or actually that doesn't sound fantastic unless you compare it to the national which is only 49% but just on the EHC waiting times but the things like the under fives speech language therapy assessment has reduced significantly from 35 weeks to 10 weeks. I'm aware in other parts of the country its much bigger than that. My question is to Steve is about the data that you hold, how confident are you that the data's you hold are correct and has there been any challenges on the data's and in future how confident are you to present the data's that they're accurate? Thanks that's a really important question and one of the challenges we flagged up is making sure that the data systems are fit for purpose. We do regularly scrutinise the SEND data with our SEND partnership board and also our SEND inspection preparation group and obviously we are sharing that with partners as well as part of operational meetings to test some of that accuracy. We've also now got some access, we've always had quite a lot of social care comparative data within London and the London region councils share data to compare and contrast across social care. We're now doing that a lot more with our SEND data but we recognise that we do need to invest more in data analysis and intelligence and one of the work streams linked to that delivering better value programme is an investment in some dedicated resource to focus on data analysis. It's an area that we are continuing to work on. Thank you Steve. Thanks Steve. In terms of demand, have you analysed and thought about numbers and need for different communities in Tower Hamlets, thinking specifically about the recent research in the higher incidence of autism in the Somali community for example and have you thought about tailored and culturally specific services to those communities? Certainly our analysis that we have available does allow us to scrutinise by population group and I think when we shared the SEND strategy we shared the breakdown so we've got about 4,500 education health and care plans and then we can break down for each in terms of race, we can break down within different communities what the primary need is and there are some stark differences that you can identify across different populations which then informs our approach. I would have to check back with our colleagues in terms of the specifics around the Somali community because it's not broken down as detailed as that but certainly at the higher level in terms of that racial categorisation breakdown we can certainly do some of that and I think the parent carer forum as I mentioned that has grown significantly but it's actually a good challenge to go back to that parent carer forum and look at the demography and make sure that we are listening to all parts of the community to ensure that our co-production approach is culturally sensitive as well so that's a good challenge that I'll certainly take away. Thank you. Thank you Steve, thank you for your presentation. I appreciate that this council has dealt with skyrocketing demand for initial assessment with speed and flexibility. In many cases bringing our waiting times down to well below the national average in spite of this. I also appreciate that significant due diligence in being applied to ensure that we are properly prepared for future inspections. It sounds like we still have significant work to do around ensuring that a quality education offer exists for all children in the borough regardless of their needs. With that said I am confident that our same service is improving every day and I look forward to what new steps will be taken with the launch of this finalised strategy. Thank you Steve, thank you. Thank you chair. Now our next agenda is serious violence and exploitation strategy. The board is to receive an update on the serious violence and exploitation strategy. As this report was not published five clear working days prior to the meeting I would ask again both to note and agree the reason for urgency as set out at the top of the report. Thank you. Now I invite Leo Hutchinson, strategy and policy manager to introduce themselves and then start us off and present this item. You will have seven minutes as usual before we open for members questions. Thank you. Thank you chair and evening all. So I'll introduce myself. I'm the strategy and policy manager for the people service within the HAC directorate and we cover a broad range of services, public health, community safety, integrated commissioning and adult safeguarding. This piece of work has come about as a result of new legislation essentially resulting in a serious violence duty that places requirements on local areas to deliver a number of actions, one of which is to produce a strategy and that strategy is what you all have been sent. I won't go through the document per se itself to be honest and more so will probably focus on what has been put across in the cover report just to kind of give a more of an overview essentially of what it is that we're after. So yeah I'll give you guys a bit of a backdrop. So as I mentioned new legislation came in in 2022, that's the Police Crime Sentencing Courts Act and essentially placed four key duties on local areas to deliver against. That was agreeing a partnership arrangement to lead and deliver against the serious violence duty. It was to agree a local definition of serious violence. It was to develop a strategic needs assessment that essentially scoped what the picture of violence looked like in each locality and then the final was to produce a strategy on how duty holders would tackle serious violence locally. So the responsible authorities also known as duty holders and they are the police, fire and rescue authorities, justice organisations so that's youth, youth offending teams, probation but also we've got health bodies so that's integrated care boards and also the local authority so they're the key partners essentially that have a duty to enact this piece of this duty under the new legislation. So there are wider partners that are I suppose have a duty to cooperate with the serious violence duty and their educational institutions, prisons, youth custodial institutions etc but they aren't duty holders per se but do have a duty to cooperate and support the process of meeting the serious violence duty. So locally the serious violence duty has been decided by the community safety partnership which obviously has a number of partners across multiple boards including the health and wellbeing board, child and adult's board, children's safeguarding partnership and partners on that board have decided the local definition which is essentially any violence exploitation affecting young people under the age of 25, domestic abuse, sexual violence and hate crime within the context of these types of violence encompasses homicide, previous bodily harm, actual bodily harm, rape, assault by penetration, sexual assault, robbery, threats to kill and violence against property caused during the commission of any of those offences. So it was as a result of a number of meetings and discussions alongside the lead member as well it was decided a hate crime would be included within this definition after some deliberation in the community safety partnership had agreed that that would be the case. So what have we done today? We've conducted a needs assessment which basically gives us the position or the scope of what violence vulnerability and exploitation looks like within Tower Hamlets, we've got a local definition, we have defined governance arrangements in terms of who or what body or boards will manage this work and that is the community safety partnership and we've begun or pretty much reached the tail end of the development of the strategy process. So the strategy development has pretty much gone through a number of stages, there's been four development workshops and as a result of those workshops that have included various partners, the partners within those workshops have decided upon proposing six strategic themes all of which have been consulted on with public partners and professionals, stakeholders and essentially this somewhat accounts for that wider consultation too but essentially those proposed themes are prevention and early intervention, safer spaces, disrupting, pursuing and managing offenders who pose a risk to children and young adults, supporting victims of violence, safeguarding those at risk of criminal and sexual exploitation and tackling violence against women and girls. Essentially we've gone through, started a consultation process at the beginning of May just after the elections and it included children, young people and young adults, we've reached out to the VCS so we've engaged the VCS and we're also still underway, we're still underway of conducting that consultation process so as I said we're at the tail end of the development side of things but we've also consulted professionals and stakeholders whether it be through working groups, whether it be through strategic boards and obviously this would be another format for that. So in terms of timelines this document will be going to cabinet on the 24th of September so we've got another month's worth of development time and then it will begin going through the stages of finalising and governance processes. So where are we now? Essentially we've been meeting with key partners to refine the detail of the strategy, we've been taking the document towards strategic boards to get the relevant input and feedback based on obviously what's been developed to date. We're in the final consultation stages of the consultation process with stakeholders, partners, public, children and young people and we're also trying to feed the findings of that consultation into the strategy. In the cover report essentially it was stated we looked at a few things that we wanted from the Health and Wellbeing Board which was essentially to provide some feedback, commentary and I suppose some information around anything that maybe feels as though we're lacking context or information within the document, anything essentially that might be glaringly obvious that we're missing, anything that might need to be expounded upon and essentially just making sure that because the Health and Wellbeing Board and partners that sit on this board have a vested interest within the approach to tackling violence and exploitation considering that the local authority takes a public health approach to violence reduction ensuring that this board has sight of this document before it obviously goes through the governance stages and has a keen interest in contributing to the content of the strategy. I think that summarises it, like I said I won't drone on and I've only got seven minutes so I suppose I open the comments to those around the virtual table and those in the council chambers. Thank you for your presentation, do members have any questions or any clarification please? Hi, thank you so much for that, this is obviously a huge piece of work so I really, really appreciate it. The first thing that stood out to me when I read this, so in the vogue section it's just the sentence bringing perpetrators to justice, now I'm going to be really careful because what I don't want to do is fall foul of any pre-election period stuff but it is a fact, the statistics show that that isn't a thing that happens, I think the conviction rate is still at 1%, perpetrators aren't brought to justice, that is a fact and I think just having that line in there without any comment on the Met Police and their role in this, the current government, again I won't say anything more, and the failures on a multi-faceted level that mean that we are in a position where there is a 1% conviction rate I think is a bit of a missed opportunity because what it means is that line becomes a bit meaningless it just is sort of a nicety rather than actually there needs to be serious movement because it's not a, it isn't something we can do here in this chamber and obviously this has been, you've put this together with partners and that's vital but I do think that when one of those partners is actually directly responsible for some of this I feel quite uncomfortable with basically just letting them off the hook for their own failures and I have to say I'm talking about the Met Police there and I just wonder whether that's something you can take on board, I know that at the moment that it might be a little bit difficult in terms of pre-election period but I think you said you have got some time till September, I just think that having just that line erases a little bit the situation that we are actually in in terms of sexual violence and rape and actually bringing people to justice there's a lot more to that and I think being in a position to actually explore that a little bit more and being brave enough to comment on the failures I think would make us stand out and I think it really needs to be said. Thank you. Thank you for your comments, I'm not silent because I'm dumbfounded, I'm silent because I'm actually typing some of your comments so I can make sure I'm feeding it back and completely understand the sentiment around the comments as well. The one thing I will say and obviously I'll be careful in what I do say as well is that we do have a dedicated Violence Against Women and Girls strategy and whilst this strategy does provide a focus on it we have a wider and more detailed approach to what we will be doing and what we have already been doing from a local, regional and national perspective so there is more meat on the bones, I say that in tiny cheek, that can be applied but I suppose to avoid duplication essentially we've somewhat narrowed some of the content down within this strategy to ensure that we're not I suppose repeating things that we've said in other documentation but I most definitely take the point and can most definitely feed that back. I think maybe there is something around because we do have a Violence Against Women and Girls strategy that's also being developed at the same time as this is I can most definitely feed that back and also provide some challenge to police colleagues around targets maybe that can potentially hold police colleagues to account, how we can actually say this is what we're intended to deliver but how are we proving that we're delivering against the things that we're saying we want to do so yeah a great point and most definitely happy to feed that back to colleagues as well. Thank you, really important document and talking about partners and I really understand that this is a draft document quite clearly but I really do think that you could talk about the voluntary and community sector at different points more in this document and I do particularly under prevention and you did put something like insert here so I'm assuming it's coming but also under engagement, under funding because it really is the key to a whole systems approach and a vibrant voluntary and community sector does all sorts of things for community safety and you did mention the Mayans consortium bid in the Isle of Dogs and also the new bid in Bethnal Green which has been successful which is really fantastic and part of that is capacity building and bringing together the voluntary and community sector to build the voluntary and community groups in those areas to support that really good work on serious violence by the other partners. Most definitely take your point there and I think you're absolutely right obviously this still is in draft format and we are definitely trying to refine some of the detail to ensure that we're reflecting all of the things that should be reflected within this document. I wonder if some of these comments like I said are really helpful if it's not yourself if you could direct me to somebody who I could speak to around some more of the detail around that in terms of what you would expect to see in the document and then obviously we can make sure that that's fleshed out and yes we're essentially making sure that what we do do and the things that we have ambitions to deliver against are reflected across the document. I was just going to say yeah I will reach out to you. Thank you very much appreciate it. Thank you chair. Councillor Mayim Talaqdar has unfortunately had to leave the meeting. He has emailed me a couple of questions that he was hoping to ask on the strategy. I just wondered is the board happy if I read out Councillor Talaqdar's questions for Leo to respond to? How many questions do you have? He's written two questions. I'll be back in time. Okay so his first, Councillor Mayim's first question is about schools. How involved have schools been both in consulting on this strategy and agreeing actions to feed into it? And the council has put a bit of commentary here. He says given the emphasis on crimes in which victims are under 25 I should think schools would be a very important partner on this. I'll just read his second question. So Councillor Mayim's second question is can we get more detail on the timeline for a serious violence action plan being put together as well as which council directorates will be involved? And again a bit of commentary from the Councillor who thinks it's crucial that any action plan has the youth service as a main component. Thank you for those questions and maybe I'll start with the latter because there's a bit more I can give around that. So in terms of an action plan there already is one and historically we've rightly or wrongly been tasked with localities not just our cabinets but localities across London have been tasked with maintaining, refreshing and updating localised violence and exploitation action plans and that's been that responsibility has been placed on localities since 2017 by the Mayor's Office of Policing and Crime and the Home Office. We submitted our local plan to the Mayor's Office of Policing and Crime in February 24 and it is very broad it's very expansive there's about eight different themes it encapsulates and encompasses a range of activities that involve a multitude of services that are both internal and external to the council so we're looking at police, fire services, trading standards, licensing, police, schools, health, education so it's very expansive and it pretty much includes everybody who should be included in it and the actions are very specific so if anybody wants to have sight of that that can be circulated and I'm happy to share that so I hope that answers that question. In terms of schools and their involvement in the consultation process and development process they have been a key partner in supporting development this plan. We've had I suppose representatives of the education service as opposed to schools specifically and we've also had LEAP who have been a part of the process as well so people like Astrid Schon, we've had people like Kerrigan Mariner who's the Head of Behaviour and Support Services and they provided that really really integral link to the education piece that fits within violence and exploitation so there has been vast communications input and contributions from those within the education sector as well. Thanks Leo for this I think it's a really exciting strategy I think but I'm just going to probably just add on to what Vicky mentioned in terms of the community and monetary sector. In terms of housing providers again I suppose the question is how involved have they been because all housing associations have some sort of a kind of safeguarding team or a strategy that could feed into this and where you're talking about adopting a kind of public health approach to reducing violence I think that the involvement of housing providers would be quite key and important to support that because looking at all of these themes or strands of the strategy we could feed into a lot of these and we are already working on a lot of them rather than working in isolation you might be good to connect some of this together and work a bit more closely together. Thank you I completely agree housing from a housing perspective and housing providers we have been fairly light I think in that area more so than any other I wouldn't say we haven't had contribution because that would be a lie but I think in terms of I suppose reaching further and wider within the housing side of things I think we could do with some more contribution for sure to add some of the more detailed context around it because obviously there will be a number of housing providers and frontline offices that will come across those who are either victims of violence and or exploitation and sometimes there's a need for training sometimes there's those that have training there's I know that in some instances there's people that have been trained in for trained that sit within housing services so I know there are a number of things that housing providers do to to address the issue of violence and exploitation and I suppose it's just making sure that all of those things or the majority or the key things are reflected within this so that so yes it would be it would be great to connect and explore what what could be reflected within this document to ensure that the great work that does happen within the housing sector is also reflected within this document as well. Yeah thanks Leo I was just going to say because with the makeup of the number of housing association within Tower Hamlets a lot of those residents that might be affected by the crime and violence that the strategy is trying to address probably would belong to some of these housing associations it's quite key that they're involved I think. Most definitely most definitely if if you could just pop me an email reach out it would be great to to also have a conversation with you and see what we can we can look to do with regards to to expand it on some of the content within the document. I'll do that yeah thank you thank you how have you linked your work with our upcoming women's and girls strategy violence against women's and girls strategy? It's been conducted as I suppose an intertwined exercise so the needs assessments were pretty much carried out alongside one another with data colleagues from public health the content within the the section of this strategy very much is focused on the regional national and local context of violence against women and girls and essentially pulls out the the key ambitions that we have locally the things that the the London mayor wants to see delivered regionally but also the national context looking at women's safety looking at safer spaces so it's been very much intertwined and and conducted in a way where where it's not duplicating work but looking at what we're doing looking at the things that have been reflected within the the consultations and the the needs assessments that was pulled together by public health colleagues around violence against women and girls but also looking at the the data the the regional context in that within the the vogue strategies for via mopac but also the national one as well. Thank you thank you for your presentation and definitely definitely especially with the recent increase of both hate crime and robbery across the world it is very important than ever that we have clear policies in place to protect our most vulnerable resident from harm and I look forward to seeing more steps being taken to engage to community about violence and prevention later in the year. Thank you once again. Does the board agree the recommendation is set out in the report please? Thank you. Thank you our next item was Tower Hamlets BCF 2023 to 2024. The next item is Tower Hamlets BCF ER end template and I understand that due to staff's sickness it has not been possible for a report to be prepared for this item and report will be brought to the next meeting of the board is it okay here there's nothing to add we'll be bringing a report to the next meeting and details of the review that's been underway as well. Thank you now our last agenda item is annual public health report headlines the board is to receive the annual public health report headlines as this report was not published five clear working days prior to the meeting I would ask the board again to note and agree the reason for urgency as set out at the top of the report is it okay? Thank you now I invite Suman Banerjee acting corporate director of adult social care to present this item and as usual you will have seven minutes to present before we open up members question or any clarification thank you Suman. Great thank you chat so just a bit of context to this it's a statutory role of the health and well-being board to have an understanding of the health and well-being trends in the borough after covid a lot of our data flows were kind of disrupted and so this this time round what we've what we decided to do is actually do a really in-depth review of the data and the available data around health and well-being in the borough a lot of that is ons data at office of national statistics data but also some of our local data primary care data hospital data we're gonna this is the actual the document is really large because we've done an in-depth review we didn't send it round we're going to put it on the on the website but my purpose today is just to talk about some of the key highlights from the review and we will have further sessions to do some deep dives so there's a lot in this report and so I'm just presenting the kind of real top-level findings but I think it's really important for board members to be aware of these so just in terms of the the top-level headline this these are graphs of life expectancy in Tower Hamlets and consistently over many decades life expectancy has been lower in in Tower Hamlets and elsewhere the thing that's of interest and this is happening across the across country is that the rise in life expectancy has been slowing and also in recent years it's actually fallen now the data shows that this predated Covid as well so I think part of the part of the explanation would be Covid but also there is a question about actually what is what is going on both nationally and in Tower Hamlets because Tower Hamlets trends mirror those so I just want to say a little bit about the demographics which I think are really relevant to health and well-being in the borough I think this is a really important graph what what it shows is the expected rate of population growth over the next 10 to 15 years and I think we all know that we have a young population but what this is showing is that in Tower Hamlets the rate of growth of the of the older populations you can see the 65 and the 56 50 to 64 is expected to increase much faster than than than London and this will clearly have implications and I feel it's probably already having implications in terms of the demand for our health and care services particularly adult social care and we are seeing actually in adult social care we are seeing increases particularly seeing increases in demand for services in the 50 to 64 year olds so so I think that's a really important thing for us to be aware of thinking about our future funding pressures I think this is this is a really striking graph here so what this is is levels of population churn turnover in London boroughs and we know that we have high population churn but what you can see is that Tower Hamlets is by some distance a real outlier so there is a really important reflection there about how our services are able to deal with this population churn our health and care services and other services so I think it's something that's very relevant the other this the next bit of data is from the census and this shows the proportion of Tower Hamlets residents who have are not fully proficient in English and so you can see it's significantly higher than London and England I think that's really important to think about or how how we making sure that our services are meeting the needs of those who need support around language so I think that's a really important one for our borough this is a new piece of data I know it looks a little bit sort of messy and complicated but it's it's just come out was come out in the last few months and what it tries to do is it tries to show the extent of deprivation related to inequalities and actually if you look at this graph for all of London you see Tower Hamlets has the greatest level of inequalities related to ethnicity in relation to deprivation and what you can see is that in very localised parts of the borough you have really substantial inequalities between different ethnicities so this is another one that you'd want to spend a bit of time thinking about but I just wanted to just share that at high level similarly Tower Hamlets has amongst the highest levels of childhood poverty in England and where you see the really dark red that is where that those are areas which have the highest levels of child poverty in in the country there's a similar one for older people I just wanted to say that for older people Tower Hamlets has the highest level of deprivation in the country and so that when we look at for instance the demand for services in older people that is in the context of a lower proportion of older people in our population but significantly significantly poorer health so just to say something about the environmental factors we know that overcrowding is real issue in Tower Hamlets this just reiterates that and demonstrates that Tower Hamlets has the second highest levels of overcrowding in London which has significant health impacts similarly in Tower Hamlets in terms of diet you can see here consumption of five a day which is an indicator of healthy diets and Tower Hamlets is in the lower quartile this shows this graph shows that residents of people who live and work in Tower Hamlets experience lower levels a poorer air quality than elsewhere this this is a graph which shows the percentage of premature deaths linked to air quality so you can see that the light blue is is consistently higher for Tower Hamlets so moving to early years there's a lot of information here I've just picked out a few ones this one I think is really important for the Tower Hamlets population which shows that diabetes that develops during pregnancy is is amongst the highest in northeast London so that's and that that's commonly you may get diabetes during pregnancy that might once you've given birth you may not continue to be diabetes diabetic but you have an increased risk of diabetes in in later life so that's a really important statistic in which Tower Hamlets stands out this one this graph I don't understand and we don't have all our unfortunately we don't have all our Bart's colleagues here but I don't understand this graph it's about early access to maternity care which is which is really important to to have the best outcomes in pregnancy I can't explain but I'm sharing this with you why early access in Tower Hamlets is so significantly different and it's something that we'd want to follow up this is a really important graph this shows the proportion of babies born in Tower Hamlets who have low birth weight and you can see Tower Hamlets is the top line significantly higher than elsewhere and that's really important because it's a it's a marker both of the health of mothers but also the future health of of the babies so that's a really important graph as well dental health dental decay is also an issue and it's another area where Tower Hamlets has consistently got higher levels of dental decay in under fives and also similarly in 10 to 11 year olds consistently high levels of childhood obesity just turning to adults what this what these graphs show are the differences in the levels of long-term to long-term conditions diabetes and high blood pressure and it's broken down by ethnicity what you can see is that by around 59 to 64 years old the chances of having diabetes or high blood pressure in the Bangladeshi community is about twice that of other communities and so that highlights the extent of that inequality with mental health you see quite a lot of variations by ethnicity now the this graph shows diagnosed mental health issues we we do know that if you actually look at need it's it's actually higher in some of these ethnicities so that starts to point to people in particular communities not accessing services looking at cancer these are the three most common cancers and what you can see actually I think I've got this I've got this the title wrong here the light blue is Tower Hamlets so in terms of the three major cancers for breast cancer it's significantly higher and also in lung cancer so in lung cancer that reflects higher levels of smoking prevalence breast cancer that is something that you probably need to reflect on because the actual levels of the incidence of breast cancer is not particularly different but the the death rates are higher which points to later diagnosis so we need to think about you know uptake of breast cancer screening and those sorts of issues there's some good news which is that smoking levels over the past years have fallen significantly in the borough and actually below the England levels and similar to London levels now but really important to highlight the variations by ethnicity and in terms of men the highest levels of smoking are in the Asian population in females actually it's the lowest in Asian populations but there is an issue about oral tobacco and oral cancer in some communities this is another one which is difficult to explain this is hospital admissions for alcohol and in men it's the highest in in London although a significant proportion of our population don't drink so this is a this is another statistic that we want to really understand why do we have significantly higher levels of hospital admissions for alcohol and also this is a this is another really important one for the town and its population and it shows the levels of substance misuse in the borough compared to elsewhere this is numbers coming through through treatment services so we'll stop there it was just a bit of a there's a lot of other data that we have but just in terms of conclusion I think it's really important and I think we need to have wider discussions around the health and care system just to understand some of the real differences the tower Hamlet's population has to elsewhere so thinking about you know integrated care board planning etc thinking about how the composition will change in future how how how significant its turnover is proficiency in English in the highest need populations the inequalities that are linked to ethnicity and the extent of housing need and its impact on health these are things that are really specific to Tower Hamlets and we need to think about how this actually translates into the health and care system and how that is how we work together to address these inequalities that we see in the borough so I'll stop there and we will have further events to dig deeper into this data and we will also put it on the website so thanks very much thank you so much for your presentation definitely it's an overview of our Tower Hamlets and definitely we will discuss in future do members have any question or any clarification please thank you chair thank you for that presentation I think this is this I think is a classic example of where because there's a lot of inequalities in terms of when it comes to provision services and I think this is a classic example where we as a council this is more of a common and if you could come back on this is that when we do our consultations when we go out there collecting data that we are on top of this because we want to actually reflect the needs of the people who are living here because as you rightly pointed out we are one of the youngest boroughs in the country if not London at least and is it truly reflecting the service that we really want to get to and the people that really need it or is it because there's we're not reaching the right people for those consultations getting the right data the service can have an impact in terms of actually dealing with the people that most need it so I want I would like your comment on this and how are we and are we in a position to or what sort of parameters or guidelines that we have to make sure that when we do collect those information these do these consultations to devise the service that's needed how accurate and how do you make sure that those information that we're getting are accurate as much as to the best of our ability in terms of having the right service and the provisions out there for the people in order to you know tackle some of these equal inequalities that the population are facing in terms thanks counselor so I think I think one of the key messages from this is so this is a lot of the data that tells you about need the needs and the inequalities in the borough what it says is that we need to match this sort of inequalities analysis to the services that we provide so that I mean it shows that in Tower Hamlets more than anywhere else we really need that as you say like accurate granular data about who is accessing our services and who is using our services what their experiences are in a very granular way and I think if we think about the data that we're actually getting through the health and care system I don't think it really matches that granularity you know if you if you really look at some of the services we provide and you ask challenging questions about who is accessing these services what the inequalities that we're seeing and how are those being addressed I'm not saying this is particular to Tower Hamlets but I think it's the system as a whole the health and care system that really needs to do more about how how we get that data so so I'm not I'm not I'm not saying that we've cracked this but I think this is the purpose of the health and well-being board which is to say well how good is our ethnicity monitoring how well are we monitoring disability how are we looking at the differences in outcome how we understanding those issues and as you can see from the sort of maps that that I showed in Tower Hamlets there is really granular inequality like you really got to understand your localities and your neighborhoods and recognize that you have areas of significant affluence right next to areas of significant deprivation and you really have to understand that in this borough and so I think that's the challenge for this board Thank you chair my question is in terms of alcohol admission in hospital alcohol related is seems to be highest in in London as how was it how the data was collected and was the I don't know how to put it is it something to do with strict drinking or part drinking or is there any data that specifically targets that where this coming from all these issues thanks so this is the data that comes through the hospital and so obviously that diagnosis will come through the clinicians in A&E or in the hospital going actually the primary reason for this admission is related to alcohol so that data is then collated and that's returned to us now we've identified this and we don't currently have the breakdown where are people coming from what are their ethnicities and what's the age bands and all of those sorts of things but that data does exist through the trust so we need to think that we need to work with our colleagues at the Royal London to really understand what is underpinning this because it would suggest that if it's the highest in London and a high proportion of men don't drink alcohol that means must mean that it's incredibly high in particular subgroups so I think it's really important for us to understand what's going on with that I think what I think is it is quite important to identify the main cause of it as you just mentioned that it is quite I mean I mean it is within the mails that the concern is but it is important that we identify the actual cause of those people who come to the hospital where are they from or what their ethnicity or where are they is it from the street drinking homelessness and things like that so it's really crucial to identify this issue just going back to this really briefly so just to confirm is this people going through the hospital from anywhere or is it nailed down these people live in Tower Hamlets yeah if it was if it was just from anywhere I might I just I could explain it but this is this is Tower Hamlets so yeah specifically all these people in this apologies and this quite alarming we know for a fact they are they live in this borough yeah okay that makes more sense yeah well actually no it makes less sense explains the problem yeah is there any other business today sorry sorry thank you so I thought that was a really great report showman I thought it was really clear apart from the one slide that we couldn't explain but everything else really clear but it always surprises me that you don't use the statistics about healthy life expectancy that came to the board before because that's the healthy life expectancy of women is something like seven and a half years lower than that of men whereas nationally it's one point four years higher roughly and I got that wrong but that seemed and I'm sure there's something about you could map that onto ethnicity as well but it's such a huge difference to national statistics it seems particularly shocking yeah thanks very much yeah I mean the data is in there I just didn't but you're right I should have presented that because what it does highlight is although healthy life expectancy in men is similar to London in healthy life expectancy in women in Tower Hamlets is consistently low and when you break that down it's specifically for particularly for long-term unemployed women in the borough and we brought that to the board before but yeah you're right that is a really important statistic sorry just that ties in with some of the other things that we've been talking about today like the late breast cancer diagnosis but it also ties into things like funding issues for voluntary and community sector groups so there was a report by the Rosa Foundation last year I think that showed that of funding to charities only one point eight percent was specifically for women and girls so there's a it's a big issue across the board thank you once again with no other business to discuss I call this meeting to a close thank you everybody for your attendance and participation tonight good evening all thank you thank you thank you everyone you you [BLANK_AUDIO]