Transcript

Welcome to Ben Lucas, who's joining the commission. So welcome, Ben. Councilor Adebayo is joining us online, and all other members are in the chamber. Just as matters of housekeeping, this is obviously a hybrid meeting. So I'll be taking questions both online and from the chamber. For those online, please keep your cameras on. If it's your item, please keep your microphones on mute. Don't make any conversations in the chat. Please raise your hands if you would like to get my attention. Members of the press may be watching or being live-streamed. It is being recorded, and I think those are the main points. I haven't been notified in advance of any declarations of interest. Are there any? No? I'm grateful. Then, with that, I'd like to progress to the first of the four substantive items we have on the agenda today. This is the Capital Build Opportunities in Adult Social Care. Those members that have been on the committee for a while will remember that I think it was as far back as April of '23, so nearly 18 months ago, we looked at this item, and Helen, who's the group director who's joining us here, was keen to explore this opportunity both in terms of cost savings for the borough but also the benefit of Hackney residents being cared for closer to home. And in summary, for members' benefit, it's about whether we can use the capital fund or assets in the borough to create housing opportunities for residents in the borough, thus saving money and enabling them to care for close to home. So I'm not going to steal too much of the thunder of the presenters. We're joined by Martin Crick, who is the programme director of Capital Build Opportunities within Adult Social Care, Helen, who I've introduced, Georgina Dibber, who many of you know, she's the director of Adult Social Care, and also James Goddard, who's the assistant director of Strategy and Assurance and Housing Strategy within the borough. So I don't know whether either Georgina or Helen, you want to say a few words and take us through the presentation. Thank you, Chair. I think that's me. So as you have said, we talked about this a while ago, and I'm conscious we've got some new members who've joined the scrutiny committee. So just to give a little bit of context before I hand over to Martin about why this is important. As scrutiny members will know, we have the same challenge that all local authorities are facing in Adult Social Care, in that we have increasing demand and increasing acuity, but no more increasing money, unfortunately. So we have to think of different ways to support the needs of our most vulnerable residents, but we're also very clear in our three-year strategy and Adult Social Care sets this out clearly. We want to do what's right for our residents. So we are fortunate in the sense that the approach that we want to take is the right thing to do for our residents. So by developing alternative forms of supported accommodation as opposed to residential care, what that allows us to do is to provide care closer to home and closer to the communities for the people that we support. I'm not going to read the slides out to you. You've all got them. But at the moment, we send a large number of the residents that we support out of borough, because we simply don't have the facilities in the borough to be able to support them. So by developing different forms of care, and that might be supported living or it might be extra care housing, we hope to be able to support more of our residents within the borough to give them more choice and control over their care, to help them be as independent as possible for as long as possible, but it also costs us less. And that's very simply because when we purchase a residential or nursing care placement, the entirety of the cost of that placement comes out of the revenue budget for adult social care. When we support residents in things like supported living or extra care, adult social care will continue to pay for and manage the care element, but what we call hoteling costs or the housing element can be paid for out of housing benefit. So to be really clear, the cost still comes from the public purse, but it doesn't come entirely from the revenue budget of adult social care. As we all know, adult social care budget is under immense stress, and the council budget as a whole is under immense stress. So this is something that we very strongly believe is the right thing to do for our residents, but also will help us to manage the cost to adult social care going forward. So to that end, we have recruited Martin, who we are very pleased to have with us, who is, as you have said, the programme manager for the Capital Build programme, and it is worth being really clear with the members that this is a very complex programme. So we are looking at different ways of funding, building, and developing accommodation, and we cannot do that in a silo. So I'm really pleased that James Goddard has been able to join us tonight, that this will have to be a cross-council programme, because we will need support from our colleagues in planning, in housing, in finance. Almost every department will need to be involved in developing this programme, and it's also quite long range. So at the moment, we're looking at a 10-year programme, because obviously, we're modelling the fact that our demand will continue to increase, and it's not a quick thing to develop Capital Build. So we need to be planning now for the demand that we see coming down the line in five and 10 years' time. So I'll stop there as an introduction and hand over to Martin to give a quick overview of kind of where we're up to and how we've structured the programme, and then we're happy to take questions. Thank you, Helen, and good evening, everyone. I won't go through each slide individually. I'll go through and just summarise-- Martin, sorry to interrupt you, it sounds slightly muffly. I don't know if there's any way we can just improve that. I'll come closer to the screen. Is that any clearer? Slightly. Hang on, I'm not sure if there might be another suggestion. We're going to try turning you up. Is that any clearer? Slightly, yes. Let's carry on and see how we go. OK, I'll try and speak up. So yeah, I will just set out the progress the programme has made to date. So essentially, as Helen's quite rightly said, the programme now is full-time programme management, and there's a governance structure that's put in place to manage and monitor the programme going forward. The housing with care needs assessment has now been completed by the consultants Campbell to Cowell, and this sets out the future demand for adult social care over the next 10 years and across different resident groups. And this piece of work was really fundamental to the programme and now enables us to commence with the workstreams as detailed in my report. The programme is working across multiple teams within the council to review existing council assets and building and involves the corporate asset team, the street design team, as well as our finance colleagues around developing a bespoke finance tool to look at the viability of any of the assets. We're also looking at existing services such as our housing with care, our extra care schemes to see if we can build capacity. As you'll see in the report, the Campbell to Cowell have identified that future demand for adult social care, we need 532 units of accommodation. As Helen said, this currently covers the 10 years of the programme. That breaks it down into our resident groups with mental health with the largest number going through with older adults, learning disabilities, and then physical disabilities. So to deliver the 532 units, we need to deliver various accommodation models because one model is not going to meet the needs of all of our residents. Delivering multiple models of accommodation to meet this demand and challenge will require a long-term capital build programme. And we'll need to consider various ways to deliver and finance this programme. Delivery timeframes are dependent on a number of factors such as the availability of assets, market conditions, construction timeframes, and our partners. Campbell to Cowell report identifies demand per year across each resident group. But we know building accommodation is going to take time and it's also dependent on the suitable assets that come forward. So we're going to need to think of other ways to deliver the programme and meet our immediate need. So there are a number of ways that we can look at that. One of those is reviewing our housing with care, as I said. Another way is to look working with our colleagues across general housing supply. So we're suggesting 30% may be delivered by them. Also working with our partners, registered social landlords and social care providers to help deliver some of this programme, as well as us delivering by capital build programme. Some of the other things that we've done and to help the process of identifying suitable assets, we've developed a design guide that helps with the process of reviewing council assets. And it sets out the key designs and criteria across specialist accommodation model. You'll also see that we screen 16 assets so far. Those are council assets. Eight have been deemed as not suitable for various reasons. That could be the location, it could be a listed building, it could be a building with heritage status, or it could be on metropolitan open land or a combination of any of those. Eight are still under review, and three are likely to progress to a capacity study. So the capacity study involves adult social care working with a number of our colleagues across different teams and departments. Corporate property and assets are responsible for identifying the assets. These are reviewed with adult social care using our design guide. If they're suitable, the strategic design team would complete a capacity study. They would say, yes, we can build the kind of accommodation we want, or they would say, no, that's not feasible, and these are the reasons why. If we assume that it is feasible, it would then go to our finance colleagues to look at the viability, and assuming it's viable, it would then come to the Capital Build Programme Board for consideration. You'll also see that we've got five live work streams that incorporate all of the work that we've already detailed and spoken about. I won't talk about the review of housing with care because we've covered that. Essentially, the finance tool we're developing, and we need that to be able to ascertain if any asset is viable. It needs to consider a number of functions, so an idea of the return on capital, how long it will take to pay off any debt, but it also needs to factor in things like revenue streams. So we would be in receipt of local housing allowance for housing benefit, but we would also want to be utilising things like GLA funding. So any funding we can get from the GLA would then mean less money to borrow to deliver on our Capital Build Programme. We need to factor in the savings that Helen's pointed out to us. And then we also need to look at things like any social value, for example, that any contract may be able to deliver. And the last for me is just around our next steps and ongoing work. So we'll continue to review the council assets and capacity studies. We'll develop and trial the Adult Social Care Capital Build Finance Tool and we'll produce an estimated delivery timetable of accommodation based on available information and we'll review that annually. Using the finance tool and delivery timetable, we'll produce a savings profile and target for this programme. And lastly, but very importantly to this programme, we'll consult with our stakeholders on the design features and service specifications for each accommodation of care and support contracts.

• Thank you Martin for that helpful overview. Am I okay now to go in for questions? Just quickly before I come to colleagues, can I just, I think Helen, you might be best placed or Georgina, I think we see in the helpful presentation there's reference to only an occupancy rate, say only of 76% in some of the housing care. Why is that and shouldn't we be making sure that is full as a priority? But I imagine there could be very good reasons why not, but where are they? And a second question I had is just specifically on the timescales between, I appreciate there are different strands, but what would you identify say sites that are suitable for capital build? Is the plan then to essentially take that to cabinet with a proposal or what's the filter and mechanism it has to go through before it goes to arguably hopefully cabinet for a specific appraisal? Does it have to go through some other internal decision-making to deal with it? And again, to explain that process, thank you.
• Okay, so the housing with care occupancy, we are working very hard to get that occupancy rate up. It was 54% about two years ago. So we've increased it dramatically and we continue to increase it. One of the challenges that we have with our existing housing with care sites is they're not purpose-built. So they are not necessarily in the places that people want to live and they're not necessarily in the communities that our residents are coming from. So that is why we're very keen to work with all of the registered providers in Hackney to look at the best use of those sites. So obviously there's a demand for accommodation across the board in Hackney and where we have some sites that are underutilized because they're not particularly suitable for our client group, it may be that we have conversations with those registered providers about converting those sites into different types of accommodation in return for identifying other sites that are more suitable for our client group. So that's part of the strand of work that Marti mentioned. So we are doing our very best to maximize the occupancy at the moment, but looking long-term, some of those sites that we have are not necessarily where we'd want them to be and they're not what we'd want them to be. So they're quite old stock as well in some cases. So the discussion that we'd have around, we need a wide variety of accommodation that meets people's needs. Part of that and part of the design guide that Marti has mentioned is around, well, which communities are we wanting to support? So for example, we know that we need accommodation for our learning disabled and older population who are part of the Haredi Jewish community, we don't have much provision in that part of the borough. And the provision that we do have is not necessarily attractive or suitable to them. So what we're trying to do long-term with this program is to design in conjunction with the people who will be using it, what that accommodation needs to look like, where it needs to be, and also then whether we have the wherewithal to develop that.
• In relation to your second question, Chair, around the process, as always with local government, there are a number of governance processes to go through in signing off areas of significant spend, and this will be significant spend. So it's a significant capital investment. What we would hope to do, and at the moment we're having discussions with our legal governance and finance teams, is, and Martin is working hard with them, to develop an overall proposal for funding for the program as a whole, which we would bring to Cabinet to get signed off in principle, but then each scheme would probably require us to come with a full completed business case, which would go through the Capital Asset Board in the first instance, and then either be signed off at CPIC or at Cabinet, depending on the size and the spend of that scheme.
• Thank you. I would have more questions if I see a number of members. So Councillor Rathbun first.
• Yeah. Just to follow up to that on page 18, it's also saying 13% new accommodation to be built. How many new units would that be, and how far have we got with that? My other question, if you don't mind, is just on page 17 can you explain more about how to work dovetails with the plans of the major registered social landlords in the borough? What are the best options, and which RSLs look the most promising as partners?
• Yep. So at the moment, what we've got is very high level figures, Councillor Rathbun. So we've got an idea of what our demand will be, and where it needs to be in particular client groups. And it's a bit of a chicken and egg situation with the capital build programme. The exact numbers will depend on the sites and the assets that are available and what it's possible to do with them. So we know overall the number that we need to build. How we achieve that kind of depends on what our opportunities are. So some of these may be conversions, some of them may be purchasing existing houses that we convert for use for smaller supported living schemes. Some of them might be actual builds where we build larger scale schemes. And we're not quite at that level of detail because we need to go through the process of identifying what is available and what the costs are of doing each of those options. In terms of our piece, the ones that we currently work with, we're quite far into discussions with them in terms of sharing what our strategy is and how we want to work with them. And we are quite lucky in that we have worked with a number of them for a number of years, as they are the registered landlords for our existing housing care schemes. So for example, we already are working with Anchor, who are developing or redeveloping an existing site. And we have had a huge amount of input into that site. And 40 of the units on that site are dedicated specifically for use for us to use as extra care supported living. That doesn't mean that it isn't a good idea for us to open communication with the wider market and see what else is on offer. Essentially, I think I'm saying we want to keep all of our options open and ensure we get the best possible partnerships and facilities for the residents of Hackney that we can.
• And I see James wants to come in now as well. And I've got Councillor Turbant-D'Olive, Councillor Adams and Councillor Patrick. So James.
• I'll be very brief, Councillor Hayhurst. First, can you all hear me? Am I good? So Helen has said it all, Councillor Rathbone, in the sense, but just two quick points. One, you asked about are we mainstreaming this into the regeneration programme? We hope so, but these are early days yet. And so we hope to mainstream that into our own delivery. Second point that Helen said there about our housing associations, I was gonna say before Helen did, we are keeping it all open. We are reviewing the type and the number of housing associations that operate in Hackney as we speak. So we will keep that open. Third element of housing supply also, which has vaguely been mentioned is whether we can use our housing company to assist in some of the things here about purchasing, managing client groups and things like that. So we're keeping all of this on the table. It's early days yet, as Helen has just said, but we'll be bringing this back here in due course.
• Thank you, Councillor Turbazilof.
• Thank you very much. This is really helpful. I wanted just to go back a little bit on the point of the number of identified units that we will need in the next 10 years, which is 532 in page 16. I'm just curious to know, well, firstly, it's very helpful to know the identified numbers because I think it helps to have a target. I'm just a little curious about the breakdown of the specialist accommodation units. Can you tell us if you know, what was the reasoning behind this breakdown? Some will have 112, some are 155 for mental health, for example, can you tell us a bit more about that? Thank you so much.
• Sure, so we undertook a piece of work with a specialist consultancy called Campbell to Kell. And what they gave us really was the expertise and the experience and the technical skills to combine what we know about our increase in demographics with the supply that we already have. So this was a quite complex piece of work because what it did was model where we think the demand for adult social care will be coming from in the next few years. So where we know we will have specific increases in specific types of need, but it also then mapped against what provision we currently have available. So we know, for example, that we have less accommodation than we would like available for people who need some form of supported living and have a mental health condition. We have more accommodation available because we have our housing with care schemes for older people. So some of this is about being clear what we already have in place and building on that. And some of it is identifying, mapped against where we know we are gonna have demographic increases and increases in specific client group and client needs and what we might need to do to match that supply and demand going forward. I would say it's not an exact science. It's more of an art than a science. So this will need to be constantly reviewed as we look each year whether the demand we are expecting is the demand that is actually coming through the door. But in general, we know that we have an aging population and we know that we have a dramatic increase in people with mental health needs who will require higher levels of support going forward. So we're quite confident at the moment that these are the types of residents who will need our support and therefore they're the types of accommodation that we need to build.
• Thanks Helen. Councillor Adams.
• Thank you for that. Thank you for the presentation. My question is in your introduction, you talked about one of the aims of this work is savings. So I'm just looking at, and one of the proposal for you that you make in the presentation is about OHSIS land and looking at the increase in the land value in ACME. How viable is this option to meet the demand that had been proposed here, which is 532. So, in your fact, you know ACME is in great demand in terms of land value. So how realistic is this option of land purchase and built to meet this demand? Thank you.
• So I might ask James to comment, but my initial response is it's a very valid point. And that's why we had talked about the need for a financial model. So I think there are a number of competing pressures in ACME because we are finite in size. So you can only build so much in ACME because we run out of room, we run out of land. We know that the demand for temporary accommodation is increasing exponentially. We know that the demand for more social housing is something that we've been working on as a council for a very long time. So whenever we look at how we use an asset or whether we purchase a piece of land, that financial model will help us determine the best use of either that asset or that land. The other point I suppose it's really helpful to consider is as a council, we are very clear that we don't want to work in siloed ways going forward. So whenever we are considering an asset or a potential purchase of a piece of land, we may have to think about it being multi-use. So it may be something that we can use to build accommodation with care for clients for adult social care, but we might want to consider whether we would also build TA on the same site and within the same scheme. So I think we have to think really creatively and be quite flexible about how we use the limited assets we have available to meet all of the various needs that we know that the council is gonna need to address in the coming years.
• And James wants to come on this before I answer.
• Just to come on the back of Helen's point there, Councillor, so everybody in this meeting knows we have a demand crisis in Hackney. There's demand at every single price point from every single client group, but we have to prioritize, which is what the housing strategy and what this piece of work is going to do. Helen's mentioned temporary accommodation and Helen's mentioned what we're here for tonight. Classic example, we are looking, Councillors, at literally everything. Development footprints on sites, can we use those sites much more complexly, much more intuitive than we've used before? What are the different supply elements there that look like? Viability isn't just the land price, Councillor, as you're aware, it's build cost, it's materials cost, it's just about every single thing we're having to manage within that context. But we do have the financial model there. We have to do this, and housing strategy, which we'll be seeing next year, will prioritize this area of work as well as TA, as well as the other things as well, and you'll see that quite clearly. But we are already looking at those different forms of housing supply that's not just about the land. Can we purchase? Where are we with those sites that are quite complicated, that are quite difficult to use? So all of those things are part of this mix, and I'd say Helen said the basics, there's not much more to be said on that, but watch this space in terms of the housing strategy, in terms of its priorities.
• And Councillor Kennedy.
• I'm just on the back of that chair, both you and I will be talking to the LGA peer reviewers this week, as will Councillor Lynch in her capacity as chair of audit. One of the questions they will be asking us is what medium to long term plans have you got as members of a local authority to actually get your way out of the cost pressures in temporary accommodation in adults that you see really affecting the bottom line in year and in your medium term financial planning. And what James and Helen have been talking about tonight is our answer to that for the future, a large part of it at least.
• James, do you want to come back in now?
• Yeah, very, very briefly, Councillor Kennedy, I will share our temporary accommodation strategy with you as well for the LGA. So it's very, very current, very up to date. I'll talk to you soon this week, but you're absolutely spot on there. Needless to say, a final thing, Councillor Hayhurst, as Helen has said, these figures change and we have to be mindful of that too. So these are estimates, there are tolerances. I talk to contractors all of the time and they can sometimes hold their price, sometimes daily. So we need to be mindful of that over the next, this is a 10 year programme. In 10 years time, some of these things will have changed dramatically and very different from what we're talking about here. But again, we factor all that in, we just need to be mindful of all of that as well.
• I've got two questions, but I'm just on this point while I just, a question from me before I go on, Councillor Patrick and Councillor Lynch. This may be a crude question in pitting need against each other, but within the presentation, we see the potential saving to the adult social care revenue budget of 300 per week per person, which roughly is 15, 16,000 pounds a year, crude. 800,000 pounds for every 50 people, we managed to move across being absolutely crude. In temporary accommodation, which I accept is a completely equal valid need, is there a same cost saving to the revenue budget or just then housing 50 people? So would we save 800,000 per year? Or I'm just trying to understand the financial benefits of the council, James, to go over something.
• Yeah, so very briefly, Councillor, then they're not exactly equal in those things and schemes differ almost on the basis by context. They're not exactly equal. But as we've said at the beginning, both of those budgets, the general fund is under pressure, the HRA is under pressure. Both of these two areas, temporary accommodation and adult social care that we're talking about tonight, we have to prioritise and we will prioritise and be working as a council across the whole piece on this. There's a lot of work going on in the background about financial analysis across the piece between the bit here, which we're looking at focusing on adults and the temporary accommodation thing. They're not exactly equal, but then they're not that different either. How we approach a site, as Helen said, as you yourself have intimated, there's multiple demand on that, that we will have a process and a way of prioritisation of that site that we will just have to agree. And that will be built into it.
• Okay, Helen, quickly, and then I need to go, sorry, sorry, I interject in the 90s, Councillor Patrick and Councillor Lynch.
• Yeah, just to add, it's also worth remembering that the client groups aren't mutually exclusive. So actually a lot of my mental health clients will also be TA.
• Okay, Councillor Patrick and then Councillor Lynch.
• Thank you. I just wondered about the capital build we're doing at the moment on our council sites of new HLA housing and whether some of those could be built specially for the adult social care group. I was interested, it's interesting to hear the anchor are on board. I just wondered whether, I know a lot of the large housing associations do have specialist care providers who are not part of sanctuary and Peabody. I'm not sure I've got any in Hackney, but whether we're talking to them, I know there's specialist care providers, so if people learning disabilities and mental health, and whether we're talking to them, 'cause I gather they can access, they used to be able to access grant money. I welcome this, I really do. I'm surprised it's taken so long. I think it was here 15 months ago and it was a top priority and it's taken 15 months and we still haven't got any sites identified. We haven't got brick laid. So I would say to officers that we do need to get our finger out and get on with this. I'm glad to hear from James that it's going to be a top priority. I would have thought it would have been a top priority, but nevermind. But I would like to see this back. I think this is something this committee needs to keep monitoring. I'd like to see it come back. There are sites. I know there's a site in my world at the moment that we haven't drawn up any particular plans for on what's going on that site. I'm told it's gonna be a range of one bedroom family accommodation. So you could put some specialist accommodation on there provided you sort of get the access. So I welcome it, but we do need to get on with it and we do need to talk to those specialist housing providers who can assist. Thank you.
• Thanks. James, have you got response to that?
• Yeah, in reverse order, very briefly, other colleagues join me. Councillor Patrick, number one, we are looking at how we can use our regeneration programme and our development to do exactly as you just asked. So how can we change it? How can we develop and build our own? Am I echoing it, Geoff?
• Thanks.
• Is that better?
• Yeah, yeah, no, that's what I can hear, thank you.
• Sorry, so we are, Councillor Patrick, we are using and we are looking at our own programme. I am working with Martin every two weeks to see how we can switch that to develop our own stuff. I can give you the details outside the meeting. The second point about housing associations. Again, colleagues on this call will be working with Anchor and will be working with Peabody. We talk to housing associations all the time. There are potentially housing associations out there that don't work in Hackney yet, but who may have money to invest, we will carry on talking to them. That may change over the next 12 months or so, but again, watch this space as well as our working with our current people. Your final point about the length of time it takes. Yeah, it's complicated. Sites do take a lot of time and there are multiple demands on each site. As Martin and Helen pointed out, we've had to get the evidence base in place. That's really complicated technical work. At least now we have the strongest evidence base for housing needs this borough has ever had. Not just on this area of work, but the strategic housing market assessment generally. So we know what we need to do across the next 10 years. It's the first time we've done that. The work is going at pace. We have got a group of sites identified. There are opportunities around housing suppliers and we will be bringing this back. So I'll just say the complexity is working, that we are working really fast on all of this. Thank you. And yes, Councillor Patrick indicated she would appreciate sort of just a briefing outside the meeting just in case of the update, please. James, I'll come on to where we as a committee take this item at the end. Councillor Lynch. (silence)
• Thank you, chair. Thank you, James and Helen for this. I think all of us on this in the meeting know the good work that James has done leading the housing supply programme, which obviously I suspect will have a similar theme in terms of the financial modelling. Just to say very briefly, Councillor Kennedy, thank you very much for acknowledging my role as chair of audit, but I actually haven't been asked to meet with the LGA this week. So if you are able to facilitate that, that would be much appreciated. I think myself, I recognise the statute of duties of adults' health. You all know my professional background. For me, this is absolutely paramount to delivering our statute of duties as a council. Under the CARE Act, I think Helen's already mentioned, this is some of our most vulnerable individuals. They are probably the same people that have multiple interventions within the council from different teams and also with our NHS colleagues and our BCFS partners as well. I think I'm just about to ask a question. I'm just, chair, going to declare a personal interest 'cause my mother is a resident in one of the buildings within Hackney that is for over 55s and that particular housing association met with the residents last week and made some reference to being in discussions with Hackney around the building being used as a temporary accommodation, which I would plea, I've already written to the director for this portfolio within the council and not received a reply. I've now just forwarded it to Mr. Goldhard. Hopefully he will respond in his normal, usual speedy way. This has obviously caused concern for the residents within that, that they, not in a prejudicial way about the fact that we need housing, but it's got to be managed very, very carefully. We have history already of people being put into properties without residents engagement and what's happening. My final point as well, Helen, is my understanding is that Northeast London has quite a well-funded and quite significant population health team. I'm just a little bit concerned about why we're, along with the expensive Newton consultancy, we are still going out to outside consultancies to do our modeling around our needs when we have an integrated care system and a, I'm sure, health, and I'm sure every health care provider that meets the needs of these vulnerable residents have a way of modeling their needs in terms of demand and capacity. Thank you, Chair.
• Thanks, Councillor Lynch. Helen, do you want to come back then?
• Yeah, so we have worked very closely with our health colleagues and our public health team. They are very well-placed and provided a lot of the information around the demand forecast for people who will require social care. What they weren't able to do was to match it with housing supply and demand and to look at the existing provision in borough and complete that modeling. So when Campbell Tical have come in to help with the housing needs strategy in total, this was one strand of work that we asked them to prioritize, really, so that we could accelerate it, as Councillor Patrick said, because it's incredibly important that we deliver as quickly as possible.
• And James?
• Thank you, Councillor Lynch. I've got your email. I will get back to you ASAP.
• Just on the wider point, when you were both alluding to the overlap between temporary accommodation and what we're talking about here in terms of housing with care and possibly thinking about the site, was it envisaged that there will be some sites that would have both client... I appreciate Helen's point that sometimes there is a complete overlap between the group, but where there is not a complete overlap, would it be envisaged that for the reasons you said, you'd possibly be thinking about a model whereby sites would have a dual client groups in them, or have I misunderstood that?
• Nope. So to give you a very live example, we're currently having discussions with James's team and with planning around median road. So people may know that at the moment, median road is being used for TA. It would actually be a really good site for adult social care use as well. What we're looking at doing is seeing, can we fit both of those needs on the same site? It's actually not a contradiction in terms, because if we design it and run it properly, what you might well have is a pathway for people who move between TA whose needs might increase, who can be managed. And in a sense, it becomes almost a preventative service so that you're working with your TA client group to prevent needs escalating as a way you can as well.
• I mean, just peeling on from Councillor Lynch's point there, I mean, there may be a piece of work to be done on the communication of the benefits to be had off that. So hairs aren't set running and people don't misunderstand it and the benefits to be had, because otherwise people might hear snippets and then reach conclusions as they had a proper explanations to what's being intended and the benefits of it, they could take a more holistic approach. So I don't know whether that's just a bit of feedback there, just to think through as that progresses. We're coming to the end of this item now. Helen, I'm grateful for you, 'cause I think it was you providing the catalyst for it coming back again now. I also want this committee to be of its most use, as Chris alluded to earlier on in promoting this, because this clearly is a key objective for this council going forward, both in terms of residents' needs and budgetary sense. So I'll be in part guided by you as to when you think it would be appropriate for us to revisit this at an appropriate point. But I certainly think, keeping update, at least on a yearly basis, I think is important now to sort of understand where we got our duties as councillors in the wider context to promote this and the importance of this. So if I leave it there, but I'll be guided by you as to when might be an appropriate point to bring it back. And just so members are aware, obviously there's a peer review going on this week. So what Councillor Kennedy was alluding to is that myself and the other chairs are meeting with the peer review group this week, tomorrow in fact, to provide our feedback and thoughts on the council. So with that, I will bring this item to a close and thanks. And for the overarching comment to see, I think probably for the first time, I see a particular energy across, it seems to me across all council now in terms of drive to move this forward, which is incredibly welcome. And I'm grateful, thank you for Helen, for your work on pushing this forward as you have done. And thank you, James, for the engagement of your team in it. So it's very positive to see that the joint working here. So thank you both. With that, then I'll close that item on time. And we're gonna move now to the adult safeguarding annual report. This is the standard item that we have before us. It's item number five. And the agenda packet starts at page 27. We normally have it in its final version. We have it in draft because of work that's been going on. No criticism from us in that regard. The chair of the board who is normally with us, Dr. Aidy Cooper, in fact, has been here, I think for a number of years and sends her apologies tonight but we are joined by Georgina Dibber, the Director of Adult Social Care to answer questions and do an introduction. So Georgina, do you want wish to... And I'm also waiting, thank you, Jala, just alerting me to the fact that Anita Marsden is also joining us and she's the new Manager of the Safeguarding Adults Board. So welcome, Anita. Regina, would you wish to just give a brief overview or Anita, and then I'll open up questions?
• Sure, thank you so much, Chair. I'll give you a very, very brief update. And just to confirm, Anita Marsden has joined as the Head of Complex Care and Safeguarding. So oversees the board manager and the team which actually undertakes safeguarding inquiries. So it's great to have her here with the department. So this is the City and Hackney Safeguarding Adult Board Annual Report. I guess it's important I just set a context that safeguarding is not a process. It's not something done to but very much about helping a person to identify the outcome they would like if they've been at risk of or abused or neglected and very much about their recovery and resilience from abuse or neglect. So an incredibly difficult area to work in but I think one of the most important thing that we all do both in terms of our statutory safeguarding where we must undertake inquiries but also the wider safeguarding of residents across Hackney. I'm not gonna repeat what's been set out both in the Annual Report or in the cover presentation by Shohel who is the board manager but thought I would just kind of highlight a key few points and then leave more time for questions. So the report sets out the subgroups of the board and also their key achievements which I think are really important. We do have a statutory duty to undertake safeguarding adult reviews. Those can be both statutory where there's a requirement to undertake them or discretionary where we feel that there's learning as a partnership and being very open to that learning and reflecting and improving as a partnership. We also have subgroups, for example around quality assurance and looking at how we constantly kind of interrogate the data, the practice and how we work as a partnership. There's a number of sets of data. You do have the draft report. It will be designed in a way that's much more accessible particularly for our residents but just to pull out some of the highlights. So for City of London, what was interesting is that self-neglect was found in the 61% of all the cases followed by financial abuse. Interestingly in Hackney, there was also self-neglect being the most reported. And that just stood out to me, I think because actually self-neglect was only added under adult safeguarding about 10 years ago when the CARE Act first came out. And it's now the most reported type across both City and Hackney. There's a slight difference in that the East London Foundation Trust which covers those under mental health who might have care and support needs. For their residents, financial abuse was the most reported but that was followed by self-neglect. So some interesting patterns there happening. I think for me, and kind of when I set that first context about why we do adult safeguarding I talked about recovery, resilience. What was really positive across all the data sets. I'm just gonna remove an echo. So what was really positive across all the different data sets is that as part of safeguarding one of the things we always do and I can speak from practise as a social worker by background. We start safeguarding by asking the person what outcome do you want to achieve? And I can share examples. I had a young man who said, I want the person to go to jail. It doesn't necessarily mean I can completely influence that because it's led by the police. But I think it's really important that the work we do is led by what that person wants and how we help them recover from that abuse. And it was really positive that in both the City of London where asked 90% of people had their outcomes met are partially met. And in Hackney in 89% people were asked their outcomes and of these 92% had their outcomes met are partially met. So really, really important indicator for me. The report goes on to set out a lot of different case studies. Very much what I noticed in them was a theme around partnership working and really about how we help people to keep safe and again, to recover from that abuse we're experienced. So some really strong examples from across the partnership. We've had two safeguarding adult reviews that are in process over the last financial year. One concluded and there's also a seven minute briefing which has been published on the Hackney website. And there's a second SAR which is currently in progress and the group is actually meeting tomorrow the subgroup of the safeguarding adults board to consider that draft report. So I expect that in next year's annual report to be updated. There's a range of, again, I won't go through them all 'cause I set out in the report but just a range of achievements across all the different partners who were asked to pull out two or three key highlights. And I think just the range of impact we've had across Hackney and the City of London has been incredibly positive in the main. So that is a very, very brief summary and I really welcome any questions.
• Thank you, Georgina. And I'll open it up to members for questions. Councilor Tebadellof.
• Thank you, Chair. Thank you very much for this report. Just on the financial neglect. Is it possible to learn a bit more about that? A recent training that we took through the GLA told us that there is a lot of scamming and fraudulent sort of practices against especially people in adult social care. And if there is that, if that's the case, is there any support for them? Thank you.
• Thank you, that's a very good question. Just going from a lot of the escalations brought to me, I would actually say scams probably aren't the most prevalent. I think anyone is susceptible to a scam. Regardless of being known to adult social care or not. So there is lots of information, I think, for generally residents of Hackney and City of London about how to prevent a scam. And we know scam artists are very good at what they do. I'm sure all of us have received text messages purporting to be from a bank, et cetera. Interestingly, I mean, financial abuse does cover such a wide range of different types of information. Different types of abuse and crimes. But interesting what we find in adult safeguarding is the majority abuse is actually perpetrated by people who are known. So it doesn't actually tend to be scams. It tends to be, unfortunately, family members, friends, people purporting to be a friend who might, for example, come into the person's home, misuse their home and actually use their money. So there's a kind of a whole range of different things. Part of the work we do is around helping people to understand how to prevent abuse. For example, basic things like having a will, making sure you don't become isolated, that you have people around you. So lots of information we give to residents around that prevention. But where financial abuse does occur, equally people should have access to the justice system and looking to recover those funds. So we do work closely with our police colleagues where we think a crime has been committed to.
• Thank you, Regina. Councillor Rathbun. Could you give your microphone, please? Thank you.
• Yeah, thanks very much, Chair. What about those who are on the edge of care who don't actually quite meet the threshold? How confident are you that these are recognized, categorized and monitored? Thank you.
• I think there's two aspects to that. So safeguarding and our statutory duty is for people who may have care and support needs, whether or not the local authorities meeting those needs. So there are people who we may never have come across before, but we feel due to their care and support needs and their inability to protect themselves, that we do have a statutory duty. So where those are referred to us, we do have a safeguarding team within Hackney. And my apologies, I speak more about Hackney than City of London, but I'm sure City of London would be saying similar. So we always triage and we have a very experienced team who will consider whether someone is able to protect themselves from that abuse or neglect. And if not, we have the ability to undertake statutory safeguarding. What I will always also say is that we have the ability to undertake what we call other proportionate inquiries. I'm happy to share the data on that, but that means where we undertake pieces of work or safeguarding planning, where we don't have a statutory duty, where we feel it's the right thing to do because we feel that person is vulnerable and may be unable to support themselves or protect themselves from that abuse. So in addition to that, we also have a general duty to provide information and advice or guidance, for example. So if someone approached us who may be on the edge of care, who may be experiencing domestic abuse, but not actually open to adult social care eligible, we still do ensure we link them with the appropriate support services, whether that be another statutory services or health or community, to make sure that they're getting some level of support. Does that help answer your question?
• Thank you, yes.
• Thank you, Georgina. Council Lynch.
• Oh, great. Thank you, Georgina, for this. Thank you for the work that the safeguarding team does. Again, it's my same thing. This is one of the core statutory duties of this council. And my question is, the first question is sometimes with the referrals, the data, I'm just trying to, I have read the papers, but it's just a quick question about some of the culture of how you get referrals into the service. 'Cause I know in other bars, there can sometimes be a disproportionate demographic that is referred because of some of the cultural challenges around people's trust with the council, particularly around safeguarding and how sometimes I think even as members, there may not be that real sort of understanding that it's not, it's there to offer support. But again, people may have a fear of trust and think that, particularly around within communities where practices of sort of caring for their loved ones may not fit what we wouldn't consider to be sort of appropriate in terms of the care act. And also just to say that I think it's statutory for members, but I would ask that it's reconsidered that we all as elected members have annual updates in regard to Safe Girls for Adults and Children and something that should be supported as well, that members undertake that as well, given our roles within working with residents and that we can sometimes be an avenue to be able to escalate if we feel that there's a need for people. So that's, again, going back to that training point around council has been having the skills and appropriate training to be able to know themselves and to be able to safeguard themselves, selected members, but also residents as well.
• Right, thank you, Councillor Lynch. We've got five minutes left. So, Councillor Adebayo, I'm gonna bring Councillor Kennedy in at the end. Councillor Adebayo, did you have a question? I saw your hand go up and then go down. Did you have a question?
• Yes. Thank you so much, Jaujina. I wanted to ask about the cultural challenges that may have occurred during the different process, but that has been asked. So that was why I put my hand down.
• Oh, thank you. So, Jaujina, are there any other questions now for members? 'Cause I'm gonna, Councillor Patrick, and then that's the last question, and then, no actually, Councillor Lucas as well, 'cause it's the first meeting. Councillor Patrick.
• Yes, Chair. On page 50, it actually talks about Hackney's Benefits and Homeless Prevention Service. It talks about making sure that there's a proper review of people with mental health and learning disabilities who are leaving hospitals. I assume to make sure that they get the correct accommodation. Can you tell me a bit more about this and how long it's been going on? And it worries me that if they've had to do this, this review, that there may not have been appropriate service in the past. I'd like to think that the review has made that we do have appropriate service and that people are not being made homeless, are not being homeless when they come out of hospital and they're getting the correct accommodation as a whole.
• Thank you. Jaujina, I'll recap over these questions, and Councillor Lucas, last question, and then I'll go to you, then.
• Thank you, Chair. Thanks for this report. I just had a quick question on age, really, because it's interesting how the highest number of concerns raised is between that age group of 26 to 64, and I think that's a consistent finding, isn't it, over previous years as well. Is that simply a function of the age, the general age of the population being younger or are there other factors that go into that? I'd be interested to hear your views on that. Thanks.
• Thanks, Jaujina. So Jaujina, four questions, one on the cultural aspect, two on training, three on the review, four on Councillor Lucas's age question, please.
• Wonderful. I've written them all down, so I'm absolutely ready to go. So in terms of culture and the people being referred into the service, based on the data, I think there are groups who are accessing adult safeguarding more than others. We are working with our health and public health colleagues to do a deeper analysis of that data in Hackney because we are keen to address any kind of inequalities with access. But what I would say is there are some communities and we know from research that there may be more barriers to reporting in, for example, because it's perceived as normal because they don't believe they'll be believed. So there's a number of range of factors that we have to be, I think, very cognizant of and actually think about, not that they're hard to engage, but we have to think about how we are engaging and our roots into those communities. So safeguarding and partnerships. So obviously from this report, while I'm speaking from Hackney, it's a range of partners. We've got incredibly strong community voluntary sector. We've got amazing partners such as Health Watch. So lots of different ways that we can work with the community and with community members to try to both increase the trust, but also share where we have made an impact 'cause I think that helps people to come forward as well. So I think we're in the right direction, but I think we never stay still and there's more that we always want to do. I think in regards to annual updates training, I would welcome coming. Any invite you give, I will say yes. So if you would like me to come to deliver kind of an annual update or my colleagues from the team, we'd be happy to do that. The third question in regards to, and this was just to highlight page 50, the London Burgh Hackney benefits and homeless prevention. They talked about a review of a particular procedure we had about people being discharged from mental health hospital. Just to be clear, people weren't being discharged homeless or to the streets. This was about ensuring care act assessments so that where people needed additional care and support, for example, at their place of accommodation, that that can be done in a timely manner. There wasn't existing policy and procedures, but we actually, rightly with every policy and procedure we have, we review that on a regular basis. So this was just to highlight that review was done and completed and is now being embedded, which I heard is going quite well. And the final question, which was about age group. Hackney does have a slightly younger demographic, but equally it's generally seen that those who are already known to adult social care by the very nature of being known to services and having support means they're more likely to be referred into adult safeguarding. So based on the demographics of the existing adult social care people accessing, they're getting increased access to adult safeguarding as well. I hope that last little bit made sense.
• Thank you, Georgina. Thank you for recapping succinctly. Thank you to members for your succinct questions. Councillor Kennedy's been waiting patiently. So Councillor Kennedy.
• Yeah, I'll be very quick. Good to hear the voice of Councillor Lucas. Welcome to the commission. I meant to say that in my earlier contribution on an earlier item. With regards to financial abuse, yes, very often, most often someone who is known is a family member or a friend. And in fact, we had a case study at the last safeguarding adults board. Of course, it's always very complex. Quite often the person who is being financially abused does actually value quite a bit of the input, the comradeship, the companionship of the person who ends up doing the financial abuse. And we had a very interesting case study of how measures were then put in place to ensure that someone could still have access to someone who they regarded as a friend, but that French couldn't be allowed to actually financially abuse them. And training, I will bring it up. Helen and I will have a look when we do our next one-to-one. I think that is a good recording on the intranet, but it is probably about two and a half, three years old. So we should definitely do another live one for all members, but I will also send round the link to the most recent intranet training. Thank you.
• Thank you. So with that, I'm gonna draw that item to a close. Thank you, Georgina, for stepping in for Dr. Cooper and presenting, and thank you to members for your questions. And of course, this is a standard item, so it will come again for us next year. The third substantive item on the agenda is the health impacts of air pollution. We're welcomed by Dave True, as we have been for the last few years, who's the land, air, and water manager in Hackney in the Climate, Homes, and Economy Directorate, and also Tom Richardson, who's the Environment Projects Officer. Welcome to both of you, and thank you for your presentation. Just to recap, this is an annual item that we've been asking to come back to us, and indeed Hackney has to make an annual submission to the GLA as to its progress and provide updates. I understand we've submitted over 100-page documents, and we can see the response from the GLA starting at page 67, but also very specifically in relation to our status report on pages 70 and 71. Dave, I think you'll remember you were here when we had, I forget the name of it, one of the country's leading sort of academic experts speak to us a number of years ago. I think one of the abiding things that came out for us is the benefit that you, Les, have had, but also where the health impacts are. They're greatest in those on the trunk roads, and so I think it remains in the particular interest of this commission as to what we are doing mitigating measures to try and reduce the most harmful impact, e.g. around the trunk roads, as part of our plan. So over to you both to present, and then I'll open it up for questions. We've got half an hour for this item. So, Dave, over to you.
• Thank you, Chair. It's going to be over to Tom initially, so we've got the presentation and I'll let Tom start.
• Thank you.
• Thanks, Dave, and thank you, Chair. Trustee, you can all hear me okay. I've got some slides. These are much shorter than last year, so I'll just share those now pretty quickly. So, thank you for the introduction, and welcome to all the new members. There'll be a brief review of some of the basics, just sort of the benefits of the new members here today, but as I said, I'll keep it quite short. We'll start with the background, and there are many sources of air pollution in Hackney, the main air pollutants being nitrogen dioxide and particulate matter PM10, PM2.5. It is important that we manage all of them. Road traffic, as was just mentioned in the introduction there, is currently the principal source of all of our pollutants, so that's the NO2 and the PMs, but we also have sources of NO2 from gas boilers and commercial industrial heat and power, for example, particulate matter from construction, solid fuel burning, and commercial cooking. This image just on the right-hand side as well gives an overview of the health impacts. It reinforces the fact that these impacts are numerous. They affect people through their entire life cycle, and there's new evidence over the last five years or so with increasing links to cognitive decline, dementia, and alongside all of the typical cardiovascular issues, such as asthma, heart disease, and so on. A recap on the situation in Hackney and how we manage it is Hackney is an air quality management area. It has been since 2006 for NO2 and PM10. As a result, the council prepares an Air Quality Action Plan, which outlines how we will take measures to reduce air pollution and exposure to air pollution. This is typically reviewed every five years, so we're about four years in now to the current plan. We report annually on the progress of our actions to the GLA and the state of air quality monitoring in the borough and the progress on all of the actions in our plan. The annual status report has very in-depth information about the trends that we've experienced. The latest annual status reports for the calendar year 2023. For nitrogen dioxide, we have seen substantial decreases over the past seven, eight years or so. This is primarily due to many factors, including the US and for increasing improvements in vehicle standards, for example. But these decreases are slowing and this could possibly be as a percentage contribution from road traffic that is declining for various reasons. As I said, mainly due to improvements in vehicles and other policies. What we saw in Hackney is that the majority of our nitrogen dioxide monitoring sites saw a decline. That's 56% of our sites saw a decline and around a quarter of them remain stable. In 2023, we did see some increases in around a fifth of our sites. Most of these increases were quite small and could be attributed to the variation that we would expect depending on metrology, for example. Although we did see some trends where we had some increases. These are typically on the transport for London red routes and some A roads. And as I said, some of these increases were relatively minor, but we did see a few micrometers keep increases on some roads. For particulate matter, we saw quite a substantial reduction over the past decade or so. But again, these decreases appear to have slowed. Over the last few years or so, the levels of particulate matter in the borough have appeared to stay relatively stable with neither a substantial increase or decrease. We only monitor these at some of our automatic monitoring sites, which means that we don't have as clear a picture across many, many different sites in the boroughs we do for nitrogen dioxide. We adopted the World Health Organization guidelines, the 2005 guidelines as part of our 2021 Air Quality Action Plan. And what we're seeing is we seem to be approaching these levels, but they're not consistently met across that yet. So in terms of the monitoring and what's happened over the last year or so, as I've just touched on the results of that, we have increased our network of nitrogen dioxide diffusion tubes following feedback on where various stakeholders, members of the public, for example, have believed that monitoring is necessary or where we view that transport and traffic schemes may result in a change in air pollution. So we've expanded our network there. We even included some monitoring on residential properties as facades to get a better picture of real-time exposure of residential properties. We've also expanded our automatic monitoring network with two new monitors. One is now live on North Road and another is on its way to be commissioned in the next month or so on Graham Road. And that will give us a better picture of particulate matter in particular PM 2.5, where we've got the most evidence of the health impacts of that. We've also, in the last year, launched our community co-design tool, AirAware, with funding from DEFRA. And this, we hope, will improve access to air quality forecasts, air quality data, and events that will be of interest to those that may be affected by air pollution, as well as improving how air quality alerts may be received. And we've also used the funds from the GLA's Mayor's Air Quality Fund to increase our coverage of Brede's London sensors, which are a lower-cost way for providing us with increased data on NO2 and particulate matter, allow us to view those changes that may occur from traffic. Maximum concentrations, changes hour by hour due to traffic. And we believe that these are important to really understand any impacts that may be occurring due to changes in traffic. We're now gonna pass to Dave, and he's gonna give you a recap on some of the measures that we've implemented over the last 12 to 18 months, and have us approving air quality.
• Thanks, Tom, yes. So, as was mentioned, that the annual status report is a report that we're required to do annually. It is a statutory report, and it's submitted to the GLA for the Mayor of London to approve. And as the chair set out in the introduction, the letter from the GLA has been included in the packet, shows that our ASR was approved in its entirety. So, the annual status report includes the monitoring, which Tom has just covered, but also some of our work towards delivering the Air Quality Action Plan. There's 47 measures in the Action Plan, and I'm not gonna cover all of them. I'm just gonna pick out some achievements just 'cause they are kind of key achievements, or they address some of the areas of key concern to the commission. So, School Streets, I think, has been a big positive implementation within Hackney, kind of leading the way on this. And by the end of 2023, there were 49 School Streets in place. And there is a continuing programme, so there are more coming, or existing ones are gonna be extended. There was a green screen programme, and largely in 2023, I mean, it's been split into two phases. So, there's a kind of a suitability, an assessment of sites for suitability, and then there's the implementation. So, I think there was 25 sites that were visited in 2023 to do the assessment. And then from that, they'll go forward with procurement for those which are considered suitable. The Eigling Signs and Banners, some of this is not included in the ASR 'cause it's happened this year, but we have been putting up the Eigling Signs, which are there in the picture, and there's more than 50 of those, but we're also putting up banners at schools. The Pharmacy Conversations is part of the AeroWare Project, which I'll come to in more detail in a minute. We worked with Public Health to revise the air quality section of the JSNA with up-to-date air quality data. With the Zero Emissions Network, there's a lot of offers there, but one of the key offers is cargo bike grants to help businesses transition to a more low emission means of transporting items. There's a rollout of the cycle hangers and the EV chargers. The Sustrans Wearable Study, so this again is a more recent thing, and it's also related to the AeroWare Project. So, the AeroWare Project was part of a wider deaf air quality project, and it was working with residents to look at ways in which information could go out to the people, to the residents, across both Hackney, Tower Hamlets, Newhamton, the City of London, and it was working with them to identify their needs and what they wanted. So, the website is designed for those people. It's designed by a number of those people. So, we had workshops, and they contributed their ideas. There was then a vote on the logo, a vote on the name, and they also implemented input into the design and content of the website. So, there is a link, which I'll show you on the next slide. Please go to it, and please do check it out. Just on that project, I was just gonna cover the Sustrans, but through that, we've also created a group of air quality champions, and they identified some projects where it was a bit of citizen science. So, we did some pop-up monitoring sessions where they spoke to people in the street about monitoring, and they also wanted to work with school children. So, there was one of the schools in Tower Hamlets has already had the project run, and school children will wear a portable device, which will monitor the pollution on their route to school, and then they'll try and devise a more low pollution route. We'll be working with Sustrans in Hackney during this term. So, this AirAware project, I have included a number of pictures here from the ads that went up, 'cause we did a campaign to try and get people more aware of AirAware and to get it used. The link to the site is there, but just to cover briefly what it includes, there's the monitoring section, so it's all of our automatic monitors, as well as those of the participating boroughs, but there's also other networks, such as the Breathe London Network, so it's bringing together a lot of information on one site. There's also a library, so it's got various information sources, like sort of academic papers, but also videos and infographic to make it more, it's dealing with some technical information, but more user-friendly. There's also a section which has community events, so we do advertise anything which is related to climate change and air quality on there, but there's also a little news section, which I find really helpful, 'cause it will just pull out any kind of news items on air quality or climate change. And then one of the sort of key, attractive things about it is there's a chat function, so you can go to the site and you can ask it any question, which I'm tempted to do when you ask questions afterwards, just to pipe these into AirAware and see what the website can produce. But please do so after the session with that link. Next slide, please, Tom.
• Dave, just because we've got about 10 or so minutes left, can I just take this last slide as read, so we can all see the timeline there for the action.
• Exactly, it's only to say that we've got a review in 26, so this is going to be the timeline, exactly that.
• Thank you. I think Councilor Turner and Mr. Loughlin wants to come in. My principal question, Dave, which I alluded to, is to what extent in the new action plan, as we understand the evidence base, is that it has its most significant health impact on those living, working, schooling on the trunk roads. And that's where, tell me if I'm wrong, but we're in the most breach of the WH guidelines, and that has the biggest health impact. So will the new, a lot of these areas, absolutely applauding, but will the new strategy really focus on where the health impact is at its greatest and what we can do to mitigate that?
• Yeah, thank you, Chair, for the question. So looking at what the data has shown us now is, obviously there's a lot of positives there, but where the slight increases are occurring are on those roads, and it's quite clear that that's where the tension needs to be focused. We are working with Street Scene, so they've done a lot of studies themselves to look at what is the traffic that's there and why is that sort of problematic and what could be the solutions based on that data. And they've found that it is through traffic. So what they found was that the implementation of the LTMs reduced traffic, not just within the LTMs, but that traffic outside, sort of on the boundary roads, but what it hasn't done is impacted as much on the traffic from outside of the borough going on those main roads. So they helped on this main roads study, and I think that they are looking at what are the solutions. I think it's going to be in the action plan, but I can't give an answer right now.
• I've got some further questions, but I'll come to the question of the members first. Councillor Turbic.
• Thank you, Chair. Thank you for that answer, Dave. My question actually follows up a little bit on that. Related to what was alluded in terms of expected increases in certain roads, I'm going to use the AirAware website, which seems very interactive, really good information. It can be quite confusing when you don't know the data, so I had to do a bit of research before to understand the results. But it seems that certain roads, yes, as you say, they're looking, the levels have decreased, and it looks acceptable measures according to the World Health Organization. But some of them, I guess that's what you allude to in terms of expected increases, do have quite high levels, like Hackney, Queensbridge Road, and certain roads just close to schools. Could you tell us what else is done on those cases in terms of the monitoring, and at what point they get reviewed? Thank you. Yeah, so, I mean, I think with the roads where the increases are being seen is on the, let's say the TfL roads or main roads. One of the actions which is in the current action plan, but which will be taken forward is working with TfL because they are TfL roads. So we've got to look at is the public transport in place and lobbying for things like that, but also what TfL can do to manage the traffic flows on there. I think that there's a number of ideas, but I think that because they are TfL roads, there's conversations which need to be had with the mayor of London. And I think that those are things that we can't say what the outcome of those conversations would be. But I think in terms of it being a wider problem than just Hackney's roads. For us and what we've got within our control, we are monitoring, there are certainly traffic schemes to improve the flow of traffic. So within Hackney Central, there's a big scheme being implemented to try and address Pembury Circus. And I think Pembury Circus is one of the key places which did see an increase, wasn't it Tom?
• Yeah, that's right, yeah. So yeah, I think that there are certain traffic schemes which are within our control and public realm improvements that we're addressing. And then where there are schools, it is those school streets ensuring that when the children are going to school and being picked up from school, that at those times that certain vehicles can't enter near the school. So at least it protects them within that area.
• Thank you, I've got Councillor Rathbone and then Councillor Adebayo online. Councillor Rathbone.
• Thanks, Chair. Yeah, I'm just looking on page 17, item five, about Dalston Lane and Stokelympton High Street. Curbside, it obviously broke the limit for NO2. But were these monitors next to residential developments? And what more can be done for those living next to junctions on major traffic routes? And if you could just explain what distance correction actually means.
• Dave, I'm gonna take questions in three. Is it Councillor Adebayo next?
• Thank you so much, Councillor Rathbone, because that's one of my question, you know, as a councilor, Dalston Councilor, that is a concern for me. And secondly, I have come across those who are anti-ULEX. So I do intend to persuade them. Is there any plan to persuade those who are anti-ULEX?
• Thank you, Carabao, and Councillor Muthu.
• Thank you, Chair. I just had a quick question around the AirAware project, 'cause I think it's really interesting project. I just, I wonder going forward what the plans are for the platform, and more importantly, how the data is used in a productive way. So it's not just sitting there kind of for information, but it's actually being put into practice and driving change. And also how we're getting stakeholders within the community to make use of the platform so they can share with, you know, people, friends, neighbours, et cetera, and really have an idea of the levels of pollution in the communities.
• So Dave, do you want to go through those three?
• Yes, sure.
• So the first one on distance correction, Tom, do you want to pick up that one, and then I'll do the other two?
• Yeah, I'm happy to. So that was all on distance correction, but also the levels on Dalston Lane and Stoke Newington High Street. Both of those monitors are curbside monitors, so they are the ones that are closest to the curb, and as a result are expected to be the highest reading. In terms of what's being done, on Dalston Lane, the monitor itself is very close to Pembrey Circulus. And as Dave mentioned, there's a very major scheme to alter and reconfigure Pembrey Circus, which will hopefully reduce through traffic in that area and with public realm improvements to increase the distance between the traffic and residential properties that are around that area. Stoke Newington High Street, I'll just address quickly. Again, that is a TFL red route, which does present the problems as to what control Hackney has over traffic there. At that location is at the junction with Church Street. So for anyone who's aware, that is commercial at ground level and residential on the first floor. So there's likely to be slightly lower levels of pollution at the first floor than there is directly at the roadside. Distance correction is with regards to the levels that are measured at the monitor. And that is often a number of meters from the receptor. So that's where people are actually living. So for example, three or four meters from the curb to a residential facade. And there's a correction just to, that corrects for that distance. And often that results in a slightly lower level at the facade.
• So Dave, the other two questions on the ULEZ and the use of the data on Arroware.
• Yes, sorry. The question on the ULEZ, could you repeat? Was about how can you persuade those around to ULEZ? How can we harness the data and the evidence base to launch a persuasion campaign?
• I think that there's certainly a lot of data coming out. So the GLA did do a report. I think it was the six months, the six months of the extension of the ULEZ, which does show that there was improvements as a result. When the ULEZ was introduced to cover Hackney, sort of when it went to North and South circular, we've got data and evidence to show that it does have benefits for air quality. It is quite difficult to attribute changes in air quality to one specific thing. But I think because of the sort of extent of that scheme, it was quite clear that there was that correlation there. How do you have a conversation with anti-ULEZ campaigners? I don't know, it's our challenge to be honest, that we put out the information. We do try to engage with people regardless of their views. And we hope that through doing that, but I think that it's a really difficult one to try and persuade someone when they're very convinced of the opposite. So I would welcome suggestions from anyone as to, if you've got suggestions, you can help us.
• And just on Councillor Lucas's point in terms of the air aware data just sitting there and how can we, I guess thinking innovatively, like how can the infographics, how can you put that on the council feeds? How can you extrapolate our data better?
• So as I said, the project was run with champions. So we advertised, we recruited, we had about 50 people register an interest. I mean, as the project went on, it was a two-year project. It dwindles to about eight who were actively engaged. So it is a difficult one to try and maintain interest. But those people who were registered, they got a newsletter, they were kind of informed. They, I think some of them at least voted in the logo, et cetera. So it was just trying to maintain that interest. And then the idea was that by having those 50 people who were people in the community, they would then pass it on to others. The point of it is we are doing that monitoring. It goes into the ASR, et cetera, but the ASR is not the most public facing friendly document. So it was how do we put out that data in a meaningful way that people can just click on and say, right, I want this and have the chat function there as well, type in a question, you get your answer. So it's all done in a very user friendly way. And it is about promoting that site to people. And I think when people use it, we did get figures from the developer which showed real positive stats in terms of the engagement. So it wasn't just simply clicking on the site and then clicking away. People were actively engaged with the site. So I think it's about the site. And just in terms of the future, we've got it maintained until end of April. But we are looking at ways to source funding to retain it, which is looking at bringing other councils on board. So that is what we're looking at for the future. Thank you, Dave. I've got three more members who want to ask questions. Can I ask members to be very quick? And Dave, if you can try and be succinct in your replies. So Councillor Adams, Councillor Lynch, Councillor before. Councillor Adams. It's a quick one on page 17.14. How come two months' dilution to data was lost? Councillor Lynch. Oh, I can't just take a couple more questions. Yeah, just very, very quick question. One thing I would suggest is within your slides, the previous item had resident stories around safeguarding. For me, I think if you want to improve your engagement with our residents is to move a little bit more to the positive benefits of using different forms of transport as opposed to what unfortunately may have happened in the past is sort of the anti-ULS community. We have residents in our borough that work shift work. They can't ride a bicycle at 4 a.m. to go and do cleaning jobs in the West End of London. We've had this discussion where we had to-- Councillor Patrick led a very good campaign around our challenges to our bus services in Hackney. So for me, I think there needs to be lots and lots of nice data. But let's not overcomplicate this. Let's look at some of the things we can do with our residents who aren't going to give up their cars and actually be really aware of some of the inclusivity of our language towards our residents, particularly for those that do have to use a car for caring responsibilities or they're a nurse going to a shift at 7 a.m. and they're a woman coming back from a night shift or a twilight shift. They don't want to get a bus. So I think that for me would be the first thing you could do is actually use some of the population health data we've got to say, oh, since we've done this, we have shown that the admissions for children's exacerbations of asthma at the Humberton have reduced by 10%. And that is what we'll be engaging to our residents and also to our members and also give a bit more of a bring to life some of the policies and plans and whatever we're doing in terms of trying to reduce because that's what will get people to do this. And make other forms of, you know, transport available and meaningful and adapt to people's needs. Thank you. Thank you, Councillor, and Councillor Ford. Sorry, thank you very much. I'm sure the council has the data for how many EV cars in every areas. And what methods do they have in place to ensure that they are prioritising this EV pass to reach the charging point and also to avoid fewer cars packing at the charging point where EV cars get access to. And it forces them to tackle the double yellow lines and end up getting tickets. What measures do the council have on this to address that problem? So David, I can ask you to put those three together if you can. Thank you. OK, Tom, are you going to go with the lost data? The two months of lost data is very frustrating and very unfortunate. One month was lost due to an error in the lab with a contaminated reagent. And unfortunately, the methodology is destructive. So we couldn't get that back. We have now taken steps and we do have a different lab for diffusion tubes moving forward. The second month was lost in the post. We don't know why that was lost in the post. We have now taken steps to ensure that all of our packages of tubes are tracked fully rather than what they were before. Dave, are you going to focus on the residents engagement and the health benefits on that one? Or I'm happy to. Yeah, OK, go for it Tom. So I completely agree with the council's remarks and thank you for bringing that up. And I do agree that quality data can be very opaque, very difficult to engage and can turn a lot of people off for its complexity from time to time. We are looking with the public health team about where we can see decreases in hospital admissions and cardiovascular admissions for this sort of thing. There's a bit of a time lag in getting these stories through. We want to make sure that our data is robust and secure. So I totally agree that that's the way to engage people. And we did some work with them on the joint street need assessment update there. With the use of cars, and obviously there is unavoidable use of that, we totally understand that as well. And the street scene team and the transport strategy will be cognizant of the needs of the population that cannot cycle at night and cannot take buses late at night for the safety, etc. So I completely agree and thank you for raising that, especially in terms of our positive messages. I didn't quite catch the last question, there was some distortion. I think if I understood correctly, it was with the easy charging point, people not actually being able to charge their cars and being forced to pass on double yellow to do so, because the bays by the market prioritise for people with electric cars. So the question is, if I understand correctly, that the bays are occupied, parking bays are occupied by electric vehicles and not other vehicles, is that right? Not being occupied by electric vehicles, but running occupied by other ones. Yes, I think the other way around, so people can't charge their electric cars, not electric cars, cars in space. Understood. Unfortunately, I don't think Dave or myself would have an answer for that. And would be with the street scene team and the parking services teams. But we are happy to pass that on and see if we can get an answer. OK, it's maybe something we can just pass through to our other relevant committee members on living in Hackney, or follow up with the officers ourselves to get your response to that point. Because we're over time, I'm going to draw it to a close there on that item. I think, thank you both for your time and your engagement. We know that some of the points you make will need to be final decisions made at City Hall in terms of TFL routes. But in terms of the draft plan, I think members would certainly appreciate being circulated to us in draft form. So we can possibly make any observations. And it may well be that on behalf of the committee, you might then go on any observations and relate them to you. So you've had a feed back in that regard. And then I think we can then maybe reconvene in a year's time to see further updates. I didn't get charged to ask you about the HEPA filters in the schools at Sadiqah Street. It's maybe something I can do in correspondence in our comments on the draft plan. So thank you both very much. And I'll draw the item to the podium staff. You've got a round of applause in the Chamber. Thank you very much for your time. Last substantive item on the agenda is East London Foundation Trust. I'm grateful for those attending today. We've got Jed Transwa, who's the borough director in City and Happily. Welcome. And also Bex Lingard, who's the borough chief nurse. Thank you both for coming. And we've all choose to come along and speak to us today in terms of what evolved from a coroner's report in terms of the fortification of records. We obviously, regardless, it's quite a serious matter. I think one of the incidents may have started life on the homerton, which is why they've been in our hospital. Although I do note your later observations in terms of particular cases not actually being in City and Happily patients per se, but obviously it still impacts us significantly as a borough. So if I can ask you to give your presentation maybe in sort of five to seven minutes, then I'll throw it open to questions if I can. Thank you. I'm going to, Jed Francis, I'm going to do a quick bit of context and framing of our contributions to the commission. And then Bex is going to go through and the work that we've been doing in ELF. So as it has been highlighted, there's been concerns raised generally about observation practice and the impact on patient safety of that. Inaccurate recording and fatalities are linked to those inaccurate recordings and practice. In the mental health and patient units specifically in the context of. OK, so in the context of ELF, there's a PFD and future death report that's related to an ELF patient that was issued on 31st July of this year. And as part of that work, the patient was caught in a home-made alley as part of the work pertaining to that PFD report. It was found that there was 11 fatalities where there was potentially an issue of erroneous recording of observations. So that was quite a significant thing. None of those cases is probably worth saying. None of those fatalities linked to city or acne patients. There is work in ELF to respond to that specific PFD. It's going to ELF to board at the end of this month. We are committed to providing you with an action plan that arises from that PFD, but it's premature for us to talk about the detail of that specific case today. So what we are going to be talking about and what VEX is going to focus on is the two years of work we've been doing on patient safety, particularly around observations practice, observations reporting and general improvements in that area. Thank you, Jed. I thought firstly it would be important to differentiate between observation practice. So we're talking about psychiatric or mental health observation practice as opposed to vital observation monitoring regarding blood pressure, et cetera. Within ELF, we have three types of observation. We have general, which every service user is supported on. And that is about assessing mental state recording, whereabouts, maintaining dignity and generally throughout the entire admission, they would be subjected to general observations. We've moved to intermittent, which is a 15 minute check. And that's if you've got some slight increase of risk that's not immediate and it offers an opportunity for a clinician to engage on a more regular basis with a service user. And then for those patients that were particularly concerned about that we need a member of staff to be with them at all times to maintain their safety, we move to enhanced observations. That is within eyesight or at arm's length, again, dependent on the risk that presents. And enhanced observations would be used to support somebody who is particularly distressed, at risk of self-harm, suicide, who's got some physical health comorbidities and vulnerabilities that need additional intervention. As Jen has already highlighted, in September 2022, we commenced a trust-wide improvement project, quality improvement project, which has got specific methodology to capture improvement and change ideas and to work across a complex system to problem solve and get some improvement results within the health care system. We work with IHI, which is the Institute for Health Improvement, and we've got a decade relationship with the organisation. This project also focused on engagement and how we could enhance and improve engagement with the population that we serve in city and actually in patients. The PUI project brought up three main change ideas, interventions, the first of which was a broad relay. We physically document observations on templates, trust-wide templates, and the idea was that the nurse that was carrying out the general, the intermittent observation board completes their tasks and then hands it over physically to the next person. So the board relay isn't dropped on a desk, forgotten about, and then there's an opportunity for missed observations. The second one was twilight shifts. This was a shift pattern to adding extra members of staff at times where the shift was a bit busier. So at supper times, medications, handover times, where you could see that the risk around acuity on the wards might increase. And that was about matching resources onto the nursing team. And the third test is zonal observations, and that's acknowledging that at different times on different wards, there may be spaces on the wards that would benefit from having increased visibility of nursing staff with a specific care plan to address, and it might be that they would set up particular groups with service users on the ward. Those were the change ideas from the improvement project. Obviously, there's a need for governance and oversight and assurance around how there is a working out and evidence improvement. In City and Hackney, we developed a standard measurement tool that was adopted trust-wide, and that looks at capturing the completion rates for the observations every time a nurse has completed the observation. On September the 4th, our completion rates indicate, on average, over 99%, and we continue to monitor the completion rates of documentation on a weekly basis. We also do spot checks, which are conducted in the senior nurse managers meeting that there is oversight, so matrons and managers would do spot checks on each of the individual wards to assure ourselves that those observations have been documented. And then we scrutinise those in the nurse governance meeting on a weekly basis. We also do senior nurse night visits, and we also look at the observation work as it happens in the shift. In the future, very soon, there is going to be some supportive digital solutions, which will provide a reporting aspect and will allow nurses to document their observations and provide a clearer audit trail. In terms of staffing levels and workforce developments, we review our nursing establishment on a yearly basis to take account of patient acuity and to inform evidence practice. There are other kind of areas and forums that we have the discussion around observation practice, including our unit-wide safety hurdles that also capture staffing, acuity, dependency and mitigating actions that we need to take in a timely fashion. In terms of training, the trust has developed an inpatient safety suite, which encompasses development and training opportunities around observation practice, and our completion rate as of last week was 89%. And we have also got a band for life skill recovery workers as part of our workforce in MDT, which is around increasing the delivery of activities and opportunities for service users on the wards. So hopefully that gives you a clear impression that ELF obviously takes patient safety very seriously. The recording of observations very seriously, the practice of observations very seriously, and we'd welcome your feedback. Right, I mean, what I'm slightly struggling with is the falsification aspect of it, because I can appreciate if staff, for example, have rushed off their feet or they simply don't have the capacity, but then they just don't enter it. They don't falsify it, you know, and they don't enter it. And then it's able to see that clearly there isn't enough capacity there because they're not able to get round and do their job. But my concern is it's almost passing the box at the end that they then get in trouble if they haven't entered it and it's deemed to be their fault, which is then encouraging them to then presumably falsify because they're worried that they're going to get in trouble and that they're not able to do it. Isn't there just an absolute red line that any falsification or any medical records being immediately sacked will face? It is an absolute no-go and that has to be a thing. And if you can't, if you cannot do it because of capacity reasons, then that needs to be, then discussions need to be had about how that can happen. So it's the falsification aspect that I'm still struggling with, as opposed to why it's just not left blank. Thank you, Chair. Yes, you make a really valid point. A lot of the work that we're doing on this learning is around honesty of documentation and encouraging a culture where nurses can report formally to us opportunities when they've not been able to deliver the care in which they would want to or that was intended or prescribed. I can give live examples when I've been on wards myself with nurses and I have noticed the observations haven't been carried out. That offers me an opportunity to speak to the nurse to understand what's happened, to learn from it, to report and flag it up to the wider system. And we do get, we do get incident reports on a daily basis. And some of those incidents, incident reports, reflect the honest, honesty that I think is an existence since it's young, because people sometimes are saying we miss this observation check because we were busy doing something else with that. Instead of falsifying a record, they're holding their hands and saying we missed this check. I saw Councillor Adams first, then I think Councillor Lynch, so if I go in that order, Councillor Adams. Thank you for the presentation. On page 79, 2.2, you declared the quality improvement work you did. But you say for certification of observation, records remain a problem. Why? And you didn't stop being sanctioned for not keeping up to their training. The number of questions, if I take it in, or Councillor Lynch, did you have one of those? OK, so firstly, I'm not myself on the NMC register, so I absolutely, yeah. So I wanted to make the point that I welcome the NMC input, because I think that's really important for members to understand that nurses and other people with professionals, especially when a professional register, the nursing and midwifery council, that would be a standard process, which is welcome to see that the organisation have followed that and suspect there's not possible to go into more depth of that, because obviously it's an ongoing referral process. Just one other thing to say is around the safe staffing and enhanced care. And just to say that I was involved in the NHS injury and enhanced care, but I don't think it ever got published because it just happened just before Covid. But I do feel that for BECCS and for the health as themselves, I think there's been a huge focus of the acute independence within the acute hospital environment. I think at times the mental health sector, there has been a misunderstanding, and particularly around some of the workforce and some of the safe staffing modelling, hasn't always been equitable in terms of how to do that sort of safe staffing and that sort of real time position where you're staffing us. And I think it goes back to, and I think you've just mentioned it, BECCS as well, is, you know, it is not uncommon for some of these people that are leading ward teams to only be, you know, not having done the years, that's what it's like to do to become a ward sister. And I think it probably wraps around a lot of what you're talking about here, which is the culture. There's a fear of not wanting to look like you haven't done your work. And I think every nurse knows that they have to do their reports. And I think it goes back to the question you asked, is the organisation providing the opportunities for these professionals to actually do their job so that they don't just maybe reduce patient harm ultimately, but also have we got enough confidence that you've got training and other external support there to support your young, not necessarily young, but your sort of your leaders that, you know, we know that there'll be people that will escalate because they might not have enough sort of, you know, insight, but also to know what is right and what is wrong. And if there is a culture where people are like, just do it after, you know, we'll just do it, you know, we'll be back at the station and record everything. And again, like, you know, do we have mobile technology? I suspect we don't because it's probably got a risk averse environment. You can't have bits and bobs. You know, these are very vulnerable, vulnerable residents and patients that, you know, you know, at that point in time, you're probably doing a lot of proactive firefighting when you work in those environments. So you haven't got time, but they need to be able to sort of look at their efficiency of those wards to make sure that, you know, again, you've got the life skills recovery workers in there. You know, there's a real opportunity to look at the stuff that registered subject matter practitioner experts are wasting and not being able to do what they are required to do, which is to fill in notes. If they're having to do other tasks that are not relevant and they're not actually going to bring any value, but fundamentally, if it's not written down, it didn't happen. And that's, I'm sure, next you recognise that line and it's absolutely drilled into you. But that's the point I wanted to make. Thanks. Thanks, Councillor Rathbun. Thanks. Part of my question was the one that Councillor Adams has asked, but from page 77, it's saying that either the GMC nor the Nursing Midwifery Council will confirm whether any of the cases were taken or the result. I just wonder, what is the usual procedure then? What exactly happens here? And if that isn't happening, why isn't it happening? And what could be done to actually make sure that I'm just asking for names, of course. But are these five nurses and psychiatrists still employed by the service? And just to go back to Councillor Adams's question about sanctions, you know, what exactly does happen in this situation? And then lastly, Councillor Zafiropoulos. Thank you, Chair. I wanted to check if you could give us a sense of the proportion of patients that I ate. This observation of this, it's just a lot to have an idea of what is the challenge, how big it is. Thank you. Four questions there. One in terms of it's still continuing to Councillor Lynch's observations, but also about safe staffing. Three, Councillor Rathbun, on disciplinary aspect and four, Councillor Taylor, on the proportion to help fix the issue. So I'll start the answer, but thanks for getting into the details. It's probably worthwhile saying I think it's 77 that relates to NELF staff, not ELF staff. So the challenges and the way that they've been flagged, predominantly we're talking about NELF, not ELF. So that's the first thing to say. In terms of as a generic point, when falsified records are identified, then there is an internal disciplinary process that is followed. So ELF is very, very serious about the importance of accurate record keeping and patient safety. So there are cases where there are cases of falsified records, there are disciplinary processes that follow as a matter of course. So that's a generic point. Bex might want to talk about the challenges over the periods of time in terms of safe staffing and getting the safe staffing levels accurate or robust. Yeah, I mean, it wouldn't be a surprise to change and to understand that the context within which mental health services are operating at the moment is being the most challenging. I've been in healthcare for over 30 years and the population that we're currently serving at the moment is much more traumatised, it's got much more severe mental illness. We've heard about how you're seeing issues. So who's coming through a door and needing a huge amount of more support at a time within which we've also got workforce challenges? I am happy to be able to say that the inpatient services are fully recruited, but that's a kind of ongoing battle. I think in terms of why it's still a problem, I think ELF has been very clear that we've been very honest and transparent about what's happening. We're tackling it head on. There's been a recent commission of an external consultant to look at human factors, just to try and understand in a complex system what human factors are at play here that prevents people. But as I go back to my original point around having conversations live with nurses around why it's more important to acknowledge that you haven't done something and to leave a gap in the documentation is to fraudulently document that action, what we've done. So that is where a lot of our energy is taken on board, particularly around training, supporting. There is a very clear policy when we have acknowledged that there has been fraudulent documentation. As a commissioning manager myself, I will commission a preliminary investigation. There is a full trust policy that guides us into that. We're very keen to make sure that there is equitable responses across the trust. So the directors of nursing have very good sight of any preliminary investigation around the observations. And then from the preliminary investigation, we will take decisions around whether or not we commission a full disciplinary policy. Once that's been done, it would be a decision around the MMC, for example, to make forward referrals. The question in terms of that it's still continuing, how do you know that? How do you monitor that? I mean, there are audits, for example, that take place. So there are sure systems in place to give us the best chance of understanding whether or not observations are actually taking place as are recorded or documented. So that's one element of it. Occasionally, and this is exceptional, there might be an incident that happens where we then look into detail of what's happened in that instance. And we might find that there might have been erroneous recording of an observation. So there's a combination of things. I think there's the proactive assurance systems that we have in place to check to see what's happening and whether or not things happen. But also reactively, there might be an incident that takes place where we will then do a deep dive and find out there might be an issue with recording. The last question. What's the scale of the current ones? Are you able to deduce from that those different aspects? What's the scale of the current problems in terms of classification? I mean, we would say based on the data that Bex has indicated that we believe that the scale of the one is very small based on the data that we've got. And we can come back with a greater pot of data, if that would be helpful. But based on what we know, based on the data that we've got, based on the insurance we're doing, we believe that the scale of the problem is smaller than it used to be. It's comparatively small, we believe, based on the data. Yeah, I mean, it may be that when you, as I understand it, something has to go, something's going to the board fairly briefly. So it may be, once it has gone to the board, will it then hit public domain? For us to be able to perhaps try and understand that. And then lastly, in terms of Councillor Ratcliffe, I understand that there are a disciplinary process. But as I understand it, 11 people lost their lives in part because of, causatively because of, falsification. So are you able to say, or is the board able to say, whether those people are still practicing? A couple of answers. So the first thing is, the people that's going to trust the board will be shared with you. So you'll see the full detailed response to the PFD report. We'll share that with you. So you'll have the opportunity if you want to interrogate that report and invite us or other colleagues back to talk about the improvement work, we'll certainly do that. I might be being pedantic, and apologies if I am, but in terms of the 11 fatalities, I mean, my understanding is, it might be incorrect, but my understanding is there were instances of false records. But in terms of causality... Oh, then please correct me, I certainly don't want to, I certainly, if I misunderstood that, please do correct me on that. So that's why we're being pedantic. It's not been pedantic at all. So there were 11 fatalities that were found to be cases of erroneous record keeping, but I'm not aware of there being a causal link with those. Thank you, it's not a pedantic point at all. Thank you for making that clear. Okay, I think, one follow up and then I'm going to close it, we will look at the report when it's done, and we may well bring it back. My thinking about it was that you're actually, that final part you're saying that the issue is likely to be systemic, is what has a GMC or the Nursing and Midwifery Council said, or can they actually exert pressure in the right places? I mean, setting aside their behaviour regarding these individual cases, I'm interested to know how further action might be taken. And I've just seen Councillor Adebayo online who hasn't asked a question on this topic, and then I'll bring it to a close. Councillor Adebayo. Thank you, on page 71.1 about the case of Nwamed Ali. The guide passed away in 2020, but the report came out 2024. Just wondering, why the delay? Why does it take that long for the report to be out? Thank you, so Councillor Adebayo's question is just in terms of the delay aspect. Yes, so quite often, coroner's processes take a long time, so I think quite often when things hit the papers in terms of the deaths of individuals, it's not uncommon that the death has actually occurred three or four years prior, partly because of the whole process of things going to the coroner's process. So that's quite often the delays. That's one. In terms of the issues being systemic, and I think all health care providers will say that there are challenges in this area, inpatient providers. From an health point of view, I can speak about what we are doing. There'll be more detail in the report when it comes out of board, but the quality improvement work, which as Bex has said, links with IHI, which is an internationally renowned organisation, is part of our response, because we recognise that it's a systemic problem. We're trying to adopt best practice, and that's why we engage with, for example, the IHI. There's also networks that we are engaged with, both London-wide networks and wider networks, again to share the practice and to think about different ways of addressing the challenges that we've talked about in the report. So what we're committed to do is always pursue good practice and best practice where we can by engaging with professional bodies, good practice networks, etc. But I think what we're trying to recognise is whilst there are humans involved in processes, there will always be challenges, which is the human factors that Bex is talking about. Thank you. I'm going to draw it to a close there in terms of future actions, but obviously, as a committee, consider the report when it comes out, and it may well be we invite you back, or if there could be concern at a wider North East London level, and it goes to that committee instead. Thank you very much. You can be both, and obviously, thank you both for coming in as well. We appreciate that, and for your time. With that, members, I've sent out an action plan with respect to that item, so I'll draw that item to a close, but we will, given it's importance, we will revisit it. A minute's going to have those speakers read, please, from the last meeting. Thank you. Work programme is set out at the back of the agenda. I haven't been close to any AOB, and with that, I close the meeting. Thank you. [BLANK_AUDIO]