Transcript

[Applause] >> Good evening, everyone. Welcome to the meeting. My name is Councillor Steve Worrall. I'm Deputy Chair of the Health OSC. Unfortunately, Councillor Dobras is unable to attend the meeting tonight, and it's proposed that I chair the meeting in her absence. Is this agreed? Thank you. I'd also like to welcome our two new members to the committee, Councillor Kim Caddy and Councillor Sarah Davies. Welcome to the committee, and thank you for attending. I would like now to go and ask each member of the committee to please switch on the microphone and confirm their attendance. I won't call them out enough, but it's cool to just go around the table. If you can start with Councillor Henderson.

Oh, sorry. Yeah, present. >> Thank you. Present. >> If you can announce your name and -- Oh, sorry, Sarah Davies, Councillor Sarah Davies. Councillor Joe Rigby. >> Councillor Samuela Arthurage. Councillor Kim Caddy, good evening. >> Councillor Daniel Kussain, good evening. Councillor George Crivelli, good evening. >> Thank you very much. Do we have any apologies for absence? >> Yes, Councillor Caroline de la Sugell, she's absent this evening. >> Great. And we have Councillor Marshall as well, has given his apologies. Okay. So I would also like to welcome Sarah Foster, Vice Chair of Health Watch, who is present at the meeting today, and I will ask Sarah to comment on items as we go along in terms of the papers. I would also like to welcome Kate Slemek, apologies if I mispronounced your name, and Lucy Etheridge from St. George's Trust, who will be in attendance for the Trust's update report. And I would also like to welcome Tom Coffey and Prius Samuel from Southwest London St. George's Mental Health Trust who will be joining us online tonight. We also have a number of offices present in person and online, and I'll ask them to introduce themselves when they speak to different papers. Item number one, minutes. Are the minutes of the previous meeting held on the 21st of February 2004 agreed as the correct record? Great. Thank you very much. Declarations of interest. Are there any declarations, either pecuniary or non-registable interests? Please declare any interest, quoting the item and the paper number in which you have interest, and describing the nature of your interest, including whether or not you'll be taking part in the item. I would like to declare I am the Council-appointed representative of St. George's Trust. As the item is for information only and there are no decisions being made, I will remain in the room and be chairing the meeting. Item number one, the report from St. George's Trust and an update on the Trust's performance and other key issues. As before, I'd like to welcome Kate and Lucy from St. George's Trust and ask them to briefly report and introduce the report. Thank you, Chair. My name is Kate Slemek. I've actually got my name right, and I'm the managing director of St. George's, and I'm here with Lucy Etheridge, who is St. George's chief medical officer. And thank you for inviting us this evening. So I'm going to be very brief just introducing the paper. I'm very happy to take any questions that anybody has. We both are. So we've got a performance update in the paper and in brief we are performing well with regards to long waiters for RTT. We hope to have a minimum, a maximum rather, of 20 over 65-week waiters by the end of September. The government intention is zero, but we are well ahead of many other organizations and we're bringing our 52-week waiter numbers down as well. We are just short of compliance around cancer standards and I can go into a bit more detail on questions with regard to that. But we are compliant with regards to the sector requirement for 62 days, referral to treatment. ED continues to be a challenge. I think, as we all know, we've put in a number of different measures over the summer with a view to a more robust winter, and we can talk a little bit more about that if that's helpful. As you know, we're in a very challenged, I think, NHS and probably the UK, they're a very challenged financial environment. This is receiving a high level of focus by the organization and there are a number of things we're putting in place to deliver a 5.5% cost improvement program. We've made really good progress with our CQC actions in maternity and we're proud to have excellent outcomes in maternity and be second in the country around patient experience. And we're undertaking a sort of workforce, developing a new workforce plan. We've got a new chief people officer who started about a month ago and she's very focused on, we're looking at our standard of having more empowered and engaged staff. So there's a whole piece of work going on around that area. And then we've just, and lastly, but very importantly, the Children's Cancer Services, as you know, the plan is for those services to move to the Evelina and we're very much in the thick of transition planning with the Evelina and GSTT, happy to talk about that as well. I was going to leave it at that for an introduction and we're happy to take any questions. Great, thank you. Any questions from Councillors? Okay, first of all, Councillor Crowe, sorry, first of all, Councillor Crivelli. Can I thank you for your report? I just wanted to touch upon the last point that you made about the transfer of the cancer services to the Evelina. I appreciate that you'll be aware of what Wandsworth Council's position is of that and we're supportive of you and respect the fact that we don't want to see the transfer to the Evelina and we've still got until 2026 to fight that Coroner. But I just wanted you to know from a long term point of view, if it is the case that this transfer does go ahead, what impact do you think it could potentially have on other cancer treatment services that are being offered by St. George's right now? And by that I mean, is it the case that perhaps that there may be a reduction in other cancer services that you're offering? Because surely if it is the case that there's a transfer from St. George's to the Evelina, that's going to blow quite a bit of a hole in your budget, not to mention the fact that you don't have the existing level of cancer services that you have at this moment in time. So I'll make a start and I might bring Lucy in who's also a paediatrician clinically. So we don't anticipate this going beyond children's cancer. We are a large cancer provider in South West London and there's no indication that this will go beyond children's cancer. We are working very hard to look at the impacts if we do lose the services and thank you to Wandsworth for your support, we really do appreciate it. But we're obviously needing to engage in the transition program and alongside that we're working with NHSE regarding if this service does move, how do we recompense what we're losing, make sure we're not dealing with stranded costs and how do we build other elements of children's cancer services, for instance, POSQ services. There are things that we can deliver higher level POSQ services than we currently do and there are other things that we can replace some of the cancer work with but it's very much live work to see how that will work its way through. Pathology also could be quite significantly impacted and we're working through whether we can keep a lot of that work regardless of the service moving. So it is a risk, we're very aware of it and we're working very proactively and openly with NHSE and they've been quite open with us about how they're going to support us with the transition but also to build on some of the excellent alternative services that we provide. But Lucy, you may want to add to that. I don't think there's much more to add to that. The risk really is to children's services and particularly to the sort of tertiary level children's services that we provide across South West London and into Surrey. But as Kate says, we're very actively working with NHS England to look at building where we have strengths and then managing our networks including in children's cancer through the provision of enhanced POSQ services for the children of South West London. Great, thank you. I've got Councillor Davies and then Councillor Caddy next and then Councillor McBean. Thank you for this report. I'm interested in the section about maternity services. Here it talks about the challenges and particularly for people with protected characteristics and vulnerable groups. I just wondered if you could give a little bit more detail here. It talks about there are 11 outcomes and so if you could talk about that a little bit. So it's on page 10. It's the second bullet point there within the Equality Delivery System. So we recognise across the country that there are differential outcomes for women with protected characteristics, particularly women from black and minority ethnic backgrounds. And obviously within this area of London we do have a high population who have English as a second language and a high deprived population in the area. So I think this is a focus for maternity services generally. It's very much part of our focus at St George's, not necessarily linked to our CQC report for example, just part of our development work. And the sort of improvements that we've made recently include particularly in access to translation. This has been identified locally through review of incidents, for example, as an area that we need to focus on, which is why we've given it our attention. So would it be possible to have a report at some point so that we'd be able to benchmark the progress for those different cohorts? Yes, absolutely. We do collect that data. I don't have the stats to hand but I can tell you that we actually benchmark very well at St George's but we're happy to share that data. Thank you very much. Great, thank you. Councillor Caddy. Thank you very much, Chair. I've got three questions. Is that okay to just rocket through them? Or do I only get one? Two, oh my gosh, okay. Okay, I'll combine one and one and three. I guess overall, thank you very much, a really interesting report. The one thing I was going to ask for probably relates to what Councillor Davis said to some extent, because lots of this is great news and things that we can potentially share for our residents. So the lowest 65-week wait is obviously great news. I wondered if there were some simple metrics or there was a dashboard of key metrics that we could perhaps look at as part of this report so that we can then maybe even interrogate you on some of the other issues, because it's difficult to know, for example, talking about the 50 million deficit, where that stands in terms of the total budget, what that is compared to last year, whether that's important, whether that's going to be an issue. I'm not sure about the implications of a 50.1 million pound deficit that's referred to. It would be sort of interesting to be able to interrogate that a bit further. And then the second question was, on the maternity services, it said that there were 15 must-do actions, and I wondered how many of them had been addressed. And then I was just slightly concerned that it talked about the group evidence and assurance panel, which was implemented in July 2024, and I think the CQC report was a year before, and it just seemed like a really long time before that is implemented. I can pick all of those up. So we can certainly perhaps talk outside. We'll know about what would be helpful in terms of metrics to see in this report. We have, as you can imagine, an enormous number of metrics, and we measure our performance in lots of different ways. So really happy to help and support for anything that would embellish and support this report further. In terms of the deficit, we're one of the few sectors in London that posted a deficit and negotiated a deficit, really because we did not feel we could break even this year, and we didn't break even last year either. So we've been really open and transparent about that right from the beginning. We have to deliver all of our performance standards and key metrics and take the savings into account. So it shouldn't get in the way of us delivering what we should be delivering because we've actually worked it through to a level that we think is deliverable rather than being asked to deliver something that's impossible. So we've got a whole program of work around savings and transforming the way we do things. Improving productivity is a big part of it, and you'll see that in terms of government messaging. We've made a lot of inroads into improving theatre productivity, for instance, outpatient productivity, all of which brings in more income as well, so it's both sides of it. But yes, certainly we can look at other metrics that would be helpful. In terms of the maternities, in terms of the must-dos, we have dealt with all of the must-do actions, and we did that very quickly, and that was required of us. The reason there's a delay and a lag in terms of the evidence assurance panels, the way we've been overseeing this became quite onerous, and if you really look at how we're going to embed and assure ourselves that the evidence exists, staff know what's happening, that we've got an overarching group now set up across the group, across Epson, St. Helier, and St. George's to look at that, but it's replacing what went before rather than nothing being in place. So it's providing more firmer governance to deliver this going forward. I don't think you want to add, Lucy? No? That's okay. Great. Councillor Rigby. Yeah, so I was going to ask about the deficit, but just as a follow-up point on that, is everything going to be covered for the upcoming winter flu season? Can you reassure residents on that, please? Yeah, absolutely. We've got our flu vaccine planning being rolled out now. We do an enormous amount of winter planning because we know that we'll see COVID obviously coming in and going out during winter, other infectious IPC issues as well that you see a little bit more of in the winter and general pressure. So we have accounted for that. I mean, that is accounted for in our planning and our financial allowance, I suppose, to put it a better way. We've obviously got to look all the time about how we do things more efficiently and more effectively, but we're finalising our winter plan at the moment, but absolutely it'll be allowing for all of those scenarios and making sure we're undertaking a winter flu campaign. I've got another go for Councillor Caddy. You indicated that, and then, okay. And Councillor Davis also indicates that once speak, and then I'll take a last quick question from Councillor Goswami and then I'll go to Health Watch. Yeah, hello again. I just wondered if you could help iron something out for me, which I'm possibly not reading something correctly, but, you know, we know about the report and the rating of inadequate a year ago for not being safe. But then further down the page 10, it says we continue to be a safe environment for childbirth. And, you know, obviously I'm reading a contradiction there, but can you explain that for me, please? So obviously the CQCR regulator, and they undertook a number of, through their inspection, they picked up a number of issues around staffing, triage, et cetera, that we have had to improve. The ABBA safety comment is linked to our outcomes. We have really excellent outcomes at St George's in terms of our maternity unit, which we're really proud of. We have very good relationships between midwives and obstetricians, which I have to say doesn't exist in every unit. And we have excellent patient experience. I suppose for us it's just the risk of having an inadequate CQC inspection creates anxiety with people who might be planning to have their baby at St George's. And certainly initially we felt quite a bit of that. We've addressed all of the issues that the CQC raised, but we wanted to emphasize the great outcomes that we do have at St George's, and that has continued throughout. And I suppose the judgment of safety from the CQC isn't, they have a number of key lines of inquiry that they follow around safety, but it doesn't necessarily align to us not having good outcomes. So I hope that sort of explains it. Great. Final question from Councillor Gussain before I switch to Health Watch. Thank you, Chair. I've got a question about children's cancer services moving. I was wondering if you could give a bit more information about the support that will be available to families during transition. And I'm sure that support will be much appreciated and it's extremely welcome. But is the fact that you are providing support in a way, an admission that there is no hope for children's cancer services remain at St George's, is that the end of the campaign, so to speak? Or are there any other possible alternatives going forward? So I think in answer to the second part, and then I'll go back to the first part, I think we know that there's been a referral that's been put in, which obviously we thank Council for supporting that. But we do have to absolutely engage with the transition process. We're not able not to engage with that. And of course, if the referral is not successful, it's really important for us for our staff to be fully involved in planning a unit at the Evelina because we have a set of expertise that they just don't have there. So the Marsden and ourselves are both working collectively with the Evelina. I sit on a steering group with CJ Francis, who's one of our clinical chairs. And you've probably met CJ before when we've been discussing this topic. And I have to say the Evelina are working really effectively and transparently with us. They've been very open. They're working with families. So they're very much leading that discussion, but we're supporting at St. George's because clearly we have families who have children have quite complex needs and have to come to St. George's for their care and don't just have their care at the Marsden. So our families have slightly different perspectives than perhaps, oh, perhaps families coming from Marsden. So they've been very open to involving our families. We've been encouraging our families to get involved in the discussion. So it's an interesting and slightly uncomfortable place because we know that we all agree that it would be better if it stayed at St. George's. But if we don't engage and get involved, then there's a risk both to our patients and our staff that we're doing them both a disservice. Thank you. Sarah, if I could ask you, you submitted some questions if I can ask you to ask them, please. Thank you. Thank you, Chair. My first question is, it relates, I think, to Councillor Caddy and the metrics in the paper, because I think it's quite difficult sometimes to, because we get different metrics from different times and it's quite difficult. And one of the things we'd like to do in Health Watch, particularly in light of some of the report in the Darcy report, is actually reassure the local community about where St. George's sits in that thing. And the other, my follow-up question would be about the cancer waiting times. Are there any particular clinical areas that you have worries about in terms of cancer care and what's being done in those particular clinical areas that are perhaps performing more poorly than others? So in terms of, I think we can probably think about how we present the metrics. I must admit they're sort of embedded, aren't they, as you go through the report. And actually some of them are a bit out of date, and here by the time when the report is written and arrives. And certainly for elective care, we are top quartile in London in terms of the weights. Electively Wandsworth has really good weights, so it's something we should be really proud of. We know we've got a long way to go still to become 18-week compliant, but we are on our journey towards that. And we're eliminating 65-week waiters, and we're now working on our 52-week waiters. So I think that will come down. Cancer, we're almost there with all of our metrics in cancer as well, but we do have some tumor sites that really struggle to maintain performance. And Lucy may want to comment. I'll bring Lucy in in a minute. And those tumor sites are breast, skin, and skin really suffers from really high referrals in the summer and us then recovering. We're seeing higher referrals coming from GPs. They're going up and up and up, so it's how we make sure we've got one-stop clinics to be able to capture those patients, do everything they need done in order to move them through the pathway as quickly as possible. And the third area where we're quite challenged is Guiney. So they're the three. We've put quite a big investment into breast cancer, but we're just needing to land the additional investment with recruitment of the right people into the roles. And again, the referrals have gone up exponentially, and it's making sure we've always got the capacity available to meet the demand that's coming through the door, and we're able to flex that. And that's sometimes quite difficult, and particularly with breast and skin. And breast and skin are high-volume cancer referral specialties, so you really do need to be performing in those specialties in order to be cancer-compliant at aggregate level. Lucy, did you want to add to that? Yes, so I think, as Kate says, it's breast, guiney, and skin are our three areas where we're really focusing. In all of those areas, the conversion rate of a referral as a possible cancer to a diagnosis of cancer is very low. So our priority really is making sure that for patients that do have cancer, we're able to make that diagnosis quickly and we're able to move people onto the right treatment pathway so they get the ongoing care they need. So we really do need to think about the models of provision for that rapid access to diagnostics, one-stop shops, as Kate has described, so that we can very quickly make that diagnosis. And then we actually perform relatively well in terms of getting people onto their ongoing treatment pathway. We also do need to focus on the workforce, getting the workforce model right for this, and that is a challenge and is part of our workforce improvement plan. And also making use of novel technology, so, for example, teledermatology, which is being rolled out across London, so that we're more rapidly able to make a quick sort of diagnosis of yes needs to be seen or no is fine. And all of these are projects that are being rolled out. Thank you. As this paper requires no decision and the report is for information, can I ask Councillors, is this report noted? Thank you very much. Thanks, Kate and Lucy, for attending and updating the committee. It's really appreciated. Please feel free to stay if you want to see the rest of the committee meeting and listen to other items. But I fully understand and feel that you would like if you want to leave the meeting tonight. Thank you. I don't know if it's the recording, but it sounds like there's, like, a radio on very, very low. Is it the sound recording? I can just hear, like, a thank you. Okay. We're going to move on to the next paper, paper 231. I just want to check that Tom Coffey and Priya Samuel are online. Yeah, we're here. Thank you. Great. Okay. I'd like to welcome Tom Coffey and Priya Samuel from Southwith London Mental Health Trust and ask them to introduce the report. Thank you. So I'll start. And first of all, actually, my name is Tom Coffey. I'm a GP, and so I don't work for the Mental Health Trust. I work as a GP at the Brockham Bank Health Centre in Wandsworth. I'm the GP Mental Health Lead for Wandsworth, and I work for the Integrated Care Board in this role. And Priya works for Mental Health Trust and will keep you very much from the trust perspective. One thing I would like to say, I think St. George's might have disappeared by now, but they are very engaged with general practice as well. I've been a GP since 1993 in Wandsworth. I was born in Tooting, so very much like people here. I've lived my whole life in Wandsworth and lived and breathed the health service. In my presentation, I try to pick up some of the points that Councillor Warrell raised in advance so I can try to answer those questions that you posed to us prior to this meeting. And I suppose I want to start by thanking Shannon, the Public Health team, because a lot of what we do is based on the public health support and public health joint strategic needs assessment that is done on mental health quite regularly to allow us to plan our services accordingly. And Graham Markwell, one of Shannon's consultants, works with us very closely and phenomenally effectively. And also, many of the services that we now provide for our residents are in fact provided by yourselves, by the local authority. So we've got very much a mixed economy, but services are provided by the NHS, but also in mental health, also provided by the local authority. What I'll try and do is talk about children first, then adults, just to give you a flavour of what we're doing at the moment. So children's services for mental health divided to Tier 1, which in essence are health visit school, nurses and general practice, and then also social care, social workers, Tier 2. And very, very much we look at the next level up of mental health provision. That is very much based around schools at the moment. So what we try to do is make sure all schools in Wandsworth have a mental health presence. That is a mixture of the mental health trailblazers, which cover about half the schools in Wandsworth, mental health professionals in West Wandsworth from the Mental Health Trust. And also, we work with some charities, significantly an organisation called Place to Be, which are based in a number of primary schools and also offer services for all our secondary schools. Also, we do work with South Thames College as well, and they've got a mental health team based in South Thames College to work with our younger adults. The local authority provides an excellent service called Family Consulting. This is led by your EdCite team, which provides services for children who are referred into the Mental Health Trust, and then to get their actual treatment, the EdCite team offer that excellent service. We also work with a new organisation called the Wells Centre, again in the community. And that's a summary of our Tier 2 services. Tier 3 are for our young people who are more unwell. They run a triage service, and they've got both general and specialist services like eating disorders, neurodiversity, you know, children in crisis and self-harming. And that's how we cover our children's services. One area which I think Councillor Warrell wanted to ask about was our ASD service and how that's operating. The Mental Health Trust runs a service for the over eight-year-olds, but under eight, naught to eight, it's a combined service by the local authority and by St George's. And that's where our biggest challenge is. There are long waiting lists in this service, as the number of children who have been referred into the service has grown over the last four or five years, but the capacity in the service hasn't matched that. Also, the service about four years ago by your previous council did some significant changes to try to make some cost savings, but that has resulted in a service now, which is perhaps underfunded and doesn't really have the capacity to provide a service for the children and young people that is needed. It does more on post-diagnostic support, which the local authority runs very effectively, but waiting to get a diagnosis can often be up to 18 months, which is unacceptable for children and their parents. We're looking at a new service designed to try to address that concerns, with St George's taking a greater lead and the local authority having a lesser lead to try to address this issue, but that will come with a cost, which we will be discussing within the ICB at a later date. For adults, again, it's very much a three-tier service. We have adult services for in general practice, which is very much GPs, but also we have a new service and it's done by, it's called an ARS service, additional role service. The government gave some investment in the general practice to try to increase the capacity within general practice, and one of the new roles was a mental health worker. So the GPs, I think that's six out of the nine primary care networks have got an assistant psychologist based in our practices working with our patients. And then the third service within general practice is called primary care plus. That's for our patients who've got a severe injury, mental illness, like schizophrenia or serious depression and that group who are very in need of great care, get the input accordingly. In a community, we've got a whole host of services, including our community mental health teams, our talking therapy service, but also a new program called MHIP. And again, this is a question I think asked by Councillor Warrell, which is the ethnicity mental health improvement project, which we are now developing, trying to develop some new hubs in Wandsworth to try to make sure we address the stark inequalities highlighted in Sharon's report amongst that BME community for mental health access, experience and outcomes. We're trying to do some family support work to get families involved in supporting adults with mental health admissions, but trying to make sure we reduce the control and restraint in the hospitals. We're trying to make sure there's greater culture capability training within the hospitals and the hubs that I mentioned. One we've got at the moment on Beechcroft Road and one in Mushka Lausanne near Tooting Broadway. And we're looking for two new hubs, one in Battersea and one in West Wandsworth to make sure all of Wandsworth is covered. And these hubs will be the centre of many of our community programs over the next few years. And then the third level, of course, is the hospital system, very much for our inpatient care for the wards, which are principally based on the new Springfield site and some patients also on Tollworth. So that tries to summarise how our system works and where our challenges are. And there has been quite a lot of governance change as the ICB tries to address some financial challenges and reorganises and reduces by 30 per cent its management spend. That has a consequence. So therefore, it does mean that we've got less management support to deliver these programmes and transformation. It does mean some of the committees are undergoing continual review, which is happening in a moment and will be completed, I would imagine, by December. So that hopefully gives you an idea of how we operate within Wandsworth in the services for children and adults. Thank you. And Priya can probably talk about the Mental Health Trust itself from the Trust's perspective. Thank you, Tom. If I can do that now, Councillor Warrell? Thank you. So as Tom has shared with the committee, there are a range of organisations that are delivering mental health activities and programmes to support local residents, and this report really illustrates that. The Mental Health Trust will at the November Health and Committee provide a Trust specific update on services, so I just wanted to reassure the Health Committee of that and the timings. We always welcome support from partners, and particularly the Council, who have a great reach to residents and a direct reach to residents, and it would be great if we could co-promote our mental health initiatives using the Council's communication channels and networks to help support increase the awareness of the initiatives that are taking place, the support that's taking place, for example, the MHIP hubs that Tom has mentioned, and to be able to know of local network groups and contacts that the Council has so that we can make direct contact. Whilst the following initiatives are being led by the Mental Health Trust, I would like to say that these will have a positive impact to residents across the borough, so we are working with the Council's Arts and Culture team to deliver the London Borough of Culture activities planned for next year using Springfield Village as one of the sites, and we are also working with Wandsworth Chamber of Commerce to deliver a business breakfast event at Trinity in Springfield Village on the 17th of October. We're also planning the opening of a youth shelter in the park in the autumn, again, to help provide a place for young people to go and also use the park facilities, and also, once a date is confirmed, we will invite the Health Committee to the opening of the new park here at Springfield. We are planning a series of talking listening benches project on World Mental Health Day, which is on the 10th of October, which will have plaques featuring our Office of Support featured on the benches, and I will be sharing all those details with the local authority and with other partners. I think there's something that I would like to talk about, which is the Patient and Carer Race Equality Framework. It's the NHS's first ever anti-racism and accountability framework to tackle and eliminate the unacceptable racial inequalities in access, experience and outcomes faced by racialized and ethnically and culturally diverse communities, and to significantly improve the trust and confidence in mental health services. There are three core components. The first is legislative regulatory obligations, which is leadership governance. The second is national organizational competencies, and the third is the patient and carer's feedback mechanism. The implementation of PCREF will build upon the MHIP program's work, which Tom has mentioned earlier, to tackle health inequalities across Wandsworth in access, outcomes and experience of mental health services for black and brown people in our community. This will be a really significant component of our work to become an anti-racist organization and to tackle health inequalities moving forward. In terms of the implementation of PCREF, the Mental Health Trust has set up a task and finish group, which will input from internal stakeholders, including patients, carers, service line and corporate representatives with assistance from NHS England. Their role was to advise how we implement PCREF, completing a self-assessment and establishing an internal advancing race equality steering group. The group has already completed this task. The next step in terms of our advancing racial equality steering group will involve voluntary community organizations focusing on organizational competencies such as anti-racist partnership workforce and cultural awareness, such as the MHIP cultural capability and multicultural orientation and psychological safety. Through PCREF, it will be used as part of our planning and accountability and partnership framework for all future advancing racial equality initiatives. As part of this, a specific data strategy group has been set up to address data requirements based on health inequalities, duties and data gaps. And we have, as part of that, members from the public health team to co-produce and ensure that we are using existing data that's available. In terms of what's being done to involve local communities within the PCREF framework, we're using an inside-out approach, combining internal competencies with external insights to develop more innovative solutions aligned with our local priorities, such as community-based and community-led racial equality interventions. We're involving patients, carers and staff who represent the local community in the implementation, and focusing on different aspects of PCREF at any one time. They're also involved in other groups, such as the workforce racial equality strategy. Externally, we started collaborating with the voluntary sector through the MHIP funding in a limited capacity. Our plan is to establish a wider system advanced racial equality group involving and embedding the voluntary community sector. The goal is to build an alliance of black and ethnic minority organizations with the capacity to run community-based culturally formed services. The Trust's Chief Strategy Officer and the ICB colleagues are also leading on integrated ICS-wide data collaboration initiative aimed at improving quantitative and qualitative data, and this work will also involve voluntary and community sector representatives. I think what I will end on is to say that in November's report from the Trust, we will include more information about the ongoing work for PCREF and where we are. Thank you. Great. Thank you, Tom and Priya. There's a lot of information that's been given to us already. There's a lot of information in the paper. In the interests of time, because we have a number of items on the agenda, if I could ask counselors to keep their questions focused and any responses focused as well. So wow. Okay. A number -- so Counselor Carelli first. Okay. I'll try and keep this as focused as I can. I wanted to go to -- you're clearly doing a tremendous amount of work on trying to address the issues with mental health in schools and young people, and that's fantastic. You're really getting a grip on this. I wanted to just go to paragraphs like 11 and 12 in your report, which focuses on schools, and you've talked about the fact that you -- the mental health support for schools, you've got 40 percent coverage of CAMs for schools. You're trying to push that up to 80 percent. Can I just ask, if I've got this correct, you're looking at having -- in the long term, you're hoping to have 100 percent coverage of mental health support teams for schools. If I understand that correctly, correct me if I am wrong in saying that, and if that is the case, do you have a sort of target frame for when you think that would be achievable to have 100 percent coverage? The second point was you make reference to the children's well-being practitioner. That seems to be somebody who takes a very prominent role within trying to address the issues that you're talking about. Could you just tell us a little bit more about what the children's well-being practitioner does and what their qualification is to fulfill that role? Earlier on, you make reference to a clinical psychologist's lead. But if you could just tell us a little bit more about the children's well-being practitioner and their role, I'd be very grateful. Okay. Very quickly, so we've got three mental health support teams in Wandsworth. We're going to get a fourth one, which hopefully will start in December this year, and that will bring us up towards about 70 percent, and we'll get a fifth one, we hope, in 2026, which will bring us up to 100 percent. The children's well-being practitioner is a junior psychologist supported by a senior psychologist, and because we identified that Wes Wandsworth, the Roehampton and Putney area particularly, had real high need, but it hadn't been allocated when we put a bid in for a mental health school trailblazer support team, we decided to use our own money to say, Let's replicate that model in those Wes Wandsworth schools. So that's why, although we've got 40 percent coverage, adding in the CWPs, who are junior psychologists, that brings it up to 50 percent. Okay. Can I just ask very briefly, so they are all then junior psychologists, the children's well-being practitioners? They are, but they're always supported by the senior psychologist, and so they're, in fact, more qualified than the trailblazer team in the other schools. Okay, great. Thank you for that. I've got Councillor Rigby, Councillor Caddy, and then Councillor Cossain in that order. Yeah, just a quick one. You mentioned about wanting our help to push out this information. Would it be possible to get, like, some email content that you could send and we can bookmark it for the right moment? And also, if we could think about getting posters to put up in the estates and libraries, but you might already be on that. Thanks. Yes. Absolutely, yes. I'll liaise with, I'm guessing, the comms team with that from the council, but I'll double-check with council offices. Councillor Caddy. Thank you very much. Again, the report is full of interesting information, which I think residents would be delighted to know, so definitely support sharing that more widely. I wondered whether there was also the possibility to have some more data in there. It would be great to understand, for example, if I'm the mum of a teenage daughter, how quickly a child with an eating disorder would be seen, what the outcomes would be like, just some of that sort of solid data, what the demand has done, and just to be able to sort of tell people where one sits in comparison with other boroughs or previous years, it would be great to have some of that solid data, and also to support some of the equalities work as well. It would be great to see that. Thank you. And what we might be able to do is, in the November report, which Priya alluded to, we can make sure about waiting time data, because there's no use having a fantastic service that you wait 19 months for. So we need to have a good service that people can access in the appropriate time. As it happens, the children's eating disorder service is accessed in a few weeks, but we can get you the exact data which Priya can share with you in the November presentation. Thank you very much. Councillor Cassane. Thank you, Chair. I've got two question areas. The first area is similar to that covered by Councillor Corvelli, but I just want to dig a little bit deeper. When you say junior psychologist, do you mean an assistant psychologist, or do you mean a fully qualified clinical psychologist under a consultant clinical psychologist? So what I -- so they're not assistant psychologists. So what I don't want to do is give -- because assistant psychologists tend to be working in adults mainly. What I'll do -- can I get back to you the exact qualifications? Because that is led by the Mental Health Trust, and unless Priya has got that information -- I don't have that to hand, I'm afraid. I haven't got the exact qualifications. Yeah, if you could come back to us for that information. It's pretty important information. I work in this field myself, and to somebody who isn't part of this field and doesn't understand the difference between different types of practitioner, there is a very significant difference in terms of the sort of quality of provision that can be provided. So it is a pretty important thing, and it will enable us to determine the effectiveness of these mental health teams, if we know that a certain level of professional are contained within these teams. I'm also curious as to why it's up to three higher level clinicians, and why you can't be more specific about the number. Can I comment on that one? Can this conversation possibly be taken offline? It's quite a technical question around criteria, and it would be useful if they were able to send in the information to us, and then we can pick it up on that. I'm happy to do that. Can I ask a different question about the autism and social communication disorder pathway and the waiting lists? I mean, this is something that we've been living with a good amount of time. The autism and ADHD search has been happening for quite some time, and I'm just wondering why, because I used to work in the ones with access service doing neurodevelopmental assessments. This is getting on eight years ago. And, you know, it was a significant problem then, and it seemed that the problem's getting worse. I'm just wondering why it's still a significant problem, and why enough people aren't being seen as quickly as they need to be seen. Yes, so I'll try and answer that. So, in fact, so for the -- so how we divide our service in Wandsworth is, for ASD, under the age of eight, the diagnosis is done by the community pediatrics at St. George's in liaison with the local authority. Over the age of eight for ASD is done by the Mental Health Trust. For ADHD, the cut-off is age 11, and therefore under 11 it goes to St. George's, over 11 it goes to the Mental Health Trust. And Councillor Gussain was talking very much about the older age group. And, in fact, the performance for that age group actually is much, much better than the performance for the younger age group. The numbers, as it happens, are much greater in the under eights, because, as you can imagine, most parents and teachers, they start having the concerns about their children when they start entering nursery and early years educational settings. And that's when the referrals tend to come in. There are many less referrals for 9-, 10-, 11-, 12-year-olds. And so the Mental Health Trust does actually quite well. For the under eights, the issue was -- it's a bit of a history very quickly. We used to have something called a Garrett Park Autism Advisory Service. It was run by the local authority, and they did all the autism data assessments and collections, going to observe the children in their homes, in their schools, and they'd get a whole information pack, and there'd be an MDT meeting led by the pediatricians to work out, does the child have autism or not? That changed five years ago when that team was disbanded, and it was suggested then from now on, the data -- the information would be collected by the individual schools and by the parents. And what's happened at the same time as a new service came in, so the increase in number of referrals happened at the same time. And so many parents and many schools struggle to complete the information that is required to have the MDT assessments. So what's happened now, you've got many, many hundreds of children who are still in that data collection pathway and have been for a year because they're trying to get the five or six different forms all completed, and eventually they're brought together to the -- to St. George's. And when that happens, the actual process goes quite quickly. So by making a change which at the time was meant to be well-intentioned has resulted in a issue whereby we've got a massive backlog in children and being -- having the information collected in a very slow, inefficient way. Great. I'm going to draw questions to a close. Go across to Sarah at Health Watch, and if you could ask a question, please. Thank you. Actually, I was going to ask about PCREF, which I think Priya's covered. So that's the advantage of sending in the question in advance, I think, because we've got a very comprehensive answer. Thank you. And Sarah, just to confirm, we will, through the Mental Health Performance Update Report, provide further information about PCREF. So the Health Committee will be expecting that at its November meeting. I recognize this paper's probably generated a lot more other questions that were in clarification. If you could send your questions through, we can pass them through and seek answers and then get responses back and pass them on to council members. So thank you for that. This paper, there's no decision required. It's for information only. So can I ask, is the report noted? Great. And thank you, Tom and Priya, for a very comprehensive presentation. Lots of detail there, which has been really useful. And as I said, it probably has generated more questions for us that we'll be following through. But thank you. And, Piers, feel free to stay online and watch the rest of the session should you feel you wish to. Great. Next one is a verbal update on the supported housing acquisition for people at risk on the Springfield site. If I could remind officers if they could just introduce themselves before they present their papers or give any feedback for the viewing public. Thank you. Good evening. I'm Rachel Sony. I'm director of commissioning for the council in adult social care and public health. Just this paper is to provide committee members with a verbal update for a paper approved at our finance committee in July to enter into an agreement with London Square for an exciting opportunity for us to acquire and enter into a lease for London Square to develop the 56 units of supported housing for us. So really the verbal update that we wanted to add to in terms of the paper and ensure the health committee has sight of that is in particular around the delivery model. Things are progressing. We are entering into the agreement. It's part of a wider development, so works have already commenced. And the delivery model in particular is a mixed use site where we will be able to meet the needs of a range of people who we have a high need for supported housing in the borough. A lot of people are placed away from their local area. So people with learning disabilities, enduring mental health needs and care levers in particular means that this exciting opportunity we can bring the partnerships that we have and the established relationships that we have, we can bring our provider in to support that mixed use on the site. That supports our wider commissioning intentions to bring more people closer to home and have a wider supply of accommodation in the borough and with the right care and support providers. So we just wanted to update committee and let people know. Again, we've provided a briefing that gives assurance around the viability of the scheme and monitoring of the works, et cetera. And I'm happy to take questions from the committee if you have any. Thank you. Thanks, Rachel. Any questions from Councillors? Councillor CASSIDY. Thank you, Chair. I think this is a really promising initiative and I think there's lots that people across the Council Chamber will support. The only sort of query that I have really is the focus on one bedroom properties. Given that there are obviously plenty of people with significant mental health difficulties that are part of families and live with their families and may have significant housing needs, why they aren't catered for under these plans? Thank you for the question. Yes, majority of our demand for supported housing is predominantly for single people, people who are in housing need and in need of getting support with that housing. So having one bedroom flats will be a significant benefit to us to be able to house that population and that is the demand that we see. Where someone with a learning disability may want their carer or perhaps live in a community with other people with learning disabilities, there will be the flexibility in the development of the scheme and the arrangements within the building. We're working with the specialist occupational therapy housing lead who will help and is designing that special specification to meet those needs. So there is ability to have flexibility. But obviously we're trying to maximise the number of units that we can make available for residents. >> Thank you. Any further questions? No. Okay. As no decision is required and the verbal update is for information only, this is noted. Thank you. Next item is paper 232, response to the ballot petitions received by the council. There are a number of people who will be speaking in relation to this. Councillor Henderson has asked to make a comment first and then we will go to the presentation from the offices in relation to the paper. >> Thank you. Thank you, chair. If my voice sounds a bit croakish because it's still recovering from a minor throat procedure I had a few weeks ago, so hopefully it will hold up. I just simply wanted to set this within the correct context. Despite the title of the report, this isn't actually a specific response to the four petitions signed by 120 people, but a much broader description of what we have been doing to address issues in Ballym. And that's set out very clearly in paragraph six. Who is the head of community safety and I had discussions on Ballym and a number of other wards in early 2023, which were showing relatively high stats in relation to antisocial behaviour and crime. As a consequence, we agreed to establish a multi-agency task and finish group in March 23, which of course is before the petitions were actually launched and that's set out in paragraph 7. Now, we also agreed that the multi-agency task and finish group in Ballym should very much be a pilot to be rolled out elsewhere and in device, what is actually subsequently happened. So Ballym was very much the first trial. More generally, I should remind the committee that the current administration has doubled the resources in community safety from the previous administration, doubling the number of community safety officers and also employing an analyst who has been very good at enabling us to target our approach. And much of what has been done in Ballym, frankly, we wouldn't have been able to do without that additional resource. And that additional resource was set out in a paper to this committee in September 23, a year ago. It's called the Community Safety Growth Report. And that set out a whole range of different initiatives which we have been engaged in, some of which are actually referred to specifically in this Ballym report. Can I just say that this is, I mean, a personal observation. I mean, I do have some serious doubts as to whether petitions of this nature, particularly ones for petitions of 120 people, you know, is the best way of actually raising this issue. They don't actually seriously run the risk of creating unnecessary concern and perceptions about antisocial behavior and crime. And frankly, you know, there are other routes to deal with these things, particularly the safe and neighborhood teams and the walled panels, et cetera. I mean, the fact remains that one sort of is and remains the safest in the London City borough in terms of antisocial behavior and crime, despite last year's crime statistics, national crime statistics under the previous government, which were the worst ever recorded in history. Thank you. Thank you, Councillor Henderson. I just want to check that Kiran and Zoe are actually online. It's myself, Councillor Horrell. Okay. Thank you. If you'd like to present the papers, please. Sure. So Councillor Henderson has covered some of the key points. What I'd like to just draw members' attention to is in table 2 of the report, we've set out each area of concern for the Ballon Ward from burglary to vehicle crime, et cetera, and we provided details on the actions taken for those specific areas as well. We've also provided data as part of this. We reviewed the data for the period of February 2023 to January 2024, covering either side of the petitions as well. So we sort of set out what the crime figures look like for that ward. And section 7 of the report sets out some ongoing work that we've got as well. We've had a huge amount of positive community feedback about the work that we've done. We've managed to get the lighting resolved as well under the walkway near the station, and generally we've had really positive feedback from the local community. Councillor Henderson mentioned the extra resource where we doubled the community safety officers from three officers to six officers, and just to say that the Ballon Ward is covered by one of those three new officers that have come into post. So we have recruited all three officers and indeed the analyst as well. Happy to take any questions. Councillor Orell? Great. Thank you. Third point is Councillor Hedges has requested to speak to the committee. Is the committee in agreement for Councillor Hedges to speak on the four petitions? Great. Thank you very much. Councillor Hedges, you have up to five minutes to address the committee. Thank you, Chair, for letting me say a few words. Firstly, I'd like to thank the council's community safety team for all their hard work in tackling and preventing crime. I very much welcome the focus on Ballon Ward and appreciate all who inputted into this report. Before I was elected as Councillor in Ballum in May 2022, Councillor Hamilton and I spent some time supporting the previous Ballum and Nightingale Ward Councillors, surveying residents about specific concerns. We had many responses about crime and the fear of crime in the Ballum and Clapham South area. Of the thousands of residents we spoke to, women's safety came up time and time again, especially when walking after dark. Some of the examples we were given by residents include feeling harassed, followed, uncomfortable or threatened as a result of strange behaviour, petrified about walking in the dark, early morning and evening, concerns about lighting on Clapham and Tooting Commons and residential areas such as those close to Ballum Station and near bus stops. I raised these concerns back in April 2022 to Sergeant Annika Jones and her team at my very first Ballum Ward panel meeting with former Ballum Councillor Lucy Moat. We asked for improved lighting then, more CCTV, better education on personal safety strategies and the provision of safety alarms. I'm very pleased that the Met Police have delivered on their promise to conduct a Walk and Talk for Women in Ballum, which I have attended twice now. Over the past two years we have seen an increase in antisocial behaviour linked to rough sleeping on Ballum High Road, behind Sainsbury's in the car park and more recently on Ramsden Road and outside Ballum Library. Women still feel vulnerable, and indeed men, when using the cash dispenser close to where rough sleepers are and where they're drinking alcohol, catcalling and asking for money. We carried out these petitions at Councillor Henderson because we wanted residents to know that we were listening to them and that we would partner with the police and the council to lobby for improved safety in Ballum. Whilst there's still a lot more to do, I am pleased that the council and the police listened and they have taken action here in this report. It's also my birthday today and the best present the council and the Met Police could give is to tackle the rough sleeping in Ballum and the antisocial behaviour that is linked to it. So if you can help us make people feel safe again in Ballum and Clapham South area as well, that would be much appreciated. Thank you for letting me speak. Thank you Councillor Hedges. Before I go to general questions from Councillors, I'd ask Kieran, are there any responses to the issues raised? If I just focus on the rough sleeping, because that had quite extensive multi-agency work taking place because we recognised that the police were aware of some of the rough sleepers, our rough sleeping team, the sphere outreach team, they were aware of rough sleepers as well. So we collected quite a lot of information around the rough sleeping there. We identified 10 individuals and there was some close working to look at some of the case work with those individuals. One example was an individual who was actually from another borough was begging in rough sleeping in our area and in fact, they did have a property in another borough and they were subject to community protection notice. It's just an example of how the information sharing was intensified. We've kept a regular check on the rough sleeping in the area. I think we're down to maybe one or two, but we do regularly monitor the area as well. Great, thank you very much. Just as a reminder to Councillors, there's a lot of information already in the paper by responses from the Council, so I refer you back to this paper as well. Any questions from Councillors, please? Councillor Caddy and then Councillor Rigby. Very quickly, this is just an appeal to help and support the person who's living under Ballinbridge because I see him nearly every day. He's not being moved on or helped or supported and it is deeply frustrating because I went through this process with, I don't know if it's the same rough sleeper, but with someone under Ballinbridge two years ago and it does take a lot of work and effort, but they can be helped and they can be supported and it's not just the ASB, it's actually fit for their own good and for their support, their mental health. So I would really make a plea because he was there today twice when I went down there. Yeah, I know. Thank you. Thank you. Councillor Rigby? Yeah, so I thought it might be helpful, I don't know, Councillor Hedges, if you'd agree, if the officers could take this paper out of the big pack and create the link and then Councillor Hedges, you could email it to the 120 people that you did data capture for so then they can see what the council are doing. I thought that might be helpful. Would you be able? Yeah. Happy to send that across. Thank you. Great, thank you for the suggestion. Any further questions? No. Okay. There is an item for decision in relation to this paper. Does the committee support the recommendations in paragraph two of the paper? Thank you very much. The recommendations paragraph two are therefore supported by the committee. Right, moving on to the next paper, chapter 233, which is the implementation of the community trigger. Once again, Karen, across to you. Thank you, Chair. So in the Antisocial Behaviour Act 2014, it provided for a community safety partnership to set a process in place called the community trigger. In most local authorities, this process is managed by the community safety team, led by the council and supported by the partnership. We in 2023 started to review our process. It was pretty outdated. We had feedback from offices across the council, from partners. There was an ombudsman complaint and we had some feedback from some of the individual residents who were involved and we took all that feedback on board and reviewed the process. So the paper sets out what the community trigger is and in appendix one it lists all the key changes that we have made. In terms of the changes that we have made, members will note that we have changed some of the time scales of our responses and part of that is around understanding the process of what the community trigger is. So if a resident raises a concern and says we would like our case reviewed, on many occasions my team won't be involved in that case. So part of the process of assessing whether it meets the threshold or not is to collect and collate that information from partners. That could include the police, it could include NHS, it could include other council departments like social services, housing, and we need to allow time in order for us to collect that information. What my officers look at is what the response has been to that ASB complaint. We have been really clear on what that qualifying complaint is. So three complaints in the last six months, separate complaints of ASB. The emphasis of the community trigger is to enable a review. It's not a complaints process, so people still need to follow the complaints process for an organisation. It's basically a sort of peer review to understand whether the right steps have been taken to address the anti-social behaviour and support the victims and their families. As a result, we do hold, we collect the information, we decide if it meets the threshold. If it does, we hold a panel meeting, we make sure that the victims' voices throughout the whole process. In that panel meeting, we decide whether there could be further steps taken to address the ASB. And also just to reassure members, it doesn't mean that the support stops whilst this process is taking place. It's just like any other complaint where the individual will continue to get the support they need. If the case doesn't meet the threshold, we would still have conversations with other colleagues and partners. We would also ensure that there's some form of risk assessment that takes place as well. So not in all, the process is much more clearer. The document that you see in the report is quite detailed because that's, if you think about this whole process sitting across a number of different partners, we have been very prescriptive on the roles and responsibilities of each of the partners, what we will hold them accountable to. We have ASB leaflets across the borough. There'll be a link around the community trigger or the ASB reviews. Information will be available online, summarised as well in terms of how it works. There's an online form that we've put together as well and we've sort of refreshed that form as well. But in all, we have looked to improve that process. And I think finally, one of the key improvements we've made is that the case remains open with us. Once the panel has met and we go back and check with the complainant or the victim around the outcomes, if things have been put in place, then obviously follow up with other agencies just to make sure that there's that whole total sort of feedback to the victim or the community. And then we close the case. So happy to take any questions. Thank you very much. Any questions from committee members? Councillor Caddy first. Thanks very much. I do have some concerns about the impact that this will have on victims. When I speak as someone who has had to report ASB in the past, this just essentially puts the onus entirely back on the victim to have to get all the data together, to have to fill in the forms. And I just predict strongly that many victims won't be bothered. And I wonder whether there is an opportunity for a third party agency such as the council to effectively sort of pull the ASB community trigger on behalf of the victim. Because the victim is just going to be going through this Kafka-esque nightmare of having to explain all of the things that they've already explained to possibly three or four other agencies. Often the problems that would trigger or that would start off a community trigger are things like somebody losing the details and not doing anything and not getting passed to the right person. So the victim has probably had to go through this, getting the data three, four, five times and have to do it all again. I just find it unbelievable that they would ever do it. And certainly I don't think I would. The other issue is that obviously the council and the community safety team will be more aware of other complaints. A victim will only be aware of their particular complaints. So for example, if it's a neighbor making noise or someone in the street causing problems, there might have been only one complaint from one person in six months, but there might have been 25 complaints from other neighbors. But it's impossible for the victim to have that kind of overarching view, whereas the community safety team will obviously potentially have that overarching view. So I guess my concern is, is it possible to do it without having all of these kind of detailed questions and the victim having to go through it all again. And then very specifically on page 62, one of the questions is, can you confirm that as far as you know, no action has been taken? And it's very often not the case that no action has been taken. Often there's some action that's been taken, but it hasn't worked or there's some action that's been taken, but it hasn't been done quickly enough. And I just think that question will really put people off. Because if I was filling it in, for example, for my case, well, I can't say that no action has been taken, but I don't feel satisfied that the right action has been taken or in the appropriate time. So I feel that that question really needs to be looked at because I think that people would not answer that, would find it difficult to answer that. Thank you. Thank you, Kieran. I was wondering, are you in the position to actually directly answer that at the moment, or do you need to take it away and come back with a response? I can answer the question, Councillor Wirral. So just in terms of the council raising the community trigger, my team needs to stay independent of that because we're obviously looking at it quite independently. The request that we've had, I mean, we will -- you know, there's not too much of an onus on the person to raise the trigger. They can give us as much information or as little information as they have. And the additional time that we've put in is for us to collect all that data. So if they say to us they've reported it to the police, that's sufficient, or they've reported it to their landlord or housing, that's sufficient. It's for my officers to collect and collate a lot of that data around reports. And that would also pick up, for example, if we've had reports elsewhere in the system. So that whole 316 in terms of collecting data, we will do that. But, you know, it is the victim that needs to apply for the trigger. But also, they can go to another agency. So an agency can raise a community trigger as well. So, for example, the police could raise a community trigger if they feel they're dealing with a case that hasn't been dealt with sufficiently. Housing potentially could. So another part of the council could raise it as well. We've had them too. So there are various opportunities. Councilors can raise it on behalf of their constituents as well to give them the support and help. So that's the answer to the first bit. In terms of the question itself, point noted in terms of is there any action that's been taken? Potentially we can look at rephrasing that. Are they aware of? Because I appreciate the fact that they may not be aware of any action that's been taken. But we need to ask that in case, for example, they have been notified that, I don't know, there's been an eviction or an arrest or something like that. So we ask for as much information to be filled as possible. Once it comes in, our officers liaise with the individual who's raised it as well to provide them with that support. That is hugely reassuring. Really appreciate that. Thank you. Councillor Rea Thoreau, sorry. Thank you for this report. It's great to see the changes that are coming to the protocol and the procedures as a result of this. My only question, you kind of touched upon it, is that how will these new procedures and processes kind of be put forward to victims and to the public? Because at the moment it's quite a chunky document and, you know, victims don't want to be reading through pages and pages. So just wondering how that this would kind of translate easy to read to victims and the public. Sure. I think for the purpose of this committee, we've been quite detailed in the changes that we've made. So we've got that element of transparency in terms of how we're improving it. The information will be available online and it will be basically what the offer is, i.e., you know, this is the threshold and here's some of the service pledges that you would get. We will get back to you in 28 days, et cetera, et cetera. I don't think there'll be obviously that bit around. We'll be sharing information with agencies so we cover the whole information sharing piece. And that's why the victim has to confirm or authorize and agree to the community trigger being initiated because we are going to be going off and asking other agencies, the other than the council, for information sensitive and other about third parties including the victim and so on. So we obviously need their authorization to do that. So it will be quite simplified in terms of the leaflets that we put out. We already have some leaflets on the community trigger. And if anything, what we've provided you as the protocol, it's more to ensure that there's a really good process across the partnership because there are different partners involved and we need partners to work with us so that we can provide the best service possible when the trigger is raised. Great, thank you. Councillor Gassane. Thank you. There's a lot said about collaboration between different agencies. And on the one hand, that can be seen as responding comprehensively to any complaint. But there's also the potential I imagine for increased layers of bureaucracy there. So there's not much in this paper about the sort of the process and mechanism by which collaboration happens and how that process will be streamlined. So I'm wondering whether you could say a little bit more about that to ensure that, as Councillor Cady said, that people don't get lost in this Kafka nightmare with multiple agencies all sort of working on different levels. Sure. Just related to the earlier report around ballon, we mentioned this sort of approach around multi-agency response. So we've got a well-oiled process around sharing information across partners and colleagues. So sharing of information is pretty, I would say, when I say smooth, I'm saying that we know who to contact, which organisations to contact. There's a whole layer of partnership work. For me and my team, it's business as usual, working with colleagues across the council and across the partnership, including the police. So there are really good, strong partnership networks already in place. A lot of the partners, I mean, Community Trigger has been around for some time, so they're all familiar with it as well. So they do buy into the process. So I would say that there's a very tight process already in place. If anything, the improvements that we've made ensures that we do a whole wrap around the individual that initiates the trigger, and we take ownership of going back to the individual to say, okay, it's been two, three months, how's it going? Is there still ASB? Have the agencies delivered what they have? And we also check in with agencies to ensure that they have as well. Before we move to decision, any further questions? Okay. What I'd like to say as well is a big thank you and to recognise the amount of work that goes into preparing not only this paper, but behind the scenes, revising this, putting things together. It's often not recognised by the public and by ourselves, the amount of work and time and effort and the coordination that's involved. So I'd just like to say a big thank you for myself in relation to the work that's been done on this. There is a decision that needs to be made. Does the committee support the recommendations in paragraph two? Great. Okay. Therefore, the recommendations in paragraph two are therefore supported by the committee, and thank you. Moving on to paper two, three, four, contain outbreak management fund. I believe this is being presented by Usman Khan. Is that correct? Thank you, Chair. So I'm Usman Khan. I work with Shannon. I'll introduce the paper. So the contained outbreak management fund was allocated in 2021 to local authorities in response to the impact of COVID-19 on population health and well being and to support local authority public health initiatives, including alleviating COVID-19 related health inequalities. This report focuses on and provides a detailed overview of comp funded projects and activities undertaken in bonds with during 2020 to 23 and 23 24 summarising the key outcomes and next steps. And the details are in the paper. Just to highlight that for our future preparedness, we have got a robust multi agency, Mossworth resilience forum pandemic plan, which was recently updated on is based on the London Resilience Interim Pandemic Response Framework published by United Kingdom Kingdom Health Security Agency in 2023. This plan details escalation triggers, strategic leadership responsibilities, communication framework and potential pressure points during the pandemic, incorporating lessons learned from COVID-19. This generic plan is available applicable to any pandemic and is being regularly tested through table talk exercises. So I'll stop here for any questions. Thank you. Great. Thank you. And before we move to any questions, I think it's important to recognise that this was a really difficult period for all for all for the communities and for the council and to recognise the response that members of the public as well as council officials actually made in making sure that we got through the COVID period and work together to support our local communities. So moving on to questions from the committee. Any questions? Council Davies. I just had a question about the different projects that were funded and whether possibly elsewhere there's an impact report available on the successes and the outcomes. So I think we provided some outcomes and outputs of the projects that were undertaken. There are different stages because some have been funded quite recently before the fund comes to an end by the end of this month. Some details are in the paper, but I've got some more details. If you are interested, I can share with you some outcomes and outputs that are available. Any further questions? No? I'd like to pass across to Councillor Henderson. Thank you. Thank you, chair. And I would like to thank Ousmane for all the work that he's done in this field. It's clearly very important. And I think the report sets out the very many achievements which have been obtained as a consequence of the work and the investments. And certainly, Councillor Moore, you're absolutely correct. You know, we can only achieve this by working in partnership with residents and a whole range of other people. But in particular, one of the reasons for thanking Ousmane is that this will be his last meeting. He is sadly leaving us after three years having worked for Wandsworth and Richmond. But I'm very pleased to say, a bit sad, but pleased to say that congratulations to Ousmane because he's actually leaving us on promotion, which is always the best way to leave. So thank you, Ousmane, on behalf of Wandsworth Council and I'm sure the rest of the members. Thank you. Thank you very much, Councillor Henderson and the committee. There is no decision required on this paper. The report is for information only. It's report noted. Thank you. Our next paper is paper 235, which is the annual report of Health Watch Wandsworth. And if I can ask Sarah to speak to this. Thank you very much. I'll keep it quite brief because time's getting on. This is the annual report of Health Watch Wandsworth and it's the first year of a new contract, although Wandsworth Care Alliance, who holds the contract for this work, had it previously. I hope you've read some of the wide ranging things that we've achieved in Health Watch, which is basically a couple, well, two and a half full time equivalent people and a lot of volunteers who've managed to raise profile of user involvement in health and social care. A couple of changes, well, a couple of kind of tweaks this year in this year was an increased collaboration with the health watches across the ICS, which has been really helpful in sharing practice and sharing the load in terms of how we'd like to influence services. While we maintain a keen focus on Wandsworth and Wandsworth residents needs, but that has been a great advantage as the ICS has developed and got more mature in its approach. The other collaboration, which I think we've worked on a bit more, is with the other aspects of Wandsworth Care Alliance, which has obviously got a lot of links with voluntary agency work and has other health type and health and wellbeing projects within it and we're maximizing the amount of way we can work across with our voluntary sector, particularly in getting the views of more people who are not always heard and maintaining the relationship with some of those agencies. Big thanks to the staff who work very hard and to the volunteers. We do, as volunteers, we do a range of things, but we do have key representation on, I myself work on the governing body of the St. Georges. We have people in the Mental Health Trust. We have people across the ICS boards, which is why when we come to meetings like this we can make informed comments as well because we've got a lot of people with quite a lot of expertise across the health and social care context. The other challenge I think for us is always to work on how our work impacts change and that's I think something that we all grapple with sometimes, but we're continually looking for how we can assess whether what we're doing is making a difference on behalf of the community and I think there are some examples in the paper of where we have managed to do that very effectively. Thank you. I'm happy to take questions and Sarah, who wrote the report, is actually here to help if there's anything very technical. Any questions from committee members? Councillor Caddy. Thank you very much. It's not really actually a question. It was just to say that as a new member of the committee I learned a lot and I thought it was a fantastic report. It really brought to life what you do and I personally think that the value of getting service users' input and feedback is absolutely enormous, so I thought it was a fantastic report, really useful to read and I guess maybe as a question is there anything else that the council can be doing to support you and your work because I think it's great. Thank you for that. Well, yes. I think we have very good relations with a lot of organisations across and the fact that we're involved in these meetings and at a high level and a lower level, so some of the, for example, some of the things have been discussed today like with mental health trust, the autism work, you know, we get involved with that, so I think there is a feeling of great support for us and the organisation we sit within. Any further questions? Okay. Councillor Henderson. Very briefly, can I endorse what Sarah said about volunteers because they do an absolutely tremendous job and I think we owe them something of gratitude. Sarah, if you could pass on our thanks to the volunteers. Thanks. We'll do. We had a little celebration of some of our volunteers in volunteer week, but we'll certainly pass that down. Thank you very much. And from me as well, just to say a big thank you, Health Wash is often not recognised in terms of the amount of work that they do behind the scenes, challenging services, improving quality and supporting people using services, so a big thank you for that. I just want to pick up on Councillor Caddy's point, however, is that sometimes it's very difficult to know, for people to know that Health Watch actually exists, so anything that we can do to help you, please tell us how we can promote it as the council, as councillors, through different contexts we actually have, we need to sometimes be led by you to tell us how to promote it. Thank you. Thank you very much. We will do. Thank you. There's no decision required on this. It's for information only, so can I ask, is the report noted? Great. Thank you, everyone. Next paper, paper 136, which is the quarter one budget monitoring paper. I believe, Sarah, are you presenting this? Yes. Thank you, Councillor Laurel. I feel like there's lots of Sarahs here tonight, but I'm Sarah Evans. I'm Director of Business Resources in Adult Social Care and Public Health. This report provides an overview of the forecast revenue position for the remit of this committee, which includes adult social care and public health and community safety, as at quarter one for the financial year 24/25. The forecast position is an overspend of 2.2 million, compared to a revised budget of 97.3 million, which is just over 2%. There are significant budget challenges within adult social care and public health, and it's the budgets for our care services that are most challenged across all our client groups, which have experienced increased demand and rising care needs. Both complexity of need and market conditions are leading to increased prices within the market, and also significant pressure within the NHS is impacting adult social care, with patients being discharged more quickly into the care system. The report sets out mitigating actions the Directorate is taking, where we're continuing to focus on a strength-based approach to keep residents healthy and independent, thus preventing, reducing or delaying the need for long-term care services. The Directorate has a transformation programme, Transforming Social Care, and it's implementing a range of initiatives to help manage future demand for services and improve efficiency, which includes the use of digital technology, integrated health and care services, and a more strategic approach to mental health commissioning. However, as set out in the report, there are key financial risks and challenges that remain, not just for Wandsworth Council, but nationally, as evidenced by the recent ADAS survey, which highlighted nationally the financial position for directors of social services had significantly worsened. I'll stop there and I'm very happy to take any questions, along with my colleagues. Great, thanks very much. Questions? Councillor Caffee. Thank you for your report. You've talked about the fact that there's the overspending the budget, and I think we're all aware of the increased costs, the pressures on costs overall, but what I want to know is, over the forthcoming year, this isn't mentioned in the report, but are we looking at having a large increase, a significant increase in, say, for example, costs for non-residential and residential services by way of home care costs or other costs for service users? Is that something that you envisage? Certainly in home care, we have seen significant increases in the number of home care users and the number of hours that are being provided, so we've started to see a slight drop-off in residential care home places and our home care increasing, and what we are seeing within those home care packages is they're much more intensive, so if we look at home care packages 10 hours plus, there's been significant increases in that area, so yes, to answer your question, we are expecting that to continue to increase. What we'd like to see is that those home care packages increase with a corresponding decrease in residential care home packages, and I talk about, in the report, use of reablement, and in particular, part of our demand management is around increasing the use of community reablement with the aim, again, of then reducing or delaying the need for care packages going forward, and that would include home care. Sorry, can I just come back on that? Is there actually going to be an increased service charge for the care user then if they're using it as a result of the overall budget changes? We wouldn't charge. That would be the charges that the Council paid to the provider market. Okay, so you don't see any significant change within that. Okay, thank you. Thank you. Any further questions? Councillor Caddy. Thank you very much, Chair. It's just on the savings. I just wondered were there any sort of specific numbers by each of those projects? In my experience, if there's no specific hard plan for creating savings and getting savings and a sort of detailed method of doing that, it tends not to happen, and it might be that that's something that's happening in the background, but I just wanted to check that the savings program is sort of being looked at in that kind of detailed way. Yeah, as part of the Transforming Social Care program that Erle talked about, we monitor our savings, and there are specific targets attached to a range of savings. So, yes, we do monitor that in the background and can include that in future reports to the committee. That would be really useful, thank you. And I guess just a plea that, obviously, $97 million is a huge budget, and I appreciate that we're talking about sort of an increase of $2 million, but there is a whole $97 million that potentially we can look at for savings, and I just want to make sure that we're sort of digging around under all those stones. Councillor Gassane. Thank you, Chair. There will be a lot of pressures, financial pressures, and it's difficult to predict what those are, but I'm curious about the potential impact of the cessation of winter fuel payments, which could lead to an increase in demand for social care services, emergency support, plus increased costs with home adaptation and mental health services. I'm wondering if the Council will be considering the potential effect on those areas of this change in national policy, and what might be in place to mitigate those impacts? Thank you, thanks for that question. I don't have an answer to that currently, I think it will be cross directorate in terms of any response that's done to that, so that work will be ongoing, but we haven't done anything specific within adult social care and public health at this stage. Thank you. So although there may not be any new initiatives on the horizon, the Council does have an ongoing winter warmth programme that helps people with a range of different offers, whether it's adaptations within their households to try and improve energy efficiency or linking them into other existing funds, because there are some regional based funds as well as some local ones that can support people with their fuel bills during winter, so all that work will be ongoing, and those budgets were increased recently in the last couple of years. Before we -- sorry, Jeremy, you wanted to comment on that one? Yes, and just adding to what Shannon said, so the Council has a comprehensive programme looking at the impacts of the cost of living crisis, so a lot of the actions being taken there will positively impact on this group, but particularly in relation to the winter fuel payment, we're looking at making sure everyone who's entitled to pension credits is then claiming that and receiving that, because that's a key factor that will then ensure they're receiving the people that need the winter fuel payments. So we already do targeted work on that, so for example, when people have a financial assessment, our offices can identify whether people are missing out on pension credit and then can proactively help them or refer them to -- we've got a special service we commission with CAB to help people, but we're looking at how we can step up that work as we approach this winter. Thank you. Councillor Henderson, do you want any comments and relations of the paper? Yeah, thank you. Very briefly, the first thing I'd like to say is that this is the first time a paper like this has actually come to a scrutiny committee. Here are two. Scrutiny committees were left pretty much in the dark in terms of how their departments that they supposed to monitor were actually spending their money, unless they delved into several hundred pages of the finance resource scrutiny committee, et cetera. So this is very much part of the administration's commitment to transparency and openness, and really putting the onus upon scrutiny committees to actually monitor what is actually happening. And, you know, the scrutiny committees are frequently asked to approve procurements running into millions of pounds, and they certainly write that they should actually see what the outcome of that is, specifically in relation to the change in the winter fuel at that, and suddenly endorse what Mr De Sousa has actually said. The cabinet are actually looking at this very closely. We had a good discussion about that about a week ago. This is a work in progress, and you will hear more in the future. Thank you. Thank you, Councillor Henderson. In relation to the paper, there's no decision required, and the report is for information only, so is the report noted? Thank you, fellow Councillors. Last paper of the evening, paper 237, which is the Richmond and Wandsworth Safeguarding Adults' Board Annual Report. If I can ask Mr De Sousa to respond. Thank you, Chair. So I'm introducing the annual report of the Richmond and Wandsworth Safeguarding Adults' Board on behalf of the Safeguarding Adults' Board executive, and the Safeguarding Adults' Board is a multiagency partnership, which Wandsworth Council has established with its statutory partners, the police, and South West London ICB, but also jointly with Richmond Council, so it's the Richmond and Wandsworth Safeguarding Adults' Board. So I'm just going to highlight a few key points from the report for members. During the last year, the governance arrangements of our Safeguarding Adults' Board were reviewed, so a new strategic safeguarding Wandsworth partnership meeting has been established. So within our joint board arrangements, there's a very specific focus on the local priorities and working with partners about issues affecting the borough and keeping our residents safe. I just wanted to confirm and reassure the committee there continues to be very close collaboration with the Children's Safeguarding Partnership and also the Community Safety Partnership, so we're making sure that we're all working together in alignment to keep our residents safe. So the report sets out actions that have been taken during the year by the council and our local partners to safeguard residents, and that includes work on raising public awareness, including issues such as self-neglect and hate crime. The report highlights areas of focused work that took place during the last year, and that includes multiagency work on homelessness and rough sleeping and work on developing a modern slavery pathway. One of the key things the board does is it focuses on ensuring that we adopt learning and embed learning from any serious cases, so they're called safeguarding adult reviews or domestic homicide reviews or coroner's reports. So during the year, there weren't any safeguarding adults reviews for one's worth, but of course the focus remains on embedding learning from previous reviews and just improving practice and sharing best practice across the wider partnership. On pages 166 and 167 of the Agenda Pack, there's a focus on the borough's key safeguarding data. So you'll note there were 3,300 safeguarding concerns in the past year, and then those led to 1,000 safeguarding inquiries being undertaken. Both those figures have shown quite a big increase from the previous year, and that's set out in the report. The main types of abuse remain as being self-neglect and neglect and then financial abuse. The report does set out some data on the quality of the borough's regulated care services, and actually those are generally very good. So you'll note 87 percent of our care homes are rated as either good or outstanding, and 79 percent of our home care providers are good or outstanding. And where care providers do require improvement or are rated inadequate, we work very proactively, so our quality assurance team work with the Care Quality Commission on supporting those providers to improve their standards. Finally I want to just note, so our aim is about focusing on the outcomes for people in the safeguarding process, so to improve the quality of life and improve -- it's how we promote well-being and safety. So we aim to do this in a person-led, outcomes-focused way and supporting choice and control for our residents. So it's worth noting 95 percent of outcomes for our residents were fully or partially met in safeguarding cases, and that does show we are doing well in our approach to make safeguarding personal. That's the aim that we have. And also in 96 percent of cases, risks were removed or reduced, and that does indicate that our safeguarding multiagency arrangements are working effectively to keep our residents safe. So I'm happy to take questions along with Verinda Bassie, our head of safeguarding adults, who's available online. Thank you. Great, thank you. Any questions? Councillor Davies. Thank you for the report. Yeah, which made really interesting reading. I noticed somewhere for rough sleepers, you know, there's good outcomes, but I wondered what room there is for sort of ensuring continuity of progress from good onwards. I'm going to ask Verinda to answer that question, and I can add anything if needed. And actually our colleague, Ali Smith, who's our safeguarding board partnership manager, is also available. Thank you. Thank you, Jeremy. I think to some extent from community safety has also kind of covered that, and we link very closely with some of the outreach teams around rough sleeping and spares. So it's something that we generally would monitor each year, kind of get feedback in terms of outcomes for individuals, and kind of look at that partnership working across, ensuring that people that have quite complex needs are being supported correctly. And I think it is about having just those links across partners, and understanding who to contact when there is quite a complex situation. Thank you. Councillor Henderson. Thanks, Chair. I mean, just on that, officers have recently, in conjunction with the UICB and other interests, completed a survey of the health needs and issues affecting homeless people. The first time a survey has been done in Wandsworth since 2013. Their report is due to go to the health and wellbeing board later, actually October 3rd is the next meeting. It does actually contain a lot of very interesting information, and I'm quite certain that once the health and wellbeing board has discussed it, and it is most appropriate to go there initially, because it does involve a lot of different agencies, but if the scrutiny committee is interested in seeing that report, I'm sure it could be made available to them. Thank you. Great. Thanks, Councillor Henderson. I think all of us around the table here would really like to see that report and the recommendations and insights shown in it. So thank you for sharing with us. We look forward to it. Any further questions from committee members? No? Okay. This paper, there is no decision required. The report is for information only. So can I ask, is the report noted? Great. Thank you. Well, that brings us to the end of tonight's meeting. I'd like to thank my fellow Councillors for insightful questions asked this evening, and also a big thank you to all the officers concerned in preparing the papers for us and sending them through and answering the questions that were raised this evening. So a big thank you for myself. And on that note, that's the end of the meeting. Thank you for attending and a safe journey home for everybody. [BLANK_AUDIO]