Transcript

Good evening and welcome to the Health and Wellbeing Board meeting. My name is Councillor Gulam Kibriya Choudhury, Lead Member for Health, Wellbeing and Social Care and I will be chairing this evening's meeting. This meeting is being filmed for the public website. Those participating in the meeting will be included in the footage. If any technical error occurs which prevents the remote attendees from participating I will decide if and how the meeting should proceed by taking advice from officers. I remind members at the meeting to only speak on my direction and engage and speak clearly into their microphones to ensure that their contributions can be properly recorded. Please virtual participants keep your microphone mute only when except when speaking and those physical attendants have their microphone turned on only when speaking. If remote attendees wish to speak please use the raised hand function, please do not use remote meeting chat function as it will not be seen by those of us in the physical meeting. I would remind members at the meeting to only speak on my direction and speak clearly into their microphones. Do we receive any apologies from our members? Not received any apologies of absence, Chair, but I note that some of the board are joining online, including Councillor Mayen and Councillor Cabia Ahmed, I think that's all. Also just to flag, Chair, it's not technical on the agenda, but just to flag that we have received a question from a member of the public to the board, it relates to weight management services. Unfortunately the questioner was unable to attend tonight, so what we'll do with the board's permission is we'll circulate both the question and the response the officers have prepared to the board and the questioner. I received apologies from Councillor Suluq, he is sick, and another one from Councillor Kabir Ahmed due to his son's illness, thank you. And item 1.2, minutes of the previous meeting and matters arising. Do all the members agree about our previous meeting -- minutes? Yes, thank you. And item 1.

It was just to sort of acknowledge that since the last meeting the DASI report has been published, we've had a look at it, I don't know if you could just say a few words about it and then maybe Warwick say how that's being sort of looked at at the ICB level, just because I think it's such an important report. I guess it's important that the Health and Wellbeing Board note that this has happened and it's going to be important. Thanks, Yeoman. As mentioned, so the DASI report was a report that was commissioned by the Secretary of State for Health. It's likely to shape the government's ten-year plan for the health service going forward. Three areas were looked at, patient access, quality of care and the overall performance of the health system, and there were a number of issues that were identified, key challenges around waiting times being too long, people struggling to see GPs, A&E performance being weak, so then the waiting times for A&Es was deemed to be too long, and a disparity, quite large disparities in terms of NHS spending between hospitals and the community, a number of causes identified, austerity being one, management reorganisations being another, but also poor staff and patient engagement were cited as key issues, and then dealing with the pandemic as well. There were a number of recommendations made, re-engaging staff and re-empowering patients was a key line there, changing the funding flows, so more funding for primary care, and pioneering or testing multidisciplinary models of care, such as neighbourhood health centres, and then clarifying roles and responsibilities of the NHS and the ICBs to ensure that there's the kind of right alignment across the piece. As Sherman has mentioned, the council and partners will be kind of digesting the implications of that, especially as it arises or influences kind of policy, and no doubt papers will be brought back to the Health and Wellbeing Board where it touches on our business. So just to add to that, and I won't say very much, but obviously the ICB and NHS partners will be looking at those recommendations and how that informs the delivery of what will be the 10-year forward plan within the NHS, but largely the report sets out what was already a direction of travel in terms of supporting more people in the community and how we do that and how we join up services, and the integrated neighbourhood teams being a vital component of that, which is one of the things we're already looking at in the bar. So it's not a change of direction, but it will give us more detail and more substance, I'm sure. Yes. Thank you. Now our agenda item is 1.3, is declaration of disclosable pecuniary interest, if any members have any interest with our agenda items, please, you can mention this. Thank you, Chair, nothing to declare. Thank you, Chair, nothing to declare, thank you. Do you have anything to declare with related to any agenda items today? Good evening, Chair, nothing to declare. Good evening, Chair, I have nothing to declare. And just clear reflection, my name is Councillor Ahmadul Kabir. Nothing to declare, Chair, thank you. Thank you. Now we have changed our agenda items, just chronological order. We will discuss first agenda item is 2.5, is better care fund review. Can ELLIAs now introduce themselves and the item? Please note you will have five minutes for your presentation. Thank you. Good evening, Chair and Board, my name is Iliya Islam, I'm the better care fund program lead, and today I am providing an update on the better care fund program review, the purpose being for the Board to note the update and provide any comments or any stay. Next slide, please. So sorry, there is an introduction slide, I'm not sure why it's not come up, but just by way of a very brief intro, the better care fund is a partnership program, it represents collaboration between national partners in NHS England, the Department of Health and Social Care, the Department for Leveling Up and Housing and Communities and the Local Government Association. There is a requirement for local systems to have a plan in line with the policy framework and to meet the four national conditions that are set out in Tower Hamlets. We have a two-year BCF plan which was signed off in July last year and runs to 2025. It was agreed to review the plan in preparation for the next policy round in 25/26. If you just stay on that slide. Sorry, I've just got very different slides here. So this slide is just providing the budget breakdown for the better care fund. The schemes funded through the BCF are statutory services to support some of our key services like reablement, hospital discharge and avoidable admissions. Most of the funding for these schemes are made up from baseline budgets that are badged against BCF and can't really be changed. We have approximately 35 BCF schemes that range from a single contract to several services under the banner of one scheme and the allocation of resources are labelled as a scheme as well. So in 2021, following the spending review, it was confirmed that the NHS minimum contribution to the BCF would rise in actual terms by 5.66% each year from 2022 to 2025. The minimum contributions to social care also increased by this percentage. We are currently waiting for the outcome of the forthcoming spending review to understand what the future uplifts might be from 25/26 onwards and the other contributions which have received an increase are the disabled facilities grant and the additional discharge funding. Next slide please. I think these are, sorry, these are not the right slides. Apologies for that. So essentially the slides that I have just to talk you through was about the objectives of the review that's being undertaken for the BCF at the moment. It is essentially to inform our plan for the next policy round. The review includes an audit of all the individual schemes, confirming their continued relevance and alignment to the BCF objectives as well as to our town Let's Together priorities. Overall, the review is a comprehensive process that seeks to be one that assesses the effectiveness of our current initiatives, the spend and establishes internal performance reporting. We are also looking to identify any future BCF schemes that we might want to put forward as recommendations to this board in December when we return and the review will also provide the baseline to inform our future BCF. There is a programme plan on a page and I'm happy to circulate it to the board via Ranjit after this meeting because it looks like this was a previous slide. So it's a plan that spans the 18 months that starts in January. It's themed across four areas. I won't go through the plan but we have the BCF core reporting, national reporting. We have by way of an update submitted our 24/25 planning template and this has received national approval at the beginning of August and we've just submitted our quarter one reporting for additional discharge spend. In addition to the individual scheme reviews, I'm also supporting the wider intermediate care and falls pathway reviews with a self-assessment against the NICE guidelines which is what we said we'd do in December when we came to this board. We're also working in partnership with the disabled facilities grant home adaptations project and just by way of an update on that, that's the slide, thank you, review on the progress. Essentially as I've said, there are 35 individual schemes that we badge against the BCF. The scope of the review has been to look at the expenditure to ascertain the spending position. I've undertaken stakeholder mapping into a central log. We've also for the first time in finance, we're mapping the cost centres into centralised logs. We're documenting any current projects and programmes in individual schemes that we'll support with developing our narrative for the next policy round or for quarterly reporting. We're endeavouring to capture the total number of service users or packages that are impacted by the BCF allocation. This is a short term sort of measure because we're essentially making an artificial distinction in many cases between the impact of the BCF and what services do as a whole. In the longer term, we might want to explore the development of an overarching high level equalities data set as a point of reference for BCF using the best available data that we have within social care and health. A large amount of the preliminary audit is completed and there's still some schemes that we are looking through at the moment. For the falls and intermediate care, we've developed the review matrix in partnership with ELFT and our reablement team in the council to include all the standards set out in the guidelines and we are meeting regularly to undertake that self-assessment. For the disabled facilities grant, I'm working with the senior responsible officer on the phase two project implementation, so to plan and deliver the five recommendations that were developed by the transformation PMO team review of the DFG process earlier on in the year. The project implementation plan has been developed and we're having ongoing discussions with the private home improvement team on data analysis and improvements. The final slide on this is the next steps. Essentially, we're looking to complete the review of the intermediate care and falls against the NICE guidelines by next month and also the individual scheme audit. We're looking to develop our BCF plan into quarter four of this year and we seek to come back to the health and wellbeing board with an update in December with proposals for the new plan. Thank you. Thank you for your presentation. Do members have any question, any query? Please. Yes. Do you hear me? Yes, I can hear you. Was that for me? Yes. OK. So can I ask my question? Yes, please ask the question, Councillor. Yes, so I just wanted to know about the budget allocation. How is it looking in terms of if you compare it to 23/24 with 24/25, I just wanted to know in terms of the programmes. Thank you for the question, Councillor. So essentially with the budget allocations, what we've done with the percentage uplift to the minimum NHS contributions is to apply them to the schemes that are funded by the minimum NHS contributions equally. And this is essentially the baseline standard inflationary pressures that we have against resources and services that this has funded. So that's the difference with the funding between 23/24 and 24/25. Thank you. Thank you. A question? No, that's fine. Thank you, Chair. Thank you, Councillor Wahid. Thank you, Chair. I just want to understand in terms of the strategy on page 388 where it says the strategy is grounded on six principles, how have we come up with this in terms of what sort of method we used, so it says to the principle that matters most to the residents of the Hamlets, how have we in terms of collated this information, what are the methods used in terms of consultation, et cetera, do we have that data available for us to have a look at? Thank you. Thank you, Councillor, for the question. Essentially the metrics are set on a national level by the national teams. There are five BCF objectives, which is what we have been reporting on, and they are related to falls, admissions avoidance, discharge to usual place of residence and discharge from hospital, and these are the measures that the national partners have decided on against the policy framework that we report on for the BCF. That's fine, but obviously nationally we have in terms of that will show you a certain picture, but how is it localised for residents? Because nationally, if you say nationally, that's fine, but bar to bar, area to area, it will be different. So how do we then because it says here clearly the principle that matters most to the residents of the borough. So are you saying nationally it's all the same? So I want to understand in terms of how does it fit in with town Hamlets, because I'm concerned about my residents here. Nationally, you know, you can go if you want to do something nationally, that's fine, but localising it, because how is that in terms of reflected of the residents of this borough. I want to understand that. Thank you. So essentially, the schemes under the BCF are core services which have their individual monitoring data set. Some of this is hospital data and acute setting data. Some of this is within contracts that we commission within adult social care. So that data is, again, for us to have kind of standard data that we bring together within health and social care is not something that is developed here in Tower Hamlets. I have been undertaking some benchmarking with our local North East London boroughs as well. It's not something that they do, but it's something that we could definitely look into for our future BCF sort of monitoring plan. So the other thing I would just add to that as well is that although those are six national principles and priorities that we are working to, we also build those into our local Tower Hamlets plan. So health and social care partners working together identify the kind of key priorities that we need to work with, and those have been here to this board previously. But these six principles were part of that local plan. Thank you. So I'm not sure if I was reading the right thing, but it's -- the thing I was reading said one of the objectives was to -- excuse me -- ensure co-production is embedded in the review. Could you say a little bit about that? Thank you. Sure. Thank you for the question. So essentially in undertaking the audit, the ambition as always, because we have a co-production framework and ladder here in Tower Hamlets, is to have that running through. However, it's something that we need to identify in terms of where it best fits. So at the moment, it's been best fitting within our stakeholder communication. So looking at case studies, spotlight case study, which we are bringing to internal stakeholders about how BCF funding is impacting them. So going forward, I think it's about finding, where appropriate, we can include residents and service users into informing our future BCF plan. At the moment, we're currently undertaking a review of the individual existing schemes within the review, and that's sort of being undertaken by a core group that's made up of our finance teams across the ICB and the local authority and our performance monitoring teams as well. Question. Thank you. Question. We need to conclude this agenda. Thank you for your providing this information. Ongoing review on the Tower Hamlets Better Care Fund. I feel confident this piece of work will go a long way to preparing us to maintain best value in the social care sector post-2021. I think the Chair is just asking if the Board is happy to agree the recommendations of the report. Thank you. Now our next. Yes. Yes, yeah. Thank you. Thank you. Now our next agenda is 2.1. It's children's mental health. First, does the Board agree the reason for urgency as set out? Does the Board members agree first? Yeah? Waheed Belal. Are you agreed? Thank you. Agreed. Thank you. Thank you, Deputy Mayor. Thank you. Now I can request Steve Brady and Sara Wilson to introduce themselves and the item. Please note you will have only five minutes for your presentation. Thank you. Thank you, Chair. I just start by offering apologies for the late papers. They are all now attached for the meeting. And also if the Chair agrees, the next item is on the SEND strategy and effectively we were sharing that for information ahead of it going to Cabinet. So if the Chair is in agreement and the rest of the Board in agreement, I wanted if we could to use the majority of our time for those two items on our mental health presentation. Given as we discussed in previous meetings the serious issues around children's mental health and nationally it's been raised and our young people when we talk to them about issues that are affecting them, mental health is a significant issue for many of our young people. So this is a really important item and I'm grateful for our colleagues who have attended today from the Council and NHS services and they're going to run through a slide set and then take questions. Thank you. Thank you. Hi, I'm Katie Cole. I'm Associate Director of Public Health for Children and Families. When we - it was a big effort to write these slides because children's mental health is really important. It spans the entire system and the first slide you can see how when we talk about mental health we're not talking about a bad thing. Everybody has mental health. Some people have good mental health and sometimes it's not so good and it changes in your life. So mental health is a state of wellbeing and it's something that we can all do to improve that kind of wellbeing amongst children and young people in the borough. There's a lot of ways in public health in particular that we frame this. So we're not just thinking about the mental health services that support children when they have poor mental health, but we're thinking about the whole system and how it supports children from preconception up into adulthood and beyond. There's a number of different ways in which we can do that and make a real positive impact. So in your deck you can see a great slide that Angela Burns and the call developed that shows the points of intervention at an individual level, at a relationship level, community and that wider society impact. But because we have only a short period of time today we're going to focus more particularly on services and I'll hand over to Sarah. Thank you very much and my name is Sarah Wilson. I'm Director of Children and Specialist Services at East London Foundation Trust. If we can move on to the second slide, just going to highlight some of the key themes. So you will have heard that there's been a real increase in young people experiencing mental health difficulties and most recently that's reported as being one in five of 18 to 16 year olds and actually it's closer to one in four for 17 to 19 year olds. We know in Tower Hamlets and in London there have been real increases in demand for children and young people's mental health services. There have been increases in complexity and really big increases in young people presenting with neurodevelopmental challenges. We know as a system we need to prevent, we need to intervene as early as we possibly can and as close to home as possible. We talked about co-production in the last matter that you considered. Children and young people really want to be involved in planning and delivering this work and in the pack there's some lovely information about the Spotlight Wellbeing Ambassadors so hopefully you really get that voice of children in here. We know the social factors like poor housing, poverty, parental mental ill health are really making a difference in terms of children's poor mental health. We know we need to work together and as Katie said that's why we're all here together. The annual public health report has highlighted particular issues around the maternity and early years so complex social factors like poverty and domestic abuse, about one in four women experiencing mental health problems during that perinatal period so pregnancy in the first year after giving birth and they're not all getting access to the support they need. We don't have a huge amount of information about that really young area but we know with the family hubs programme where there's been additional investment we know that there's been opportunities to learn more and to offer more. You know very well we've got some of the highest child poverty rates in Tower Hamlets. We know that physical activity is incredibly important for emotional health and wellbeing as well as physical health and wellbeing but we know children in Tower Hamlets are not as active as many others in the country and really sad the issue about the pupil attitude survey. Children in Tower Hamlets are saying they're not as happy as they used to report being and that's in primary and secondary schools so it's much bigger than the sort of sharp end of mental health. It really is how can we empower our communities. Looking at the next slide partnership response and priorities actually I think I might have skipped but if you go to the next one after that please. So what we're doing is working together to deliver the accelerate strategy, the priority around mental health and wellbeing. There's a lot of resources and you'll see in the pack there's a lot of things going on across the system. Capacity in schools, health visiting, school nursing, huge amounts going on in primary care with our GPs, huge amounts going on with the voluntary sector. We've also got sort of specialist can services all the way from teams working in schools to 24/7 crisis services to inpatient services to eating disorder services. So there's provision there, it's how we map it, how we maximise it and how we use it in a really challenging financial environment as well. We're looking at using a framework called Thrive which is really about how we use the resources in the most logical way and again try to promote access first. And we're really also wanting to focus as a partnership on children and young people with special educational needs and disabilities. If I just go on to the next slide very quickly you'll see the Thrive framework which is what we're using as a system and it's being used nationally as well. And it's very much about as Katie said focusing on the wellbeing of the child and family so that the centre point which is how are we supporting thriving communities. We talk in the similar language, it's very much focused on the needs of children and families rather than looking at diagnoses. It's very much trying to be proactive and focus on outcomes for children and also reducing stigma and increasing accessibility. So that's how we're working as a system and if you were to move on to the final sort of front slide you'll see what we've done through Grace, our Joint Commissioning Lead, is look at mapping all of the different, or as many interventions as possible against the Thrive framework so you can see what's out there. But we will stop and open for questions. Thank you for your presentation. Do members have any questions, any clarification? Please, it's a very important piece of paper, children's mental health issues. Thanks very much for your presentation. I think maybe a few years ago we had some young people who came to talk about mental health as well and one of the key things that they mentioned was that they weren't clear what to do if they were experiencing mental health issues or particularly mental health crisis. So it was just a basic question about what have we done to improve that over the past few years or is there more that we need to do? I could start with that and I think that sort of practically the services that are available have increased, so there's been a lot of investment in children's mental health, particularly in schools, so that idea that you should be able to get help whenever you need it rather than waiting until you get to a crisis point. So that network of the Tower Hamlets Emotional Wellbeing Service, FUSE, I've probably given it the wrong title, but the network working across all of the schools is really important. There's obviously the access through the NHS 111 service in terms of the kind of real sharp end of crisis. We've also been able to invest in crisis and home treatment services, so there's stuff out there. I think the real challenge is how we get it out there, but whether anybody else would want to add. I can add a little bit. I'm Catherine Bell. I'm the Medical Director for Children's Services for ALF, I'm a child psychiatrist by background. I think all the things that Sarah said, so we recognise there's a need to almost de-specialise a lot of this stuff, so you shouldn't need to have to jump through hoops to be able to get into specialist camps. We'd like people to be able to access advice and intervention much earlier on in their journey, so how do we support schools' teams to be able to do that? How do we develop the schools' office so that people have got very easy access to that? We have already expanded the crisis services, expanded development of home treatment teams so that young people are not necessarily needing to go into hospital, but be able to get quick and early support. The other thing we're wanting to do is to work carefully with social care as well, to think about how we partner with social care, to think about the needs of the more complex cohort of young people who are often falling through gaps in systems, I think. So there's quite a few things that, trying to think really early on, early intervention, what can we do so that people don't have to spiral up through levels of system severeness, if you like, as well as thinking more broadly across the whole system. How do we work with children's social care? How do we work with the voluntary sector? How do we work with education? To think about a sort of whole system approach is kind of where we're aiming at. Sorry, can I just follow up? I just have one more point. So Grace Walker, Head of Commissioning and Strategy in the Council. We also have, you'll see in the PAC, there's an emotional mental health and wellbeing service where we're kind of currently prioritising working with the emerging kind of Young Tower Hamlets offer. So seeing how we can go to where young people are to this point around before children escalate into crisis. So that's like a current live piece of work that we're prioritising at the moment. Thanks. That sounds really good. It sounds like there's more services available. Do we have insight into the extent to which these services are being utilised more and do we have insight into which groups might not be, which young people may not be accessing those services as much as we like? So are we able to track progress in that way and understand which children may be experiencing mental health issues but not accessing services? I think there is, we have information, for example as Cathy talked about the group of children with particularly complex needs and that how do we as a system sort of join up and target those people. I think that's an area where we would have concerns and we would want to do additional work. I think we're very focused on schools so it's that thinking about the children, young people maybe who are not accessing schools so regularly and how we focus on that out of school cohort, children with special educational needs and disabilities, then potentially how they're able to access services and how we're adapting services appropriately. Grace? Yeah, so we have, so in terms of like listening to social care and those kind of children who are having more difficulties in their lives, we're kind of, we're putting additional emotional mental health and wellbeing support into the Youth Justice Service and alongside a CAMS worker and with our Care Lever cohort as well, we have emotional wellbeing and a CAMS practitioner in there to kind of provide that additional support for those young people who may be out of education or may kind of struggle to access kind of more mainstream services. And I think with that as well we have some children that maybe are accessing services but these services are not necessarily meeting their needs. So we are thinking about how we adapt or what services we already have that we need to adapt and modify to be able to meet the needs of particular groups, so particularly the neurodiverse group that we see in increasing numbers of children, particularly with autistic spectrum conditions presenting. So we're thinking about that. At the sort of pointy end, we did a strategic health needs analysis across not just Tower Hamlets but across all of the services and we know that admissions to inpatient services for children and adolescents are least used by Asian young people. I don't want to have a target that says that more Asian young people should be admitted to hospital, that seems wrong, but we do want to make sure that those young people, that we understand why that is. So is it that they're accessing services earlier or in other places, is it that they're being adequately supported by crisis home treatment teams, et cetera, or is there something else going on? So we are, I don't want to say more children will be admitted, that's just not what I'd like to see, but to understand that better we're looking at as well. Just quickly, we're planning a joint strategic needs assessment of children's mental health in Tower Hamlets this year. Thank you, Deputy Mayor. Please go on. Thank you, Chair. Thank you. Those slides and diagrams are very helpful and they're quite clear. My questions, I have two. One is related to school and parents and also young Tower Hamlets. So the first question is, what can we further do regarding engaging with parents? As Steve Redd is there, the Corporate Director for Children and Families as a council, what can we further do? Engaging more with the parents and also my other question is around schools. I mean, I can see, I can't remember the number, the page number. I think there are a lot of schools I engage in, but there are one or two or six or seven or not. Is there anything we can do as a council to kind of get them engaged? And my third question is around young Tower Hamlets. As you know, we're investing quite a lot of money and hopefully in the near future, we will be having a safe space in every ward. Which we will interact with lots of youth, lots of young people. So is there any role or anything young Tower Hamlets can do to support this program? Thank you. I think in terms of just speaking from the school's point of view, in terms of the mental health and school teams, they are two different teams and the aim is that by the end of next year, we should be, we are in majority of the schools, there is probably six, seven that we are not in, but with the new cohort that we've taken on, the aim is to be in all the schools in Tower Hamlets. So I'm hoping that that would increase engagement in terms of schools. Again, speaking from a camps point of view, sorry, I'm the General Manager for Tower Hamlets camps. In terms of engaging with parents, I'm sure we have working together groups locally, which is bi-monthly, we bring in young people and then we also bring in their carers, parents, family members. So that's an opportunity for them to obviously engage them in co-production, not just, they may have suggestions that they bring in that may be beneficial for the service, so we have an opportunity there. And then when we have projects locally in terms of whether it's a service redesign, a new offer, this is where we take. So there's something, I'm sure there are other collaboration opportunities within our partnership working, but that's what happens on the ground in terms of camps. On young Tower Hamlets, so yeah, so as I said, it's kind of quite early stages at the moment, so what we've done is we've kind of, as part of the scoping and sort of mapping in the drive, we've kind of identified some areas of overlap where we had some emotional wellbeing support going into schools with whose were actually able to kind of develop that. So we're kind of reframing some of the delivery of that so that we are going into those spaces. So we're working with group managers and the director in young Tower Hamlets at the moment to just think about how best to start to kind of pilot that kind of approach of clinicians being in those spaces and how they're kind of going to work with young people to kind of co-design what that might look like going forward in any kind of business cases around it. At the moment we don't need additional funding, it's quite a well-funded service, but going forward I think probably the more presence we have in the community, the more need we will inevitably find. So kind of thinking about how to develop that evidence base going forward so that we make sure those children get support in those safe spaces in the community. Thank you. I was just thinking about two things. So you were talking about parents, but I'm also quite interested in peer support. There's an award-winning scheme in Hackney called Tree of Life, and that trains young leaders to go into the schools and work with children there, and that's had a huge impact, and it's kind of culturally appropriate. So they train people from a similar cultural background to the students, and whilst the students didn't realise beforehand that that's what they wanted to have, afterwards they really appreciated it, and that's really on the preventative side of things. So I'm happy to give you more details. And then if there's some money to commission something similar in Tower Hamlets. And then there's the link with poverty. So there's this social welfare stocktake and looking at social welfare provision across Tower Hamlets, and I just wondered how you could tie some of your work in with that. So there's a rollout, for example, of social welfare advice to each GP practice in Tower Hamlets, and what the link with schools might be. I mean, it's just a kind of open question. I wanted to pick up particularly, I think, the idea about how we maximise the resources that are available and kind of point them in the direction of child mental health and wellbeing. So I think the point about peer education is absolutely right, and there have been interesting initiatives in Tower Hamlets as well already around that. So it's that how do we as a partnership catch all of the different opportunities and say this is our priority, our priority is around helping early, our priority is around developing neighbourhood resilience. That's a terrible word, isn't it? But neighbourhood capacity and confidence sort of talk about emotional health and wellbeing. So I think all of that makes a lot of sense. We've been talking about the poverty briefings initiatives around, there's an initiative called Poverty Briefing Schools, which is about working through the school day and looking at how the school can make it easier for children who are living and experiencing poverty to get through that day. So it's things like uniform policy, that sort of thing. But you can expand that poverty briefing initiative to other services, and we've had early discussions about how that could be applied across ELFT with the Director of Public Health who works in ELFT. So there's that. We've also got a pilot in the early years in the health visiting service called the Start for Life Workforce Pilot, where we're trying to join up perinatal mental health support alongside social prescribing and health, domestic violence for example, immunisations, sorry, and infant feeding support alongside routine care for immunisations. So there's a new team that we're developing. Thank you. Thank you, Councillor. Thank you, Chair. Thank you for the presentation. I just wanted to, I think in your presentation you highlighted in terms of the priorities, in terms of stakeholders, the partners, I think really important. And I think the deputy mayor has already basically asked the question in terms of how are we basically in terms of working with the schools and those schools which are not engaged, how we as a council can further support and basically get those schools on board. I think it's really important. I think it's fundamental that schools are involved in terms of going forward. But my question is around in terms of how members, someone like myself and colleagues, how can we help in terms of furthering this and basically promoting it. Do you have like in terms of things like healthcare champions, et cetera, and things like that. So do you have anything like that in the pipeline or how can we look at those kind of steps going forward? Thank you. We ourselves as leaders and also our communities know what's there. So there's a few different pieces of work that we're doing to try and discipline that we all need to adopt. So I'd say that's our number one challenge. In terms of being a champion for mental health, yes, great. I'm not sure if there are any particular programmes, we could probably look into that. But learning about mental health, moving beyond the stigma of it, finding a language that you're comfortable using and being able to kind of champion those services. Just to kind of support that, in camps we have rules called cultural advocates and that was developed keeping that in mind, the cultural sensitivity and the stigma that some parents bring in. So we have those staff members on site facilitating and supporting those helpful discussions with the parents, with the young people involved. So I think there is some work already happening but I agree, I think there is a lot more we can do. One second, thank you. Thank you. Before you come in, my question to you, what work are we doing to enable teachers and school staffs to support this mental health student? Thank you chair. It's a really important point. Our schools are absolutely critical in this debate. We do have some excellent practice locally and some really positive work that goes on alongside with our partners into schools. But I think what we've picked up and has been indicated is that it's not consistent and what we need to do is work with our school leaders on agreeing where we see good practice and how we can share that. Obviously the education landscape is quite complex now and there's lots of different types of leadership and governance in schools but I think we are building really strong relationships with school leaders. Tomorrow evening we've got all the chairs of school governing bodies for their termly meeting and this is something we'll talk to them about. I think our colleagues in Ofsted and others will be holding schools to account for their performance here but I think locally it's about building on and improving our relationship and ensuring all our school leaders are aware of what's really good practice because I think there's a lot to be proud of around the work in many of our schools and with our partners in health services but we also know, as has been said earlier in the meeting, that we're seeing a large rise in demand so we have to work out how we meet that. The other couple of things while I've got the microphone, we mentioned the family hubs, I think they're a really important development in terms of that question around how parents and families are briefed on these issues. Certainly I think Councillor makes a really good point around how members are champions for this agenda and being workplace wellbeing champions around mental health is one way of doing that. We're also looking with the Deputy Mayor at putting on a special session for all members which was particularly around SEND but we can include certainly mental health will be part of that briefing that we're going to offer to all council members hopefully within the next couple of months. I've got one question as well, if I may, is it okay, Chair, have I raised that? Colleagues will have seen where you see in the media briefings around the crisis in young people's mental health is what's often linked to that as well as the demand and issues that young people raise is timeliness and access in services so I'd just welcome views of colleagues here around locally what you think the position is and in terms of how we can work together as partners to address any issues as well as obviously the focus on prevention. Is there anything we can do to flag this as more of a priority for resourcing and staffing? Thank you. I could start with that. I think in terms of access I think broadly we're doing pretty well. I think that the challenges are areas like neurodevelopmental needs combined with mental health and we talked about the real demand that there is there so I think where young people are waiting, what we would say are long times, it's going to be for those areas. I think that the demand is growing and the resources are not growing. I think we've seen a period of growth over the last five plus years but that is stopping at the moment. I think there is fast access to crisis services, there is good access to inpatient beds, there is better access to intensive home treatment, really good services for children with eating disorders so there's a good range of access but I think some areas it's more challenging. I don't know if Kathy or Norm would add to that or Grace. I would agree with that. I think especially if you compare us to other parts of the country, those areas that Sarah has talked about, we are doing really, really well and I wouldn't worry about the child feeling that they've got a long way in a crisis. That isn't the case. What we'd like to think about is how we stop them getting there so I think we've got ever expanding demand for autism and ADHD assessments and I think that seems like a bottomless pit. I don't think the answer is to just do more and more assessments. I think we need to think radically about how we approach that. I think that's something we need to do in partnership with schools. What does it mean to have a diagnosis? How can we make something more needs led? How can we think differently about the needs of those children rather than sitting on a waiting list for a year or two years or whatever it is because that is a problem we're seeing everywhere, not just here. And then I think also how do we work with the system to think about how do we make services, all services, sort of neuro-diverse friendly from the get-go rather than waiting to have your needs identified. I think if we could do some of those things, some of the demand might reduce because you don't have to jump through those hoops to get what you need. So I think there's almost a bit of a sea change, if you like, in the way that we look at these children and the way that we look at the demand and how we work collectively around that. But as Sarah says, on the other areas, I think we're doing really, really well. If you're presenting in an emergency with an eating disorder, you'll be seen very quickly. If you need a bed, we have beds. But it's these other areas that we're struggling. And I think coming back to your point as well, I would like to think about how with sort of shrinking resource, how we can move to truly be able to move to a preventative viewpoint because that is really what we need to do. Lots of investment has been at the pointy end and we've got good service as a result, but we do need to think more preventatively. And I think, again, it's not just what can mental health services do. It's a system issue. How do we collectively come together to think about what we do differently or how we can be connected to the point over here about how we can be aware of what's going on to make sure that there is a really good early offer. I think the key to that is going to be schools. But I don't know whether that answers your question. Just going back to the waiting times, autism therapies, it's like a thing we all know. It's a place where we kind of feel like no matter how much investment we ask for and how much resource we try, we're ultimately moving towards a kind of shared understanding that the offer before a diagnosis is where. And we're doing some work at the moment in children's social care with colleagues around placements for children who are experiencing behavioural difficulties, some of it related to mental health, who don't have an autism diagnosis. So how they can kind of get the funding that they need, the support that they need so that they can be supported to live at home which comes back to resources and comes back to pressures in the system so that we don't have children who are waiting to be discharged who aren't getting the support that they need. So just kind of trying to think about how to rely on investment earlier on in the journey of those children. Due to time, Konstantin, I will take only one question from Mathieu. Thank you. Just sort of reflecting back on something you were saying earlier, obviously there's a lot of other factors which result in poor mental health, obviously housing, poverty, et cetera. So I suppose I want to find out what are the links with those services in order to let you talk about prevention. Are there links with housing, are there links with social welfare or community voluntary groups to try and start the prevention, to try and start that messaging early to families and young people? Certainly from a VCS perspective, VCS very much involved in provision across child mental health services. So obviously colleagues in Bernardo's were involved with the new service. We've got Coffee a Freak providing services. We've got many services involved. I think in terms of links to housing and other services. I guess you can link mental health services with housing, but linking mental health with housing without the services is much easier because as I'm sure you know when you ask the question, the living in overcrowded poor quality accommodation is a massive driver of poor mental health. There are other things like the quality of sleep, noise pollution, that sort of thing, the environmental indicators that drive poor mental health and they kind of sit outside of the mental health system generally and span all of the council's work really. The whole of the council contributes to the mental health of the population. Yeah, so I'm not sure quite how to break that one down. No, I mean absolutely. It's exactly I think it's a difficult situation to sort of resolve and really to not put it all on your step because like you said there's a lot of other factors which lead to people getting poor mental health, specifically children, in the circumstance. So I suppose really it's about the awareness with these other sectors to make sure that they are aware of your services if they come across young people or parents who are struggling with children who are suffering from crisis or prevention of crisis in the future. Thank you. Thank you, Steve. Thank you for your presentation. Definitely it's a serious issue, children's mental health. And everyone knows it's different social factors just like poverty, poor housing is influencing children's mental health and it's a big challenge. And as a parent, as a civil society, we need to do more because we know even if a child in his or her family have been facing mental health issues, then the whole family is facing a problem with the council, as a parent, as a teacher. We need to do more. And in Tower Hamlets, this report is clearly updating its epidemic. Thank you. One second. Thank you. Now we have another piece of paper. It's a very important paper. Sand Progress Update and Local Offer. Can Steve Brady and Lindsley-Bell introduce themselves and the item? You will have five minutes for your presentation. Thank you. Thank you, Chair. Members of the board, you'll see there's a range of documents that have been included with this agenda item. One is the annual report for SEND, which we've shared with a number of meetings and boards. But I wanted to particularly draw your attention to the SEN and Inclusion Strategy, which we have spent a significant amount of time consulting with young people and families and schools and providers and others, and we're bringing it to yourselves as a health and wellbeing board. It's also going to go to the council's cabinet as well in due course. So that was really unconscious of time and significant other items on the agenda. So I just really wanted to draw your attention to the draft SEND and Inclusion Strategy, which, as I said, has been revised and reviewed based on significant consultation with many groups of people. And I really just wanted to present that, and hopefully, happy to take any questions, but hopefully, given what a priority SEND is for ourselves and across the country, you would agree the need for this and would be supportive of the six priorities that are in the document, which, as I said, we've consulted widely upon. Happy to take any questions on any of the other documents and obviously, really grateful for colleagues' support with the new SEND and Inclusion Strategy. Thank you, Chair. Do members have any questions about SEND progress update, please? Thank you. Thank you. Thank you for your presentation. My first question is, this strategy focuses mostly on supporting children and autism spectrum disorder. What steps are we taking to improve support for young people with other diagnosis such as ADHD and OCD? And second one, it's my understanding that there is still a serious gap in our Council's SEND education offer for those over 16. Are we currently taking any steps to improve opportunities for SEND students after the complete sixth form? Thank you. Thank you, Chair. Just to confirm, yes, the strategy and the six priorities within it are to address all those conditions and certainly whilst, as we've heard, there's been a significant rise in particular presentation of needs such as autism, the strategy itself is a broad strategy and should be addressing all needs for our population. The issue around post-16, as you'll see in the strategy of the six priorities, two of the priorities are around how we work with young people and families and support them, but several of the priorities are specifically linked to the age phases of our young people and there's a specific priority within the strategy which is focused on the transition period. I think it's right that you flagged it up as an area that we want to put additional investment in support. We already do work closely with Children's Services and our Adult Services colleagues, but I think based on some of the feedback we've had from young people and families, we recognise it's certainly an area for development, particularly looking at areas such as education and training and employment and in terms of creating additional opportunities for young people with SCN to access training and the world of work and certainly we are putting additional investment in this year. The Mayor is committed to that additional investment to support transition linked to this strategy. Thank you. Members, don't have any questions, then we can conclude this item. It's great to see that this council is doing targeted work to support the same educational needs of marginalized groups like our Somali community and ensure that prejudice and inequality do not stop any child from getting the support they need because our EACP and everything is now the time is reducing. It's good. Thank you once again. Thank you Steve. Now our next item is Nel maternity and neonatal demand and capacity. Thank you. Thank you Philippa Cox and Kelly Wells. You can introduce yourself and the item. You will have five minutes for your presentation. Thank you. Thank you. Good afternoon or evening. I'm Philippa Cox. I'm the clinical lead for the North East London clinical maternity and neonatal system that sits in North East London ICB. The presentation we have for you today. If you want to go on the presentation. Sorry, I think we just present for five minutes first and then it would lead into. OK. OK. I'm James Courtney. Thank you. I'm a group director of midwifery for Bart's Health. Hi good evening. I'm a patient experience and quality lead midwife. Hi. Good evening. Thank you. We were asked to prepare a little bit of background for the committee board and on the offer at the Royal London just to set some context before the elements present their case for change. So on the next slide you'll see some background about the services at the Royal London offering care to around 6000 women a year and about 5000 babies are born in our services as well as being a local hospital for local residents of Tower Hamlets. We offer provide network services as well for maternal medicine for fetal medicine detailed cardiac scans of the babies while they're still in utero. Also for a fetal medicine unit which provides specific support for women coming in every day so they don't have to be inpatient and also really busy diabetic clinic to offer specialist care to local residents. So improving patient experience and equity of care. So there is a massive drive nationally as well as locally. So we've improved our referral pathway that now is translated into 100 languages where women can self-refer to our maternity services. I work quite closely with our community partnership organisations that includes women's inclusive team, our MNVP chair as well as practice and Limehouse where we conduct monthly antenatal education classes out in the community. So most recently on Monday we did a hypertension session and preeclampsia session and that was with our maternal medicine specialist midwife who caseloads all the women who have got complex care needs. So that's things like cardiomyopathies, women who've had any transplants or women who have, you know, require complex care. These forums are run on a monthly basis and it's an opportune time for women to have their voices heard. I'm then able then to give them on a monthly basis updates of what's going on with maternity and how their feedback is being utilised with driving quality improvement as well as shaping service improvement as well as. Most recently, as of in the last three weeks, we've been able to improve our translation services so we now have six iPads specifically designated for maternity across our labour ward, our triage and antenatal ward, postnatal, our stand-alone Barkentine birth centre and our antenatal clinic and that has been done to improve translation so it's language on meals, it provides translation 24 hours as well as British Sign Language. The next slide just shows some of the improvements that we're doing in our maternity triage. We've recently launched our BSOTS which is a Birmingham symptom specific triaging system that was on July the 29th and that has been done as a safety measure to ensure that each woman that presents to our maternity triage is actually triaged within 15 minutes and that was done to improve safety but also utilising women's feedback that they had given us as well. We're also looking at our demand and capacity for induction of labours, we've got quite a high induction of labour pathway and women who utilise that so we're looking at that across the NEL so that we can look at sharing workloads and as Royal London is the tertiary unit and we are most privileged to have things like our fetal medicine unit and a level 3 NICU. It also does mean that effectively our demand and capacity is quite raised so we are working quite closely with the LOMS to look at how we can share workload and for any sort of low risk induction of labours and women who are not presenting with any complexities in London so that's to ensure that women are having their inductions of labour on time. With regards to maternal mental health we have got a specialist perinatal mental health midwife who caseloads women and she does all the birth planning as well as all the antenatal appointments as well as their postnatal appointments and that's to ensure that women are getting the help that they need and it's in conjunction with looking at the birth trauma report and benchmarking our services to ensure that we're embedding all of the recommendations that came out of that report. The final slide from us was just a few questions of how we thought that as a committee and a board we could consider the report from the ICB and the now LMNS so how do we balance the needs of our local population against those women who require the specialist services that are being offered at the Royal London Hospital and how do we better utilise primary and community based care options such as GPs and community pharmacists to provide pregnant people with the care that they need near to their homes. How can we balance the high risk emergency medical care needed versus planned care for induction of labours and electives as their in sections and how can we all ensure that families get the best possible care when they're discharged home for example help with infant feeding. Thank you. The next presentation is a summary of the work that's currently being undertaken by North East London ICB in collaboration with Carnell Farrar and the next presentation is a summary of the work that's currently being undertaken by North East London ICB in collaboration with Carnell Farrar and the next presentation is a summary of the work that's currently being undertaken by North East London ICB in collaboration with Carnell Farrar looking at the demand and capacity across North East London Maternity Services. We're looking at how maternity services can meet the changing needs of women and babies. We've got more complex pregnancies. We've also got some areas that are predicted to have increased numbers of birth. The first stage of this work was taking an exercise to fully understand the issues that maternity services are facing. We were gathering information. We had a number of stakeholder events. We had a desktop review of data and that included analysis and looking at models of care. The second stage of work has been working in collaboration with the clinicians. Maternity clinical reference groups were set up and also neonatal reference groups were set up and we're currently undertaking engagements with service users across North East London both in person and through an online survey. These groups have been looking at different models of care guided by national clinical guidance, guidance that's been published by professional bodies such as the Royal College of Obstetrics and Gynecologists or the British Association of Perinatal Medicine and also recommendations that have come out of recent reports such as the Ockendon Report and the East Kent Report. The aim is to strengthen maternity pathways including antenatal and postnatal pathways and address the variation of quality across North East London including improving access of care and experience. Looking at delivering neonatal care in the appropriate settings and also looking at how we can enhance transitional care and also at home services. It gives us an opportunity to make the most of effective use of the staff that we have and also very importantly improve staff wellbeing. Maternity care has been split into four main areas pre-conception and access to care, antenatal care, birth and treatment and postnatal care. Neonatal review is looking at labour and the decision to admit inpatient stay and onward care. We see the enablers of having a culture of collaboration and we've truly seen that in the clinical groups, workshops. Communication and engagement and this is part of our communication engagement. Digital and informatic systems, making good use of the technology that's now available to us to develop a workforce strategy and looking at the estates and resources that we need to support this work. As I say we've completed the clinical working groups. We have very good engagement from across all maternity services. Currently we've had stakeholder engagement through workshops and as I say we're currently undertaking some service user engagement which has been well participated. So going forward Carnell Farrer currently writing up the work at the moment. The report which will have recommendations in it will be developed by the end of this week hopefully. The aim is to go to the ICB board in November and to all the trust boards for their review and to agree and finalise the recommendations and then it will then go out for consultation. If there is any decisions to be made. Thank you, do we have anything, something? Yeah, thank you. I'm from HealthWatch Tower Hamlet. HealthWatch in North East London has done quite a lot of work in this area as you see from the appendices. I'm just interested if any of you are aware of the MVP Chair quarterly report. I'm just going to go through, it's quarter one, I'm just going to go through the positive and negative feedback from a role learning perspective. So this was a walk, a patch which was done, there was 19 service users which was spoken to. So positive feedback was around excellent staff, helpful environment, breastfeeding support and clear communication. However the negative was around two yard issues, 10 of the responses reported negative experience of two yard. I know you mentioned that earlier so I just want to see the timeline if it relates to this quarterly report. There's also something around availability of rooms, there was delays, 8 responses for that. Rude and unhelpful staff, that was midwives and nerfs specifically. Communication issues, sorry, once again with midwives and there was also PN ward issues. So five responses reported uncleanness and lack of assistance and inattentive night staff. So I'm not really expecting to give you all the outcomes for each thing, I just want to know if you're aware of these and if actions are being taken from this feedback that you're receiving. Thank you. Thank you Matthew. Yes we did get the report from Vishali. It's actually the first report we've had from our MNVP for over a year so it's really welcome to get that feedback. We have obviously started reviewing it and it's a really sobering read from what our women were telling us. The report was for Q1 and our triage initiative started in August. So we're really early days, when we came to speak to the HOSC earlier we knew that we had challenges in that space. The way that women and birthing people are using triage as a 24/7 access all area has become incredibly challenging for us in terms of environment and resourcing and timeliness of care. So the new Birmingham system that we've implemented will help to stratify women into a pathway much like would happen in the Accident and Emergency Department so that you can see the most complex, most seriously ill people first and that becomes quite obvious to the care team. I think it very much feeds into the paper that Philip has presented about us exploring further what community-based offers could be for women so utilisation of primary care, utilisation of community-based pharmacy assets so that women don't see that the triage department in the acute maternity ward is their only option to get same-day care that we can look at other alternatives for that. Sabrina and I could talk a little bit more around the plans we've got for improvement around staff attitude because as you say it's a real sobering weed and something that unfortunately isn't a new find from this report. I'll hand over to Sabrina. Thank you. So it is something I'm aware of. I got the report Vishali kindly shared it with me and it is something that I've shared widely. In addition to that, myself and my counterparts who work across Newham and Whips Cross created a patient experience development day and what that is is a day for staff to attend and it's not just for midwives but it's also for obstetricians, our administrative staff, it's open for all and we go through things like civility, communication, we do some role play so we act out scenarios from feedback that we have gotten and that helps to bring some awareness for staff so that they can see actually sometimes how their communication can really impact patient experience. So as Shereen said, it's not something that we're not aware of. I'm very aware of it and it's something that is very much a priority. On top of that, we have expanded our birth reflection service. So myself, the two consultant midwives and one of our obstetricians, we do weekly clinics where we see women with a trauma informed approach and lens where we go through events of the birth, postnatal and any questions that they might have. Now there is plans to expand that out to our PMAs, our professional midwifery advocates so we can expand that service because we recognise actually there's a great need and there's a great demand and even between the four of us, the workload's quite high so we're looking at expanding that so that actually women can be seen in a timely fashion. So it's something that we're aware of and it's something that certainly we're working really hard to get on top of. Thank you. Thank you, it's really good to hear. Sorry, finally, based on what you've just said and all the improvements that are taking place, will that be available to the women service users? Is there some kind of, you said we did, are there posters, something along those lines so people can be aware of what's happening? Yeah, absolutely. So we have also recently been working on improving our environment so we've got new vinyls covering the walls with welcome messages so really making the environment much more holistic to a calmer, more welcoming approach for women. But also our improvement boards, so as the committee will be aware, we've been working with the maternity safety support programme as part of NHS England to look at all of the maternity services across bars and within that we've got a dedicated work stream looking at women and service users experience and each of those work streams has got a board which updates pieces of work. We're also really excited to be entering a phase with our MMVP where we can really start co-design and co-production of services. I think our MMVP has been very much in transition over the last year with the previous commissioner and the new one and we're looking forward to having a space where we can do that work together so that we can base anything that we want to do on actually what our women and service users really want. It was a question just to get your thoughts really. In our joint strategic needs assessment this year there was a really striking statistic around early uptake of antenatal care and it's really striking that TAM is a really significant outlier so a much higher proportion are accessing antenatal care late and I just wondered A whether that's visible from the ITB in terms of what you're looking at and B does that, what insights, does that accord with your experience and what your insights about why? The dates a little bit old so it's probably from a couple of years ago now so certainly when Sabrina and I came into post and working with our consultant midwife for public health it's something that we needed to change and turn the dial off. One of the things we recognised is we really didn't make it easy for women to refer themselves for our service. We had a form that you had to download from a desktop to computer, fill out in English and then email back as an attachment. That's not easy for most people let alone a service user that might not speak or understand English or has a digital poverty situation in her household. So as Sabrina presented on her slide we've now got a direct access self-referral form. It's available to translate at source in a hundred different languages. It sizes very well to a mobile phone or a tablet so you don't necessarily need a desktop computer and the majority of our referrals are now coming through that way. We're seeing our early refer rates so our rates of women coming into the service before 10 weeks completed of pregnancy now within the achievable levels that NHS England set for us. So they're around the 50% mark of women being seen by 10 weeks of pregnancy and then when you go up to 12 and 6 that's nearly all of the women that are coming through. If they refer on time they get seen on time. So we've already seen over the last couple of years of development some really positive change in that area. Do we now benchmark closer to the NEL averages than we did before? It's in our report so we keep an eye on it. We look at that rate every single month and we log it on an SPC chart so statistical process control so we can keep an eye on that fluctuation and identify any challenges we have. We put additional resourcing into our antenatal clinic to have weekend clinics so women and birthing peoples can access that service outside of a Monday to Friday environment and it's something we're really committed to continue to monitor. Now as a whole London as a whole is not as great as the rest of the country. We have to continue to work to make our services as accessible as possible. And I think it's important to add particularly with our birth reflection services. A lot of women who use our services also then will reuse our services and that's why we've had quite a drive for having birth trauma and birth reflections to ensure that when women are re-entering the service whether it's a year later, two years later, that actually they've dealt with the subsequent pregnancy and been able to process that. So we have seen, the reason why I'm bringing this up is because actually it was something that was flagged to me last Monday when I did an antenatal education session in the community where I asked women what was the reason as to why they're booking late and they had explained it was because they had previous traumatic experiences but hadn't actually accessed that service. So that's why we are expanding that service because we've actually recognised that actually being able to process any sort of experience before whether it's to do with the birth, post-natal or anything that potentially happens so that when they actually do re-enter the service because the majority of the women do re-enter the service that they actually have come into it and they've been able to process what's happened before. As far as the question around it being fed into the demand and capacity, yes it definitely is. It was work we undertook a couple of years ago to help inform our equity and quality plan and that in turn is going into the demand and capacity work. I have one question to you. Have you spoken at all with the Council's new Women's Commission on this work? But maternity health is one of their many great areas of focus and I believe their input would be very valuable to this piece of work. Please. Yes, we have Councillor Chaudry. They've had the presentation from all over London and my land. I'm sure they'll be reaching out to Nell colleagues as well but we're very much part of that review. Thank you. Thank you Adam Price. It's an important piece of paper as well and you will have five minutes to introduce yourself and the item as well. Thank you Chair. Regrettably I'm not Adam Price I'm afraid but I can be this evening if you wish. I'm actually Simon Smith the Head of Community Safety and I'm responsible for the VORG and hate crime team. Thank you very much for this evening Chair. I refer you first off to pages 163 to 278 of your pack this evening which refers to the 2024 to 2009 VORG and Women's Safety Strategy which is to be considered by Cabinet on the 16th of October. In advance of Cabinet this strategy is presented to you for your discussion and consideration with particular reference to the ownership, responsibility and wider contribution to ensure that VORG and Women's Safety is everyone's business. The context of this strategy is that we know that younger women, women with disabilities and black, Asian and minority ethnic women are more likely to experience gender-based violence and face barriers in accessing support. Tower Hamlets has the fourth highest rate of domestic abuse offences per 1000 of the population as measured in 22 and 23. In the years 23 to 24 the police received over 4000 domestic abuse reports from Tower Hamlets residents with five domestic homicides taking place over the past five years. However there has been significant work undertaken as part of the current 2019 to 24 VORG strategy which is highlighted in your Appendix 5. That has included training of almost 10,000 professionals in a range of topics, mainstreaming and raising the awareness of VORG and misogyny and commissioning and providing specialist support for victims of VORG with our independent domestic violence advocate service. The IDLA service received almost 6500 referrals since 2019 with a 96% satisfaction rate. The new strategy aims to build upon this work and broaden it just beyond the criminal justice and community safety service. The new strategy will focus on strengthening systems and leadership i.e. to make sure that VORG is everyone's business and to ensure responsibility, accountability and ownership from all stakeholders. We will adopt an intersectional approach recognising the way that different characteristics can compound vulnerabilities e.g. housing needs, substance misuse, mental health and the work within the strategy will fall into three priorities namely prevention and safety, supporting victims and survivors and responding to perpetrators. Within each of these priorities we have identified key areas of focus where we will build upon the significant work done under the form of strategy to improve what is already in place. The strategy will be supported by a detailed action plan which is being finalised with all key services and stakeholders. I'd like to ask Naveed just to contribute as to the development of the strategy and the methodology that was undertaken to come up with the final strategy. Thanks Simon. I just want to touch on the raft of work that we did in bringing the strategy together and in particular the work that we did in engaging stakeholders and residents to ensure that local views were reflected in the strategy that you see included in the papers. There are particular three items that I want to talk to. A needs assessment which is usually a staple when it comes to development of these sorts of strategies but in addition to the usual analysis of current provision, future need and gaps, there was a lot of work done by our public health team to engage local residents. There were over 370 residents of Tower Hamlets that were engaged in that particular process as well as 120 professionals working in the borough and their views were incorporated in that strategy. There were workshops held with residents but also key stakeholders and that's the usual stakeholders working in the kind of vogue space but in addition to that substance misuse colleagues were engaged, housing colleagues were engaged and also planning colleagues were engaged and that appendix for the gender inclusive design report just kind of reflects some of the innovative work that we've tried to incorporate in this particular strategy. And the final thing I want to touch on is the equalities analysis, obviously very important for Tower Hamlets and so we partnered with the Cornerstone Project with a lot of support from Tower Hamlets CVS as well as real Tower Hamlets Interfaith Forum and the Limehouse Project and what we did here was we developed an exemplar approach in how we conduct equalities impact assessments and although in and of itself the impact assessment did not identify any disproportionate and/or negative impact again the feedback that we got from stakeholders and residents was used to inform the strategy. So there's a lot of collaboration that we've had with residents and stakeholders in developing this work. No one is here today. That's fine. Do members have any question, any clarification please? Thanks Arjun. I guess your question is about the, I think what you call, yeah vogue is everyone's business. In terms of, because obviously this is the Health and Wellbeing Board and in terms of the partnerships across the health and care system are there areas that you feel that we need to develop and strengthen in terms of identification? Excellent. I mentioned the action plan that is currently in its final stages of authorisation. We have made significant inroads and building upon the strategy from last year where I think it's fair to say the strategy really did centre on the community safety team and the board team to deliver a significant part of that work. But I think that this year looking at the action plan in its current state that we have certainly engaged and managed to get a far wider cross-section of partners involved and that's been the result of a significant amount of outreach by the board team. So in terms of gaps, I think that the gap that I still see really does sit around I would say the education space more than the health space. I know that Steve mentioned earlier on some of the challenges around schools and engagement and I think that's an area of work that we do want to focus on because we do consider that some of the issues that we currently face around misogyny and violence really do need to be addressed with younger people in the school system. So there is a whole plan of activity which is going to be delivered by the board team focusing on the education space but we do need to navigate that to some degree due to the various challenges that we do have faced previously with the education system. Just coming back to those issues about identification of domestic abuse in, for instance, A&E settings or primary care settings, are we making inroads into that? Again, I met with the team this morning and there was a lot of discussion around the demand for health settings to be trained and how we're keeping up with that and the capacity for that. So I think that certainly there has been a sort of program of activity over the last five years that has certainly engaged with health care settings. I still think there is a significant amount of work to do which is reflected in the action plan that we've got that's being finalised. I think that it is the scale of the demands that may well be, we need to consider how that's managed and prioritise key focus points but the demand is significant but I just think we need to make further inroads. Thank you. I have one question for you. When will we be able to see a comprehensive delivery plan for this new strategy? Yes, thank you, Councillor. The delivery plan is literally this afternoon being signed off by the directors. It is going to be submitted for MAB consultation next week but as soon as that happens then we can have that circulated. But literally it is in its very final stage today so it will be imminent. Thank you. Thank you for your presentation and I am extremely pleased to see some truly ambitious goals in this strategy that include new specialised enforcement around women's safety, the delivery of more culturally specific victim support and community engagement service and commitment to meet the needs of our most marginalised female dissidents such as those involved in sexual exploitation and trans women. Thank you. Yes. Thank you, Margaret and Emily. This agenda is our Secrecy Inspection Readiness. Readiness is a very important paper for us because it is regarding our Secrecy Inspection Readiness. You will have five minutes to present this item and after that we will open this agenda for our members. Thank you, Councillor. My name is Margaret Young. I am the Interim Director of Adult Social Care and I was very happy to come into Tower Hamlets and to hear colleagues talking about the preparations that had been made. I am hoping that there will be an opportunity tonight to have a bit of confidence in that and also to realise how valuable our partnerships are in this process because I think there is a very good story to be told. I know we work in difficult circumstances sometimes that people have reflected on tonight but I think there is a good one for CQC. Now, for those of you who aren't aware, the CQC process is underway and it will be finished, they say, by the end of December next year. However, many London boroughs and ICB areas have already had their CQC inspections with various outcomes but, however, that is something we can learn from but we don't know exactly when they are going to arrive. First we will get a notification and that could happen and I believe at the moment they are saying Mondays a day. When we get a notification then we have to send in lots of information and Emily, who is sitting next to me, project managers on that side of the business and has got a big treasure trove of documents and some of you may well have contributed some that have been joint documents and lots of data. Then we go through possibly quite a lengthy process of more detailed discussion and preparations with individuals around our sort of mixed, you know, sort of through the ICB health partners and the local authority talking in detail about some of the areas. And that could take up to about six months before CQC might come and visit us. Could be a bit shorter but it's looking like months from what we can hear from other partners in London and up and down the country. I think now, as I've said, Emily has dealt with some more of the detail and she said she'd just quickly run through some of that and then there'll be opportunity for questions because we're very conscious that we haven't got much time. But there'll be plenty of opportunity afterwards in the months coming forward. But what we'd like really is just for partners to cascade some of these messages. We've put that in the recommendations which I'm sure you've all run through. Thank you. Hi, I'm Emily Fearon-Reed. I lead on improvement, transformation and CQC preparation for adult social care. If we can go to the care quality commission assessment framework slide, please. Thank you. Just to say that there are four different themes that the CQC are looking at. Next slide, please. And that gives you some more details of the framework you've got on your pack. We'll move on to the next slide. And then this one just lists the kind of things we've been doing to just demonstrate that there's lots of work we've been doing to prepare. If we move on to the next slide. The next one. So our vision for adult social care is for residents to be supported to meet their goals, be connected to others and be as independent as possible. And that's what we want to get across to CQC. Next slide, please. So we had a peer review in January to give us a sense of where we're at. And that identified that we have really strong partnerships with health and the voluntary sector. And of course some areas of focus as well which are highlighted there. Next slide, please. So the key messages particularly in relation to partnerships that we wanted to just mention tonight are that we work collaboratively with partners. That we have effective governance and that we have ambitious leaders. Next slide, please. And we're asking our staff and our partners to think about their own work and the examples and the evidence that they can use to sort of evidence that. Next slide, please. Next slide. And yeah, I think this is the last slide I'll say anything about is just to say that we obviously continue to become more prepared and increase our preparation. But we do need the help of all partners in doing this to engage partner organisations. And we will be sharing contact details of the health and wellbeing board members with the CQC when we're notified of inspection. But we'll be in touch as soon as we are notified with key partners to brief them further and alert them to the next steps. That's it. Over to questions and discussion. Thank you, Margaret and Emily. Do members have any question, any clarification, please? Do you have any key messages for board members specifically? And how are you going to brief them? What's going to happen as soon as it's announced? Yeah, I think for board members specifically, the ones that I've highlighted about our collaborative partnerships would be a really good one. And about our strengths-based approach into our hamlets, the fact that we take an approach that looks at the positives around a person and what the outcomes that they want and that they need rather than looking simply about what we can do to look at what we can do with them. So I'd say they would be some of the key things. Yeah, I think too that from what I've heard from elsewhere, they may be asking us various partners how they've been able to deal with conflict and difficulties in a positive way. And they're likely to triangulate that throughout the system, that type of thing. And I think a balance of the positive and negative, that's the sort of thing I've come across. I think the kind of leadership that members of the board demonstrate and the things that you've done together as a board and as part of your work through the board, I think that would be really important to talk to TQC about. And I think too they'll want to see, they're very keen to speak to people on the ground level and to speak to practitioners and they'll want to triangulate that with what leaders are saying. So that's quite an important thing that they'll always check back if leaders are saying, well we tell staff this or we have this dialogue with staff or we have this type of training or whatever you say, they'll triangulate that back and ask questions to try and make sure it's true. So sometimes, and this is the sort of thing we'll get into much more as we get closer to any visits or any real discussions. We'll focus on some of the areas that we think we might need to do some work on. Thank you. It's been quite a while since these services were inspected in this way, and whilst you might have some staff who've worked here a while and can remember when TQC used to inspect councils like this, I'm just wondering, have we done some work for those more recent staff who've not experienced this, what an inspection's like and how to manage that process? Because I guess people might be a bit anxious about it. I think you're absolutely right and that's something we've really considered. There is a service provided through the LGA, which I think is Partners in Care, I'm not sure what that's a division of the LGA, who will actually come out and facilitate staff groups so that they can best showcase their services but also talk about the challenges in a constructive way. And people have accessed that service. The feedback certainly I've had from people, and I know you go to some Penn London groups, has been quite positive. I think just to add to that in terms of the types of things that we've been doing so far, so we've had an all-staff webinar on CQC which was very well attended, and we had a conference as well which was dedicated to CQC, a half-day conference, which again was sort of very well attended. Most, by far the vast majority of our staff attended that. What we do on top of that is we have monthly videos and presentations that we provide and we talk through those with team managers and then they go out and kind of take them to the teams and discuss them. So there's a range of different things without going into all the detail, but yeah, we're very much working with staff, sort of talking about it all the time and helping to prepare them and providing opportunities for them to tell us what they need and kind of responding to that as well. Just to add importantly, also with partner staff as well, so this presentation has been to THT Board, those videos have been shared with partner agencies as well to cascade within their respective organisations, and so we're definitely a focus in terms of getting that message out, especially to staff who might not have been familiar with these sort of inspections more recently. Thank you, Margaret. Thank you for your presentation. You have joined with us in recent. How confident are you about this inspection? We will get a positive outcome. I'm fairly positive because I do see a lot of good stuff in town hamlets, lots of fairly innovative services and lots of committed staff with a lot of passion about the services, so I'm pretty sure that they'll be able to articulate that to CQC and also great partnerships and lots of integration, integrated services and I think that's all very positive. So, yeah, I am positive. Thank you. Can we agree the recommendation in this report? Thank you. Now our next agenda is 2.7, Tower Hamlets Health and Wellbeing Board and the Tower Hamlets Together, Proposal for Future Arrangement. I understand that there remains some work to be done to ensure that the Health and Wellbeing Board and Tower Hamlets Together are able to work effectively together. An option paper is going through the approval stage and will be brought forward once it's ready. This is also pending mayor's office sign off. Does the board agree to defer consideration of this item? Just a bit of context, which is that as elsewhere, in all kind of local authority areas, there's an increasing kind of duplication between what Tower Hamlets Together does and the Health and Wellbeing Board. Also, the Tower Hamlets Together board plays a role as the place committee of the ICB. So there is a discussion about actually how in this new kind of configuration, how do we make sure that we've got the most efficient arrangements in relation to the THG board and the Health and Wellbeing board. What we thought we'd do is that before the next Health and Wellbeing board in December, we would have a specific meeting in which we would discuss this further. So that's kind of the proposal here. The next agenda is supplementary agenda is Pharmaceutical Needs Assessment 2023. Does the board agree the reason for urgency as set out first? Thank you. This is here for information. The Pharmaceutical Needs Assessment is a statutory requirement of all local authorities. It happens every five years. There was an oversight in which it should have come to the board earlier, but in order for it to be properly validated, it needs to come through the Health and Wellbeing board and be minuted. The purpose of the Pharmaceutical Needs Assessment is to understand the need for community pharmacy services in a local authority area so that if pharmacies want to open or expand, they have to do with reference to the Pharmaceutical Needs Assessment. So when the Pharmaceutical Needs Assessment was done in 2023, it was all 51 pharmacies in Tower Hamlets engaged with it. There was an engagement with 194 people from the public about their experience of using pharmacy services. The overall conclusion was that yes, at that time there were sufficient pharmacies in place to meet the needs of the population, but it did note that we have a rapidly growing population, so we need to be mindful of how that picture might change with future growth. It's a formality that needs to come through the Health and Wellbeing board in order for it to be validated for pharmacists to use for future business cases, so that's the purpose of that. I've had a look at all those charts, very interesting. So clearly pharmacists have a really important role to play generally, but also presumably in terms of reducing the demand for urgent and emergency care. That said, when I looked at the charts, the only thing I've got to say because the rest of it is great, there is no Saturday evening provision and no 100-hour pharmacies in either the north-west or the south-east localities. I just wondered what you're going to do about that, because that presumably has an impact on pharmacists' ability to reduce that pressure on urgent and emergency care. I think that's actually one of the reasons why it comes to the board, and we can feed that back to the local pharmacy committee if we've got that properly minuted, just to make sure that we've got Vicky's point correctly reflected. So we will feed back, in public health we will feed back to the local pharmaceutical committee and say this was the commentary about access on Saturdays, because that might actually inform future developments in pharmacies, so that's helpful. Does the member have anything, any questions please? No, thank you. If we don't have any other business, can you conclude this evening today? Thank you. Thank you for your participation, thank you for your cooperation, thank you. Thank you. [BLANK_AUDIO]