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Agenda and decisions
October 3, 2024 View on council website Watch video of meetingTranscript
Thank you. Welcome to this meeting of the Health and Wellbeing Board. Good afternoon.
My name is Councillor Graham Henderson. I'm the chair of the Health and Wellbeing Board.
Members of the Board, I will now call your names in alphabetical order. Please switch
on your microphone to confirm your attendance. Once you have confirmed your attendance, please
remember to switch off your microphone. Abby Plater.
Afternoon, everybody. Present. Thank you. Mark Creelman.
Present. Excellent. Robert Guile. Welcome, Robert, to this,
I think, your first meeting representing the Central London Community Health Care, replacing
Jimmy Dawoodo. So, welcome to you, Robert, and thanks to Jimmy for all her contributions
to the Health and Wellbeing Board in the past. Thank you.
Stephen Hickey is on his way. Shannon Couture. Good afternoon, Chair. Present.
Good afternoon. Ari and Jayce just arriving. Ari and Jogia. I tell you, I'll come back
to you. I'll let you - Nicola Jones. I'm here. Thank you.
Philip Murray. I think he's - President Chair online.
Excellent. Thanks. Tihani O'Orban, who is the new care representative. Welcome.
Present. Thank you for having me here. Thank you. Well, you're most welcome. Mike
Proctor, I think, also, virtually. Oh, he sends his apologies. Okay. And Councillor
Kate Stark. Good afternoon, everybody.
Excellent. Thank you very much. And Ari and Jogia, sorry, could you just simply confirm
your present, even if it is obvious to the rest of us?
Present. Thank you. Excellent. Thank you very much.
Yeah, when you are speaking, it would be certainly helpful to everyone if you can refer to the
page number at the top of the agenda and the paragraph number so the members of the public
can follow the discussion. Please also indicate in an unusual way by raising your hand. Once
I have invited you to speak, please turn on your microphone and please try to remember
to switch it off after speaking. We do also have a number of officers present at this
meeting who will introduce themselves when they address the board relevant to the particular
topic. So we can start on the agenda. Apologies. Apologies for absence have been received by
Councillor George Crivelli, Jeremy D'Souza, Mike Jackson, Anna Popovici, Dr Wakashar and
Kate Slomek. Any additions to that? And Mike Proctor. Okay. So if we can note those. Declaration
of Interest. Are there any declarations of either pecuniary, other registrable or non-registrable
interests? Please declare any interests, quoting the item and paper number in which you have
interests and describing the nature of your interests, including whether or not you will
be taking part in this item. So can I ask, does anyone have any interests they wish to
declare? Excellent. So we can move on to the minutes of the previous meeting held on the
29th of February 2024. It seems a very long time ago since which time we've had two elections.
These are to be agreed and signed as a correct record. Any comments on the accuracy of the
minutes? Are people content that the minutes are an accurate record? In which case I will
sign on behalf of the board. The third. Thank you very much. Excellent. Good. So we're moving
on to the first substantive item, which is the emerging needs pathway paper 24249, pages
13 to 18. This is a report by the Executive Director of Children's Services and I gather
Deborah Johnson, who is the Assistant Director of Ascend and Inclusion, will introduce the
report virtually. Deborah, I can't see you. I haven't got eyes in the back of my head,
but hopefully you're there. I am here, yes. Excellent. Would you like me to start? Okay.
The paper that I've got that you have in front of you I hope is very informative and has
all of the detail in front of you that you need. From the paper there are three real
key recommendations as to why this is coming to the Health and Wellbeing Board. The first
is to currently note the experience of families that are going through the ASD diagnostic
pathway. So that's obviously included in the report. The second is to notify and ask for
notification of the proposal for a new model for the emerging needs pathway. And the third
is to hold all partners to account for their areas of responsibility and to monitor the
outcomes of the new pathway. So to explain slightly further the background of this, the
emerging needs pathway is the pathway for children under eight years of age who are
referred into the local authority and the health authority for a diagnosis of autism.
At this moment in time, the original pathway was pulled together in 2019 and due to substantial
change in both the health authority where we've moved from the NHS to an ICB model and
also following the 2019 local area send Ofsted inspection where the local authority has also
undergone substantial change in terms of the development of the sending inclusion service
which was actually not in place in 2019. What has happened is the two organisations now
are very, very different. They're structured very differently. Services are delivered very
differently and substantially because of the current challenges with the emerging needs
pathway for children and their families, the proposal is now to completely overhaul the
system. So what we've had to do is we've had to re-examine with our health colleagues.
So it's been the local authority and the health authority have looked together at
re-examining the current system, what the challenges are and that's from the point of
referral when it comes in, the pre and post diagnostic support services and the waiting
list for diagnosis. So all of this has been examined between the two organisations together.
So section four of the paper outlines what the current aims and what the current impact
and what the current issues are with the current system, which I hope the way that it's
set out is quite self-explanatory. And then it moves on in the paper to section eight
to say that what we're aiming to produce now are two parallel pathways where the pre
and post diagnostic support and intervention for families would be provided by the ELA
in conjunction with the second pathway where the actual diagnostic wait list would then
sit with the ICB and St George's Hospital. This then actually puts the key areas of
responsibility back where they should be. Section eight goes on to identify what the
ELA proposal is for their pathway for the pre and post diagnostic support and section
12 then lists what the ICB and St George's Hospital aim to achieve with their pathway
but to clarify both will run in parallel so we will work together but it just really aligns
the responsibility to where it should lie. And then the last section in section 14 just
outlines for you what particular challenges there may be in the terms of delivering the
pathway and actually organising the pathway. The key aim for changing the pathway is to
reduce wait times for parents which are substantially long at the moment and are in the paper but
also to make sure the pre and post diagnostic support is provided to children and their
families from the local authority in a timely manner. And this all to a larger extent aligns
with the new SEND and AP improvement plan which will be coming in into 2025/2026. We
think now it will be delayed till 2026 because of the change of government but this then
actually aligns our pathway to where the areas of responsibility lie. So that's to a larger
extent the reason for bringing the paper to the committee. So I'm very, very happy to
take any questions that may have arisen from the paper.
Thank you, Deborah. So can I ask the board if they have any questions or comments. Mark.
Thanks, Chair. And just thank you, Deborah, for presenting it. I just wanted to emphasise
that this paper was agreed by both of us. So we were involved in the construction of
the paper but perhaps as being the joint author going forward might be the way forward. And
just to say that some of the waiting list issues are national issues. What we are seeing
is an increasing demand for services. And we have workforce challenges across the board
really which means that often services aren't meeting the capacity that they plan to meet.
Deborah mentioned that it's a joined up piece of what the solution needs to be joined up
as well. So that from pre-diagnosis through to diagnosis and post support, absolutely
we need to make sure that we are aligning everything that we do even though we've separated
the pathway. And there's just a couple of others. I just wanted to acknowledge the issue.
Waiting times of this length and this magnitude are not acceptable. We need to be seen to
be doing something about that. We are working with St George's now around increasing their
usual business as usual service capacity. And I'm happy to say that I've just identified
a resource to work on the backlog. So we should start to see improvements over the next few
months. But it's going to take us a while to get the amount of backlog cleared. There
are some challenges and we shouldn't shy away from those challenges. We all know that in
public services finances are challenging so actually additional funding into these services
might mean that we have to look at other services that we commission and move money around.
And from a health perspective, I think one of the things particularly around SEND is
that we see waiting lists across a number of areas. And what we want to do is we've
kicked off a piece of work to look at all our waiting lists for children and young people
with SEND and to have that action planned so that we can assure ourselves and partners
that we are doing something about it. One last thing and then I promise I'll be quiet.
Two last things. We're going to work with the Mental Health Trust as well. We've spoken
to them about supporting us in the system around this. And then finally the communication
with parents which is really, really key. So we have a comms going out telling parents
that we need to redefine the pathways and the diagnosis pathways. But I think there
is also something just about our ongoing communication so that we're being transparent with parents
as well.
Thanks a lot, Mark. That was very comprehensive and very, very helpful indeed. And I think
what I'll do is I'll go around the board taking comments, et cetera, and any questions
and then ask Deborah to sum up at the end. So Abby.
Thanks, Chair. Couple from me. One is what, if any, modeling has been done around the
new pathway to kind of try and project what improvements would make, that was kind of
an obvious question. I thought that would be great to see if there's been any work done
there to see how quickly you can move those people through and what rates. And then I
guess the second bit, Mark, to your point around comms out to carers is who do you kind
of plan to target there? Is it people? Because obviously there's kind of people within the
system, I suppose, as it were. But then there's lots of people who might not yet know that
their child is autistic. And so I guess it was kind of and how would you proceed to do
that? Would it be through just kind of health networks or would you be looking for charities
and voluntary sector to put that out for you guys as well?
Yeah. And Nicola.
Thank you. Mark has probably answered quite a lot of what I was going to ask about. But
as a specific thing, I just wondered if I referred, if I would refer to patient now,
when would they be seen? So I wanted to understand that. And then the issue, it's a bit about
the comms here, but I think it's probably about transparency as well on this. And on
page 16, paragraph six, it's got officers want to ensure parents understand the process
of the pathway, which I think is really kind of important. And I would support that openness.
But I wonder if it would be helpful if patients, people understood what the waiting time is
at the point when they enter the pathway, because I think it might just help with transparency
and openness about this, because everybody understands that this is a really difficult
area and we're working hard to resolve it. But I think it might help manage patient expectations
and help families, therefore, to plan and understand what support they might need in
the interim. So I think it would be helpful all around, really. And I would support Mark's
point about the authorship of this paper. It's just a point of process, really, I guess,
because the organizations are working very closely together to crack some of these really
difficult issues. And therefore, a paper like this, I think, should come to this board probably
jointly authored. I think that would have helped us to understand in reading it where
it was coming from. And then just finally, I think, could we bring back an update to
this board and plan when that would be? Because I think we need to be assured that progress
is being made, because this is quite a long -- and it is a national issue. We're not the
only system that's struggling with this. But I would love us to see some progress.
I mean, absolutely, Nick, and I think the paper does actually call for my council and
partners to be held accountable. That's actually in the recommendations 1C. What I'd do is
I'll take questions in clusters of three for Deborah or, indeed, I think Mark would probably
want to answer one or two of them, so we don't actually lose sight of what the questions
are. So first of all, Deborah, have you got any comments to make on the first sort of
three contributions, please?
I think to go back to the last point that was made around wait time, I think one of
the main reasons why we've worked -- and to be clear, I've worked very, very closely with
Robert Dyer and all of St. George's Hospital, Mark, Mike, et cetera, in terms of the
development of where we need to go. But I think there's an understanding at the moment
that because the diagnostic pathway, to a larger extent, the actual waiting is being
held by the local authority, if a parent was to come to us and say, how long is the waiting
time? It's something that we can't answer because, obviously, the diagnostic element
has to be done through a clinical setting, through a clinical expert. There isn't that
expertise in the local authority. It has to be done through, you know, pediatric services.
So one of the key elements of changing the pathway is so that wait times can be advised
to parents by the people who know when the child will be seen by the pediatrician and
at the right time. So that was one of the key things for us, because to a larger extent,
parental complaints are not necessarily about the fact that they are not receiving the
right support in school, but it is because they don't know how long they've got to
wait. And I think that's been recognized by the ICB and St. George's Hospital that
that's part of the reason for change. One of the other things as well around the pathway
is that we're looking at it right from the very beginning when it comes in from the referrer
and the best way to move it forward more quickly. And that is through a health model rather
than coming into the LA and going back out again. So that's one of the main reasons
to close that gap. In terms of improvement, we've taken a lot of information, both from
our own knowledge inside the local authority and the ICB and St. George's Hospital around
what it is that actually parents want and what they're asking for. And a lot of the
improvements that we're trying to make is from the very start is the parent experience
from the point that they are referred in for an autistic diagnosis and the support and
groups and sessions that they can attend to actually help them work with their child at
home and with the school or the education setting. So we've started to look at how the
referrals come in, where they go, who looks at them, how we get that support into the
child and family much, much earlier. And so those improvements have already started with
the way that we're developing our services both inside the local authority and in St.
George's. So we've started to make those improvements, but we've just got to actually
make this pathway much, much quicker than it already is. I absolutely agree around communication.
One of the biggest issues for parents is around a lack of communication, and I think we both
accept that. And that's something that we need to improve on. And it's something we're
looking at very closely. And as Mark correctly said, a letter has been agreed that we'll
be going out to one of the parents shortly to actually explain what we plan to do. I
think that addresses the current questions, but please tell me if they haven't. Thanks
Lord Deborah. Mark. So just agreeing with everything that Deborah said, but also I think
just in terms of Abi's challenges. So there is something about seeing what others are
doing and using best practice. And so we know that some of our colleagues in Epsom and St.
Helier have just looked at their pathway and they've got some positive and negative experiences.
So we want to learn not only from London, but elsewhere. I think the waiting list, the
magnitude of the waiting list, I want to reassure that on that waiting list, there's a cleansing
exercise that we also have to do. Are people already accessing the correct support? So
there is hopefully a relatively cleansing exercise to help us reduce it immediately.
And I agree with Nicola just really in terms of bringing up a regular update. I would suggest
that we give us a couple of months to get all the arrangements sorted out and then bring
that back at a later date. Excellent. Thank you very much. Next round of questions. Tihania.
Just a few comments. I think this is a very nice summary of where the situation lands
and stays. I see three major areas of why all these health problems have not been resolved.
One is autism is more and more recognized and appreciated as a child health care issue.
So there is more incoming as a disease. The second issue I think is here and in general
the NHS system, it is very fractionated. How I see that one hand doesn't know what the
other hand does. So patients are getting lost in the system. The third is the bottleneck
of the specialist to actually see the patients. So I'm just wondering, you cannot help the
number of patients that are coming in. The problem is I think what you can help or can
be helped is somewhat make the link between GP, school health, nurses communicating with
each other much better to find the patients. It doesn't solve the specialist bottleneck
to have the diagnosis. But on that front, I think triaging would be helpful to get the
more severe, clinically more demanding patients into the system with the specialist, especially
because those children, parents, are the most affected and unable to handle. So this is
just my kind of comment of how this might improve over time. Thank you.
Thank you. That's very helpful. Kate.
Thank you, Chair. Thank you, Deborah and thank you, Mark, for your kind of explanation of
the papers. Just really kind of adding from my perspective on behalf of kind of children
and parents across the borough in my role, I think the points that have made about communication
are entirely right. I think a lot of what we hear at our Parent Carer Forum is that uncertainty
over the wait time is causing significant anxiety and having a significant impact on
parents. I know with our own service we try to clear as clients at that point that Nicola
made earlier about making sure that parents are able to know as soon as possible after
a referral kind of actually what is the wait going to be. I think actually that will support
and help parents and carers who are in this situation. So again, just thank you for your
acknowledgement around children are having to wait too long for a diagnosis. I think
that is right. We can't sit here and accept that as a status quo, though. So I think I'm
keen that we have these pathways finalised, that they're mobilised at pace and to make
sure that all partners, I think a number of us were in the room when we had our offset
sentence section that Deborah referred to and there was acknowledgement that positive
progress had been made but perhaps a comment that all partners need to be moving at the
same pace. So it's really important that we continue to do that. I completely recognise
the points that we made about challenges. I think that's the challenge that is shared
across all partners but equally these are priorities that are in our shared written
strategies and we need to make sure that those written priorities are followed by actions.
And then there was just kind of one question or point of clarity for me from page 17, paragraph
13, just around the aim, there being an aim to kind of establish a St George's paediatric
led multi-disciplinary diagnostic team and just to clarify if that is kind of a commitment
to do that or if that's just the aim and that's still being explored.
That's very helpful. Can we go to Deborah first and I'll come to you Mark. So Mark,
can you turn your...
Deborah.
So in terms of the current issues around parents, I absolutely agree with the view that was
provided earlier, both Robert, myself, you know, from the ICB and from the local authority
have met with parents on a number of occasions to carry out parental workshops on what they
would like to see, how they would like to see this working better, what they see the
potential barriers are and we've worked together, Robert and myself, on, you know, sort of unpicking
all of that information. But to clarify, we both meet with the Parent Carer Forum very
regularly and we've also offered to come out whenever we're requested to, to talk to parents.
But absolutely, you know, the whole, one of the main points that we want to make sure
happens in what we do next is that parent communication is there from the very beginning
and so that both, you know, the local authority and health, you know, communicate with parents
all the way through as to where they are, you know, what they can do, what they can
access, where they can go, because that's absolutely critical. But a lot of the recommendations
that are in the paper have stemmed from those workshops with parents. I absolutely agree
with the point as well around the number of children that are coming through with, for
a diagnosis. You know, the numbers are no different here than they are in other local
authorities. They're substantially higher than they were before, which is putting demands
on all of the services, therapies, our own support, you know, services, which is why
both, you know, St George's, the ICB and the local authority have looked at how we change
our services in order to meet the demand. But I would agree with the point Mark made
earlier that the demand is outstripping our ability to keep up, but this is not a Wandsworth
issue. This is a national issue. And I think part of the government agenda around the new
Send an AP improvement plan is to look at how we actually then make that that much easier.
I do agree as well with the point around early triage, which is the point that was in section
13 of the paper. The ICB and St George's Hospital are very clear and very committed to that
early triage and to making sure the most complex children are triaged much earlier because
we see children with very, very complex needs coming through as early as two, two and a
half. So effectively, the triage element is something that we're all committed to making
sure that that is a main focus of what we do next. I hope that answers it from my point
of view. And probably apologies, Mark, if I've picked up anything that you would normally
pick up. No apology needed at all. I think just in terms of the number of patients, what
we are trying to do is design the service to meet that need. I think in terms of the
comments around fragmentation, that's why we've got to integrate our approaches so that
actually we are in some ways working as one around the families and so that communication,
not just with families, but also between partners is really, really key. I think the triage
element, what we want to do is bring the expertise further up the referral process so that actually
that triage happens. Because we do know that it may be that we have to go back and look
at things like universal offers and education, et cetera, to make sure that the people most
in need are getting the service as quickly as possible. And then with communication,
and I know that Deborah was talking about the forums, and picking up on Abby's point,
it might not just be about attending forums, it might be about how do we communicate with
a wider population, whether that be through schools, whether it be through voluntary organizations,
and that's something we need to consider. And just to kind of emphasize, Councillor
Stocks, these are our most vulnerable children. We need to make sure that these are absolutely
the priority. And so therefore, going back to my comment around resources, we need to
make sure that we, in some difficult times, and we might have to make some difficult decisions,
but we need to make sure that we are putting the right resource to meet the need.
Philip, you have your hand up.
Thank you, Chair, and apologies, I can't be there. What I was reflecting was that what
we often see, where we get backlogs like this is, as we improve our services, I suppose
hidden demand can sometimes come out, i.e. people either seek alternate ways to get input
and support, or they don't ever come forward saying, Well, what's the point? I'm going
to wait three years.
So I suppose it's a comment, but also asking those that are closer
to it, do we think we run the risk that as we put these services in place, we will see
new demand coming out, and we might see the position worsen rather than improve in the
short term?
Yeah, good question, Philip. I suppose my answer would be, well, if I'm just going to
help people, and if there is unmet need, we obviously need to address that. But anyway,
I'll leave it to our experts to comment. First of all, Deborah, any comments on that particular
point from Philip?
I think that the point that Philip has made is absolutely valid, but I have to be honest,
I've been doing this type of work for a very long time, and looking at the data, we had
a major explosion post-COVID, where a number of children were coming through, and I think
it's been very difficult for both education and health staff to actually look at those
children and try to figure out what is the COVID impact, and what is actually a more
long-term difficulty. But I think Mark would agree with me that we've now started to see
those numbers, not plateau so much, but that substantial growth that we saw in a short
period of time, which we're now experiencing, seems to be slowing slightly. And what we've
moved back to is really the high numbers in the three to five category, and not so much
the older children, which we were seeing coming through before. But I will hand over to Mark,
but I think we are now beginning in the local authority with the numbers that we're gathering,
seeing a slight plateauing of that.
So Deborah answered that brilliantly. I think the thing is, Phillip, just to make sure that
we are building in the capacity to meet the needs. When we go through that cleansing exercise
on the list, we need to learn from the data that that gives us. So actually, how many
of those people ended up with a diagnosis of autism, and what's the alternative if they
haven't? Where are they accessing services? So I think it's a valid question. I don't
think we know the answer to that right now, but I think as long as we track what we're
doing and share that information across partners, then we may need in a different way going
forward, and it might be a different range of services, but that's part and parcel of
us looking and reviewing this now.
Sorry. Are there any further comments from any members of the board? If not, I think
that was an excellent discussion, so if we can move to a decision, and hopefully to agree,
the recommendations are set out in paragraph one of the report. For the benefits of members
of the public, I will summarize. I won't read them all out. You've got them on the papers,
but the first is to know the current issues experienced by families associated with obtaining
a diagnosis for the child with autism spectrum disorder. Secondly, to note the new model
for the emerging needs pathway, introducing two new pathways running in parallel to reduce
diagnostic waiting times. And thirdly, hold the council and partners to account for their
areas of responsibility acting as a critical friend. Can we agree those recommendations,
please?
Excellent. Thank you, and I think that was a very good discussion. I know, Kate, I think
you're dashing off to my ward of Rowhampton for the launch of the family hub, so thank
you for attending for our first item. Hopefully you found it very useful, and please do give
my apologies for lateness to the launch. Okay, excellent. So moving on, I'm very pleased
to welcome Stephen Hickey, representing Health Watch. That's okay. Don't worry. Good to see
you anyway. So if we can move on to the next item, one of two concerning the Better Care
Fund. The first one, Paper 24-250, is the end of year update, pages 19 to 36, and this
is a report by the executive director for adult social care and public health, Jeremy
D'Souza, and I gather that Brian Roberts, who is the head of health and care integration,
will introduce a report with Ninh Wild, the assistant director of health and care integration
in attendance, to answer any questions. So Brian, would you like to lead us off? Thanks.
Thank you, Chair. So this is the first of two items for the Better Care Fund, so the
first item being the end of year report, which then actually acts as a baseline to then complete
the refresh, so I'll move from one to the other if that's okay. Before I start, I just
need to acknowledge that both the end of year return and the BCF refresh, so it summarizes
all the partnership work in the borough, and all parties contributed to both reports, and
there's a shared understanding of the demand from intermediate care and the capacity needed
and provided to meet that demand, so we've got working groups set up to do some of this
work, and it felt very much like that was happening in partnership.
In terms of the end of year update, so this was due in early May, so apologies for it
not coming here earlier. It consisted of the following areas, so agreement of the national
conditions around the BCF, which we confirmed were met, the progress on the metrics, so
avoidable emissions, discharge or use of place for residents, emergency emissions for falls,
long-term residential emissions, and reablement, and of which we didn't achieve avoidable
emissions and residential emissions, but achieved the others. Avoidable emissions, we saw a
rise in patients going to St. George's with heart failure, and Campbell Flack from CLCH
is working with St. George's to work out some of that reasoning and how best we can support
those people.
Residential emissions, we saw a spike during the year, which are small numbers, but unfortunately
we're working from a very small baseline, and so we missed that target.
Thirdly, spend against plan for the BCF, which we confirmed that that was fully spent. We
had to refresh our demand and capacity plans for intermediate care and put actuals against
the planning, which we did. Probably the notable thing to point out there is the CLCH and then
Battersea Healthcare, CIC, urgent community response, we were expecting an increase in
people seen by those services, and we saw an increase over and above that, so lots more
people being supported to remain at home during the winter.
And lastly, feedback on delivery successes and challenges. All partners believe this
was a successful BCF period. Actually, in terms of successes, there was a lot of joint
work across the health and care system, a lot of system understanding, and there's
joint work to support people in care homes that remain in care homes, rather enhanced
health and care homes work that happens joint between the council and the ICB.
In terms of challenges, so one of those challenges is, quite frankly, that the demand was greater
than the finances we had to support that, and we're obviously working through some
of that at the moment. And the other one we flagged here is quite a lot of the information
about demand and capacity that's centralized is on a trust-wide basis, as opposed to a
borrow-by basis to NHS England, and again, so some of that you will see starting to be
talked about in the demand and capacity plan in the 24/25 refresh. But they're the ones
to note, yeah, partners worked well to pull together the reporting. There is a better
care fund oversight and delivery group that we use for that purpose, but also there are
links through to the Urgent and Emergency Care Delivery Board, which is chaired by Mark
Hillman. So some of that reporting is joint, and it feels like we've sort of joined some
of that up. And just lastly to note, so any of the data in the report isn't just about
St. George's, though I mentioned them earlier. It's about any resident anywhere who goes
into or comes out of hospital or is supported at home. Obviously, most of those are around
St. George's and Chelsea Westminster, but this is the view of the population and not
just the view of St. George's as a trust. I think that's a whistle-stop view of that,
considering I'm going to be talking for a little while on these reports. So probably
any questions?
Yeah, thanks. Thanks, Ryan, for that. Any questions or comments on this report from
members of the board? Stephen?
Thank you, Chair. As always, the BCF papers are incredibly techie and sort of spreadsheet-y
and therefore not quite -- you sort of -- I glaze a little bit. But the point I just wanted
to ask about was, in last year's outturn, we missed two targets, avoidable admissions
and reablement, and those reappear in this year's targets. And I wasn't totally clear
from this. Is anything changing this year that means that we might actually achieve
them, or are these impossible targets that we're going to fail to meet year after year?
There's a three, if there are three. Well, hold on a minute, Brian. Any other comments
from anyone? No, in which case, Brian, right away.
Thank you. Yeah, so I'm sorry about the return template. That's the NHS England return
template. I wish it wasn't quite as it is. You do get used to the color yellow quite
quickly. So in terms of -- so reablement target has now been dropped, but obviously we do
have local measures around successive reablement, and we do know that a very high proportion
of people who have reablement actually go on to need much less or no long-term care.
So thankfully we have got that measure that we can continue reporting, although not in
the BCF. That's been dropped from there. In terms of avoidable admissions, so this is
-- so absolutely we see rises in this cohort. I think for me, Stephen, this is how things
-- things like our MDTs, things like our intermediate care offer, things about our UCR, this is
where we need to take this data and ensure that we are being as responsive as we can
to that. So there is achieving or not achieving the target or the ambition, but there's also
using the information behind it to try to transform and configure our services to meet
that need, I think. So I think we didn't achieve this, but actually we have been doing a lot
of work trying to support the people behind these numbers.
Mark.
I suppose just in response to Stephen is that actually, as Brian said, there's a lot of
work going on around a number of areas. Now they include things like rapid response teams.
We have a virtual ward that also has a step-up facility, not just a discharge facility. And
there's also proactive care and general practice and multidisciplinary teams, which are becoming
very much part of the integrated neighborhood team approach. And what we need to do is make
sure that as we develop that, all partners are there working around these individuals
to make sure that they're not admitted to hospital.
Thanks. Thiram.
Thank you. I'm not sure that this is the right place to mention this issue. Being a carer
and being with other carers for now two years, there are a couple of major deficiencies which
we experience. The second paragraph is the discharge to normal place. It's on target.
Maybe the number is on target. But I think the problem is, and I speak now from personal
experience, that when a patient in need being discharged from the hospital, there is a total
chaos how the patient and the families and care potential future carers being thrown
into total chaos and the need for structured guidance, how the carer should be supported
and how the clinical follow-up should be organized in terms of mobility, rehabilitation, all
the rest is total chaos. So my suggestion would be, I don't know whether this is the
right place to say, but when a newly diagnosed acute patient goes back to the normal place
at home, I would put a person like a patient advocate or ambassador of that case. It doesn't
mean that that specialist who would guide the care of that particular patient is the
one to one. But let's say my wife was discharged from Charing Cross and we got like 15 different
people and nobody knew who was doing what. And I had to figure it out all the way through.
So my recommendation would be a patient advocate and ambassador at the time of discharge would
ease everybody workload, including the patient and the carer, to put a carer plan custom
made for that particular patient. It might sound a lot, but would save a tremendous amount
of resources for the healthcare.
Thank you, Jeremy. A useful point indeed. I think, Philip, you have a comment to make.
Thank you, Chair, and thank you for the report. So what I was reflecting on is, you know,
it's all well and good to consider how well we did and whether we hit the targets. But
what does all this mean for reducing health inequalities? So we can see that, you know,
we've done very well on discharging people back home. We've hit ninety three point eight
percent of the target. But where we're missing the target, have we got a disproportionate
impact on certain elements of our communities? And therefore, are there any underlying trends
that we need to reflect upon in terms of our processes so that we're not causing more inequality
rather than reducing it, which is what we should be doing. So I just wondered if there's
anything behind this, because that's what I'd be interested in.
You know, we look at this stuff every year. What's that sub analysis telling us and what
are we doing about it if it exists? And if it doesn't exist, can we get it?
Yeah, thanks, Philip. Another good question. I mean, some of the questions are probably
more relevant to the second paper, but I'm quite happy for the discussions to continue
in parallel. Hopefully, I mean that when we do actually come to the refresh paper, we
will have largely answered those questions. So, Brian, would you like to address those
three particular points? Thanks. So in terms of in terms of care, thank you
for that. I mean, clearly, we need to do a lot more work around around how how carers
are supported as possible. So so, again, some of those will be hopefully covered in the
refresh or in the work that we're trying to do to support carers out of hospital.
So so whether that's regenerate, rise, supporting people to to get back home or other services.
Yeah, it's it's it's a difficult it's it's a difficult balancing act in terms of the
trends at the speed of getting someone out of hospital and home and and supporting them
holistically. So and and obviously we are doing we are doing work in terms of, you know,
Raven and other services trying to pick some of that stuff up. I absolutely appreciate
your your your lived experience and thank you for that.
And Philip, in terms of your point, in terms of inequalities. So so I think we absolutely
have to have to look at that so that the headline figures of the headline figures.
But actually, we have to look at those people that are being that are being missed and and
not supported. So I thank you for that. And we absolutely will look at that and try to bring something
back in terms of those people being, you know, that you're right, you're absolutely right.
Both questions, you're absolutely right. People being discharged home, a large proportion
of people are being discharged home. But actually, who are we missing? Who are we not supporting?
Where do we need to fill those gaps? And that and that will sit on the work plan of sort
of the BCF oversight and delivery group and other groups, I think, as we as we manage
that. Moving seamlessly on to the refresh again.
Oh, yes. Sorry. What I'm saying, Brian, is I'm quite happy to take the discussions in
parallel because they're obviously overlapping. Can I just sort of check with anyone who wants
to add anything in relation to this paper? OK. Nicola, then Mark, thanks.
Yeah, I'm not quite sure which paper it relates to, really. But so if taking that's all right.
So firstly, just on the point about the carers and the kind of proactive care planning, which
I think what you're talking about here. So we we do do proactive care planning for our
patients who we think are at high risk of admissions in general practice and with wider
multidisciplinary teams. And I think it's a really important angle to ensure that within
that our carers are considered and and the whole plan takes into account that element
of the patient's care. So I think that's a good one for us to take back, just to make
sure that we are actually doing that in a structured way. I think that will really help.
So thank you. The other thing is sort of a reflection, really, on the fact that for the
unplanned admissions, we have historically had very low rates. So it's very difficult
to continue to achieve that target without going into the realms of actual clinical safety
issues. And I think it's very important that you look at cases to understand what it is
the system is delivering in terms of care. So the patients who you think they went into
hospital and it probably could have been avoided, we should as a system be reviewing those cases
to see what we could do better to keep them at home. But the other way as well, when you
get down to the numbers we're talking about, is very important that we do admit patients
to hospital when they need to be admitted and patients sometimes need to be admitted
to hospital. And we should look at people who perhaps have been kept at home inappropriately
when we get into these kind of quite small numbers and narrow margins. And I think we
need to take that into account when we're reviewing how we manage people's care.
And just to share that we have an integrated discharge hub now between local authorities
and St. George's. And part of that is ensuring that the discharges are not just safe and
clinical, but also that the right support mechanisms are being put in place, including
information and advice for patients and carers. We have had conversations about moving that
support up to admissions, so therefore actually when people get admitted they get information
about what to expect at discharge. And that's something we need to pick up further with
our George's colleagues. And just to say that we have quite a vibrant voluntary sector,
a range of services that are there to support people in their own homes on discharge. And
I apologize for your experience at Charing Cross.
Just a quick answer. The services there is fantastic. There is a lot of offer from different
parts of rehabilitation. The problem was that it was not organized. It took me one year
when I figured out what things are available and how to put the service and support together
for my wife. So I'm not saying that the services are missing. I think the structure and personalized
support at the time of discharge, and I think what you mentioned at the start at the admission,
would be even better because then everything is ready when the patient goes home. And in
this way the patient will stay at home longer, the carer will be less distressed because
everything is available and structured and built up time by time. Thank you very much.
Thank you. That clearly is an important point about coordination, people knowing what each
other is doing, et cetera. Are there any further comments from the board? If not, I'll ask
Brian to say something about the refresh paper. The discussion has really overlapped both,
so we might as well continue with that discussion and then hopefully we can agree the recommendations
in both reports fairly quickly. So Brian, would you like to say anything about the refresh
paper specifically? Great. Thank you, Chair. So the refresh paper, so obviously the BCF
between 2023 and 25 was a two-year BCF with a refresh period, and this is the refresh
period. All of the information in it is built on the end-of-year return, so including refreshing
the intermediate care demand and capacity reporting, including the spend and trying
to use some of that spend to best affect in terms of tech-enabled care, in terms of supporting
the integrated transfer of care at St. George's work that's continuing and to meet additional
demand. So part of that was also a narrative update, just trying to describe the plans
in terms of demand and capacity for intermediate care. Some of that was about actually the
further ambitions for the metrics which we've discussed. I think it's also worth acknowledging
there are a couple of new things in there that I just want to bring to the board's attention,
one of which is the demand and capacity plan has a, for want of a better word, a new metric
which describes the average time in days between when someone is referred to be discharged
and when their service starts, so which I tend to refer to as the turnaround time, so
how responsive we can be in terms of hospital discharge, and that's supporting some of those
conversations in the borough about actually how quickly and safely can we discharge people,
where those blockages are, and that feeds into also the conversation, both in terms
of the quality of discharge, which we've spoken about, and also making sure that those people
that are going through the St. George's hub and the Chelsea Westminster hub to be discharged
are supported adequately and quickly enough, and that then talks then about have we got
enough demand, enough capacity to meet the demand that we're expecting in the system.
So that's in place. There will be further reports that give actuals to that, so at the
moment we're in the middle of the quarter to return, which we will bring back to the
Health and Wellbeing Board to show that progress, but I think that's probably the thing I'd
want to highlight, other than the thing I started with, which was this is a system-wide
view, so all this reporting has been put together between the council employees, the voluntary
sector, CLCH, St. George's, and the ICB, and as best as we can get it, this is a shared
understanding of where our system is in terms of what we can achieve, where we think the
gaps might be, and where we need to face capacity to meet those demands.
Thank you, Brian. Any further comments from members of the Board? Ariane.
I'd just like to thank Brian for the paper submitted, and some of the metrics were very
encouraging, especially in view of the fact that the population ages complexity increases,
and I'd like to also maybe reinforce what Nick alluded to, in that there is this proactive
care model in place in GP surgeries, with particular emphasis on the patients that are
the most vulnerable, called the enhanced care pathway, which again is mentioned in the model.
Services like Quick Start, with effective social care immediate on discharge, provided
by CLCH are working really well with GPs, and then there's the urgent community response
service that GP practices try and ensure that patients are seen within two hours of presenting
by the new total trial system. So all of these services are in place and working effectively
and probably contributing towards this reduction in urgent admissions. I'd just like to take
this opportunity to encourage the newer model of discharge and re-enablement to link up
as much as possible with GP surgeries, because one of the things we do face on a regular
basis is not having all the information at our fingertips when patients have been discharged,
when we have the means and capacity to improve the seamlessness of that transition. And my
final point is, within every surgery within Wandsworth, to the best of my knowledge, there
are allocated members of staff called care coordinators, and they could effectively take
on the role TMO is struggling to find in navigating the NHS. Even as a doctor patient, navigating
the NHS can be challenging, to say the least. So if the information was shared about a discharge
with primary care more regularly and they were incorporated more into that pathway,
care coordinators could take on that role and ensure that advocacy was maintained. Thank
you.
Again, a very useful and important point. What I was going to suggest, unless anyone
wants to make an urgent comment, I mean, the Medicare fund is reported to the Health and
Wellbeing Board once every three months. I mean, I know meetings don't always take place
once every three months, but they are reported quarterly. So there is plenty of opportunity
to follow up on this and to check that things are happening. So, as I said, unless anyone
has any burning questions or comments, what I was going to ask you to do, Brian and also
Lynn, I think we've heard some very useful and pertinent comments from people. If you
could go away and reflect upon those, and then at the next report to the Health and
Wellbeing Board, if you could summarise what actions or what proposals you have in relation
to them, I think that will certainly go a long way to dealing with those issues. Do
you wish to comment? No? Okay.
Oh, Philip, sorry. Have you got your hand up?
I have, Chair. Sorry, I know it's painful when you're not in the room, as you said earlier.
I'm behind your head. I suspect Lynn might be able to second-guess what I'm about to
ask. So in the first paper, we reflected that some of the targets we haven't been hitting,
and we heard that there's work ongoing with St George's and other providers to reflect
on that. And equally, even where we are hitting the targets, I wonder how much we've looked
at how we're delivering the targets, or indeed the services that in many cases we've had
in place for many, many years, and reflecting, do they still give us the outcomes we want?
And in addition, do they reduce health inequalities and target those most in need populations,
rather than just rolling over the same process and the same contracts, delivering the same
things? It's a bigger piece of work and would need some potentially tough and very difficult
decisions, but I just wonder where we've got in that process, because we have talked
about it a number of times in the past, but neither of these papers to me have brought
that out and where that review or thinking's got to.
Okay, yeah, interesting point. Would you like to comment on that briefly at all?
Hi. I think, Philip, we have reviewed it, and you're right, it is complex, and it's
not in the services that we need to change, it's the how we deliver them, and as a system,
we are committed to thinking about it. At the moment, there's a lot of focus, as we
said, on the hospital discharge and specifically in how the integrated transfer of care hub
supports that to be effective. And the second thing that I think there's a lot of discussion
around where we need to start landing it into action is in that intermediate care space.
So whereas we've got a lot of good services which deliver excellent outcomes, we need
to create more coordination between that. So we stretch our resources just a little
bit further and meet the needs of more people. So I think that you have absolutely been heard
on the health inequalities thing. It's a really important analysis which, to be frank, we
probably haven't done sufficient justice to, and we will report on that next time.
Excellent. Thanks, Lynn. Thank you, Chair.
Thanks for that very important point, and thanks, Lynn, for that answer. Health inequalities
is, as far as I'm concerned, what drives us in relation to virtually every single item
on the agenda. So it is vitally important we do monitor that.
So I already summed up, which is basically asking Brian to go away, take on board the
very pertinent comments which members of the board have actually made, and to bring the
paper back as is routine to the next meeting of the health and wellbeing board with some
commentary on the proposed actions, et cetera. Now, with that, for the sake of formal record,
can we move to the recommendations? First of all, in the end-of-year update, the decision
of recommendations in paragraph one to sign off the Medicare fund plan end-of-year review
for 23/24 is set out in the report. And secondly, to note the demand and capacity plans and assumptions
which feed in to the planning of the 24/25 Medicare fund refresh, which we'll come on
to shortly. Can we read those recommendations in relation to the end-of-year report, please?
Thank you very much.
Moving to the refresh, which was paper six, paper number 24251, the recommendations from
that is to sign off the plan refresh for 24/25, set out in the report, and to note the refreshed
Medicare fund demand and capacity plans and assumptions for 24/25. Can we agree with those
recommendations as well, please? Thank you very much indeed. Yeah, thank you. And again,
that was another very good discussion. This usually takes place in the health and wellbeing
board.
Now, the next item is the joint local health and wellbeing strategy delivery, paper number
24252, pages 59, 68. It is a report by Shannon Lee, our director of public health. Would
you like to introduce the report or delegate it to someone else? Thanks.
Thank you, chair. I'll roll up my sleeves on this occasion. I'm really excited to present
this report, which marks the start of the delivery phase of our joint local health and
wellbeing strategy, which is 19 steps to health and wellbeing. The purpose of this report
is to recommend a proposal on the delivery arrangements for the strategy. As the board
will be aware, the strategy was collaboratively developed with system partners to ensure that
there'd be joint ownership of the agreed priorities and the subsequent actions by the different
system partners. This report presents a proposal for delivering, monitoring and oversight of
the strategy over its life course. The strategy will be delivered through the health and care
plan with each step prioritizing specific activities over the next 12 to 18 months.
The key points to highlight in the report are the key roles that have been designed
to support delivery and oversight, which are the step sponsors, step leads and action owners.
And these roles are outlined in appendices one and two. The board will note that significant
progress has been made in identifying people to fill these roles, although we still do
have a few gaps. So this is a work in progress. The steps particularly around mental health
for both adults and children, childhood immunizations and screening, I think still require further
consideration in terms of sponsorships. I welcome any comments or offers around the
sponsorship of these steps. We will update the board using the bulletin after this meeting
once we've clearly identified and confirmed all the roles in the appendix. The second
point to highlight is table one, which outlines when each of the life course areas start well,
leave well and age well, will report to the health and wellbeing board on progress. The
proposed timetable is indicative only, and we're happy to adapt that to the requirements
of the board. If the board requires certain steps to be brought forward or pushed back
accordingly, then we will work with the step sponsors and leads to accommodate that.
Finally, I just wanted to highlight the last appendix, which is an example of the form
that the updates will take to the health and wellbeing board and gives you a flavor of
some of the information and the snapshots that will be brought to the health and wellbeing
board to provide assurance that work is happening and also be able to highlight some case studies
demonstrating the impact that is actually happening for residents in the borough. May
I also take this opportunity to thank Fusi Adeki and her predecessor for all the work
that they've done to get us to this point. It has been a long journey, but finally, I
think we're getting to the point where we're actually delivering on the priorities and
being able to report on them. The health and wellbeing board is recommended to note the
report and agree proposals for coordinating the delivery. I'm happy to take questions.
Thank you.
Thank you. Any questions or comments from members of the board? Yeah, thanks.
Thank you, Chair. I think I may have joined after the paper was prepared and just to confirm
that the childhood immunization and adult immunization gap for the step sponsor will
be me.
Thank you. Any other comments at all?
Just on the screening, I think we will take that back into our organization as well to
see if we can identify someone to sponsor.
I said we will take the screening step six to eight just to kind of see if we can identify
someone.
That's excellent. Good. Any further comments?
Yes, just a comment on the screening update. We do have a provisional name of Sophie Ruiz
on there, so it would just be good to get your reflections on if you're happy with that
representation and Lucy Sneddon as the step sponsor.
Good. That's excellent. Anyway, thank you for your comment, Robert. Then any further
comments? I think you got off lightly, Shannon. But I mean, you know, it is a comprehensive
piece of work. And the reason why there aren't any questions is precisely because you've
involved everyone that you needed to involve, which isn't as it should be.
So hopefully we can move to formally agreeing with the recommendation. And it is simply
to note the report and agree the proposals for coordinating the delivery of the Joint
Local Health and Wellbeing Strategy as set out in paragraph six to 22. Are people content
to agree that? Thank you. Thank you very much indeed. And obviously the actual delivery
of that strategy is really the key thing. So I'm sure everyone will play their part
in that. Anyway, thank you very much indeed. So we can now move swiftly on to a substantial
paper. Paper eight, which is the health and care plan of 2022. It's a 2024 final report.
Paper number 24253, pages 69 to 140. So this is a report from South West London ICB place
executive Mark Creelton. Thank you very much. So buckle down. We're going to go through
every slide by slide. We're not. No, you're not. You're definitely not. So just to say
that the health and care plan very much aligning to the health and wellbeing strategies. We
had a two year plan and we are bringing this report back as a kind of closure document
for that plan. Mary's going to kind of give us the highlights in a second. But just to
say, moving forward, we want to make sure that absolutely the 19 steps and that any
health and care plan are absolutely one in the same and that we are really aligning those
activities, including things like timeframes. So we want to align some of our timeframes
so that we're not repeating a health and care plan every two years. We can do it in five
years with the health and wellbeing strategy. Mary will then take you highlights through
the report. Mary, please. Thank you, Mark. Thank you, chair. So as the chair noted, we
are talking about the reports that is detailed on page 69 to 140. And if I can, and I will
take the paper as read. So if I can just re-remind ourselves of the vision that the health and
care committee identified back in 2022, to provide the same life chances for all residents
in Wandsworth, healthy, independent and fulfilling lives, dynamic, thriving and supportive communities
and equal access to health and social care. And as Shannon has outlined, the approach
that we took for the previous health and care plan was start to live and age well. And again,
we have detailed the vast number of projects that were delivered and I would just really
quickly touch very high level on a few of the fantastic results that we achieved. So
the promoting alternative thinking skills or paths in the start well, we increased the
uptake in schools and the students that were supported around emotional literacy and resilience.
100% of the teachers and head teachers felt it was very useful and 80% of the pupils had
a very positive experience. Again, childhood obesity, the number of schools achieving the
awards for healthy schools in London. In the live well section, we had some physical health
activities that were really targeted towards the specific communities where they were able
to identify health needs and then signpost them to the relevant healthcare professional.
Mental health and inequalities, a fantastic programme around active wellbeing, which had
extremely low DNA rates and really strong engagement in completion. Again, apologies,
there are lots and lots of projects and rather me going through and I know we are overrunning.
I guess I just wanted to say a huge thank you to colleagues that assisted in delivering
this programme. If we note, I said one of the earlier things was about how we are working
together as a system and I do think that the health and care plan really demonstrates that
from a delivery perspective. I also wanted to extend my thanks to the partnership group.
So as Shannon outlined in the previous item, we want to plan to essentially revive that
partnership group for the new health and care plan. But again, I think the previous iteration,
a real strong group that really drove and challenged the projects, but also offered
the support where required. If I can just highlight three challenges that I think were
common across various projects. Workforce, so again, if we can think going forward around
how we're recruiting, thinking about staff turnover, but equally how we are advertising
roles that they are appealing. Equally competing pressures, so health and social care,
equally our local authorities, equally education, as well as our voluntary community sector.
We are all overwhelmed, but equally thinking about how we can try and align some of those
priorities and work together to deliver them. Finally, around data. So again,
I think the partnership group were very strong around using data to make sure we are driving
the impact and the changes we are hoping for. But just to note, some of our data isn't always
immediately available. So for example, it may be academic year focused, et cetera.
And so how we are assuring ourselves that the projects are making the difference just to be conscious of that.
So I'm asking the board if you can note the activities that have taken place and to approve the report.
Thank you. Thank you. Thank you very much, Mary, for that quick run through the highlights of the last two years.
Any comments or questions from members of the board?
I don't. Stephen, yes.
It's really a comment. I mean, I think it's excellent stuff. So, you know, I think it was read.
The thing which I always struggle a bit with these reports and applies to all of us is keeping a sort of long term perspective.
I mean, this is obviously unbiased nature reporting on two years activity and by definition, two years activity.
A lot of activity. But the data is always going to be a little bit, you know, tell us, really.
And I'm not sure whether this is the right place for it, but somewhere I kind of feel the need.
We ought to be always reminding ourselves of 10 year kind of perspective. You know, are these problems actually getting better or worse?
And this this report might not be the right vehicle for that, but somewhere I kind of feel the need to have that.
Otherwise, we drown in lots and lots of activity, lots of quite short term statistics.
So we hit a target, we didn't hit a target, all that stuff, which are all important and essential.
But keeping an eye on, you know, are things actually improving or staying much the same or getting worse is kind of hard to see at times.
Yeah, very, very fair point. I sometimes raise this myself in relation to a range of different things.
So, Shannon. Thank you. And that's a really fair point in relation to the outcomes, which is something that obviously from a public health perspective, we're always focused on and keeping an eye on.
You probably be aware of the Public Health Board, which is a combined Wandsworth and Richmond board that I chair.
Part of that board's responsibility is to look at and review public health outcomes using the national framework, outcomes framework, and provide a longer term view and oversight on how things are changing.
And the trends exactly as you said earlier this year at one of our quarterly meetings, we did have such a review.
And you'll be aware that on an annual basis, we do then report back into the Health and Wellbeing Board on the work of the Public Health Board.
So I'd definitely be very happy to share some of the highlights in terms of the longer term indicators that we're both pleased about in terms of progress, but also the ones that we're concerned about, where we feel that they should be more concerted work to do.
And a possible recommendation for the board would be whether it would like to consider a high level summary of the kind of snapshot of the public health outcomes framework in all their 121 of them.
It's rag rated, you've got the comparisons to London and England, but very quickly you can kind of get a snapshot of areas that as a system we should be concerned about and areas where we've got good improvement. So that's an option as well. Thank you.
I think that's actually a very good suggestion, perhaps to put it on the agenda when we haven't got quite so many agenda items, but I do think that's very important to monitor things over a much longer period of time.
In the previous report and in this report, there are a number of diseases and health conditions listed as focus for care and improvement.
Being a pediatrician, I'm just a little bit surprised that one of the most common chronic childhood disease, type 1 diabetes, is not on the list.
Type 1 diabetes is a very serious condition. I mean, obesity is an issue, but type 1 diabetes has actually shortened the lifespan by 10 years.
An early complex healthcare delivery system and support for patients with type 1 diabetes and their parents would be a major focus, at least probably because I'm a little bit biased because I'm a pediatrician, but I know the healthcare impact of type 1 diabetes.
And on that note, it's at least a serious issue, if not more, than childhood obesity.
In fact, every single hour, there is one newly diagnosed type 1 patient in the United Kingdom.
Every single hour. This is a very serious issue and I think I would recommend the board to consider to put some focus on this. Appreciate it.
Yeah, I'm sending you to a good point. Nicola?
Yeah, so perhaps just to remind people of the status of this plan and what we're required to do and what we've done with it.
So this was at the beginning where South-West London became an integrated care board and each place, Wandsworth being our place, was required to put together its health and care plan.
And we had a whole process where we talked to lots of people and tried to make sure that we were going to be focusing on the right things because we knew we couldn't focus on everything.
And what we wanted to do was make sure we were focusing on things that we could do better at if we worked at them together.
And so I completely understand your point of view regarding childhood diabetes, absolutely.
But there's lots of work goes on with that all over and obviously we can be involved in a lot of that in our general practice services and caring for children generally.
But it wasn't in the plan because of the process that we went to to decide what it is that we can achieve together.
So I remember Stephen saying at the time, Hang on a minute, waiting this is very long, why aren't we dealing with that?
Well, because actually that goes somewhere else and we didn't think together that would have been where we could have most impact.
So that was just to kind of remind people where we got to with this.
The complicated thing is that haven't we got lots of plans around and trying to align them all and make it make sense is really important.
And I'm really struck by what we've been talking about, about the 10-year thing because of course we've just had the Darzi diagnostic which has been looking at how we've got to where we are
and what the problems are in the NHS with related issues about social care, of course, because you can't look at them in isolation.
And we're going to be having a 10-year plan coming up in the spring.
So do you know it's a really good time to take stock of what we've done throughout a decade.
Some of us were sitting here a decade ago, so I'll remember what we were doing and I'd be really pry was looking at a longer term view of where we are
because with some of these things, they were important 10 years ago and they'll be important in another 10 years.
It doesn't mean to say we shouldn't keep trying and they might have got worse if we hadn't been doing what we're doing.
They might not have got better but there are some of these things that are out of our control
and I think we need to make sure that we understand what it is we can impact on and what we can collectively do to most effect.
Absolutely correct.
Perhaps we could take off line with meeting the issue of type 1 diabetes amongst children and give you some further thoughts.
I mean clearly it is a serious problem but Nicola is equally correct with the health and care plan.
It's very much directed at what we can immediately impact upon and have the greatest impact on.
But perhaps we can take the issue of childhood type 1 diabetes off line and give you some further thought.
Nikkei.
Just to add to the general discussion, I really agree and welcome the talk about taking the longer term approach.
But I just felt I needed to remind us that the health and care plan, the joint health and well-being strategy
all came from the back of taking a long term plan by looking at the joint strategic health needs assessment
which did all of that, highlighted some of the key things and that's what informed that.
So while yes, we want to look at the 10 years, we will probably need to think about which point do we want to take the data from
and do that look. So I just thought before we leave here thinking let's go and do another, the past 10 years
is that we have that data, we refresh it as I'm going to highlight when I get to my part.
But that doesn't mean that things don't emerge and we will pay attention to some of those emerging points.
The only thing I wanted to also ask with your permission chair is how we start with linking, if we're looking at a type 1 diabetes,
really linking with the people who see it because it's always, as Nicholas said, getting the data and knowing where it's happening
and that's what would lead into really understanding how we address it as we can see with even the autism pathway.
So those are kind of the reasons why some of the, not small numbers, but the ones that don't cut across everything
don't necessarily make it into the borough health and care plan. Thank you.
Sorry, chair, can I just add a comment because I think whilst colleagues have been thinking it all,
what I came to present today was the past health and care plan.
I guess what we are planning to do going forward is what Shannon outlined earlier.
So at the moment, childhood diabetes does not feature as one of the steps,
but equally around childhood obesity, physical activity, et cetera, absolutely does.
Now, if, for example, there is a subset of the overall step that we absolutely want to focus on,
which may be childhood diabetes, absolutely.
But again, I think we should, as colleagues have already outlined, be doing that as a system opposed to being reactive.
And secondly, again, just to pick up the points around the long-term plan versus the short-term plan,
I think we need to do a both and and.
So absolutely, we need to be thinking about where are we wanting to get to, what's our vision over the next 10 years.
But equally, what are the marginal gains we're going to achieve to be able to get there?
And so, again, I take the point around maybe we should be thinking from the partnership group,
are we still keeping our eye on the long-term vision rather than just thinking about this is our two-year plan, this is our five-year plan, et cetera.
Thank you.
Yeah, thanks. Thanks, Mary. Again, another very helpful contribution.
Given the time and people really have something very urgent to say.
I mean, as Mary quite rightly points out, this is actually a final report on activities 22, 24.
And obviously, further work is going to be done on a new report, et cetera, a new plan.
So I'm sure the authors of that plan will take into account, again, the very pertinent comments from members around the board.
But if we can move to a decision and the recommendation is that we simply note the activities delivered on the health and care plan 22, 24, and approve the final report attached as appendix one to the report.
But I should say, I think there has been, as Mary indicated, very substantial and significant improvements and successes.
And whilst clearly we need to also focus upon those areas where we haven't been quite so successful,
I think it does demonstrate the value of a plan like this, a targeted and focused attempt to address some of the most serious issues impacting upon our population.
So with that, can I ask if you agree with the recommendations?
Thank you very much. Next item, which again is a very substantial paper and discussion, homelessness and health needs assessment.
This is paper 24254, pages 141 to 224.
And this is a report from Shannon, our director of public health.
Thank you, Chair. This time, I will hand over to a colleague in the gallery, Javed Rahman.
Welcome, Javed.
Yes, thank you. My name is Javed Rahman. I'm the public health lead covering homelessness and health.
Just to give you, I'm just going to give you a background regarding the report,
and then I'm going to hand over to my colleagues in housing just to give an update in terms of their provision and services that they provide.
So in terms of the report and the needs assessment, we hadn't undertaken one for some time.
The last one was conducted in 2010, but that was drafted and never published as we were in the NHS and then transferring over to the local authority.
The pandemic and COVID-19 really brought to the fore the need to for us to do a needs assessment because of the triggers everyone in,
which was a government, the then government initiative around bringing in rough sleepers and providing temporary accommodation to them during that period.
And through that engagement process, we identified substantial significant health and well-being needs, particularly for our rough sleepers within the borough of Wandsworth.
So the needs assessment was principally undertaken by engagement with stakeholders and service providers.
We didn't directly engage with people experiencing homelessness because of COVID restrictions at that time,
but we did get significant input from frontline staff engaged with providing support such as colleagues working in housing,
such as colleagues working at St. George's.
So the needs assessment we carried out in 2022 finalised in '23 and published earlier this year.
And some of you may have seen the report in the PLACE committee, which I think it may have gone to.
In context of South West London, Wandsworth has historically had the second largest number of rough sleepers and statutory homeless applicants after Croydon.
And so it is quite a prominent issue at a borough level.
The needs assessment highlights eight key issues, and they are to, as a system, to increase collaborative working across the sector, to improve the health of people experiencing homelessness,
to improve the mental health offered for people experiencing homelessness, to reconsider where and how services are delivered, especially for rough sleepers,
to improve the primary care kind of appointments for rough sleepers as well, improve access to preventative health care support,
particularly around the industry, podiatry and musculoskeletal services, better targeted collaborative working to reduce health inequalities,
increasing social support, and finally, adapting as a network to support people experiencing homelessness.
And that, again, links into the need for collaborative working.
So since the needs assessment was carried out, we've had considerable joint working, especially with colleagues in housing, our substance misuse team, as well as the ICB.
And we've had a number of initiatives, such as the Health and Well-being Days being delivered by SPIRA Outreach, Homelessness Outreach,
a charity that we commission via housing, and the Driving for Change bus, which is around providing support for rough sleepers,
particularly around wound care and kind of initial dentistry assessment, particularly in the Clapham Junction area.
So the other initiative that our colleague in housing will highlight is around our new rough sleeper assessment hub in Lavender Hill.
So there are further work to be undertaken.
The ICB is currently, through the Southwest London Homelessness Working Group,
is looking at a strategy around how they take forward the recommendations outlined in the needs assessment.
And I think they'll be developing paper early next year for presentation to the health and well-being board, as I understand.
We, within public health, will be working with our colleagues in housing and setting up a six-monthly meeting to then progress the key recommendations
and working with colleagues within that forum.
Just as a kind of follow on, I'm just going to hand over to my colleagues in housing to highlight their initiatives.
I'm not sure if Dave Worth is online. Is he online?
So I'll give it over to Dave and then Michael from housing.
Thanks.
Yes, thank you, Chairman. Good evening. Good evening. Good afternoon, colleagues.
So, yes, we have been successful pretty much on the back of the everybody won in
initiative,
although we were building it prior to that in really building our rough sleeper street homelessness service over the last four or five years.
The previous government and the current government have put significant monies into that.
And we've got, we've drawn in several million pounds of funding.
Part of that goes to our street outreach work, where we have a partner charity, Spear, out in the early hours of the morning, twice a week,
verifying where the rough sleepers are, where they've been reported by members of the public through the street link service, et cetera, seeking to engage with them and seeking to find a housing solution.
So this report is very much welcomed. It adds a lot to that piece.
And Chair, with your agreement, I'll hand over to my colleague Michael, who's leading and is very, you know,
invested in the development of the Hubbard Clapham Junction and he can explain to members of the board how that's going to work and how it's going.
Thank you. Thank you very much for having me.
I'm very glad to update the board on that and all the work that's going on in this field.
As Dave just mentioned, we've had quite a rapid development of street homeless services in Wandsworth.
Only five years ago, there were no services whatsoever.
So throughout that process, we've essentially been able to recruit specific services and roles to sit within statutory services because of the multiple disadvantages that street homeless people face.
Those specific services are required.
So we've had a lot of really, really good outcomes since the start of Covid.
We've housed about seven or just short of 700 people off the street, which is which is obviously great.
However, we still have people who are currently street homeless and they at the moment fall under three categories.
So those with a considered low need, low priority need in terms of vulnerability,
those who are extremely entrenched and find it very hard to engage with services or accept offers of accommodation and those with no recourse to public funds.
So essentially, we still have people on the streets where if we're able to offer accommodation, often that's temporary accommodation that's very far away.
And we've got lots of bespoke services, which is fantastic, but they are spread across 15 different buildings across the borough.
So that is where the hub concept came from.
So thanks for bearing with me for that little background.
I think it's helpful to explain where this whole project started.
So essentially, the hub will offer a local accommodation space for people who are currently street homeless, who are currently not accepting that offer.
So that really applies to a lot of the entrenched people who who won't go to Croydon because it's outside of their outside of their support network.
And we're not going to be applying any kind of priority need requirements.
So anyone who's low, sort of assessed as being low needs would be placed in that building as well.
The other very exciting side of this is that we have made, we haven't filled the building with bedroom accommodation.
We've made a large provision for office space.
So essentially, if you are a service who supports people who are street homeless, you will be co-locating into this building.
And that lends itself to all of the points that Jabba was making about collaborative working.
Essentially, at the moment, you've got someone who is street homeless might have to engage with their outreach worker, housing worker, drug and alcohol worker, mental health worker, social services worker.
And, you know, it's essentially it's very, very difficult for that person to do that and for services all to work together.
So essentially, by bringing it all under one roof, that's it also presents us with another opportunity for a new way of working,
which is my last point, which we're very excited about, which is our super outreach approach that essentially is based on two main principles.
One is that every door is the right door.
So regardless of what service someone who is street homeless comes into contact with, it will enable them to access any other service within our within our pathway.
And the second principle is that no one should have to keep on repeating their story.
We essentially have a cohort of people who are street homeless that I would say the vast majority of which have trauma in their backgrounds and expecting people to repeatedly go over their story.
And I'm sure we all go to the doctors and you get a new doctor, you have to repeat everything again.
And it's frustrating for us. Imagine having to do that with six different professionals all the time.
So this super outreach approach essentially means that someone who is street homeless would pick their trusted worker.
And it could be anyone that they have their best relationship with out of all of these different services that are involved that are all based in the hub where this person will be staying.
And that trusted worker essentially coordinates the work, doesn't do the work of the other people, but essentially coordinates the work of everyone else in the sort of team around me approach.
So that approach requires not only the people who are all involved in the case to be talking to one another and letting the trusted worker communicate that to the person involved,
but everyone in this approach also needs to know what each other's jobs are.
And I think at the moment if I ask my outreach worker what exactly does a drug and alcohol worker do, they wouldn't be able to tell me.
And I think that's also really exciting. We're essentially going to be asking people what do you want rather than are you a heroin user or are you paranoid schizophrenic.
It's more of a strength based approach, what do you want and we're basically sort of like starting afresh and thinking actually how is the best way to support this extremely vulnerable cohort. Happy to answer questions.
Thank you, Michael. I mean I was very pleased to see this particular piece of work. It is very important. It's really good to see housing colleagues that are working with our social care etc and children's etc.
That is how we need to go forward a very holistic approach in relation to that. And also the one stop shop you described in terms of the facility. Again absolutely essential so really pleased to hear this.
I know time is pressing. I'm not doing a very good job as chair but we have quite a lengthy agenda. But can I ask, I don't want to suppress any discussion, but can I ask if members of the board have any comments. Ariane.
I'll try to keep it very brief. I just want to thank. Thank you all for a wonderful presentation of some really visionary work and just how it's your vision of actually collaborating and centering around the individual for their needs is really inspirational I think
to the extent that Philip might not be asking questions about identifying the most vulnerable patients because clearly that's where you've started. And the hit team in St. George's has changed cultures amongst doctors so that homelessness is really on everyone's radar.
And again you know I've seen that being quite transformative in junior doctors. There was just some mention about whether they would get ongoing funding. And I was wondering if there was any update as to the continuity of that because you're very thin on the ground in terms of capacity.
Looking at the, you know, looking at all the data you've submitted. So, I wholly support the work you do and applaud. Thank you. So, just, sorry, can we take over comments and I'll come back to you at the end.
Yeah, I wanted to thank housing colleagues and public health for this paper. We've always said that housing is one of the major determinants, and it's really good to have us a proper discussion about it at this committee so congratulations on the very thorough piece of work.
And welcome very much the work you're doing to to follow up there. One is you how identify the paper is, it doesn't think an action plan as such, I think, you know, so there's a kind of step to go and you obviously are doing a lot of actions so that's welcome but I suppose
the question is, are all recommendations here being picked up somewhere. My other question is, this is a really important aspect of housing, but there are other aspects of housing that we might want to consider.
One is about the quality of housing. I mean, I went, people are not necessarily homeless but living in poor accommodation. And, you know, I don't know at the moment whether that is a big issue in Wandsworth or not, you know, what data have we got, and what processes
that we got to address that, where it is an issue and including links between GPs where they're picking up issues like asthma in children, that kind of thing, and housing.
So I think there's another dimension of housing that'd be really useful at some point to to address as well but very strongly welcome the fact we're having a conversation about housing at all at this point is really important.
Thank you.
Yeah, I mean, perhaps if I address that from a council perspective, I mean, one of the objectives of the administration is to ensure much more joint up working between the various departments within the council and I think this is actually a very good example of what's been done.
I mean the paper is very specific about homelessness, and there is of course a legal definition of that which is actually set out in the paper. The other point you make around housing are entirely valid.
And I do know we spend a lot of time in cabinet talking about how we can increase the housing stock and actually improve it and repair it. I mean, there are certainly some parts of the housing stock which do actually need urgent maintenance which has been neglected for a very, very long time.
And it's now catching up with buildings, many erected, you know, before the Second World War. And so, your point is entirely valid I think, but this paper is very much focused upon homelessness.
I mean we can look at the other issues of course in due course.
So, any other comments here? Yes.
Shall we go to Dave first? He'll probably disagree with everything I've just said.
No, Councillor, not at all, just to amplify. I mean, you're right, this paper is focused on the health needs of homeless people and Michael has just spoken about the, arguably the most vulnerable amongst the homeless, those who are literally without a home.
But on the broader piece, the problems described are generations in the making, I think.
So, we've got an ageing stock, we've got a large stock of social housing, but it's ageing. We spend a lot of money repairing it. But just some points to mention, so members of the board are probably aware of the 1000 Homes programme, so that's where the Council is building 1000 new modern, you know, decent affordable social rent homes across the borough.
We're currently up to rough numbers, about 300 odd completed and let another 300 odd on site at the moment, and another 300 odd at the pre-planning stage, so we went on track to achieve that.
The other thing to mention, I think, to pick up the health-related impacts of things like overcrowding, damping mould and so on, which we all know have been highlighted in recent times, is that where the Council is doing its regeneration schemes on the Winstanley York Road and currently after consultation on the Alton Estate in Roehampton,
the new homes are designed around the needs of the people whose current homes are being replaced. So, if someone's in a two-bed and is overcrowded, the design of the regenerated estate will meet their need, not their current property size.
So, those are things that we're doing, which are both in the department and across departments, all positive on this agenda, but really, as I said, the problems are, you know, generations in the making and, you know, it's really for the new government to set out
shortly where their priority on housing is going to be, so that's something to watch very closely and, of course, where necessary, we would come back to the board with updates as necessary. Thank you.
Yeah, thanks. Thanks, Dave. This is obviously a major piece of work, one of the top priorities for the Council. I mean, we can certainly discuss how we can look at the health impacts from housing, but yeah, it's just widely recognised, certainly from my perspective, housing is the principal determinant of health inequalities
and, of course, it stems also from income distribution and inequalities, but yeah, I think that's certainly something we can take away. Michael, quick comment before we move to the recommendations.
Yeah, just coming back on the comment about the homeless inclusion team. Yeah, I know we're short for time and I want to do a whistle-stop tour, but I think I forgot I was presenting to the health board.
We are very much linked in with Danielle Williams and the amazing work they do at St. George's Hospital. I'm also very aware of the precarious nature of that funding.
One of the benefits of doing all of this and the cross-departmental shared responsibility and approach to commissioning is that we can look at things like that in terms of funding, so we're very aware of that at the moment.
Just a last point, Danielle Williams and the homeless inclusion team and Dominic in particular have been fantastic at designing the clinical space that we have at the hub,
which is a specific space that will have medical equipment from St. George's Hospital there to be able to deliver health interventions for people where the average deaths of males is 45 and women is 43 for people who are street homeless.
So, just as a last summer point to end on.
Yeah, summery thoughts indeed. I mean, I think Stephen raised a very important point in terms of what follows the needs assessment.
Usually what follows the needs assessment is then an action plan or something very similar.
So, I think, you know, this paper actually said its purpose. Hopefully we can agree with the recommendations, but I think certainly looking forward, we've obviously been looking to see actions arising from this as to how we're going to address those recommendations.
So, unless, again, anyone's got any burning comments, so please.
Thank you, Chad. Veena Smith here on behalf of our assistant director for Strong Green Safe Heart, Kiran Bhagwal, which gives her apologies.
Just welcome this report and some of the work which our community safety team are also doing alongside our housing partners and SPEAR in terms of outreach.
One of the areas which we, in terms of getting those interested part like interest from communities around the perception around rusty purse and also some of the difficulties and what experiences that they may face and maybe the council not being perceived as doing enough.
So, I think we definitely welcome the fact that we'll have this happen. We'll have this initiative available to those individuals and we definitely welcome the work which will pursue in regards to those who are really hard to engage.
Or maybe find it difficult to access services to support them in terms of moving on.
My only consideration around this was around the transient nature of some of these rusty purse in terms of coming maybe in and out of the borough, maybe not engaging as well, but then reappearing again in another part of the borough.
And where our community safety officers and ASB team are kind of picking up and having to take enforcement actions.
So, just thinking of that in terms of the second part of your action plan to build into that work.
But happy to work alongside you with that work. Thank you. Thank you, Chair.
Yeah, thanks indeed. Of course, community safety are an integral part of the total holistic approach. So, can we move to the recommendations? Again, contained in paragraph one to know the findings of the needs assessment. I think we've provided feedback in the implementation of the recommendations. We'll take that away and develop a plan and to support the dissemination of the findings from the needs assessment. Can we agree those recommendations, please? Okay, thank you very much. Now, I have felt miserably to keep this on time to two hours. We have gone through quite a lot of stuff. I do know that I think there was intended to be a presentation in relation to the next item. Interactive semi-automated JSNA production update. I think if whoever is presenting that, which is I think Nikkei, it is important. If you could try to keep it as -- I mean, I know it's a complex area. But if you could try to keep it as short as possible, I think that would be much appreciated. Thanks, Lil. If I can just get on to it. So, I'm going to share my screen. I will take the paper as read. So, the purpose of today, thank you very much, is just really to share, give you a chance to see the JSNA, the automation. Because sometimes people look at it and think, oh, how do we use it? So, we've made very good progress. There's two products, the interactive JSNA 2024 and the JSNA at a glance dashboard. They have key indicators and they're on the council website. As of July 2024, it went live on to the website. Move to my next slide. So, the JSNA, it has three functionalities, which I will show you at the end. One is it's got a very clear web structure. It has a JSNA guide that you can use. And it also has this process of actually updating things, which I will show you. I've got a colleague, Ben Humphries online, who will click into the web link once I get to the end of this to avoid us going to and fro. We were going to do it now. But in the interest of time, we'll just do it at the end. This is the other one I was talking about, which is the JSNA at a glance dashboard, which we will show you as well. And what I will say to you now before we go into it, because you'll be wondering when you see it, can we copy this, can we cut and paste? If you hover over that camera, if you look, when it's online, you'll see the camera. If you hover over that, you can copy and paste. And in the at a glance, you can just right click. Now I'm going to ask my colleague, I'm going to stop sharing. And I'm going to ask Ben to please take us into the semi-automated JSNA on the web page, as you would see it if you wanted to use it. Ben, do you mind going to the web page itself first, as we did in our... Yes, so when you go into the JSNA, that's what you'll see. Ben to the one that has the dev, if not people won't know which one we're doing. Okay, so normally when you go into the front, you'll see JSNA and it will have DEV. So you'll know you're in the correct interactive version. And when you go into that, it will give you a breakdown of all the areas that the JSNA has. One of them is JSNA people. And then if you want to go into JSNA, at the top of it as well, you will also have the user guide. For some reason, Ben has gone straight into the thing, but not gone to the front page. So I'm trying to show you how you go in from the front page, but we're not starting from the front page. So on the front page, you would also have the user guide. And the user guide will take you through how you can use this as well. So if you can imagine that you have front page with DEV, and then you go in a list of everything. So you can pick which ones you want to go into yourself. And then we were going to pick population. Yes, that's it. So this is what it looks like. And then you can see the user guide, you can see a list of everything that's in the JSNA. And why it's interactive is if it was paper, you'd have to go through everything from the first page to the last page. But this way, if you only wanted age, well, if you only wanted to get something about the population, you could go directly into the population. So Ben now, if you want to just go to that population one just to show so people feel comfortable. So if you only wanted something about some data, you could just go directly to that. And if you went on to, do you want to go to 1.2 now with the graph? Just because of time, we're doing it quicker than we anticipate having to do, but that's fine. So if you've got the graph, you could hover over the graph, it will show you all the boroughs in London. You could hover over London, you could hover over any of them to get the data, to get the numbers you wanted. So like there, yes, you could, you know, so you wouldn't have to come out, you know, if it was in a document, you'd have to go to a table. So you could get that and you could, and this is where I was saying, if you wanted to copy it at the top, just before the search, you could see a camera top of it. Yeah, then you could, if you hovered over that, it would help you take a picture of this chart. Thank you very much, Ben. Should we now go into the JSNA at a glance document so people can just see that as well. So what we've also done, and this fits in with some of the conversations earlier about how is Trend doing? How are we doing? How are we comparing? We have a JSNA at a glance that you can just go into. It has all of them. It rat grades it for you so you can see, and it mentions whether it's higher than the year before or whether it's lower. It would. And then if you go into, if you click on one M, so each one will have something. Just click on it on one of the at the bottom. Yeah. It is also accompanied with some narrative so you can see the time trend you were asking for. So a healthy life expectancy. And it then gives some indication about where we sit, what it looks like. And just that's why we've called it the at a glance. So the narrative is there. Why it's semi-automated and why we're sharing this is every year it refreshes. So where there's routine data like FOF and stuff, it will, instead of us having to sit down like we had to all sit, we've used whatever, the digitalization, all these things that I have in there. Python and it just all uploads. We then upload the narrative where we need to. And what we're trying to do is do this in the cycle of joint health and well-being strategy and the health and care plan. So when you want the big refresh, we will then also have a big refresh of everything. That's probably what we wanted to show you. The other two points I'll very quickly make is just to highlight the what the next steps. So the next steps will be, as I mentioned, we'll have this periodic template refresh. We will try to train people for the ongoing management as a technical group. And I just would like to thank InfoInsights, the provider who did it. The JSNA working team, my colleagues, Ben and Martin, who really did a lot of work to really get this to where it is. And to let you know what I've said already, we'll do the major refresh in line with the cycle. And we've also varied the contract from a two plus one, because to meet the timeline, it was going to end in 2026. We moved it 2027. So everything happens chronologically at the same time. That is all over to you, Chair and members, if you have any questions. Thank you. Thank you very much indeed. I think that's a very, very useful tool for all of us. And I look forward to actually exploring it myself when I go to the time. But I mean, there's a lot of useful information there indeed. And any comments or questions from members of the board? Mark? Fantastic. It's my only comment. That's what I like. Short and sweet. Shannon? Thank you. Maybe not as short and sweet. I just wanted to highlight as context for some of the board members who may not have been there when we embarked on this piece of work, that the JSNA doesn't just support the health and well-being board. It's used by commissioners. It's used by the voluntary sector to position themselves for the market. It's used by students doing research. It's used by people wanting to find out about the borough. So actually increasing the accessibility and making it easier for people to interact with the JSNA is at the crux of the reason why we produce it, so that it can really be used and embedded into everything relating to the borough. So it's an excellent job and well done to the team. Yes, indeed. Thanks. That was a good point, Shannon. Do pass on our thanks to the team. I think this really is an excellent piece of work. OK, well, if that is the case, no further questions on that. We are asked simply to note the interactive, semi-automated JSNA products, which are now live. And the next steps for ongoing maintenance and management products, including future JSNA production. So can we agree that as one recommendation? Thank you very much, indeed. Right. Well, hopefully the next two items shouldn't take too long, but then perhaps some tempting fate. Revision of the terms of reference paper number 24256, pages 227, et cetera. Report by Jeremy D'Souza, director out of social care. And Lynn, I think you're going to introduce this report. Thanks. So accept the challenge to make this as quick as possible. I think the paper is fairly self-explanatory. I hope it is. So the key changes is just updating some of the things that there is no longer commissioning plan. Changes in the number of seminars delivered, because we have found it quite hard to set the original target. And to define what deputations are and then noting how we might involve wider participation in the board in our attempts to ensure that we are relevant. It is marked up in the appendix and then there's another appendix where it's all cleaned up. So hopefully you'll agree that it's good. Excellent. Thank you very much, Lynn. I want to say very briefly, from my perspective, you know, we've been sitting here all afternoon and we've been having some really great discussions around reports. The health amount being pulled is very much report orientated. And, you know, we ended up and there's no criticism anyone with 260 odd pages of documents. And what I would actually quite like the board to explore would be to invite interested groups to come along, give presentations to the health and well-being board. That is including the proposed change to the terms of reference to encourage deputations as well. And that is also part of the revised terms of reference. So, I mean, I do see this as quite a significant potential change. It will take some time to develop. But as I said, I'm quite keen to have some really great discussions here. And I often feel that sometimes a bit lost that other people could benefit from them and we could actually benefit considerably from other people with expertise in specific areas. So those are two of the most important changes for myself. Obviously, recognizing the carer representative, that's the vitally important part. But any comments on that, please? Abbie. Thanks. And thanks for redoing the terms of reference. Just a comment from me, which I had previously given to Luke. So I guess FUSI is just around kind of -- we talk a lot about health inequalities. We've got to make sure that people who aren't in this room, who don't talk in jargon and understand how the NHS works and stuff, understand what the point of this board is. So I think the terms of reference have improved, which is good. But I would encourage maybe to think about things like an easy read version or different languages and so forth to try and help inclusivity. Because I think a lot of people who really need to understand what people in this room do don't really have the foggiest clue, which is not a criticism anyone in this room at all, I think is the way it is. But I think we've just got to be really mindful of trying to make it as easy to understand and accessible as possible. Yeah, that is a very good point, indeed, as well. Something I do sometimes mention, I think it's almost a function of this being sort of port-driven, really. And obviously, as you say, the people around here are all part of the cohort who do understand most, if not all, of the terms. But, yeah, clearly in terms of communication with members of the public, male residents who ultimately are on the customers for everything we do, we do actually need to ensure that people are very clear on what we mean about certain terminology. And, unfortunately, every profession has its own jargon, and 9/10 of the battle series is actually to understand what that jargon is. So, again, very well, good point made, Abby. Any further comments? Yeah, Nicola. Yeah, so just on the membership, the bit that's about the ICB membership with the roles in primary care, I just think we might need to work through that a bit. We've had a little bit of change in structure, and we've got an impending appointment of a clinical director, for example, and I think we just probably need to future-proof this a bit, and if we could just have a little time to have those discussions, that would be great. Thank you. That would be great, Nicola. If you could, we can just sort that out offline in terms of title, the idea of title rather than names. Yes, exactly, and the principle of having three representatives there, I wouldn't disagree with. It's just like who they are in our structures. Thank you. Okay, excellent. And so with that matter, then Nicola will take that away. Any further comments? If not, can we approve the revised terms of reference? Thank you very much. Right, so we now move on to what I think is the last item here, which is Health and Wellbeing Board Work Program 24257, pages 245, et cetera, and this is another report from Jeremy D'Souza, and Lynn, I think you're going to talk to this one as well. Thanks. And I'm not going to dwell on this because it's completely self-explanatory. I'm just going to make the usual things. If you have something you'd like to bring or a deputation indeed, do let BUSI know so we can put it on to the forward plan, and if for whatever reason you can't make the deadline, just let us know and we can shift it to a time that does work. The thing, we were hoping to, we haven't yet firmed up a date, but we're thinking that we'd have maybe our second seminar in January or February next year about developing our partnerships, so picking up on Councillor Henderson's intention to make this as relevant as we can as a board, rather than just as a place where we nod at worthy papers, so just to draw your attention to that. Otherwise, any questions? Yeah, any questions on the board program at all? No? Oh, excellent. Well, in which case, if we can, does the board note the work program? But do take Lynn up on her offer. If there are particular groups of people who, specialists or whoever, who have a keen interest in any issue related to health, particularly obviously focused upon health inequalities, then do have a chat to Lynn and hopefully we can schedule them to come along so we can actually have a full discussion on the topic. So, if we can approve that work program, yeah, agreed. So, I think the date of the next meeting is held on June 21st, November, a bit like buses, they come along one after the other, so we don't have a meeting since February and now we've got another one in a couple of months' time, but that's unfortunately the nature of the scheduling of meetings and elections and unplanned elections and a whole range of other things. I think, I'm sorry, I must apologize for my very poor chairing that we've run over by 15 minutes, but I do think we have actually discussed an enormous amount of excellent stuff, particularly since we obviously did drop a meeting as a consequence of the elections, but can I just simply thank you for your contributions, for attending, and also to thank any members of the public who may be watching this and who have stuck through to the very end. Thank you very much indeed, thank you. Thank you. [ Silence ]
Summary
The Board agreed the recommendations in each of the reports on the agenda. These included holding the Council and health partners to account for the implementation of the new Autism Spectrum Disorder Emerging Needs Pathway, to sign off the Better Care Fund Plan end-of-year review, to note the activities delivered as part of the Health and Care plan, and to note the findings of the Homelessness Health Needs Assessment. It also agreed with the Director of Public Health's proposals for coordinating the delivery of the Joint Local Health and Wellbeing Strategy, and to note that the interactive, semi-automated Joint Strategic Needs Assessment products were now live. Finally, it approved the revised Terms of Reference and noted the work programme.
Autism Spectrum Disorder Emerging Needs Pathway
The Board discussed a report about the Emerging Needs Pathway (ENP), which was introduced in 2019 to help families of children under eight years old who were suspected of having Autism Spectrum Disorder (ASD). The Board heard that there were long waiting times for children to be triaged and to be seen for an autism assessment.
Nearly 900 children on the ENP list awaiting triage
225 children on the MDA list awaiting an autism assessment 62 available only appointments in 2024
The Board were told that to address the current issues, a new model was being introduced with two new pathways running in parallel, one overseen by the Council and one by the ICB. The Council's pathway would focus on ensuring children and their families received wider support, including parenting advice and help with finding and accessing suitable education provision. The Health pathway would focus on reducing waiting times for initial assessments. This would be achieved by introducing a centralised referral system, led by St George’s Hospital, and establishing a multidisciplinary team to provide comprehensive evaluations. The new pathway aims to ensure parents understand the referral process more clearly, which will reduce stress and worry and reduce the number of complaints received by the Council in relation to diagnostic wait times.
Councillor Kate Stock, the Cabinet Member for Children, said that the points that had been made about communication were entirely right. She said she had heard a lot about the uncertainty over the wait time for families. The Board were told that the ICB and St George’s Hospital were committed to making sure that children with complex needs are triaged much earlier because children with very complex needs were coming through as early as two years old.
Better Care Fund
The Board discussed two reports about the Better Care Fund (BCF). The BCF is a government scheme that supports the integration of health and social care. It is a pooled budget that is used to fund schemes that support people to live independently for longer and receive the right care in the right place at the right time.
The first report provided an end-of-year update on the BCF for 2023-24. The Board heard that Wandsworth had met all of the national conditions for the BCF. The report also highlighted the progress on the metrics. These include:
- Avoidable admissions: This metric measures the number of unplanned hospitalisations for chronic conditions that could be treated at home. Wandsworth did not meet the target for this metric.
- Discharge to normal place of residence: This metric measures the percentage of people who are discharged from acute hospital to their normal place of residence. Wandsworth met the target for this metric.
- Falls: This metric measures the number of emergency hospital admissions due to falls in people aged 65 and over. Wandsworth met the target for this metric.
- Residential admissions: This metric measures the rate of permanent admissions to residential care per 100,000 population (65+). Wandsworth did not meet the target for this metric.
- Reablement: This metric measures the proportion of older people (65 and over) who were still at home 91 days after discharge from hospital into reablement / rehabilitation services. Wandsworth met the target for this metric.
The report also showed that the BCF had been fully spent.
The second report set out the BCF refresh for 2024-25. The Board were told that the minimum NHS contribution to the BCF had been uplifted by 5.66%. The report also set out the refreshed demand and capacity plans for intermediate care1. The demand and capacity plans show that the expected demand and the capacity to deliver it is broadly in balance, although there are seasonal fluctuations. The plans also include a new metric that describes the average time in days between when someone is referred to be discharged and when their service starts. The new metric is intended to help the borough understand how quickly and safely people can be discharged from hospital. The Board were told that work was underway to identify and support carers. There was also a lot of work going on around a number of areas to prevent unplanned admissions, including rapid response teams, a virtual ward, and proactive care.
Health and Care Plan
The Board received a final report on the Health and Care Plan 2022-2024. The Board heard that the plan had been delivered through a series of projects across three life course areas: Start Well, Live Well, and Age Well.
The report highlighted some of the successes of the plan. These included:
- Reducing childhood obesity through programmes like the Family Weight Management Programme and the Healthy Schools London programme.
- Improving children and young people’s mental health through programmes like the Mental Health Support Teams (MHSTs).
- Supporting people to live well through initiatives like the Active Wellbeing Programme and the Diabetes Decathlon Programme.
- Improving the support for older people through the Enhanced Health in Care Homes programme.
The Board also heard about the challenges that the partnership had faced in delivering the plan. These included workforce challenges, competing pressures, and data limitations.
Councillor Stock said that housing was one of the major determinants of health and she was pleased to have a discussion about it at the meeting. She asked if there was any data available on the quality of housing in Wandsworth and if there were any processes in place to address the issue of poor quality housing. She also asked if there was any data available on the link between poor quality housing and health problems such as asthma in children.
Homelessness and Health Needs Assessment
The Board discussed a report on the Homelessness and Health Needs Assessment (HHNA). The HHNA details the health needs of homeless people in Wandsworth. The report highlighted the following key findings:
- Homelessness is increasing in Wandsworth, both in terms of the number of rough sleepers and the number of people applying to the council for help with homelessness.
- Homeless people have worse health outcomes than the general population.
- Homeless people face significant barriers to accessing healthcare.
The report made a number of recommendations to address the health inequalities experienced by homeless people in Wandsworth. These recommendations are being taken forward by the South West London Integrated Care Board (ICB) and the Council's Housing Department.
The report was welcomed by Councillor Graeme Henderson, Cabinet Member for Health, who said that he was pleased to see that the Council's Housing department was working with other partners to address the health needs of homeless people.
Councillor Stock said that housing was a key determinant of health and that it was good to have a discussion about it at the meeting. She asked if there was an action plan that would follow on from the needs assessment.
The Board heard that a new Rough Sleeper Assessment Hub was being developed in Lavender Hill which would provide a one stop shop for rough sleepers to access services.
Joint Local Health and Wellbeing Strategy Delivery
The Board considered a report about the delivery of the Joint Local Health and Wellbeing Strategy. The Board heard that the strategy will be delivered through the Health and Care Plan with each step prioritising specific activities over the next 12 to 18 months.
The report highlighted the key roles that will be involved in delivering the strategy. These are:
- Step sponsors: provide executive level oversight for each step in the strategy.
- Step leads: are the main point of contact for each step.
- Action leads: are responsible for delivering specific activities within a step.
The report also set out the frequency of reporting on the strategy. The strategy will be reported on quarterly to the Health and Wellbeing Board.
Interactive Semi-Automated Joint Strategic Needs Assessment Production Update
The Board received an update on the interactive, semi-automated Joint Strategic Needs Assessment (JSNA) products. The JSNA is a document that assesses the health needs of the population of Wandsworth. The interactive JSNA is available online and includes a range of features, such as:
- A clear web structure.
- A JSNA guide.
- A process for updating the JSNA.
The Board was told that the interactive JSNA was published on the Wandsworth Council website on 8th July 2024.
Revision of the Terms of Reference
The Board approved the revised terms of reference (TOR). The changes to the TOR include:
- Updating the language to reflect the new Integrated Care System (ICS) structures.
- Adding a carers representative to the membership of the Board.
- Allowing for flexibility in the number of seminars delivered each year.
- Defining the term ‘deputations’.
- Allowing the Board to invite special interest groups to comment on reports on the agenda relevant to their field.
- Updating the list of partners that the Board will work with.
Councillor Henderson said he was keen to have more discussion at meetings of the Board, and suggested inviting more interest groups along.
Health and Wellbeing Board Work Programme
The Board noted the Work Programme. The Work Programme sets out the planned meetings and seminars for the Health and Wellbeing Board. It is a live document and will be subject to change in response to the evolving requirements of the Board. The dates and draft agenda items for the upcoming meetings are included in the Work Programme.
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Intermediate care is the name for a range of services that help people who no longer need to be in hospital but who are not yet well enough to be at home without support. ↩
Attendees
- George Crivelli
- Graeme Henderson
- Kate Stock
- Abi Carter
- Ana Popovici
- Dr Aryan Jogiya
- Dr Nicola Jones
- Dr Waqaar Shah
- Jeremy De Souza
- Kate Slemeck
- Mark Creelman
- Mike Jackson
- Mike Procter
- Philip Murray
- Robert Guile
- Shannon Katiyo
- Stephen Hickey
- Tihamer Orban
Documents
- Agenda frontsheet 03rd-Oct-2024 13.00 Health and Wellbeing Board agenda
- Public reports pack 03rd-Oct-2024 13.00 Health and Wellbeing Board reports pack
- BCF End of Year
- BCF Refresh
- Draft HWBB Minutes 290224 other
- Better Care Fund End of Year - Appendix 1
- Emerging Needs Pathway v2
- Better Care Fund Refresh - Appendix 1
- JLHWS Delivery
- Appendix 1 - Health and Care Plan report
- Health and Care Plan-Cover
- Homelessness Health Needs Assessment
- Homelessness Health Needs Assessment - Appendix 1
- Semi Automated JSNA Update
- Work Programme
- Terms of Reference Update
- Appendix 1 - Terms of Reference for Approval
- Appendix 2 - Previous Terms of Reference other
- Decisions 03rd-Oct-2024 13.00 Health and Wellbeing Board other