This meeting was scheduled to discuss a range of issues relating to the Council’s provision of services to adults, with particular focus on learning disabilities and sexual health. The most significant issue on the agenda was the Council’s proposal to close the Markhouse Centre, a day centre for people with learning disabilities. The agenda also included an update on the planned recommissioning of the Council’s integrated sexual health service, in anticipation of the current contract expiring in late 2025.

Markhouse Centre

The Committee was scheduled to consider a report on the outcome of a public consultation on the Council’s proposal to close the Markhouse Centre. This proposal arose from a review of the Council’s provision of day services to adults with learning disabilities, which the Cabinet had previously decided to consult on in June of this year. According to the report, the Council believed that alternative day opportunities providers could meet the needs of the 52 residents who regularly attend the Markhouse Centre, and that this would offer better value for money to the Council. The consultation received 128 responses, including from people who use the Centre and their families.

According to the report, a large majority of survey respondents disagreed with the proposal. There was strong feedback that the service provided by the Markhouse Centre was very good and met the needs of those who used it. People using the service and their families felt that the Centre provided a sense of safety, security and familiarity, and that the staff had built strong relationships with those who use the service. Some respondents were concerned that alternative services in the borough would not be suitable for those who use the Centre, particularly those with more complex needs. Some respondents also felt that the Council had not maintained the Markhouse Centre building to a sufficiently high standard, meaning that significant investment (£1.2 million, according to a 2023 building survey) was now required. Other respondents felt that the Council had pre-determined that the building would be sold and had not sufficiently considered other options, and were concerned about the impact of the closure on those who use the service, their families and staff.

During the consultation, several alternative options for the future of the Centre were put forward. These included seeking funding to renovate the existing building, leasing part of the building to another organisation to raise funds, and the possibility of another organisation taking over the building and the services. Three day opportunities providers had approached the Council during the consultation period expressing interest in the service and the building. Of these, two had since withdrawn their interest, while the Council was continuing to explore whether the remaining proposal was viable.

The report pack also included a summary of alternative day service providers in the borough and the surrounding area, and a breakdown of the current capacity of these providers. The Council had conducted a ‘desktop exercise’ which looked at the number of service users with each level of need currently using the Markhouse Centre. By comparing this data to information on provider vacancies, the Council concluded that the market had sufficient capacity to support those who currently use the service, should the Centre close. The report pack also included information about how the Council would work with service users and their families to manage any transition to new provision, should a decision to close the Centre be taken.

Integrated Sexual Health Recommissioning

The Committee was also scheduled to discuss a report that provided an overview of the Council’s plans to recommission its integrated sexual health service (ISH). The current contract, which is provided by Barts Health NHS Trust and covers four boroughs, is set to expire in November 2025. Local authorities are legally required to commission sexual health services. The report explained that sexual health services are essential to ensure a healthy population and tackle health inequalities.

The report pack included a summary of the current need for sexual health services in Waltham Forest. There were over 3,000 new STI diagnoses in the borough in 2022. The current ISH service, known as ‘All East’, was accessed over 20,000 times by Waltham Forest residents in 2022/23.

The report stated that the current ISH service had been performing well, and had responded positively and flexibly to ongoing challenges. Some key successes of the current service included increased provision of LARC, increased uptake of PrEP for the prevention of HIV transmission, exceeding pre-pandemic levels of Hepatitis vaccinations, improved service access through online and telephone booking, and the introduction of dedicated clinics for high-risk and vulnerable residents.

The commissioning intentions for the new service were informed by a review of the current service, a needs assessment for the borough, public and stakeholder engagement, and an independent review of the service model. The report pack contained information about the proposed service model, which would broadly be the same as the current provision, and the locations of the service, which would also remain the same. The report pack also described the Council’s priority outcomes for the new service, including: decreasing the proportion of HIV that is diagnosed at a late stage, reducing the numbers of abortions and repeat abortions in the borough, and continuing to ensure effective vaccination and early intervention.

The report pack also contained a description of some additional areas that the Council would ask the new service provider to focus on, including: improving partner notification, greater system leadership and shared learning between outreach partners, a more proactive service for high-risk groups such as asylum seekers, a broader range of routes to access the service, measuring and adapting to respond to unmet demand, and considering delivery in additional locations. The report pack also stated that a small increase in funding for the service was being proposed, primarily to cover inflationary increases in staffing costs.

The Scrutiny Report

The meeting agenda also included the Scrutiny Report, which was designed to help the Committee monitor the actions and recommendations that had come out of previous meetings. The report pack included details of outstanding actions from the meetings on 16 July 2024 and 9 November 2023, and outstanding recommendations from the meetings on 16 July 2024 and 6 March 2024.

The report pack also included a draft version of the Committee’s forward plan for the remainder of the municipal year, showing which topics the Committee was planning to discuss at future meetings. This draft forward plan included the following items:

• Integrated Sexual Health Recommissioning (October 2024)
• The Future of the Markhouse Centre (October 2024)
• Commissioning Framework Paper (December 2024)
• Primary Care (December 2024)
• Tobacco and Vaping Strategy (February 2025)
• Marmot Inequalities Report (April 2025)
• Hospital Discharges (April 2025)

The draft forward plan also contained a list of items that had been suggested for discussion during the 2023/24 meeting cycle. This list included an update on the Babies, Children and Young People strategy.