Transcript

Hello everyone. If I can start the meeting. First of all, good afternoon and welcome to this meeting of the Health and Wellbeing Board. I am Councillor Graham Henderson and I am chair of the Health and Wellbeing Board. I think I am particularly grateful for you coming out on such a cold day. 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 done so, please remember to switch off the microphone. First of all, Abby Carter. Present. >> Mark Creelman. Present. >> Councillor George Crivelli. George, I think you are joining us virtually. >> That is correct. I am here but not in the room, unfortunately. >> OK. Fine. Jeremy de Souza. We have apologies from Jeremy. Steven Hickey from Health Watch. I believe you are also joining us virtually. He is not here yet. >> OK. Fine. Well, you will be. Arjen Jogia. Present. >> Thank you. Nicola Jones. Present. >> T. M. R. Aubin. Present. >> Thanks. Mike Proctor. Present. >> Katie Slomeck from St. Georges. I believe you are also joining virtually. Unfortunately, I haven't got the eyes in the back of my head so I can't let you see who has joined and who hasn't. Thank you, Kate. And also, Councillor Kate Stark. Good afternoon, everybody. >> Excellent. Fine. I would also like to welcome Kristal Shawcross who is the chair of the safeguarding adults board who is attending to present her board's annual report. And a number of officers will, of course, as usual, be contributing and they will introduce themselves as to when their item comes up for discussion. Again, can I ask that when you are speaking you can refer to the page number at the top of the agenda pack and the paragraph number so that members of the public can follow the discussion. Please also, as normal, indicate by raising your hand. Once I invited you to speak, please turn on your microphone and please remember to switch it off once you have finished speaking. Excellent. So I think we can move first of all to the first item of the agenda, which I probably should have read in advance. But anyway, apologies from Robert Garl, Shannon Cottier, Philip Murray, Anna Popovici and Brian Riley who has taken over as interim chief executive and Anna Popovici has taken over as interim deputy chief executive. So I certainly wish them well in those roles. Moving on, declarations of interest. Are there any declarations of either pecuniary of the registrable or normal registrable interests? Please declare any interest in quoting the item and paper number in which you have interest and describing the nature of your interest, including whether or not you will be taking part in the item. Can I ask if there are any interests in relation to this afternoon's papers? I take that as no. Item 3, the minute of the 3rd of October, 2024. This is an occasion when the meetings are so close together that you could probably actually remember what happened at the previous meeting. But are there any comments on the accuracy of the meetings? Excellent. I will sign them as a true and accurate record. Thank you. Excellent. I have been advised by officers that there are no matters arising from the minutes. So moving to our substantive items and having had a jam-packed meeting on the 3rd of October, this is a somewhat lighter meeting but still considering some very weighty issues. The first one is the safeguarding of adults which I am sure you will take extremely seriously. And formally it is a report from the Executive Director but Christabel Shawcross who I introduced earlier, the Chair of the Safeguarding Adults Board, is to introduce the report. Over to you, Christabel. And thank you very much for attending. Thank you, Chair. Thank you for having the report for discussion. As you know, the Safeguarding Adults Board is a statutory requirement and some representatives around the table, their agencies are represented on it. So that's the local authority, the ICB, and the police who aren't part of the Health and Wellbeing Board. But our role is very much to work in partnership with all our partners and particularly to provide a way in which we can help with the health and wellbeing strategy, public health strategy, working with children's partnerships and the community safety partnership. And I'm pleased to say that we've done a lot of work and a lot of progress on this for last year. So the report that you have is outlining what we did last year and of course we're now nearing the end of this year and I'm thinking about what we're going to be doing next year. So what I'd like to do is to draw your attention in terms of our key principle, which is making safeguarding personal, to give you the assurance and overview of the residents of Wandsworth who needed safeguarding and what their views were on that, captured on page 27. I'll tell you a bit about our strategic priorities, our strategic initiatives last year, which resulted in a more local focus. So we do now have a strategic partnership for Wandsworth particularly and a separate one for Richmond whereas before we had joint meetings and we did feel it was really important to have more of a focus on what was happening within Wandsworth and enable wider community partners to contribute to that and I'm pleased to say that we've achieved that. Another key area is around learning, learning when things don't go well and we have to set up a mandatory review which is called safeguarding adult review which we report on in the report but also we have an ambition to look at and learn from other reviews and the children's service areas, domestic homicide reviews and from the coroner's prevention of future deaths report. So we're beginning to try to collate and look at what those issues are for all our partners and crucially what is the role that the safeguarding adults board can have in bringing everybody together to ensure that everybody understands how to work better together and one of our key responsibilities is to ask agencies to seek assurance themselves of how well they're doing but equally to let us know how well they're doing and what can the SAB do to help them go forward. So in terms of the residents of Wandsworth, we had a rise in the increase of concerns, people telling us about concerns of abuse and a significant rise, 26% increase in those going forward to become an inquiry which is when it's deemed that there is an issue around safeguarding that needs to be looked at. The numbers that we have, we have to report the instances of abuse so in fact the 3,366 instances relates to 3,068 people, some of whom may have had several areas of abuse reported and the same goes for the inquiries and the fact that it's been an increase to my mind is a good thing. It means more people are being referred and if they don't meet the safeguarding criteria then they benefit from a screening to see what advice and information, how to promote their health and wellbeing can be done in a different way and we do also look at what happens to some of those people as well. So what are the protected characteristics of people? Well, in Wandsworth, as we know, there's a higher proportion of young people from black minority and other ethnic groups and although our data shows that 63% of referrals are from white people, we also know that the majority of those will be over 75 and indeed you can see that about 46% of referrals are for older people, but underneath that there are strong cohorts of younger people and black people are usually over misrepresented in mental health referrals and we do get quite a lot of instances of safeguarding, working with the trust on that. One area that we particularly wanted to focus on and that links with our partnership with community safety and the children's partnership is a growing understanding of the needs of young people 18 to 25, although we've actually got 18 to 34 here, because of the issues concerning young people coming through the care system, young people coming through health and education, care plans, people with learning disabilities or indeed people who may not be captured by any service and who may end up with substance misuse, issues of rough sleeping, homelessness and we've done a lot of work to try to ensure that we understand well how those young people can be best supported, because as we know, young people don't traditionally fit around our services and the emphasis is very much on ensuring that we've got multi-agency systems and partners that can fit around the individual, the person, who needs different styles of engagement than the traditional approach, which may be sending a letter or just making a phone call. It's being more proactive. So I'm very pleased that we've been pushing on that work this year. I've mentioned our local focus and we know that within Wandsworth particularly the issues around homelessness are being well addressed and we've had a lot of engagement with the new homelessness hub lead person for that and rough sleeping and looking at how we can learn from the reviews that are carried out and with public health on the unexplained deaths or unexpected deaths of people to see whether there is any way in which safeguarding could have been considered at an earlier date and brought more people to look at the support provided for individuals themselves. A particular issue that I raised last year was around we would like to work more effectively with our Health Watch partner and I know the chair of Health Watch was here last year, I know maybe he's online at the moment and I hope to be here to hear the report on what they've done last year, but I'm really pleased to say that we've had much better engagement with Health Watch, we've done some work with them on carers, on our carers strategy and trying to ensure that carers understand where there may be safeguarding needs and how to seek help, particularly where there may be difficulties in encouraging the person they're looking after to receive appropriate health care because often people don't want the appropriate health care and then it can end up into a situation where it could become self-neglect and we need to work closely with our GP partners, community health services to identify those situations. Another situation unique to Wandsworth is of course Wandsworth Prison, which you will all be well aware of and last year I think I said we had started to make engagement with the prison who have had a lot of different governors, I had engagement with the second governor last year, we had an effective engagement meeting with a lead person in the prison to look at the issues around safeguarding and I want to stress that the SAB does not have the same responsibility for engaging with partners as it does with health and the police and the local authority to have assurance on what is happening as it does with the prison, as rightly the prison comes under the Ministry of Justice and has its own safeguarding system and requirements, albeit the local authority and the Commissioned Health Service of Police Trust provide the health and social care assessments for those at risk within there. So there is an inroad into the prison on the social care and health side. But in terms of the protection of people within prison, we knew from the adverse inspection report that they've had over the past few years a high number of self-inflicted deaths of people who were self-harming and I know Public Health originally were helping us look at how to provide advice to the prison on that. After that very good start, there were lots of changes, more issues as you will know nationally and locally within the prison in terms of what was happening and until a few days ago I was going to have to say we're still trying to engage but I'm delighted to say that the new prison governor who started in June who is really keen to make links with the community. We met, Ali Smith who's here, my business partner who's the engine room behind all of this, we met with him and he's really keen to engage to attend our groups and whilst I'm not keen for people to come to meetings for the sake of it, there's got to be a definite outcome but in terms of the prison being able to understand what our concerns are and how we can help them, it will be a really good start. So one of the key areas is on the pathway of people coming out of prison. As you know, Wandsworth is by and large a remand prison so different from other prisons where people are literally in there for a long time and I know through discussions nationally and I'm part of a national group looking at a criminal justice framework that we can develop with local partners so that would be probation, housing, community safety and a prison where we have that to look at how we can work better together when people are released. I mean there's a particular issue here with people being on remand who will turn up in court, case dropped, they're left and although probation are there in theory to provide support, they may not always be able to do that and so we want to do some more work. So I'm really pleased that we're making progress on that but obviously it's a really, really difficult issue. They've got a lot of issues within the prison itself. Transitional safeguarding, I've already mentioned and we will be wanting to do more work, develop better I think integrated approach with the Wandsworth Children's Partnership. I had a meeting with the scrutineer some months ago now and we want to go back there really to have a better approach to that. We've got a more integrated service on the Richmond side which involves Kingston and achieving for children so we will be doing that and learning from that as well. We know that the police themselves have had a lot of changes so they are going to be reviewing I think how they better engage on a more consistent basis with the SAB. We know they're well engaged through community safety. We have a safeguarding adults boards executive where the police are representative and they are reviewing that. But some issue for this year will be how we implement new arrangements on the MASH, that's a multi-agency safeguarding hub that is a met police review with local authorities. So we will be reporting on the better working there on that for this year. I mentioned I would look at learning because one of the key areas we have is learning from either where things go wrong locally and we think there is learning through a safeguarding adults review or other ways of learning. Those are detailed in the report. We actually had two referrals from Wandsworth this year which didn't meet the criteria and although there was good multi-agency working there were particular issues on both cases. One we believe will probably has gone to the coroner's court so if there is any learning from that we will be looking at that and the other was a single agency issue around a homeless man and there was very good learning and new systems brought into place by the health trust there. So we look at what the learning is from that, we don't then go and look at it again, that's not necessary. In terms of people with learning disabilities for which there is always a lot of concern, particularly those in large institutions, lots of organisational abuse issues raised nationally, but locally in terms of people who are placed either within Wandsworth or elsewhere, the NHS through its learning from reviews because people with learning disabilities typically die earlier than would be expected. So we detail in the report the numbers there and the learning and the good work that's been happening on that, but we are hoping to get some more information on the age and ethnicity of people to see if there is anything more that we should be doing there to work on that. Quality of services is absolutely important and the report itself at page 31 does identify the quality of our provider services which are both people who are cared for at home and people who are in nursing homes and care homes. And I have to say that we have provided this information via CQC, but it's a moving data set, I suppose, and a question from Councillor Henderson just earlier was on how do we work with people who require improvement. There were three noted here, but my colleague here, Brian, has done a quick check on the CQC website and I'm pleased to say that there are no longer three homes requiring improvement and it looks as if those three have gone up into being good. And that I think is testimony to the very good provider quality forum that Wandsworth will have with the CQC, with health and other providers to look at what's needed in terms of improving the quality. It's not always necessarily a safeguarding issue, although I would say most issues are safeguarding because it tends to be about the quality of care or the quality of environment, quality of staff that's provided. So that's very good. And also to note that we do have an outstanding care home. We'll also be looking again to let Councillor Henderson have that information, which of the homes, which one was outstanding. Is it one of either people with learning disabilities, mental health or older people? There's different types of homes and equally the same with our care at home services. So I wanted to say a bit about what we're focusing on this year. We had our new strategy, we've got our new local strategic partnerships. One area which we were challenged from the ICB colleague last year was about how can we relate data sets to health inequalities and how can we look at improving the understanding of safeguarding in those areas. Well, the initial work that we've done has shown that overall the numbers that we have are very small and in any one area, in terms of the public health we've looked at it, they're probably not statistically significant to say that's really what we need to focus on. But we've had an offer from public health to look in more detail this year to help us see if there's more raising awareness because one of our key strategic priorities is to prevent safeguarding, to promote awareness, particularly with families and local communities about what is safeguarding and where to go to if you're worried about somebody. So we want to look more at those areas. Obviously, working with community safety, I mentioned our cuckooing guidelines, which came out of us a couple of years ago. That will be looking at are there particular areas on any particular estates where there are concerns either from local councillors, from the housing provider, from local neighbourhood police that we need to focus on. And that's obviously a moving target, if you like, in terms of those areas. I've mentioned homelessness particularly, so we are getting more information and data on deaths of people who were substance misuse happened and where we can look at what the learning is from that. Because I probably mentioned last year there was going to be a second national SAAR review of all the SAARs in England and all boards reported on that to look at the learning on those SAARs. And homelessness came up as one of those key areas. So we work across London on that as well. But it also reflects in terms of the types of abuse that we had reported, the majority of which were self-neglect and neglect. That is also the national picture, although acts of omission are also quite high, but that can feed into neglect as well. One area that is very, very low nationally in here is determining that discriminatory abuse was a factor in what happened. So we've been trying to do more raising awareness of that because it's really important to look at the protected characteristics, particularly in an area like Wandsworth, which has a high proportion of people either from black and minority ethnic groups, so is racism an issue there, or people who have physical disabilities or learning disabilities. So it's disability awareness, something that we need to raise and obviously work with police on disability and hate crimes. So those are the areas we have this year. There was one area I just wanted to raise which is not actually reflected here and is coming out of a SAAR that actually isn't a Wandsworth SAAR, but we know I think from some of our national data is likely to be a more general issue which affects I think public care and the ICB in terms of the commissioning for palliative care and the services that are provided for people with substance misuse and who may be nearing homelessness or not and end of life care. So I just really leave that as a thought to see how that might be developed. I have to say that's me saying it. I'm not speaking here on behalf of the SAAR because it hasn't gone through the processes, but I couldn't not take the opportunity with the Health and Wellbeing Board to raise that, and I'm sure that is probably an issue that has been thought about elsewhere. So I'm happy to stop there and take any questions and comments. Thanks a lot, Christabelle. I just want to say to Christabelle, since we have a relatively light agenda, that she shouldn't feel too constrained by the time, and I think that is very, very comprehensive. You've certainly answered some of my questions. I mean, particularly around Wandsworth Prison, we had a meeting with the Community Safety Partnership Board a couple of weeks ago. All I would say is that I think a number of partners and different organizations are concerned about a whole number of things which go on there, which didn't impact upon safeguarding, but I entirely accept that because the Ministry of Justice has the primary role. The other thing I'm really pleased to hear is the joint working between yourselves and other agencies. That, of course, is vitally important for us to make progress on all these issues. Anyway, enough from me. Over to members of the Board to ask questions, please. Nicola. Thank you, Chair. Christabelle, thank you. It's an interesting read, this report. I always find it's really – there's a lot in there. But I just had a couple of questions. One is about the concerns and inquiries. I just wondered about the source of them. I don't think I missed it in here. Could you just give me a kind of view of where they're coming from, generally? If you've got some specific numbers, that's great, but just, you know, generally where the most come from. And then the other thing was, in your introduction, you mentioned GPs, but they're not specifically noted, really, in the report. And I just wondered how it feels from your point of view in terms of the engagement with general practice and the wider primary care? Look to my colleague here, Ali, to see if we – we do have the data on the referrals, and we break it down very, very well. In fact, I was asking a question about that the other day. The majority of referrals will either come from a range of emergency services, so that would be ambulance and police, but mainly from adult social care, who tend to go in a lot. We've also – thank you for answering that question, actually, because I was also going to say – we've also been looking at who is referring situations when they're concerned maybe it should be looked at by the Safeguarding Adult Review Board. And we do know nationally and locally that health are very low referrers, so we want to do some work on promoting the understanding about that, because it's not just about seeing does it meet us all, but it's looking at is there anything we can do as a board to help bring those agencies together in a different way to look at the learning from that. But I can get back to you with a very detailed outline – okay, high-level outline on that, because what's important to us is to – or the reason we look at it is to make sure that a broad range of partners are understanding what concerns are. So we could say, actually, there's too many concerns coming from this agency. That means they're not understanding the role of the safeguarding, and they could refer to other people. Equally, we may say, actually, they're not referring enough, and I think probably GPs is an area we want to promote understanding on. Perhaps they're not doing enough either. But I would say one of the issues for GPs is – and I don't know if there's an ICP representative here – but Wandsworth does not have a GP lead to safeguarding for adults, whereas Richmond does, and other areas do. And it's potentially that could be a gap in having that link and promoting awareness with Wandsworth GPs and health centres. I leave that as a thought. Thanks. Oh, very interesting. I believe Kate, Kate Symeck, you have a question online. Thank you. More of a comment, really, because I sort of shared this. We've obviously got a safeguarding team here at St. George's. My name is Kate Symeck. I'm the managing director of St. George's. And just saying St. George's is an active participant in the Community Safety Partnership and Wandsworth and supports significant data to support wider safety work, violence tracking, because I think the sharing of data is absolutely key, isn't it? The information sharing to tackle violence sort of initiative. And this data complements police data and seeks to give a more rounded picture in relation to serious violence duty and help us better target violence reduction interventions. And then also just want to say that we have now got an amnesty bin installed at St. George's that happened a little while ago and it took a while for that to happen, but that is now in place. Excellent, thanks. I'm Thiam Tamma, who represents CARES. Thank you very much for the report. I have a question. On page 53, there is a beautiful report on care at home services, 33 registered with care home services and their evaluation based on quality condition criteria. So my question is, what was the method of collecting this information and this grading? Is it self-reporting by these care providers? Assume one of those like Bluebird. So if it is a self-reporting based on that self-reporting, wouldn't it be helpful to actually evaluate the care at home service from the carer point of view, i.e. get the feedback by a questionnaire or other means whether they actually receive what the at home care provider services actually do. Thank you. So the information that's on the provider quality page 51 details the care quality commission rating of the care at home services as well as the care homes. So these are where the care quality commission requires services who are providing personal care to be registered with them and to meet their standards, all of which will follow the leadership, safety, medication, working with users, user feedback and so on. And these may well be a bit out of date, as I just said earlier, because the CQC only goes in at certain times. However, having said that, this is information that is used alongside the local authority and NHS who will be commissioning personal care services. So there will be more up to date in the moment, if you like, information about providers that are shared there to look at what needs to be done. So whilst the CQC may not have gone in to change their rating, if there were serious concerns, they would be referred to CQC who may or may not, depending on the issue, go in to look at what's happening in the agency. I don't know whether there's anybody from commissioning here who wants to speak about all the quality assurance mechanisms there are, but anybody, so either NHS or the local authority who have contracts with care providers will have their own contract monitoring and one key area of that will be the feedback from service users and their carers, particularly. So there is a plan to actually get the feedback from the carers regarding the service? I would, well I think I will ask my colleagues to say whether that should be happening at the moment in some way. Yeah, thanks. Yes, well we have a robust set of a number of things that happen in terms of feedback. So the people who receive services and their carers will all raise concerns about quality or complaints, et cetera. All of those are monitored as part of our contract monitoring process with providers and we deal with that collectively with our colleagues from the NHS who also commission services as well as colleagues from CQC in a provider risk panel where we consider what we're learning, that's intelligence from the feedback we've got from everybody. So yes, there is feedback from everyone. Thank you. I think Arian suck his hand up first some time ago. Sorry, my apologies. Thank you for your report, Christopher. I made very good reading and very reassuring on many fronts. As a representative for GPs for Wandsworth, I just wanted to come just make a couple of comments if I might. Personally, it's absolutely true there's no adult safeguarding lead for GPs in Wandsworth. All GPs are required to undertake level three safeguarding, which they do, and the range and breadth of training available is limited. I think I'd leave it at that. Just with regards to your suggestion that we might be under-referring, I mean, I think unless the capturing of data for the referrals is robust, it might be that it's just not being picked up. Certainly within our practice we are regularly referring to adult safeguarding and have a safeguarding lead for both adults and children, and I suspect that's the case across the board. So the under-referring might not be accurate in terms of the data you're capturing and also the fact that you mention yourself that high-volume referrers might be over-referring and we're just more aware of what's appropriate and not in terms of referral. A key change that has happened in the last couple of years with regards to our links to children's safeguarding is that we get feedback, and that's huge because it really does help direct how we're managing cases. And often when we make safeguarding referrals or we get Section 47 or 17 submissions to us, which is safeguarding alerts regarding vulnerable children, and we reply, but we didn't always hear back what the outcome was. So a lot of GP practices would have alerts for safeguarding cases which actually were closed or anything. But we're now getting more and more information back, and the dilemma lies in the fact that there are different IT systems, so it's not that we can just look on social services and see what's happening with the case. So if I might suggest that there's more feedback with regards to joint shared cases, that might be a very good way forward, especially in view of the fact that we've got a population that's aging, increasingly vulnerable, and the 10-year plan is all about addressing this. Thank you very much. I did just want to – as Christabel said, she didn't have the data in front of her. I've got a set of data in front of me, and certainly the referrals are coming from GPs as well. And bearing in mind, this is adults, and you're looking at adults and children, aren't you? So you're doing both. And in fact, we've seen a rise in concerns from a police hospital, GPs, everybody. So there's a positive awareness in our community. I just wanted to give that piece of assurance. I suppose it's just to pick up on the adult safeguarding GP lead. So there has and is a review going on across South West London to ensure that there's equity in each borough. I do anticipate that it won't be long before we're recruiting into that post. Can I just add something else? And that's just going back to your comments, Christabel, about particularly mental health services and the overrepresentation of black communities and services. So I think, speaking on behalf of the Mental Health Trust, I think there's a lot of work now going on around coercive practice around a culturally competent organisation. And actually, they are seeing improvements in terms of the likelihood to be admitted. Now, there's still a long way to go. But I think our Mental Health Trust is working very hard to kind of look at those safeguarding issues, particularly organisational led ones. Waka. Thank you very much, Chair. Christabel, thank you very much for a brilliant report, I think. Christabel, I just want you to understand a little bit about the criminal justice safeguarding framework. And I'm going to, in a moment, invite you to help me understand a bit more about that arrangement, but also to understand the mechanics in a bit more detail in terms of how that will unfold. I'm aware that there's a lot of work done in other parts of society in terms of tackling abuse. So, for example, the police are now authorised to apply for domestic violence protection orders. The courts and probation service have various programmes on, say, DV, but also they have programmes on getting people to address their thinking, and thinking skills programmes are quite rife amongst the court system. There are programmes for people who are on post-release and so on and so forth. So there's a lot going on in the criminal justice and police system, and over the last few years there's been, you could say, a revolution in terms of what facilities are offered to people. So it just seems to me that the opportunity for the local authority to exquisitely engage with the criminal justice system is really aposite at this moment in time. So I just really wanted to get an understanding of the mechanics of how this safeguarding framework is going to work to bring about the wraparound care and surveillance we need for patients who are vulnerable and families that are vulnerable. Let's just take the last one. So the criminal justice framework is a very basic framework in so far as following what other boards have done with other prisons and probation. It's basically to get an agreement to come together. So we set up a task and finish group to look at a framework that gave expectations about what the criminal justice – so we're talking about probation, police, community safety, and the prison here – to be engaged with the safeguarding adult board and what that might mean, what the benefit would be, and how we can promote awareness of safeguarding when people are in the criminal justice system. Because I think I've mentioned GPs and I would like to say everybody probably needs to refer more, so I don't want to single anybody out, but I think clearly probation may be an area we want to target as well more, and it's about our understanding as a board then, how can we help promote the awareness of where there may be a safeguarding issue to refer to, to enable people to perhaps come sit around the table with others to look at, well, is this safeguarding? Is it self-neglect? Is it neglect? Is it abuse in the traditional sense or not, and how can we prevent something from happening and raise that awareness? So at the moment we haven't – we've had some people look at it. Our prison governor is going to look at it for us to see if we've got that at least as that basic, to say this is our expectations and this is what we can do. And just to add to that, that the prison – we're very keen if we could offer some training and learning to help them. It's not strictly speaking our role, but it's in our interest, I think, to make sure they understand how the ones where system works. So they're going to be looking at what might help, and we have loads of training available, which is all online, which isn't the best way, I know, but at least they can know what there is if they want to encourage their staff to undertake such training. And we would work with community safety on that. And does that involve His Majesty's courts and tribunal service? Because I think they would be quite a rich repository of data and ideas. Yes, well, we could certainly – we haven't thought of engaging them or how we would do that. We would expect perhaps probation to help be the link with that. But obviously, we know our probation service is very busy, too, but that's certainly a helpful suggestion. Thank you. So if I can just come back to the comments on engagement with GPs. Yes, so, I mean, we'd be very pleased to look at if there's more perhaps in-depth training needed, because there is quite a lot of learning out there which goes beyond that sort of basic, and we can certainly help with that. And one of the other areas is – and it's not just GPs, but it's sort of knowing what has come out of SARS. And particularly, there are a few panels which we know agencies aren't as aware of, as I would hope they would be, to perhaps make a referral to bring people around the table to talk about – particularly, I mentioned this situation earlier on palliative care, substance misuse, mental capacity, a big issue. And people are not quite sure what to do if they think someone's got capacity, but with substance misuse, it can be fluctuating, or actually, they may not be able to make an informed decision on their physical health care needs, as in this situation. So there's an opportunity to come around there, and GPs are often very involved with situations like that. So it's about providing that support, as well. Nicola. And I was actually going to already ask just about that, because it's this – I think I might have said this last year, and so at the risk of being a stuck record, I think that the model that we have for child safeguarding and education is much closer to what we need than what we've got at the moment with adult safeguarding. But I think even the child safeguarding could be improved. But GPs, every three years, have to do eight hours of adult safeguarding training. And you know what? There's only so many times you can do the online mental capacity act kind of stuff. It doesn't bring it to life for you. And whilst you know the details, when you do have to actually deal with that, it's so much better if you're dealing with it with colleagues who, together for all of us in Wandsworth, if we could look at how we could do that in a more kind of – it could have so many more positive benefits than just understanding the theory amongst many of our professionals. Can you champion that? Yes. Well, I actually have our SAB executive next Tuesday, where I will be reporting back the issues raised here. And we have the ICP representative safeguarding there as well, who happens to be the Wandsworth lead. And we have discussed this issue about the lack of the GP lead on safeguarding. And I know, as a colleague has said, that's being looked at. But in terms of that sort of in-depth training, that's certainly something we can discuss and try to get into our plan for this year. Thanks, Abbie. Thanks, Chair. And thanks, Christopher, for your report. Just to say I 100 percent agree with you there. I work for a learning disability charity. And I think, obviously, you mentioned there around the stats about wanting to do a bit more work on understanding the discrepancies between age of death and learning disability, then within that with ethnicity. People from minoritized ethnic backgrounds and learning disability die at 34. And if they're white, it's 62. So this suggests there's something very badly wrong going on there. And I think there's probably a lack of understanding in the health care sector about how to adequately communicate with people with learning disability. But one of my questions was just around deaths of people who have been diagnosed with autism. In the report, it says that no autistic people were recorded as dying in southwest London last year, which does seem highly unlikely. So I'm just wondering if the issue is that people don't know that they should be reporting that or whether people do know but aren't reporting if you were able -- if you knew what the reason was there for the zero number. The NHS -- okay, start again. It's an issue across NHS England and the requirement to report on people with learning disabilities who have died. And I know people with autism was brought into that. And so I don't know why that is the situation. But again, I can ask. That's probably better rather than -- I don't quite know the answer to that. But I don't think it would be that people wouldn't know to report. But I don't know. So I need to find out. Thank you. Thank you. Excellent. No further comments from anyone behind me? No? I mean, I did raise one point with Christopher, which I think I can cover fairly quickly. And that is about also learning from a range of different organizations, children's services, et cetera, with various reviews that you've instigated, I think, in Kingston. And my question is simply how do you see that working in Wandsworth? How can we best enjoy something very similar? So we're trying to set up a meeting with our colleagues in Children's Partnership and the scrutineer to actually ask that very question, having had the experience of what's been developed with Kingston and Richmond, which has lots of advantages. So we will be asking how can we do that? Would that make sense in Wandsworth? Because obviously not -- it's slightly different because Richmond, as you know, is part of the -- what's it called? Achieving for Children, thank you, with Kingston, hence Kingston's involvement, which can complicate things because they're not quite part of the same system, but they are part of South West London. So the learning is the same. So it's about getting that particular focus. Excellent. Thank you very much. Well, I think there has been an excellent discussion, a vitally important topic. We usually see Christabelle once a year. But the comprehensiveness of the work that she and her team does I think is unquestionably excellent in terms of protecting adults. So on behalf of the Council, on behalf of the Health and Wellbeing Board, thank you very much and do pass on our thanks to your colleagues. I think that was a very rich discussion indeed. For the purposes of any members of the public who you may be watching, I will actually read out the recommendations. In paragraph 1 of the report, A is to note the information in the report and the assurance that safeguarding practice in Wandsworth is monitored and multi-agency arrangements for oversight improvement and joint working are in place and working well. And I certainly think that we can say yes to that. B is note that the Richmond Wandsworth Safeguarding Adverse Board is aiming to map out main locations of abuse and compare these with areas of health inequalities to consider if there might be any links between these and how to address those. And I think I'm sure you'd all agree that is also vitally important going forward. And thirdly, to consider if there are more links in joint working between the Health and Wellbeing Board and the Safeguarding Adverse Board, which should be explored. I think we've actually done that as well. So our members of the Board content to read those recommendations. Thank you very much indeed. And thanks again Christopher for turning up. You're all welcome to stay if you wish, but I'm sure you're very busy. Excellent. Excellent. Okay. Well, let's move on to the next report, which is the joint local health and wellbeing strategy. We decided to break this up because it's obviously a massive agenda into Start Well, Living Well and Age Well, two sessions on Living Well, but we're starting off with Start Well from younger people reported by the Director of Public Health and Lynn Wilde on behalf of the Council, Assistant Director of Health and Care Integration is to introduce the report. So thank you Lynn. Thanks. So I'm really just going to remind members of the Board that the joint local health and wellbeing strategies, five-year strategy, it spans a life course, and we've got an expert team here from Public Health, I think it's the whole of Public Health, who are going to actually talk us through the first four steps of the Start Well. So I'd rather leave them time. We have asked colleagues to keep it really brief, so there's time for each step for people to ask questions. And what I propose, if this is okay, Chair, that we take one step at a time and give them five minutes per step, not to talk, to talk and answer questions. Thank you for that. Excellent. Otherwise, you may well be here until three o'clock. But anyway, thanks a lot. If the officers could announce themselves and tell us who you are, et cetera, before you start speaking. And I presume you have some type of script and order, so I'll leave it entirely up to you. Thanks. Good afternoon. My name's Graham Marquel, and I'm the Senior Public Health Lead, and I lead on mental health and public mental health. And the first step is around self-harm and children's mental health. And what we can see in terms of our priorities, we recognize that over recent years, there's been a steep increase in the prevalence of poor mental health within children. And we recognize that we need to have a primary preventative approach, a secondary preventative approach, and a tertiary preventative approach. We recognize that the NHS cannot solve the problem of mental health disorder on its own, and that we need to very much work as a system to ensure that we make children more resilient. And we are doing this through services to children and families, through family hubs, and through mental health support team coverage. Our mental health needs assessment identified that we needed to improve our coverage, and this year we will be taking our mental health support team coverage up to 100 percent. But it's more than that. It's about the system working together, and it's about ensuring that children are at the center, that they have personalized care, shared decision-making, and early intervention and holistic support. So if there are any specific questions that you want to pose on this first step, then I'm more than happy to answer those. Excellent. Any questions on children's mental health? Big topic could take all afternoon, but in relation to the actual strategy, I think, if we may narrow it down a bit. Thanks. So, Graham, thank you for the update and the progress, which is aimed at ensuring that we're kind of -- there is additional access and additional services. I just wonder what's the mechanism to learn from those services as well, though, just in terms of are we seeing different trends or different presentations that perhaps will shape future services for us? So we're kind of looking ahead as well as addressing the now, if that makes sense. Yes, thanks, Mark, for that question. Absolutely. I think our mental health needs assessment was able to drill down and pick up on emerging threats. I think what we saw is an impact of social media, particularly on young people, and recognizing that we need to safeguard children from certain aspects of that. I think that's a key focus. And I also think we came across a lot of trauma, and recognizing that adverse childhood experiences are significant contributors to children and young people's poor mental health, and absolutely our services need to look at how we can prevent those from happening in the first place and intervene early once that's happened. And again, I would point to the family hubs that are now set up within Wandsworth in Roehampton at the moment and in Battersea, which are specifically there to ensure that there are multi-agency, one-stop shop services that are available for communities to pick up these issues really quickly and ensure appropriate responses. Thanks. I gather Councillor Crivelli, George, you've got a question. Yes, I've got a question, and I think it's probably not just relevant for step one. It might be all relevant for step two, step three, and step four as well, if you'll indulge me. But I wanted to ask a question about the initiative that started back in 2021, the Social Workers in School initiative, because I know that Wandsworth were quite supportive of that initiative. I think there's about 20 educational establishments in Wandsworth where they're using social workers in schools to build relationships as part of the prevention framework. And I know social workers in school is something that Wandsworth have seen as playing a prominent role in the prevention framework. I was just wondering if any of the officers could see how that actually fits in with the sort of role that we were talking about as part of the overall health and wellbeing strategy. I can pick that up, Councillor Crivelli, absolutely. I mentioned primary prevention being one of our focuses, but secondary prevention, I think early intervention is a key aspect. We need to ensure that those with increased vulnerabilities and increased needs are supported from the earliest outset. And I couldn't talk in detail about the Social Workers in School program, but I have spoken to schools about this, and I know how valued it is. And speaking to those with pastoral responsibilities have said that it's really been a game changer in terms of getting the help and support to families that need it as quickly as possible. And we know that the earlier intervention, the more positive the outcome, and I would say that that program is certainly supportive of that from a mental health perspective. Thanks. Kate. Thank you, Graham, and thank you for the update and the report and the good work that we're doing and really great to hear about the increased spread of support across the borough and also acknowledging the opportunity that we still have in terms of family hubs. So just picking up on that in a way. In the strategy, our ambition is to improve access to early intervention, self-help and specialist support. So you've talked about in the report what progress we may have made so far. But as I understand it, various different levels and tiers of kind of mental health supports are just really keen to kind of understand where we still think the gaps are. Thank you, Councillor. I think we recognise the sheer demand is one of the biggest challenges ahead. And as I've said over the last few years, we've seen from one in 10 children with a probable disorder to one in five. And we all know as well that we've had to, in terms of public spending, in terms of spending on the NHS, there have been considerable restrictions, which has meant that there has been an increased demand. For me, we're working really hard as a system to try and ensure that we can pick up and prevent these issues from occurring in the first place. And I think the mental health support teams have a huge role in that. So I really do see a good bedrock of primary prevention. I think we can do more to support parents. We are doing a lot to support parents. There's some great programs out there. But I think parents and carers, I should say, really would appreciate, I think, some additional support in terms of just pathways, knowing how to navigate through a system, a complex system. And so we're working really hard to ensure that the pathways are accessible, that they're understood, and that people know where to get help when they need it as quickly as possible. Yeah, thanks. I think we could probably spend a very long time talking about children's mental health and perhaps sort of bring it back in the future meetings as a very specific item. But thank you very much, Mr. Mark-Well, for that very important report. I mean, this is essentially an update on where we are in terms of the strategy, which obviously enables the health and well-being board to focus upon things we want to come back to and discuss. So that's very helpful. As I said, I'm sure you've got an order of script, so I'll leave it up to the next officer to present. Thank you. Good afternoon, everyone. I am Tolu Oloyede. I'm public health lead for children and young people. So I'll be talking about the childhood obesity update. Similar to the children's mental health, there has been a national increase of the prevalence of childhood obesity, especially coming from the COVID-19 pandemic. So in Wandsworth, how we're tackling that is firstly looking at increasing up and promoting breastfeeding just because of the benefits, obviously the benefits between relationship of mother and child, but also the protective factors as well for the child. As later down the line, they are less likely to develop childhood obesity. Then we've also got a family weight management program that's delivered by our 0 to 19 service, and they particularly focus on three main areas, so the 2 to 5 postnatal mothers and also children who are 5 to 11. And through the national child measurement program, when children are identified as obese or overweight, they're usually referred into that service for intervention. And then finally, we've got some work that we're doing with our leisure partners around the Wandsworth strategy -- Wandsworth, sorry, leisure and environment strategy. Just a couple of key things that you probably have noted on the report. We are -- obviously, we've got our data for childhood obesity that kind of shows us already that year 6, the prevalence of obesity in year 6 is increasing and getting worse. And also, just to highlight some of the good work that we're doing, I probably will get some questions about involvement with family hubs, but at the moment, we're working with family hubs to support them to achieve their UNICEF BFI accreditation, which is a program that helps other services to promote breastfeeding to their families as well. So if anyone's got any specific questions, I'm happy to take those. Thank you for the report. I'm now speaking a little bit in the role of being a pediatrician and reading this data, it's very worrying, I must say. One recommendation is that when you look at breastfeeding, which is very important to start with, looking at 6 to 8 weeks is definitely not sufficient. The minimum is 6 months or beyond. So first of all, I would recommend to look at the breastfeeding success up to one year, at least for the first 6 months. How to improve that? In my personal experience, the breastfeeding falls off after being discharged. And home visit with the mother to actually encourage and teach breastfeeding, people think that it's so easy. Some ladies, they have inverted anyway, so there are some issues which are not all that trivial, and these ladies, especially the prima gravitas, they need at home help and service, and I'm just wondering whether that is happening or not. Secondly, sorry, okay. If you can be brief and summarize. The second is the obesity is disastrously increasing, somewhat related to the breastfeeding. But what I think is missing here is the link to metabolic diseases and type 2 diabetes and screening and prevention for that. Thank you. Thanks. Would you like to respond to that briefly? Absolutely. Thank you for that question. So the reason why this report specifically highlights 6 to 8 week data is because we take this data from the office of health disparities and they only report on 6 to 8 data. Funny enough, there was actually a point where they were doing 9 month data, and I think that's completely stopped nationally. So at the moment we're only able to report on 6 to 8 week data. However, just to touch on your point about support for families, so as I mentioned, we do have a health visiting service that has a successful breastfeeding service that offers clinics to families who are struggling with breastfeeding. So they have those families on the radar and there is support available for them, and they're also looking to increase that support as well. So unfortunately we're not able to supply much more than the 6 to 8 week. I mean, yeah, it's unfortunate because we've only got the national data to work with, but it could be something I can take back anyway and see if there's anything else. Excellent. Thank you. Any further questions on child obesity? No? Well, thank you very much for the presentation. Excellent. Can we move on to the next officer's presentation? Thanks. Good afternoon. Hi, I'm Holly Stone. I'm a senior public health lead, and I'll be speaking to the childhood immunizations update. I also have with me my colleague Pooja, who co-leads on this step from the ICB. We work very closely. But I'll lead on the update. And Pooja, if you have anything to add, please do. So in terms of the headlines, actually if you look at the date, the latest data in terms of childhood IMS, the routine IMS show that actually there's higher levels of coverage across the majority than regionally, but lower than England, which is not unusual for London virus, unfortunately. And there's not necessarily been a significant change in terms of the routine IMS, where we're seeing a national decline in childhood IMS, with the exception of MMR1 and 2 doses at five years of age. In terms of the work that's going on to support the strategy, we've actually got some really exciting projects that we've been delivering. Hopefully colleagues will be familiar with our annual director of public health report, which saw engagement with our communities to really understand some of the challenges around childhood vaccines. That saw engagement with parents, GP staff, as well as young people who have the opportunity to take up vaccine in school. At the beginning of this year, there was a comprehensive measles, mumps and rubella vaccination campaign delivered to protect children from measles, which people may have seen in the media, was a real threat to child health. And that campaign, we know in Wandsworth, saw an additional 389 children receiving the MMR vaccine in the 1 to 5 age cohort when comparing the coverage to the same period the year prior, which is really good news. Public health have worked to develop a make every contact count training module so that we can facilitate vaccine positive conversations amongst our communities. And that offer of training is available to voluntary sector organizations, anyone who's essentially working with our residents to really facilitate those positive conversations. There's been actions across the system to protect infants from whooping cough, in particular working with maternity services where vaccination during pregnancy is really key. And then there's a number of other projects working with the school age immunization service in terms of a call recall center that tries to encourage parents to complete consent forms for the flu vaccination, as well as some engagement approaches. We work closely with our schools as well to get those messages cascaded out to the schools as well as to the parents who receive communications from schools. So I'm happy to take any questions. Thank you very much. Another important question on the camera. I will be brief. For this report would be very useful if there would be a table of the percentage of the fully vaccinated children in each of the vaccination on time. That will tell you the story. How good is the vaccination immunization program is. Thank you. So, partly following up on that to help out with that. So I'm a GP and I'm just trying to join some dots here because yesterday our integrated care board meeting, we had a paper on childhood immunizations. And so it's really really challenging to achieve childhood immunization targets. And we want to achieve herd immunity don't we wish about 95% and we're not that far off that with the first series of childhood vaccinations but once you get to beyond a year old it kind of goes down and down. So that's the broad picture, probably enough detail really. And at the SCB we also do this is so important infectious diseases is something that we can actually prevent we want to do everything we can so I think you're doing all the right things because what we also don't want to do is increase health inequalities by just focusing on the things that are easy. Big issues with data in our system it's quite hard to really understand who's vaccinated and not so which seems ridiculous but it's actually very complicated. And I'm going to steal a line from yesterday's board meeting so when I was a GP there were about five vaccines that you gave and now there's like 35 or something like that. You know what it's actually so much more complicated. But we must do more and you know infiltrate into our communities to help people to understand about vaccines and to encourage people to have them. And just one other thing to join up, Royal Marsden Partners also presented yesterday at a board meeting and one of their priority areas you could think hang on a minute what's cancer got to do with this? Well it has because there's a vaccine for cancer which is HPV which we're not particularly focused on but if they are and then we also are then that will help won't it so I just wondered if it's maybe something you might want to build into next steps. Not that you're already not doing a lot but thank you. Thanks if you would like to respond to those points. Thank you very much. Thanks for the questions and for highlighting the number of data points with regards to all the different vaccines I think it is challenging so thank you. Yes we have certainly linked in with our own partners regarding that initiative and we're going to be bringing in the school age Imms team who are primarily delivering that into that into that discussion but thank you very much for highlighting that. Excellent thank you another very important topic. If there are no further questions on childhood immunisation then shall we move to the next one? Any attendances here? Councillor Henson I'm afraid that the lead is on annual leave at this point in time but we certainly if there are any questions on that from from the panel we can take those away and respond quickly. Yeah thanks a lot people need their annual leave. Maintains they're good at mental health and physical health. Any questions? You do have a slide on the attendances and if you have any questions here alternatively you may wish to put them in writing and the team will obviously respond but are there any immediate questions on any attendances and hospital admissions caused by unintentional and deliberate injury? If not and if there's no one behind me okay thanks well as I said don't feel inhibited from asking questions putting them in writing and putting them to the team. Thanks well I think that probably concludes the presentation and can I thank the officers for sort of presenting those likely important subjects. As I said the real purpose of this was to satisfy ourselves as a board that the work which is being undertaken in terms of the health being strategy is achieving its principal goals or alternatively working towards them and hopefully I think I hope you would agree that that is certainly the case. I mean clearly members of the board would like to revisit some topics in greater depth. I mean I would generally welcome board members actually suggesting topics. I mean I've been in discussions with the LGA and hopefully we'll have a seminar I think in January talking about how we can work together a lot better and I'm very aware that we're very sort of focused on reports and I would ideally like to make the health and well-being board rather more interactive particularly for members of the board to actually suggest things they may wish to discuss in greater depth. Anyway back to the actual item and this is for information yeah this is purely for information so thank you very much indeed. Excellent right good now another very weighty and important report from Health Watch the annual report and Stephen Hickey unfortunately who's the chair of Health Watch he had to leave but we're very fortunate to have Sarah Cook the Health Watch manager present who actually presents the report so thank you Sarah and over to you. Thank you Graham. Thank you for the opportunity to present our report to you today. We hope that you'll read it as an opportunity to celebrate some of the engagement that has happened with local people and what we do like to do is include many of the organizations that we're working with on that so it's actually there's quite a lot of you were involved in one way or another in our work so thank you for that. So we publish our annual report every year and in it we've listed the sorts of things that we've been working on and many of those are areas that require integrated working across the system addressing some of the issues that actually are fitting between lots of different services and we've put a list here in our report to the board. We also welcome any questions on the report and suggestions about any potential topics that we might consider in the following year although we can only focus on a couple at a time. We like to include as many opinions and views as possible and to understand the context of what you're all going to be working on. Thank you. Excellent, thanks. Any questions? Tiamo. I have a question on number six it says access to health care services after hospital discharge as a care is I think last time I mentioned the difficulties of patient carers who take home the loved ones and look after it. I was recommending a kind of patient ambassador to streamline the access to services. I'm just wondering what is implemented at this point and what is the plan to actually ease the access of the complex and multidisciplinary access for the patient care when they go home. So I suppose that question relates a bit more to other work that we did last year on hospital discharge and the experience of carers. So we had a report with various recommendations which reflected the sorts of things that carers were telling us they were having difficulties with. A toolkit was created for the hospitals to better support people and St. George's Hospital if they're still on the line have been looking into all of the difference quite a lot of different things that they can do to support carers and one of those things is a discharge hub which they have and there's a team who look at the different voluntary sector support and other support that could be put in place before somebody goes home and there's even initiatives where some of the voluntary sector organizations are going into the hospital to speak to patients and their carers before they leave. There's developments around information packs within hospital as well. So there's quite a lot going on but it takes time to implement and we're trying to follow what's happening next. In terms of this priority it's more about primary care. So it's the care that people are having outside of a hospital that is not urgent and it's accessing things like GPs and maybe support via a pharmacy so that they're getting the support before they go to hospital and our remit is a lot about collecting insight and understanding what people are having trouble with so that's the phase that we're in with that one at the moment. Thank you. Thank you Abi. Hi this is a kind of question on behalf of one of the voluntary sector organizations I represent around your work in terms of strengthening the ICB's digital inclusion strategy. It was kind of just if you're able just to explain a little bit more about what you're doing that would be really helpful so I can take that back. I will try my best. This is something that we're doing with the other health watchers in South West London. There's a sort of a director level person who's employed on behalf of the different health watchers to go to various meetings and work with the ICB at the ICB level which unlocks a bit of time for the other health watchers to focus on the local so it's very important that we work in that way. I've asked for an update from her based on the meeting yesterday that you all had. So she's told me that there is a Southwest London digital strategy and that's just been published literally this week so she's been back to look and see if the recommendations that we were making have been included and they have. There's things like case studies and references to lots of our insight reports that have been referenced in that strategy which I can send more detail on afterwards if that's of interest. Thank you that would be great and if I just made just one other quick question or more offer really which was from the Wandsworth carers centre which is saying that I'm very happy to survey carers from your behalf and just the longer the lead time the better just so they can plan that in which is probably stuff you hear all the time but just wanted to note it for you. Definitely thank you. Thanks a lot. I think Kate Slomek you have a question? No I was going to just supplement what Sarah said around I know sort of raising questions about how carers can be better supported which is a really good question it's something that we've really tried to improve at St George's. Wendy Doyle who's our Head of Patient Experiences worked really hard to look at what we can do differently and do some significant work this year to support carers we've got a new tab on our IPLIT which is our IT system to actually make sure we're capturing details around carers and we're involving them more in decision making and in contacting them earlier in the process. Co-designing it was an external web page with a governor carer we've got intranet pages for staff and training for both planned and bespoke team requests and a new group carers forum which again helps us sort of learn and think a little more broadly about what the needs are and how we best meet them and we're already partnered with the community and several reps attend our steering group including one's work rep as well so it's something that we're really working hard to improve because we know traditionally yeah hospitals haven't been as good as they could be around supporting carers and involving them. Thank you very much I think it's extremely reassuring that there are some movements to improve this because there is a quite a bit of concern in the carers community. Appreciate it. Yeah thanks Kate that was actually very helpful and yeah clearly this is an area we do need to focus on so particular thanks to Health Watch for actually focusing upon that. George I believe you also have either a question or a comment. It was a question about the focus that you've put on homelessness and mental health and you know I think that's very laudable that you've you know you've highlighted the very real concern that there is between mental health and homelessness and I was going to ask you about the emphasis that you're putting in if I understand it correctly that a lot of people sort of experience homelessness but they only sort of receive the support from health services once their mental health has deteriorated significantly and they are actually in effect in some cases they're actually street homeless. Do I understand it correctly that your emphasis is now more about services being proactive and ensuring that people don't fall through the net I mean I make that assumption with the new assessment hub which seems like a really positive initiative on your part. I perhaps should make it clear that we are kind of insight gathering organization we do the research and we provide suggestions to services for what they can do to improve so the assessment hub isn't something that we are implementing but what we do is we provide those recommendations after having spoken to service users people who have lived experience to help guide how they develop their services so the people developing the assessment hub will have read our reports and our recommendations and then we follow up to check that there are initiatives that are being developed along those lines so I think the key thing that we took away from it is there's always and I think this goes across most services actually there's always more that can be done to support people around mental health I think the concern we had was that the prevalence is so high amongst people who move into homelessness so they already may have mental health concerns the various determinants of health that have led them to where they are again are all associated with increased risk of mental health conditions or problems and then once they get there the impact on mental health when you're struggling with your housing or actually homeless so we were trying to make the recommendation that every service that deals with people who are homeless are considering mental health and trying to bring those connections to support a lot quicker than or as quickly as possible. Thank you, Kate. Thank you, thank you for the report. I'm just interested in one of the research priorities that you've identified for next year around access to support autism. I'm really interested to hear that that's come out some conversations you're already having with parents and families in our family hubs and something certainly we hear is a concern for local families so just it sounds like this is probably something you've already done by inference looking at the report but just to ensure kind of you're reaching the widest possible voices just to kind of if you plan to engage with some of our parent forums that already exist in the borough such as parent champions, the SEND and parent care forum. I think we have been to all of those. I think we have but when we write the report we'll list it. I think when it links to the comments we were just making I think mental health is coming up as one of the things at the moment that sort of support whilst people are waiting for the diagnosis particularly for parents as well and I think that's already been mentioned today so that's really reassuring that people like Graham Markwell are actually aware of that. Excellent. Any further comments on that? Yes, if I can just make a question. I know we've worked much more closely with you this year but it occurred to me with some of your projects it would be really good if we could have an early alert which you might be looking at so we could perhaps help define a safeguarding question in terms of understanding how people might feel safe. It's all about wording I think that might help us as a board also know what more we can do in terms of raising awareness. Sure. That's good. I mean we we produce a business plan in about July time and we do circulate it I think to this board. Is there a way that we can include the safeguarding adult board in that as well. And then that hopefully will prompt those conversations. Yeah. Thanks. I mean that's excellent. One of the roles of the board is to bring people together and ensuring ensuring that we're all joined up working. So that certainly sounds a very sensible suggestion. Thanks. Thanks Dr. Christabel. Any further questions on the health watch annual report? Right. OK. So if I can take the recommendations. The first one is simply to note the annual report. And I think we have I think Sarah has provided feedback on progress and priorities and important topics for the coming year and obviously members of the board have contributed on that. So can we please make those recommendations. Yeah. Thanks. And Sarah on behalf of the board and the local authority can you take back our gratitude to the work you do. It is vitally important. And in particular to thank all the volunteers who I know do an absolutely stunning job throughout the course of the year. Thank you very much indeed. The next item is the better care fund called the one two thousand twenty four to twenty five update page hundred twenty three hundred twenty eight. A report by the executive director and Brian. We've been sitting incredibly patiently throughout the entire meeting. Hopefully you've actually found the discussion generally interesting. But Brian Roberts I gather you are introducing the report. I am a thank you for. So we'll have well-being board for having me here to introduce this item as well as signing off the better care fund refresh for the last meeting. And so and as part of the B.C.F. plan there is a quarterly report that that is produced and returned to NHS England and and then comes to the health well-being board for quarter one that return was only so the only request in there was to monitor and report the spend of the discharge element of the B.C.F. for quarter two that's a much bigger report and actually that contains quite a lot of some impacts and metrics which the board will be much more familiar with and that will also include some of the requests the health well-being board had last time of what impact the B.C.F. is having. So that that is on its way and that will be there. But but just briefly in terms of the in terms of the discharge fund element. So so which was about six point six million pounds of funding between the I.C.B. and the local authority at the moment actual all the schemes to support discharge are up and running the spend to June. So twenty five percent of the way through the year. So actually we've spent about thirty seven percent of the money and actually some those schemes are having and having an impact on on discharge and and trying trying and shortening the time between when people are referred for discharging in hospitals to to be discharged and we and again that's some of the impact work that you will see you will see next time. So with that I believe that's probably the shortest report I've ever given anywhere. OK thanks and questions yeah brevity is always appreciated. Abby. I'll try and make this short as well. Is it usual Brian that you'd kind of front load your spending so be spending more upfront or have you got any concerns about the fact you've spent thirty seven percent of the money in twenty five percent of the time. So so where we've spent ahead of plan. So some of that is where we've spent specific things. So there was a there was a view done by in the care transfer hub in St. George's which which in readiness for winter which was was paid for. But actually there are some areas here where demand has increased for for home care for Raymond for residential emissions which we're having which we're using to meet through here. So so so and that demand we we are we are managing as best we can. All partners are managing that as best best we can. And so obviously we're monitoring that internally as well as as well as these reviews. But demand is only increasing for this area. Good question. I suppose it's and it's just to say there's an awful lot of work going on between partners including local authority ourselves at the ICB. Kate who's on the call around how do we enable discharge to be as sleek as possible. Wandsworth council commissioned an organization to support us looking at that. And there's some quick wins which we we've collectively signed up to which doesn't really come across in this report. There's an awful lot of work trying to get the patient experience the patient out of hospital quickly safely and into the break care environment as much as possible. So I just wanted to kind of add that there's a lot going on. It's not just a static pitch. Sure. Any further comments. Just one quick one. I mean how do the allocation of monies between ICB and the local authority. I mean how's the expenditure between those two funds actually work. So the the local authority part of the discharge fund is centrally mandated. That's that's handed down to us as a as a grant that comes directly to local authority. The ICB funding is given to the look of the ICB to to split between the six boroughs within South West London and a lot of work goes on in the area splitting that fairly and to achieve outcomes. And on page 124 you'll see that there's there's some hosted monies there which pays for mental health step down beds in a unit and that supports five of the six boroughs. And obviously that agreement was then so the reason it's five or six boroughs is Croydon points towards a different direction. They point towards SLAM and this is sort of a South West London St. George's provision. And so a lot of work goes on to actually make sure it's it's fair and equitable across the boroughs. And and I have to say this is this is the second year this has happened in this way. And and actually it feels like it is a fair representation of how that split and a lot of work goes in it by the ICB to ensure that happens. OK thanks. Yeah I've obviously prompted quite a few discussions. I'm just intrigued how is money assigned to each of the ICB and the local authority. I mean what determines ICB expenditure and local authority expenditure? Or then do you want to answer that? The phone can probably do better than me but it's about different formula that is used. So in the allocation of the Adult Care Discharge Fund, NHSE or the DOH decided to use a particular formula in which Wandsworth Council is slightly less advantaged than if they'd used a different formula. But other friends of ours close by are more disadvantaged than we are. Let me say. And so it is weird because not all the things are done in the same way. But at South West London we've agreed to use a different formula to split the money which is more fair and considers the relative sizes of six populations. I've obviously opened up a can of worms here. But anyway Mark and then Kate. So I think it's just worth offering the clarity is that these aren't within our existing budgets. This is a ring-fenced amount of money that comes down centrally and then it's kind of allocated across the board. As Lynn said, where there are any decisions to be made it tends to be on weighted population and bringing in deprivation as well. But yes, it's just to make sure that everyone understands that this is ring-fenced and not actually sat there in a budget. We get this on an annual basis. Absolutely, absolutely. Kate. Yeah, just to reiterate, we spent a lot of time together as system partners talking about discharge and flow and how we can do things differently and better. Only this week we had a big meeting working that through. And I think for me with this Better Care Funds and allocations, it'd be good over time to see the impact that we think each of these schemes is having and having the ability to flex over time, maybe move pots of funding around. I think that's something that I hope we consider buying to do together. I know there's an element of fixedness in some of it, but to have that sort of opportunity to flex where that's supposed to be, I'd say the quick start bridging has been, that makes an enormous difference. So more of that would be fantastic because it's getting people out quicker whilst they're waiting for their actual packages of care to be available. So there are some things that I recognise here that make an enormous difference, but it's just understanding the impact of all of them on the overall pathway and the ability to flow patients as quickly as possible out of hospital when they're ready to go. Well, we all thought this was going to be quite quick items, didn't we? So it's also worth acknowledging that this is about discharge from anywhere. So obviously St George's is a big part of that, but obviously the work we've done in this borough is also supporting mental health discharge, which not every borough has done. Some are very much focused towards the acute system, but we recognise that actually the mental health system needs support and needs support in this way too. Yeah, absolutely, Brian, because we have a mental health trust hospital in our borough. Yeah, that's absolutely correct. Good. Well, I don't see any further comments, but again, a very important topic. Formerly, as Brian said, it is simply for the health of our being brought to note for on the transmission to the NHS England in terms of what money has actually been spent. So the recommendation, et cetera, does the board note the BCF spend and outputs activity for those schemes reported on for the period of April to June 2024 as set out in Appendix 1, which I suspect is probably not the most challenging of decisions we've been asked to make, but can we agree with that, please? Thank you very much indeed. Good. Excellent. So we're now on the home straight and item 8 is the health and wellbeing board work programme. And Lynn, I think you're going to introduce this. I know this is everybody's favourite item. So I'll take about 15 minutes and read it to you. It's all very clear what we've got coming forward. As ever, the forward plan may change, is subject to change. As ever, I would really encourage, as Councillor Henderson said earlier, that members of the board do offer ideas, reports and topics for our consideration. I'd also like to draw your attention to our exciting seminar programme. So the first one, which will be in January or early February, is about the LGA work, thinking as a board about what can we do better? What can we do more of? How do we get more connected to our residents in terms of the work of this board? And then Abby's offered to do an interesting topic, we haven't figured out a date yet, on health inequalities with learning disabilities and we're potentially looking at spreading and scaling innovation. So again, ideas, thoughts, where we can spend a little more time in a seminar reflecting on something, please do come forward with ideas. On the understanding of course, as Abby learnt, if you come up with an idea, you get to do the work. But please do come forward. Great. Any comments on the report that's currently drafted in which a number of items are being listed for future meetings, particularly the one in January. But yeah, I'll just simply reinforce what Lynn said. We are actually looking to develop the health and well-being board into something which is much more interactive, involves community, et cetera. That should be the opportunity at our seminar even at the end of January, beginning of February. But don't let that inhibit you from putting forward suggestions or topics you think could usually be discussed by the board. So on that basis, I think we're just simply being asked to note the report, if we can do that. Excellent. So the date of the next meeting is due to be held on the 27th of February of next year. And I've been told, please note there is no other business included on the agenda. So that now concludes the meeting. Can I thank everyone for attending, especially since at least seven weeks since our last meeting. Can I also thank all the officers who have presented. I think we have had very detailed discussions and a whole range of vitally important pieces of work. And I think it only remains for me, and this does seem still a bit early because I'm still out of school, but I will nonetheless wish you a Merry Christmas and a Happy New Year. Thanks a lot. And we've actually finished in only about 15 minutes. Amazing. Excellent. Okay. Thanks a lot. Cheers. Bye-bye. Thank you. [BLANK_AUDIO]