Transcript

Hi, everyone. Good evening. Welcome to Health and Adults Overview and Scrutiny Committee. My name is Councillor Lizzie Daybrays. I'm the chair of this committee. I'm going to call the names of the committee one by one. So please switch on your mics to confirm your attendance and make sure to switch them off after you finish. And we have had apologies from Councillor Davis and Councillor Gussain. Do we have any other apologies? Don't think so? No. Great. So Councillor Cuddy. Good evening. Councillor Corelli. Good evening. Councillor Della Sajul. Hello. Councillor Marshall. Hello. Councillor Riggby. Hello. Councillor Varra Farage. Good evening. Councillor Worrell. Good evening. Also in attendance is the Cabinet Member for Health, Graham Henderson. Do you want to introduce yourself? Good evening. Lovely. Lovely. We will now start the meeting. I'd also like to welcome Stephen Hickey, chair of Healthwatch, who's present online this evening and at the meeting. I'll ask Stephen to come in and comment on any item that he's indicated that he would like to ask a question on when we get to that item. And hopefully most councillors have seen, but unfortunately due to illness, the lead presenter at St. George's Mental Health Trust is unable to attend tonight. So we're going to defer that item to the next meeting. However, if councillors do have questions, we'd really welcome them on that report in the meantime so that they can answer those questions. And we have a number of officers present virtually and in person who will introduce themselves when they first address the committee. So moving to the first item, the minutes of the 18th of September meeting. Are the minutes of the previous meeting agreed as a correct record? Agreed. Thanks, everyone. Moving on to declaration of interest. Are there any declarations of either pecuniary or registrable or non-registrable interests? Please declare the interest, quoting the item. Councillor Worrell. Yes, paper 367. I work for an organisation that makes referrals into the e-service. We do not receive any financial recompense for the actions and I'll be participating in the discussion. Thank you, councillor. Any other interests that need to be declared? So moving on from the first item, which would have been South West London, St. George's Mental Health Report, we're going to start with Homelessness and Health Needs Assessment, paper 24-364, pages 43 to 126. We've got a number of officers here who will be able to talk to this paper, but Shannon, Director of Public Health, is going to start and kick us off and then I think we've got some housing colleagues welcome who are going to take some questions. So over to you, Shannon. Thank you, Chair. Good evening. My name is Shannon Katia and I'm the Director of Public Health. I'm going to give a very brief introduction to the report and I'll take the rest as read. Having a safe, secure and warm home is one of the most important determinants of health. And we know that when people don't have that, then it can significantly impact on their health and well-being. And we know that the health outcomes of people who do not have a safe, warm and secure home are worse than people who do. You can expect a life expectancy reduced by more than 30 years for people who are homeless and a lot worse as well for younger people. So it is in this light that a homelessness health needs assessment was undertaken for one's worth. One hadn't been produced for a while and it was conducted as a rapid needs assessment which was published in 2022 and then worked to update it and to publish the findings happened in subsequent years. So the purpose of the needs assessment really were to understand the scale of homelessness in one's worth and to underestimate the health inequalities that are experienced by people who are homeless in the borough and also to identify unmet need in terms of the support and the services available for people and then consider what the implications are. The key findings from the needs assessment were that there are increases in homelessness rates and this is nationally but also affecting London and the borough, particularly in terms of statutory homelessness and people who are rough sleeping. The report also found that there's a need for more support and better access in the context of mental and physical health and physical health services for both rough sleepers and statutory homeless people. It found that the availability and appropriate location of health and well-being services including the need for outreach especially in the context of unpredictable living arrangements, digital exclusion and cost of travel and physical condition of rough sleepers was important and that there was a lack of a joined-up approach to services both at a borough and southwest London level for people who are homeless. And just very briefly, the key recommendations from the needs assessment in order to try and address some of the health inequalities to improve health and reduce health inequalities, to have more flexibility including better targeted outreach access to health services for people who are rough sleeping including particularly access to primary care and mental health services. There was also a recommendation to improve access to preventative health, support including dentistry, podiatry, musculoskeletal services for people particularly those who are rough sleeping and finally to increase social support for people who are homeless to help them support and maintain relationships that are beneficial for health. I will take the report as read and happy to take questions together with colleagues from housing. Thank you. Oh, lots of questions straight away. I think I had Councillor Wurl first, Councillor Rigby, then Councillor Caddy. Thank you. First of all, I'd like to commend Dr. Bannerman and the team who actually developed this report. A lot of work has gone into this. There's some really interesting findings in here. And it just reflects the depth that the team has gone into actually looking at the issues around homelessness and the causes and coming up with some solutions. So from my part, a big congratulations to everybody that's worked on this amazing report in terms of the information. One of the issues that's contained in the – one of the themes that runs through the report is the public health approach and looking at social determinants, which I really welcome. And I know, Shannon, that you've been a real champion of this in the Council and together with your team. I was just wondering if you could – are you able to elaborate a bit more about how this would – how this actually works in terms of then working outside of the homelessness team but actually picking up on the issues around homelessness across the Council? Thank you. So a public health approach recognizes the need to look at the causes of the causes. So it's looking beyond kind of the superficial level in terms of the presenting need and trying to understand the unmet need as well as the interventions that could be put in place upstream to try and prevent, for example, people becoming homelessness in the first place. A public health approach also recognizes the need for interactions between services because often the risk factors that act in terms of homelessness can be interlinked and can compound each other. So structural factors, for example, can include poverty, housing supply and unaffordability or unemployment or access to social security. And then there are individual factors that can be both the cause or exacerbate the risk of homelessness. For example, if people are experiencing issues with mental health, disability or they're in poor health. So basically that is the public health approach that tries to look at all those different risk factors and how they interact in terms of what needs to – you know, the solutions and the interventions that need to be put in place. Thank you. Can we go to Councillor Rigby? No, if that's all right. Yeah. I think this is, for me, in my six years, this is one of the most devastating papers I've actually read. And I think, you know, thank you for putting it together. It must have been really hard at times to have to deal with some of this data. And, you know, especially I think the qualitative feedback, some of the statements were so hard to read. And I think some of the things that can happen in Wandsworth is that our society can get quite divided by hate and othering of homeless people. I mean, I've even seen ones with counsellors writing on next door that, you know, this group of homeless people, it's a choice. They're not homeless. You know, they've done it as a choice. It's a lifestyle choice. And that diminishes empathy and is highly irresponsible. One of the things that I would really like to have as a resource, as a counsellor, I can't send this whole report to people who write to me saying, get rid of the homeless under Ballon Bridge. But what I'd really appreciate is like a one or two pager that has this, it lays out the situation, it lays out the health issues, it lays out even some of the verbatums. Because I think we need to work as counsellors to, you know, create shots of empathy. Because I do get emails every week saying, can you just get rid of them? And, you know, it's hard to read. It's hard to respond to those emails. Because, you know, we want to, I think we had even a counsellor at one of the last committees saying it would be her best birthday present if we could just get rid of rough sleepers. I mean, it was just such a lack of empathy. And, yeah, that would be something that I would really value as a counsellor to help to give to the community to say, this is, these people are going to, you know, die probably 30 years younger, earlier than you will. They're going through all these health issues and they have no access, you know, so this is something we're doing. Yeah, thank you. Thanks. Is that, officers, is that something we think we can bring back and circulate to the committee? Yes, absolutely. And, I mean, I absolutely agree with the point that, you know, the hidden complexities that may not be apparent to people, particularly when they experience rough sleeping. But we know both from the needs assessment and from some of the outreach services that some of the compounding issues may be related to mental health issues. We also know that sometimes there are issues around substance misuse as well that people need to be supported holistically around those. So that's certainly something that we can look to produce to help people understand the issues. Thank you. Councillor Caddy. Thank you, Chair. What struck me when I was reading it in conjunction with all of the other papers was how critical housing and homelessness is to all of the other aspects that we're going to talk about at this meeting. And it's a shame that the mental health paper isn't coming because that was one of the things that I wanted to draw out of that. But specifics, I think it's a really valuable paper. I guess my biggest concern is that the recommendations don't feel very sort of detailed and specific and measurable. And I wondered whether there was going to be any extra work or further work done to get those recommendations kind of, I guess, honed down into something much more specific that particular departments can work on. And then I had a couple of sort of factual questions. On page 116, it references housing plans as an issue. And I wondered whether we were going to share that with the housing team or the planning team in terms of looking at the mix of housing that we're providing. Because obviously there's a concern over, I guess, one bed or studio flats being provided at the expense of some of the sort of larger flats. On page 107, I think there was a comment that over half of rough sleepers were found temporary accommodation or hostel placements on discharge. I mean, what happens to the other half? Should it not be 100%? Is that something that we're sort of specifically working to? And then on page 84, there's a reference to employment and how beneficial that is for mental health. And I wondered whether we'd circled back with the EDO and the lifelong learning team to try and maybe get some recommendations for improving help and support into employment for people who are homeless. That was my... Thank you. Is this Chantal and Michael? Is that for you for Michael? Do you want to introduce yourself? Yeah, can I come back on that? Hi, so I'm Michael Sheeran-Weller. I'm the Street Homeless Service Manager for Richmond and Wandsworth. So I commission the services that support people experiencing street homelessness in both Richmond and Wandsworth. Just on the point about the non-specific recommendations in the needs assessment, for us it's been incredibly helpful to have such broad recommendations that are not so heavy in detail but very, very clear. That's been very, very helpful to us and they quite encouragingly are reflected very much in our plans related to our new street homeless hub that we're going to be opening on Lavender Hill and also our new integrated super outreach model, which is only made possible by the hub model as well. So actually, just on that point, we have very specific things that have come as a result of the broader recommendations from the needs assessment. Sorry, Shannon. Shannon, do you want to come back on the others? Yes, thank you. If I may add to the same point, since the needs assessment was published, actually the recommendations have been referred back to a wide range of stakeholders and support services for people who are homeless. So that includes obviously housing colleagues, but also the drug and alcohol commissioning teams, primary care operations. We've worked with Southwest London ICB, SPIA, the outreach providers, St. George's Mental Health Trust. And we've found a way where those different stakeholders can own some of the recommendations and actually thrush them a bit more within within their service plans and provision in terms of taking them forward. Earlier this year in March, I think there was a workshop as well that was held and chaired by the cabinet member for housing, which involved ones with housing providers and other stakeholders were there as well. And that was another opportunity to look at the recommendations and to try to get ownership from the different parts of the system in order to address those. We have also agreed subsequently that we'll convene a biannual forum between public health and housing and other stakeholders just to monitor progress on those recommendations and how they're getting on with them. Great. Brilliant. Thank you. And I just had, I think Councillor Royal had a quick follow-up and then I'll come to you. Okay. Councillor Crivelli. First and foremost, can I thank you on the report you've done. And it's very, very thorough and there's a tremendous amount of data and that's really well compiled report. I was really pleased to hear the point you're making about access to primary care because that's clearly a very big issue for people who are homeless in particular, people who are street homeless. Difficult for some of them to register with GPs for a number of reasons. And I see that GPs have gone out of their way to really try and emphasise that, to try and work. But I was going to say that the experience that I have working with organisations like, just for example, Crisis, I know that these sort of organisations like Crisis, Glassdoor, they're in effect very good, I think, at interacting with giving assistance to people who are street homeless. And I was, I'll give you my own example, I know some work that was done by, I don't think they do much work in Warnsworth, but I know they do it in Central London, Quaker Action for Homelessness. And I know that they've employed volunteer psychologists to actually try and interact with people who've got PTSD issues, which is a quite common feature for people who are street homeless. And I was just wondering if it is the case that we interact with these charities and use them as a means of trying to encourage people to get direct access to primary health care. Because clearly it seems to be interacting with, getting over that first hurdle of even getting registered with a doctor or even having a medical appointment is something that is few and far in between for a lot of street homeless. That's the question I wanted to ask about health. I wanted to ask a second question, if I may. And it's, I see on page 51, you mentioned scenarios about housing, about people getting home, being made homeless. And you've said a scenario there, person leaves prison with, with, with no accommodation. I have to say with my own personal experience, I know that in a number of occasions, you've got people who are actually, say, for example, incarcerated and they can't even get bail. They may well be a candidate for bail while they're waiting the trial or something like that. But because they don't have an address, they're then held in the prison system when they could be outside rather than being incarcerated. And I was just wondering, this does seem to be like a perennial problem with people, one, not having addresses that they can, they can go to so that they can make a bail application. And then secondly, of course, they may well be granted bail. Their case may come to an end. They may be acquitted. And then what happens is they're out on the street. I was just wondering about, you'd tell us about this, the sort of work that you're doing and that sort of thing to, to stop these people ending up on the street. So I would like to respond. Michael. So with regards to your first point about the barriers to people who are street homeless, who present with, you know, extreme and complex needs, the new, you're absolutely right to point out that, yeah, that that is probably one of the biggest issues that leads to entrenchment. And what we've been able to do over the last sort of seven years, because it's worth pointing out that seven years ago, there weren't any commission services that support people who are street homeless in Wandsworth, is that we've been able to create new roles and teams and embed them within the existing statutory services across, you know, the drug and alcohol service, the mental health service, physical health, and, you know, I think it's, it's those expecting statutory services to, to support people on the street clearly is unrealistic and doesn't work. So you need those bespoke services embedded within them to be able to go and conduct outreach, which is what Shannon referred to in, as part of the needs assessment. Um, so we're already doing that on a commissioning basis. So, uh, the crisis is, um, is a fantastic organization, but we are commissioning, um, other services like St. Mongo's and Spear within our own borough. But yeah, it's absolutely right that we should be drawing on the expertise of those fantastic organizations to do that. And, um, just the second point on that is that our new hub health has been at the forefront of the design of that entire building. Um, having all of the services co-located under one roof makes access to those services so much easier for people on the street. So they don't have to go to lots of different locations to access lots of different things. All of those services are in one place. Uh, and we've also included on our plans, uh, there's going to be a clinical space where, um, we're going to have GPs coming from the homeless inclusion team at the hospital, um, who, uh, which is run by Dr. Danielle Williams, who's absolutely fantastic. And that, that team is going to be coming down and delivering health interventions along with nurses as well. Um, along with our drug and alcohol team, who will be able to deliver, um, drug and alcohol interventions from there as well. So, yeah, absolutely recognize what you're saying. And, uh, yeah, just to assure you that that's been included in, in, in the designs of this, uh, of this new service. Just, just to go on to your next point, I think, I don't know whether, Chantelle, you wanted to mention anything about prison release. Oh, sorry, Chantelle. I just wanted to highlight a couple of examples of work that is being done jointly with the voluntary sector and other partners to try and, um, join up the interface that people who are homeless have with health. The first one is health and well-being drop-in days that are led by sphere, by spear, sorry, that bring in health and other partners so that people can access all those services, or at least, you know, they can, uh, start to, to have their needs assessed around some of their other health issues under one roof. Uh, and the other initiative is the driving for change bus, which is an innovative service, um, that offers a range of services from a bus, including mobile dentists, testing, vaccinations, uh, and access to various advisors. And it also even provides useful products such as toothpaste, soap, as well as mobile charging and haircuts as a means of just engaging some of those people that might have entrenched, uh, rough sleeping issues and, and providing an opportunity for them to, to more strongly engage with health services. Just to say, we've got Kieran with her hand up online. Kieran, did you want to come in on this? I thought I could cover off the, um, question around prisons. Oh, great. Thank you. Yeah. So, um, obviously we've got Wandsworth Prison, um, in our borough, um, as a community safety partnership, reducing offending and re-offending is one of the key priorities, um, for the partnership. So we've done lots of work, um, around some of those pathways, you know, housing, mental health, substance misuse, they're all clear pathways that need to be addressed, uh, for individuals to, um, make sure, or, um, prevent them re-offending. In fact, about two weeks ago, we held a multi-agency workshop to look at what housing pathways exist, um, in the borough. Because when people come out of Wandsworth Prison, if they don't have any fixed abode, then they do come out into Wandsworth, and they are, they are, they end up being our statutory, uh, responsibility. So we've got some real close working with the prison, uh, with colleagues in housing. We know that there's a, um, a unit of 33 units, um, on the borough as well as a throughput. So there's lots of multi-agency working going on at the moment around how we tighten up that housing pathway for people who leave prison so that they aren't, um, homeless or end up on the streets. And that's part of the work we're doing with community safety, um, in partnership with housing colleagues and in partnership with public health, um, and prison as well. Yes, of course. I just wanted to add, um, on the resettlement, um, sort of prison discharges and doing that early doors, early work to be alerted of, um, people likely to be discharged. It is really, really important, and as the colleague said, uh, just earlier to me, uh, that we have that early doors, early alerts, um, because that is what we want to do. That's what the legislation leads us to, to, to, to doing. So, you know, we do have, uh, things like resettlement panels where conversations are had about people who are likely to be discharged from prison soon. So there's that planned approach to how we will support and avoid the, you know, the, the, the, the instances where someone will come out of prison and find themselves street homeless. So, you know, there are things like duty to refer arrangements where public bodies must or should alert us with, uh, someone is due to be discharged or released from prison. So we do encourage a lot of that early doors work, and as the speaker said before me, it is absolutely imperative that we have those conversations about, uh, a planned pathway, uh, so people do not find themselves in more challenging circumstances post, uh, a release from prison. And as we know, if people don't have settled accommodation, you end up in that revolving door syndrome where you're going back into those pre-habits, and we want to, uh, minimize those as much as possible. Thank you. Thank you so much, Chantel. Uh, Councillor Orell. Yes, thank you. Um, in terms of the paper, the paper works through a number of different demographic groups, um, which is really helpful. One I want to pick up on, though, is one, uh, group of people with no recourse to public funds or who are overstayers, um, and outside of the immigration system. Often this group of people for either fear of the home office, um, or they have no statutory rights to access certain services, um, fall under the risk of the home office. And often then get picked up when they're admitted into A&E with severe health issues and then get discharged back once again. And I'm just wondering, for this group of homeless, uh, the subgroup of homeless population, who are most of the time are street homeless, although sometimes can be sofa-surfing, I recognize, um, what work has been done to support them and engage with them and actually support them, um, in terms of their health and their health needs? Officers, which person's best place to talk about no recourse to public funds? Chantelle? Yeah. Okay. I mean, in terms of no recourse to public funds and overstaying, um, uh, people, housing options, if I'm being realistic, of course, are limited due to their legal status in the UK. Um, however, we always say there are potential avenues for support, um, the main ones are the local authority may have some limited opportunities to be able to assist where, for example, there's, uh, for example, if children were involved or where there was a care need or, uh, a return to their country of, of origin posed a human rights risk. Uh, there are some charities, um, um, um, who might be able to offer services, support services to people with no recourse to public funds, uh, like Refugee Action, sometimes the Salvation Army, um, and there are some specialist housing projects, but, uh, the reality is, really, um, with people who have no recourse, the options become a lot more restricted. So, a lot of the time we will have conversations with, perhaps, agencies like the Home Office around if, if there were no impending issues why they can't return home, how we can work with them to assist them to return, um, from wherever they may have, um, sort of arrived from. Um, but it is difficult. And, of course, there's also advice around immigration, uh, getting the right support, legal aid, in order for them to regularize their status where that is possible. But then, that then opens, once your status is regularized, it opens the avenues to mainstream housing. But the legislation is very, in terms of homelessness, is very clear on who's in and who's out. And, but it is a challenge. But we do do a lot of work. I know, Michael, you were talking about, uh, Council, you were talking about, um, um, uh, people who are street homeless around the Ballum area, et cetera. We do know that some of them are, have no recourse to public funds. Um, my colleagues in, in Michael's team will work with the police and other agencies to try and find short-term and, you know, longer-term support. But the reality is the options become quite streamlined where the eligibility issues, um, are at the fore. I hope that answered your question. And I think Annabelle's got a little bit more to add on there, of course. I was just going to add that, um, we recognize that this is a particularly difficult area to work in. And as part of the new refugee services team that's been in place since April, we are, um, we, we are looking at and bringing in a resource of a person with expertise to work in that team that will be able to support all the teams in the Council that are dealing with people with no recourse to public funds as a kind of advice and support resource. Um, oh, some more questions. Yeah. Samela, sorry, I didn't see you there. Samela. Just to quickly add on to that point, as part of our Borough Sanctuary, oh, sorry, as part of our Borough Sanctuary accreditation, we have actually made a commitment to, like, lobby national government on kind of changing the policies around low, um, public resources. So we can try to do it, so, yeah. Um, sorry, but my question was, um, to kind of echo what other councillors have said. Thank you to everybody that was involved in the paper, to all the contributors. Um, my question is that the last needs assessment was done in 2013, and obviously homelessness has been on the rise over the past few years. So why was a needs assessment not done a lot sooner? Shannon? Thank you. I, I, I can answer that, um, the conduct, you know, conducting a needs assessment is not something that has, uh, sort of specified, um, period or, or time scale. And it's just due to a combination of professional judgment in terms of, uh, when we think that the level of need might have changed to such a significant level that we need to go back and assess it again. Um, but also just, um, in the context of juggling other priorities, um, and, uh, needs assessment would probably have been conducted much sooner, uh, outside of all those extenuating circumstances. Um, and, and it just so happened that just coming out of the pandemic felt like the time to bring that work forward. Thanks. Councillor Crivelli. Uh, I, I, I, I was, I was, uh, encouraged by the, the, the, uh, point that you've made on page 93 about Wandsworth is now supported by a high tolerance facility, uh, which enables access to maintain their, uh, accommodation if they're still, uh, uh, drinking and using substances. Uh, I, I, I know from some of the, the, the, the hostels that I, uh, I, uh, I knew in, in, in central and then they did three rules, no drugs, no drink, no violence. And then, of course, if you're somebody who's alcohol dependent, you find that you, you're not able to access any of those sort of facilities. I was just going to ask about that service in general, because you said that you have, uh, engagement and motivation and referral routes to, to, to treatment. I was just wondering if you could, you could expand, expand on that and tell us what sort of work you're doing around the referral routes. Yeah, of course. So, um, I think it's a really good point that you've made, councillor. Um, people who are street homeless are often at a pre-competitive stage of recovery where they aren't yet, uh, in a environment where they're able to even think about, um, stopping, uh, using, uh, substances or, or alcohol. So, they need somewhere where there is support in order to give them the foundation to then, you know, work, work, work on, work on that. Um, and yeah, so the, the, the, the place that you're talking about in question, we've, it was previously support accommodation, uh, and we've essentially used additional funding to upscale it, to, um, put in additional support in order to take on people who are on the higher end of those complex needs of, um, co-occurring mental health and substance misuse. Um, and, um, and, uh, essentially we need more of that because I think that is a, that is a model that, um, works really, really well. Um, at the moment we have people in temporary accommodation who obviously do not have that support, um, and actually, um, there is the, the need for, um, this kind of provision, um, far outweighs what we actually have in the borough. So, that's something that we're definitely going to be looking at in terms of commissioning in the future. Can you just ask about the referral routes? Are you working with, uh, the AA and other sort of things like that to, to try and encourage people to, or is it more sophisticated than that? Well, I, I don't know whether it's, uh, well, I think it's sophisticated enough. Um, uh, so essentially, um, this all came about, we've got lots, uh, after the pandemic, we essentially took a lot of people off the street and into the into temporary accommodation, which was fantastic. But what it was left with was we essentially had a lot of people with high needs in temporary accommodation, which isn't suitable. And all of the, all of the supports that accommodation or most of the support accommodation in Wandsworth was very silted up with people not able to move on. So, um, we established a, um, supported housing, uh, panel, which essentially, uh, allows us to use, uh, government grant that's under our budget to move people on from supported accommodation, um, into, um, other housing options that are suitable when people don't need the support accommodation. And then we essentially move people from, uh, uh, then who need it from temporary accommodation or from the street into those new vacancies. So that's been working really, really well, but it's, uh, it's all through, uh, our own street homeless service. Thank you. And we've got a question from Stephen Hickey. So can I ask Stephen to ask the question that he submitted? Uh, thank you, chair. Um, firstly, can I echo the, um, praise for the report, which is a really excellent piece of work. So thank you very much to the team. My question is, this is clearly a needs assessment and the, and it finishes up with recommendations and enablers. Uh, my question is almost a process one. Um, what happens next in terms of recommendations as a whole? Will there be an explicit action plan, which sort of moves on to the specifics and the timings and, and so on? And how, how, and who will be monitoring the implementation of the, uh, of the action plan when agreed and reporting back on progress against the proposals in this excellent report? Thank you. Shannon, would you be able to come back on that? Thank you, chair. I think I had alluded to it, uh, slightly earlier when I mentioned the fact that the recommendations have been discussed and disseminated to a wide range of partners. And we've agreed some biannual, um, um, uh, a biannual kind of, uh, coming together to review and monitor progress against the recommendations. So I suppose to answer the specific question around an action plan, there isn't one central one. We've embedded the actions within, uh, plans from different stakeholders, but we'll ensure that there's the leadership, system leadership to bring, uh, those different stakeholders together, um, at least, uh, a couple of times a year. And review overall progress with the recommendations. I don't know if I was in call. It would be great if that could come back to this committee at the appropriate time so we could have an update if that's okay. Yeah. Thank you so much for all the great questions and just to echo it is a really fantastic piece of work. So thank you. And we've got, we've got one more comment from the cabinet member. Thanks, um, chair, um, very briefly, because I think we have had a very in-depth and very, very good discussion. And I'm delighted, in fact, we have actually spent the time to, um, actually input into this very important and valuable report. Um, it is an impressive report and it reflects the joint working between a number of departments, obviously, housing, public health, and, uh, community safety as well, as well as engagement with external organizations. This is a subject which, in my opinion, has been sadly neglected for far too long, almost swept underneath the carpet. Um, people's immediate response to homelessness and rough sleepers is perhaps not always as caring as it should be. Um, this report does actually, um, make very challenging reading, as Councillor, uh, Rigby, uh, said. But I do believe that it has actually set a path for, um, at least moving towards improving the situation for very many homeless people, uh, in Wandsworth. Thank you. Thank you. So, we're, we're just taking this report for information. So, can the committee confirm they're happy to note the report and take it for information? Great. And we look forward to seeing updates. Thank you both. That was great. Thank you. Okay. Moving on to, um, commissioning of extra care services at Chestnut House and Ensham House, paper number 24-366. So, this paper is for a decision. Then we've got Rachel here, who's going to give us a introduction to the report. Thank you, Chair. Good evening. I'm Rachel Soney, the Director of Commissioning for Adult Social Care and Public Health. Um, my colleague, Hannah Alipour, is online as well, um, who we'll invite as necessary. Um, thank you for, um, taking this report, um, regarding our extra care housing services that are really important, essential services for our residents in the borough to meet their housing and care needs. Um, we are seeking approval to recommission. So, we have existing contract and services, um, in the borough across two, um, services, Ensham House and Chestnut House. Um, it's about 86 units in total, 40-odd in each scheme. Um, so, we're seeking to recommission because the existing contract expires in August 25. Um, people have their own tenancy and their own front door in these services. Um, and then we commission the support provider to come in and provide, uh, care, registered care services, um, to the tenants who live in these services. Um, so, we've, um, carried out, uh, listening exercises and engagement with people that live in the existing services and listen to what matters to them and built that into the service specifications. Um, we're looking to engage a strategic partner to work with us in partnership to deliver high-quality care services for us for the future for a four-year contract with a potential to extend for two years at about £10.9 million. Um, so, really crucial services, uh, for us, um, and, um, we have got an enhanced provision that we're looking at through the specifications. Um, we're looking at, um, we're looking at listening to the residents. They've told us that having something really to do in the day and having meaningful activities is really important. So, we've looked at adding and enhancing our service around that. Um, we are going to commission on a, um, a core set of hours. So, the provider will make sure that there's core hours, people on site, have waking nights, enhancing the waking night offer, um, and then a flexible staffing that can, uh, support people in what they need when they need it in the service. Um, so, I'm happy to take questions on the report. Thank you, Chair. Um, and as will Hannah, who's joined us online. Thank you. Thanks, both. The Councillor Marshall, did you have your hand up? Yeah. Over to you. Um, thank you very much. This is obviously a wonderful initiative to see this kind of service being, um, developed and promulgated in Wandsworth. Um, I just wondered if you could expand a little bit about some of the costs. Uh, just my own arithmetic on this suggests the costs of £21,000 per year per person accommodated, if you're at full accommodation, I suppose. Um, and I just wonder what the costs have been previously. Is this a big change? Um, will be my first question. Um, a second one related to that is, you know, what, what actually drives the cost? Is it the total hours of service provided? Or is it the number of residents? Thank you. Over to you, Rachel. Thank you, Chair. Thank you for the question. Um, the, um, we are seeing an enhancement in our specification. Plus, we, um, the current contract doesn't include a contractual requirement to pay London living wage. So we will expect, um, an enhancement to what we currently pay for the contract. The previous hourly rate or the current hourly rate is about £19.71 per person. Um, and the predominant feature of the cost is staffing costs. So the number of hours that we commission to provide, uh, care to the people who live in the building, um, is what drives the cost of the service. So we are expecting an increase, but it's not a huge shift in budget. Um, plus we'll have to, um, accommodate inflation and that increase in workforce costs. Um, but we hope with that enhanced service and building, working with high quality strategic partner, how we work together in partnership with our provider, we'll also facilitate that and building a really good relationship with the landlord who, um, runs the tenancies, um, is really important as well. And that helps provide, um, higher quality, more efficient service if that's working well in terms of the three-way relationship between us, the landlord, and the care provider. Thank you. Did you have a follow-up? Or are you okay? My follow-up on that would be, you know, 86 is a good number, but I imagine it's a drop in the ocean, really, compared to the number of old people across Wandsworth who might be eligible for and want, uh, accommodation like this. What's the, the vision for developing it further? Thank you. Um, this is, there, uh, we, there are, will be four extra care services in Wandsworth. I'm really pleased to say that we are opening, uh, a further scheme, um, in Roehampton. Um, and so that will meet the increased demand that we see for people's housing and care needs. Um, so really that gives us really good coverage. And with the commitment of the council to continue the funding and enhance this service, that will give us quite good borough coverage. There are sometimes a waiting list into the services, um, but also sometimes there are vacancies, and it's about how we manage where people would like to live and receive their care, and ideally prevent people going into, um, long-term residential care, um, where people can retain their own tenancy. So it is a, it's a good model, um, of provision and, uh, trying to prevent escalating care needs for people. Councillor Regney, did you want to come in? Yeah. Um, I'm, I'm interested in hearing more about the enhanced services and what they include, and also hearing a bit more about the new coordinator and what their role will be. Thank you. Thank you. I'll invite my colleague in because she's worked, um, really hard talking to the residents and on the specification and enhancements. Um, so Hannah, if you'd like to, um, can you introduce yourself? Speak to that, Anna. Yes, of course. So good evening, everybody. I am Hannah Alipour, Senior Commissioning Manager for Regulated Older People Care Services. Um, so I work in Rachel's team. In terms of this activity, social inclusion and wellbeing role, that really came out of the feedback that we heard when we went to visit all of the tenants in both Enchant House and Chestnut House. So just to give you a bit of background information, we held a lot of engagement events through both paper-based surveys, um, going to group meetings at both schemes and individual one-on-one meetings to make sure that we heard, you know, the quiet voices that you do sometimes find happen when you go to visit schemes. Um, what came through really strongly from everybody that lives in extra care is they value the fact that it's very much got this community ethos, but for everybody, they don't necessarily feel connected to their neighbours. They want stimulating activities that happen within the schemes. Um, there are some residents that had previously lived in sheltered housing. They found that it was really vibrant. There was lots of activities, whether it was, you know, bingos, movies, activities that might involve going outside of the scheme on occasion to, say, you know, a local park or, um, a theatre. And they felt that that was an area that was really strongly missing to help them connect to their neighbours or new people that move in. Um, we also spoke with our Wandsworth Older People Forum. So, we presented to them the feedback that we'd heard from our service user engagement in extra care. We asked them for some of their solutions to the feedback and the concerns that we'd heard around the lack of activities and said, how do you think we could meet this need? One of their suggestions was the activity coordinator role. Um, and it was also having a care provider that could support the setup of a residence association. Um, so, um, what we are looking for in this activity coordinator role is somebody that will work very closely with the people that live in extra care to organise and design activities and events in the schemes. Um, I would envisage that they would set up something like, you know, a formal tenants committee or forum where they can get a group of tenants together, listen to their views about the activities they want to see, what frequency they want to do the activities, come up with a mechanism for finding out, is that activity that's being put on meeting their interests, do they enjoy doing it, is it happening for long enough, is it too long, is it too short, what can be changed, what can be tweaked, to make it very, you know, interactive and responsive to make sure that everybody in the scheme that wants to be able to participate has that opportunity. And I think it's through having that dedicated post that's got the time and, you know, the creativity and that really good, um, values of wanting to make that difference to people that live in extra care to make it vibrant and not just being, you know, accommodation that they live in, but someone that's really vibrant and it really thrives. So it's, um, you know, very much investing in that service to make sure that that happens based on the feedback that we've heard. Thank you so much, Hannah. That was a really thorough update. Um, does anyone else, yeah, Crivelli, would you like to ask a question? Uh, can I just ask a question about, uh, a cost because, uh, you, you pointed out in paragraph 37, the contracts will be subject to indexation. However, the actual financial implications will be not known until the procurement is completed and appropriate budget adjustments, uh, can be made. I appreciate we're talking about a contract that will start in September, 2025. Uh, I mean, the figure that you've got there, the, the, the, the 10 million over, uh, four years, I mean, I'm sorry, nearly 11 million over, uh, over four years, it, it, it, it, it could be more than that, couldn't it? I mean, that's. Rachel, would you like to come back on that or? I will. Thank you, Councillor Crivelli. Um, yes, um, we, we never know until we have receive our bids, uh, from our, uh, bidders, what the, um, what the tendered rate is. Uh, we obviously have an affordability issue, um, and, uh, we work with providers, have, um, conducted market warming, we have a specification, and quite clearly actually setting out our requirements and the number of hours that we expect to be delivered, which should help with, uh, relatively accurate, uh, you know, bids being made that ideally will come in on budget. Um, but there is no guarantee that, uh, all the, all the bids will be affordable, and we will assess the bid based on price and quality. Um, and this is what we expect, um, the service to come in over four years plus two over the total contract term. Um, the indexation, um, we expect London living wage to be paid from the beginning of the contract, September 25, and then annual inflation based on 70% London living wage, 30% CPI, um, is what we are, um, anticipating our contract terms to be. Thank you, Rachel. Do anyone else like to ask any questions before we move to a decision on this? Okay. Oh, sorry. We've got the health watch. Um, Stephen, would you like to come in and ask your question? Uh, thank you very much. A rather specific one on page 151, um, which discusses sexual orientation. Um, there's quite interesting figures there, um, showing that, um, that all those who declared, um, their sexual orientation have shown themselves as, as straight. But there is still a significant, they're falling minority, um, who are not, who are unknown. And there's obviously various reasons for that. And the question really is about whether, um, the, in the contract and the relationship with the ultimate provider, there will be any requirements to ensure that, um, non-straight, um, residents, um, will have their, there will be sensitivity to their needs and, um, any particular requirements in the absence of any statistical evidence at the moment that, you know, they exist at all, which is, um, unlikely in truth. Thank you, Stephen. Rachel, do you want to briefly come back on that? Uh, thank you for the question. Um, there will be a requirement around, um, equality, diversion, diversity and inclusion. And we're also, um, requiring providers to collect more information and better information about projected characteristics. Um, also looking at best practice. Um, I also know that Hannah and her commissioning team in developing the spec have been out to specific workshops around LB, LGBTQ, LGBTQ plus and around dementia and their carers and supporting older people and how we can build some of that into our specifications. So, um, you know, it's important to be reminded and ensure that we are always promoting and improving our specifications around, um, our EDI. Um, so I appreciate it. I don't know, Hannah, if you do want to add anything or whether that's adequate. Um, I think you've covered it all, Rachel. Thank you. Thank you. Thank you. Let's move to a decision on this paper then. So does the committee support the recommendations in paragraph two? Yeah. Unanimous. Okay. Um, the recommendations are therefore agreed. So we'll move on to the next paper, which is the continued participation in the London sexual health and contraception e-service paper 24-367. This is one that we'll make a decision on and I believe we've got Leah to introduce. Yes, hello. Um, thanks for having us and for, um, considering this paper. So, um, Wandsworth has been participating in the provision of the London sexual health and contraception e-service since 2018. Um, they're STI testing only to date. Um, and, uh, the current contract is commissioned by City of London Corporation on behalf of 30 collaborating London boroughs. Um, the contract that is in place at the moment is delivered by a partner called Preventex, but it's coming to its natural end in 2026. So the City of London Corporation, uh, needs to go through a formal procurement for a new provider. Um, and as such needs us local boroughs to get our local approval to continue participating, to be named as named participants, um, in the process so that they can then go out and do their, their procurement once we've provided them with that assurance. Um, so that's why we're coming here today asking, uh, the executive to agree to the recommendations at point two in our paper, um, which essentially is just please could we continue participating. Um, it outlines that the indicative contract term is, um, five years plus a possible two plus two extension. So up to nine years, um, and, uh, and that there is a small governance fee that we pay annually to the City of London team to obviously administer it on our behalf. Um, I'd welcome any questions. Thank you so much. Oh, yeah. Councillor Caddy will come to you and then Councillor Orwell. Uh, I mean, it sounds like a great service and it sounds like a no brainer in terms of decision making. The only question I had was on page 162. Um, I presume, uh, the ones with representative on the service management board means that we will have some say in, in terms of what the contracts asked for and what kind of things we need and how we want it to look, um, when it is tendered. Absolutely. All of the participating boroughs, um, are members of that board and anything that is agreed by the board membership, which is mainly commissioners who really know what's happening in the local services, then goes up to the strategic board, um, for approval, which is the likes of me. So my team, uh, are involved than I'd be on the strategic level. And in fact, um, a member of Shannon's team on public health side, um, is also involved at that point. So, uh, that's correct. Thank you. Thank you. Councillor Worrell. Thank you. Um, it's a great service. So I have no, um, no qualms in supporting it. I suppose just a couple of technical questions about the paper. Um, the first one is about the market testing exercise. Um, from my knowledge, there's only two real providers in the markets, which would be Preventex and SH24. So I was just wondering what sort of market testing exercise has been done and how many potential providers could be brought into play. Thank you. Um, so, uh, the city of London team did, uh, do a soft market testing exercise, which received seven responses. There has been some significant change in the system. Like you're right. The two main providers are, um, the two you, you mentioned, but, um, in time, things are, things are moving. This is a rapidly evolving area, which is one of the other benefits of being able to go out to procure at the moment. Um, in recognition of that, there, um, were various meetings held with the, um, the management board and also at the strategic board to discuss, um, whether we should be looking at direct awarding or going out to a competitive tender. And on the basis of that level of interest in the soft market testing exercise, it was agreed that, um, we will be going out to competitive tender. Are you satisfied with the response? Do you want me to come back? Uh, yeah, I've just got a supplementary follow up to that. Great. And that's great news to hear. Um, and I'm glad the market is developing. I just want to then just pick up in terms of the tendering exercise itself. Um, on page one, six, five paragraph 26, you mentioned a number of potential options or proposals, including the month, the appointment booking system, um, increasing prep access, um, and other forms of testing. Um, I was just wondering then in terms of what's being asked for the money. Um, would this service, um, these additions be commissioned within the envelope or would, um, you be coming back to ask for extra money? Should, um, these be a consideration? Thank you. Yes. So the funding mechanism for the service is activity based at the moment. Um, and so with any additional options, then boroughs have the option to either switch it on or, or, or not. And as such, the mechanism continues so that they would then pay for activity for anything that they are participating in. So in that respect, um, the, there isn't a funding envelope of such, which is limited as a, as a block amount. Um, and we wouldn't be charged for any development costs as such. The idea is that these would be developed. You then as a borough choose to switch it on or not, and then you pay for the activity associated with that provision. So then that, that funding for that specific additional provision funds that element and doesn't have a knock on effect on the existing core offer of STI testing. Um, and contraception, um, and, uh, and wouldn't have any impact on any KPIs relating to those as well. Thank you. Yeah, of course. Come on. Um, final question. I think you'd be happy to know. Um, I suppose it's just in terms of the, this program was designed to be a channel shift to shift some activity away from sexual health clinics and reduce costs, which, um, it does really well. As this is recommissioned and there's proposed increased activity, I'm just wondering then, would that have a, have any impact in the, in terms of the tariff rate, in terms of the activity in the sexual health clinics and the tariffs that are charged? My concern with this question is, um, sexual health clinics are already under strain. Um, they are short of money and they have, and there are several papers out there. And my concern would be by supporting this, which is a great initiative that we don't actually put the sexual health clinics at a financial disadvantage. Yes. So, um, absolutely, um, not, we, we aren't putting them at a financial disadvantage. The system is under immense pressure at the moment. There is more demand. Um, and there are, you know, there was even a report by the LGA in January this year highlighting the pressure that, um, clinical services are under. At the moment. So the, the whole purpose of, um, the e-service is that it's been designed to compliment, uh, the face-to-face offer that is there as opposed to take anything away from it. And so the benefits of being able to see, um, low complex cases, um, on, or asymptomatic cases online is that it frees up that space within the clinical face-to-face provision to see the people who really need to be seen face-to-face. Um, and so they work in synergy in, in that respect. Thank you. Yeah. Shannon, did you want to come in? Thank you. If I may add, I just wanted to highlight that a recent, uh, sexual and reproductive health needs assessment that we undertook this year actually highlighted the increase in uptake, uh, through this particular service, um, during the pandemic period. But actually that has been sustained beyond the pandemic period. And I think that highlights that it's meeting a particular need, uh, for our residents where maybe they don't need to go in to see, um, you know, a physical service because the service meets, meets, meets their needs online. Thank you for that addition. Any additional questions from the committee? Okay. Let's move to a decision on this paper. So does the committee support recommendations that are in paragraph two? Agreed. Agreed. Agreed. Fantastic. So we are supporting the, yeah, recommendations. Thank you very much. And the report is new. Thank you so much. Okay. So on to item seven roadmap to health and care integration paper 24 dash three, six, eight. This is quite a comprehensive paper. Um, so I'm going to hand over to Lynn to give a bit of a brief overview. Thank you, chair. I'm Lynn wild. I'm the idea of health and care integration, and I'm, I can try. Is that better? There you go. Um, so the purpose of this paper is really to outline the areas in which the council, um, particularly adult social services are working with partners, um, in the NHS, primary care, our local community and voluntary sector organizations to deliver services to our residents. The key aim of integrated working, I know, I know this isn't a new concept. We've been talking about integration, haven't we, for forever? Um, but the, the key aim of, of integrated working is not about structural integration or changing, you know, making a mega organization, but rather about a cooperative working across partnerships to ease people's access into health and care services so that services collaborate rather than people having to access various points to, to get the services that they need. Uh, at least that's the aspiration. Uh, our priorities are, are outlined here about prevention, hospital discharge, intermediate care, or reablement, um, about mental health and integrated neighborhoods. And I think you can quite clearly see how those priorities align with the, um, the three shifts in the NHS long-term plan, which is from, just to remind you in case it's a test, um, is from prevention, from treatment to prevention, from analog to digital, and from hospital to community. And I think it's clear how some of these initiatives are really trying to pull services away from what we do now to something that's better aligned, um, with the needs of our people, um, and, and for the future. Uh, I think, uh, clearly the word integrated working is a bit of a, a jargon word and it can mean anything really, um, or nothing. And I think what, what we're talking about here is working on shared priorities with a common purpose. So really linking it to our population level health needs and how we improve access and outcomes for our residents. So speaking really to addressing issues that I know are dear to the hearts of our residents and our members around things like addressing health inequalities, improving access, hearing people who are seldom heard. Um, I, I know that the work of neighborhood, integrated neighborhood teams is probably of, of great interest. And it's fair to say that post fuller, everybody's sort of scratching their heads to think how exactly do we deliver this? And it's very much. Sorry. Could you just explain what the fuller report is just for those that might not know? The fuller report is on integrated neighborhood teams. And, and she particularly sets out how primary care, so GP practices will work with, um, the rest of the partnership to improve access for local residents. Um, and what we need to work out, I think, is there isn't a blueprint given down to us by, uh, the DOH or NHSE, uh, NHS England. And it's rather a thing that we need to work out locally. And we've got really good collaboration, um, going on through our partnerships at Place Committee and at, um, our new, newly established Wandsworth Provider Alliance. And where we've got to is that we want to work at neighborhood footprints of about 30,000 to 50,000 residents, which broadly align to our primary care network, so groups of GP practices. Um, and the idea is that we'd find ways to meet the really quite hyper-local needs of those residents. So, the, um, the example I've given in, in the, um, page, plan on a page is Battersea to Brazil, which fundamentally is about finding people who often don't present at services and, um, supporting them to get the, um, the health needs that they need. We also have in place, um, uh, and, uh, proactive care program, which has been working at, uh, at, at GP, uh, practice level for a number of years. Where, where it's, um, GPs, nurses, social workers, therapists, and our social prescribers, considering, um, a group of people whose needs are not yet that top level of need, but who would become that. And trying to support those people, give them the support that they need so that they can maintain their health and wellbeing as long as possible. And don't hopefully delay the tip into, into having higher levels of need. Um, I think I'll stop there and ask for any questions. Thank you, Len. That was really comprehensive. Councillor Worrell. I feel like I'm talking all night here. Um, apologies to everybody. Um, thank you for the, this report. Um, I found the appendix with the, with the diagram, diagrammatical approach really useful, um, and, and a nice visual way to, to understand some of the processes. And thank you for trying to, trying to explain what neighborhood means and partnerships. I think you're right. It's such a vague term that we all, we all struggle to understand it. And I liked the way that, that you were trying to describe it. It gave me something to hang on to. And so thank you. That was really useful. Thank you. That was really useful. I suppose my only question is, and you partially answered this is, if I was a patient or a member of the public, what would I see difference? Or what would I feel in terms of difference for, for this coming, um, coming into play? And I said, you've partially answered that, but I was wondering if there's anything else you'd like to add? I think, I hope what you'd see would be that it's easier to navigate the system. The health and care system can be quite hard to navigate. And, um, often people with multiple health conditions can spend their lives going on to various appointments. Um, uh, and, and that's all there is time to stand in queues to go to appointments. So to try and bring services more locally and in a more integrated way, in a way, the team around the person to deliver the services is what is the ultimate aspiration. So that, uh, we work more closely with health colleagues, with community and voluntary sector, and the access for our residents is easier. Just, just to build on Councilor Oral's point, I guess, what are some of the kind of tangible, um, integrations that we can expect? Like, will teams come together physically, you know, a council, health, um, other VCC organizations in this integrated way? Or will it be more virtually, like, you know, what will it feel like? Um, I think there's a little bit of a combination of both, depending on the scale at which things are being delivered. So for example, um, uh, uh, in some intermediate care or reablement, which is about supporting hospital discharge, but also preventing hospital admission through a range of provisions such as therapy, um, social care, et cetera. Um, that would be, um, that would be likely to be more at a, at a sort of, um, um, a, a, a borough-wide level, um, with ourselves as social services working much more closely with community and voluntary sector and our health providers. Um, so a virtual team, but seeing ourselves together in physical spaces. Um, I think in some of the other things, it is about using resources like our buildings, um, our family centers, for example, as places where interventions, services can be delivered from and sharing space. Because we do know that presence, for example, in offices is often less than it was pre-pandemic. So a lot of organizations have some space available. How do we share that space meaningfully? And we know, particularly locally, our community and voluntary sector are often looking for spaces to deliver services. If we share spaces, uh, we, we bring services to people and we, we, um, it, it works for all of us. I'm not sure if that answered your question. No, no, that did. Thank you. Um, so the reports for information, do we have any other questions before we move to note the report? No. Is the report noted? Great. Thanks, everyone. Nice. Okay. We're on to annual complaints report for adult social care, um, 2023 to 24 paper number 24, three, six, nine. And we've got Nancy who is here. Welcome Nancy to introduce the report. So can you give the committee a bit of an introduction? Good evening. I'm Nancy Carissa complaint service manager. The report's a good news story. It captures learning from complaints, including case studies at the end of the report. And it also gives examples of some of the excellent compliments that adult social care receive to ensure that we also learn from what we're doing well. The numbers are consistent with previous years. There's been a slight drop. Um, complaints are spread evenly across the teams, um, and overall complaint numbers are low. So there's no areas of concern. And the themes that are coming through are the themes that we expect to hear each year. Um, finally, the good complaints practice in Wandsworth is reflected by the low number of escalations to the ombudsman of only of which three progressed to a formal investigation during the year. And I'm happy to answer any questions. Fantastic. Yeah. Councillor Caddy, go for it. Oh, thank you very much, chair. Um, yeah, really interesting report. And I guess my only comment is really glad to see the kind of lessons learned point because I think any large organization is always going to have, um, some complaints coming through. But the key is that obviously we, we learn from those complaints and change our systems going forward. So I thought that element of the report was great. So thank you very much. Thank you for noting that. Councillor Caddy. Councillor Rigby. Yeah. Yeah, I just want to acknowledge all the work that not only went into preparing the report, but to actually get those number of complaints down. It must, um, have had a really big boost on staff morale. Um, have you noticed if it has helped with any retention or recruitment that we've been able to produce figures like this? Can I clarify if you're referring to retention within the complaints? Within your team. No, within your team. Yeah. Um, we have good retention in our team. We've, you know, we have long standing members of the team. We're a supportive team. We love complaints. We love the work we do. So I would say that we do. And, and we, we think that they're, they're, they're brilliant. They're free information for, for the council. Um, and you know, receiving complaints isn't always a bad thing. But we do such excellent work with adult social care teams to, to resolve things when they come in and look for opportunities to stop things from progressing to form complaints. And I think that's shown in the reflection in the, in the drop in numbers. So I would say, yes, it does have a good impact on morale. Thank you. It is, it is really good to see that culture of real transparency and openness around that. So thank you to you and the team. Please pass on our thanks. Um, we've got a question from Stephen Hickey. Would you like to come in, Stephen, if you're there? Yes, it's, um, it was, um, on page 203, which is about the equalities data. And, um, it's really a sort of a curious question. Really. It's about, it's, it's about whether, whether we're getting enough complaints or to put it that way from, um, disadvantaged groups in particular. Um, it may not be within your gift. Um, but I suppose behind the question is the, is the slight concern that there may be groups of people with complaints or with issues who may not be raising them and particularly from disadvantaged groups and whether there's anything, you know, we, we should be doing just to almost check that out and to, um, encourage people to come forward with complaints. Perhaps it might be helpful to kind of, uh, explain, yeah, how you practically reach out to, you know, communities who might be otherwise, you know, have barriers to, to complaining. Um, I mean, yeah, the, we strive to be as accessible as possible in the complaints team. Um, and you know, we, we publicize the fact widely that, that we want to receive complaints from anybody who, who wants a complaint. We welcome complaints. Um, our policy and our website is clear that we make adjustments to make the process of complaining easy for anyone. Our complaint literature that's on our website reflects the diversity of our service users. Thanks very much. Did anyone have anything else to add before we, um, take this report for information? No? Okay. Thank you so much, Nancy. And is the report noted? Just to confirm. Noted. Thank you very much, everyone. Okay. Okay. We are on to item number nine, quarter to budget monitoring, 2024, 25 paper, 24 dash three, seven, zero. This is, um, a paper that Annabelle is going to introduce. So I'm Annabelle Parker, the director of adult social care, and I'm introducing this report to you in the absence of the author, Sarah Evans, our director of business resources. Um, so this report provides an overview of the forecast revenue position for the remit of this committee, which includes adult social care and public health and community safety. The forecast position is an overspend of 2.7 million or 2.8% compared to a revised budget of 97.3 million. There are significant budget pressures for adult social care and public health. And it is the budget for social care services that are the most challenged for all groups of residents receiving necessary services for which we are experiencing increased demand, rising care needs, and rising costs of services. Increasing complexity of need and market conditions are leading to increased prices within the market. In addition, the significant pressures facing our NHS partners are impacting on adult social care, with patients presently waiting longer for some treatments or surgery and being discharged earlier, needing more intensive social care support. Paragraph 14 of the report sets out the mitigating actions being undertaken within the directorate. Um, so we're endeavoring to manage the increased demand and to reduce the pressure on the budgets. We continue to focus on our vision to support residents to lead fulfilling longer healthy lives, to meet our statutory duties via a strength-based approach, which supports residents with social care needs to be as independent as possible for as long as possible, and which needs to, seeks to prevent delay and reduce the need for long-term care services. By our transforming social care program, we are implementing a range of initiatives to help manage future demand for services and to improve efficiency. Um, some examples are identifying opportunities for using technology to work smarter and deliver better outcomes for residents, including the use of digital care technology. Um, driving service integration, focusing on improved reablement, some of the things that Lynn's been talking about earlier, anticipatory care, and a more strategic approach to mental health commissioning. Um, embedding intelligent commissioning to support local care markets to become more sustainable, meet increasing a more complex demand and address workforce challenges. But, there are, um, as set out in paragraph 16 to 21, key financial risks and challenges remain for the social care sector, not just for Wandsworth, but nationally, as evidence in the recent ADAS survey, which arise from a combination of increased costs due to increased complexity of needs, financial pressures faced by the NHS, increased costs due to inflationary pressures, increased costs due to market pressures, and demographic pressures. Um, um, myself and colleagues in the room are here to answer any questions. I've got three questions. Um, the first one is relating to paragraph 18. And, obviously, reading this report, it's clear, and all the other reports, it's clear that we've got an issue of driving our costs up, where we're saving costs for the healthcare services, which is an entirely rational thing to do for the, for the system as a whole. Um, but, obviously, it's causing us a problem. And, I wondered whether we were able to, um, quantify that at all, and be able to sort of say, well, look, you know, our policies are getting people discharged from hospital much more quickly. We're looking at, looking after people in their homes, um, much more often and for much longer, which means it's adding an additional cost of, you know, pounds for us, and saving that costs, um, for the healthcare system. And I appreciate, you know, it's a, it's a different budget, but it would be good to at least be aware of that. Um, the second question is, I wondered if the costs or the, the, the predicted, the predicted budget overspend included the effect of the recent budget measures, um, and if not, how much that would add. And then, also, the mitigations, I wondered whether there were any numbers on that, and how much we, um, might close the gap by with those mitigations. Do you like to come back, Anna? Okay. So, so I think on the first one about the, so we are obviously in constant conversations with our NHS partners. And, you know, we recognize their challenges and they recognize ours. We've, we've both got challenges. And what we want to make sure is we don't forget the people in the middle and make sure that they get the right things. Um, so, and, you know, we do, there is support there where it works. I mean, Lynn's can talk about some of the things that we're doing together to address some of the challenges, especially, for instance, a good example of that would be the mental health reablement service, which we're working on together to try and address some of the, uh, demand upstream and to, to, you know, because I think obviously we're looking for things that are going to reduce the number that, you know, the, the needs coming towards us. And then also we've got the things in the market, which we're working some, we obviously do looking at our commissioning strategies together with the NHS to, again, think about how we can manage the costs as well. Um, I mean, there's a lot of things going on this guy from got specific details here, but that's kind of the sorts of things. Did you, did you want to briefly touch on the national insurance? I think Rachel's going to just. Should we just take and then we can come to Lynn after? Uh, yes. Um, obviously for next year and the announcements around national, uh, the employers and national insurance, um, and increases to the workforce, London living wage, et cetera, that will impact again next year. Um, we have just had a round of inflation uplifts with our providers. Um, and we are currently, uh, working on the analysis of what that looks like. We've, we know that the analysis from, um, the LGA and ADAS, the association of directors of adult social services, um, have started producing analysis and we've collectively doing that as well as working with Southwest London, um, across the boroughs, um, so that we've got a collaborative approach of how we address and support the market. Um, but there is going to be an impact, um, in terms of driving costs in our provider sector, uh, for next year. Thanks. And Lynn, did you briefly want to touch on that integration point? I did just briefly want to mention in terms of quantifying that, that sort of, is there cost shifting between health and social care? We have a piece of work which, um, um, the directors of adult social care across Southwest London have commissioned, led by, uh, coordinated through, um, South London partnership, which is to identify that. And that's joint piece of work with NHS colleagues to, to identify where we each think the other ones, uh, cost pressuring, and then to start to understand that and to agree the action. So, although we don't have the answer just yet, we will in a few months down. Thank you. Um, should I just briefly come to, or do you want a quick follow-up? It was just that last thing was about the value of the mitigation. Um, so on that point, we are seeking at the moment to put figures against the different measures about what we think we can achieve in terms of, um, helping us to get back on budget. And then, again, we're currently looking at the position in 24-25 as part of the budget review to assess the full-year impact of the growth in service user numbers, the higher than average cost of care packages, and all those other costs so that we can try and start moving forward with, um, you know, you know, I mean, the, the problem that we have is that, that, you know, the report sets out, obviously, activity patterns remain uncertain, and there is demographic growth. It's difficult to predict, but we will bring more information back to this committee again in, in September. Yeah. Thank you. And Councillor Crilly. I think you've, you've, you've mainly covered the point about the, the mitigation, which I, I, I, I was going to ask. But I mean, the, the, the, the chart on, uh, page 211, uh, the, the biggest problem that you have is the continued increase in demand, and any increases that you have in funding or anything appear to be automatically wiped out by increase in, uh, uh, service user, uh, demand. Do, do you think that these mitigating actions can actually address long-term the fact seems to be an inexorable rise in the total number of service users? Oops, come back in. So I think that's a difficult one to answer, but I think that, um, some of these measures longer-term will have a significant impact in, I think, in, some of them are quite sort of, quite innovative and quite groundbreaking, but of course, it's very difficult because, you know, the demand is going up, going up, and it's hard to know when it will stop, I suppose, in some areas. Some of the demographics we can understand, but there are other things that are happening as well that sort of, you can't, that can't necessarily be predicted in the way that we, you know, that we can be sure of. So we're doing the best that we can in that respect. And I think, as Lynn referenced earlier, the three shifts, you know, around hospitals, community, analogs, dialogue, like, over time, if we work in this more proactive and preventative way, should provide the money upstream that should prevent some of this spending. Well, obviously, it does take time. So thank you for outlining that. Did I have another question? Yeah, go for it. Thank you very much, Chair. Um, just coming back to, um, paragraph 14 again. I just wonder if you could give me some examples of care technology. Sorry, I will follow up after that. So there's a, there's a huge range of care technology out there from specific things for care, like wearable devices, but also just things that you can buy anyway, like an Alexa can be a really, really, you know, impactful device to have in the house for a person with a disability. So we're using the technology that's available there for everybody, but also specific care technology that can just monitor what people are doing. It can monitor, it can talk to people and remind them to do things. There's so many different things that can happen. And also the other thing that you can do is say, if you're not sure what's happening for somebody at night, then there are also things you can use to monitor the situation at night to see whether someone is having disrupted sleep or needing more support. So it's a huge range. It's really, and there's more new things happening every day. Um, thank you. Um, I guess my sort of slight concern that I just like to probe here. I mean, if I look at the language in your third bullet point, it's estimated that care and support needs have been avoided for 59 cases this year. I mean, the care and support needs are going to be what they are. Um, it's how they're met. I guess that perhaps that would have been better worded as, but I just wonder whether this is slightly indicative of the fact that, you know, some of these care technologies are coming obviously at lower cost, but what's the depersonalization of the service that's implied here? And how are you watching out for that and taking it into account? Thank you. So you're quite right. I mean, what we were in the business here of meeting eligible social care needs and how we meet them depends on what the person's outcomes might be. And it's really important to us that the care technology is there. Sometimes it might reduce the need for other care and support. Sometimes it might promote someone's independence. Some people would prefer to have less people coming into their homes, but it would never replace, you know, a person coming in if that's what someone actually needs. So, you know, we're very careful to make sure that this is augmenting the care and, you know, helping to promote independence, but it's not a replacing. That's really reassuring. Thank you. Thank you. Yeah. Go for it. Apologies. I did have one very specific question. It's page 218. Um, one of the biggest core, in fact, page 216 is probably the best place to start. Um, services for adults with learning disabilities has one of the biggest variances. Um, but the number of learning disability service users hasn't really gone up. Um, so I wondered whether there was something specific that happened to the costs. Um, all of the other sort of items seem fairly consistent. So the numbers are increasing and the costs are increasing, but this one just looked odd because the numbers weren't increasing. So, so for, um, the variant, the main drivers for the change in the forecast between Q1 and Q2, you're right, they, they were in learning disability. And actually in this case, it was a substantial sum because of a number, a small number of residents with learning disability being reassessed as no longer eligible for fully funded NHS continuing healthcare. Um, this means that the council becomes responsible for, um, meeting their social care needs and for funding their services. Okay. So is this report noted? We don't have a decision required by the committee. Yeah. Noted. Great. Thanks for a really great discussion on that one. So coming to our final report, we've done well for time. Um, so we're on Wandsworth corporate plan actions and key performance indicators paper 24 dash 371. And we've got BB who is going to introduce this report. And then we've got Kieran that's also going to come on briefly on some of the new KPI. So BB, would you like to go first online? Okay. Uh, so, uh, so I'm BB Jean Glescar. Uh, I work in the corporate performance team. Uh, this is a standard report that the overview and scrutiny committee receives roughly every six months. And this particular mid year report provides progress updates on the corporate plan actions and sets out the key performance indicator results that are related to this committee's remit. Uh, the corporate plan actions and KPIs are refreshed each year to ensure that they remain fit for purpose and reflect the council's priorities. And the current sets were agreed in the June cycle. And so that's just a brief instruction. And obviously if there's any queries, um, myself and colleagues will hopefully answer them. And Kieran, can you talk to us about some of the new community safety KPIs that we've introduced? Yeah, sure. Um, so, I mean, colleagues, uh, sorry, Kieran Vagawa assistant director for stronger and safer communities. Um, so members will see that we've provided quite a detailed update on some of the new refreshed, um, KPIs that we've got. Um, so we've covered off, for example, um, the Casey report, um, that the Met police have got. So we've aligned some of our KPIs with that, um, and some of the outcomes that we've provided as well. Um, there's a clear focus around neighborhood policing. Uh, for example, we've shown some examples of work that we've done in Tooting, Broadway, and Clapham Junction, but also to say that there's been other targeted areas as well by both the police and community safety. Um, for example, St. Mary's Ward, Shaftesbury, Queenstown, Ballum. We've come to the committee before to sort of let, you know, to share some of the work that we've done in Ballum, et cetera. So there are other areas that we've covered, um, as well. Um, I thought I'd also, um, share with the committee that the police, um, in, um, September, they thanked the partnership and the council because they've had consistent increases in confidence in policing in Wandsworth. Um, it's the only borough in the Southwest VCU that have seen these increases and the increases have been around about 10% of our local community agreeing that the police can be relied on when they're needed, but they do listen to concerns, um, uh, that our local residents have. They've also seen an 18% increase in confidence that they're tackling ASB and a 13% increase that they're tackling knife crime. Although those things aren't on the KPIs, they're an outcome of some of the intense work that we've done in some of those, um, targeted areas as well. Um, also just to highlight, we refresh all the, uh, VORG indicators as well. So if we separated out, um, the positive outcomes for domestic abuse and we've separated out, uh, sexual violence offenses as well, um, just to sort of represent the priority that we're giving, um, around VORG. And I think the final thing really to note is that in terms of our IDVA referrals, there's been a lot of work that's gone on, um, across the partnership to raise awareness. And you can see that we're above target for some of our, um, IDVA referrals as well. Thank you so much, Kieran. I think I've got a question from, um, similar. Uh, thank you. Um, I just want to say that first of all, it's fantastic that we are, um, on target for all of our KPIs, obviously, except for the one on occupational therapy. But, um, as Kieran said, I just want to highlight that, um, it's great to see that we are, um, above target for our referrals into the independent domestic, um, violence advisers. Um, obviously the council launched its, um, VORG strategy in August this year and it has been a priority. So it's kind of great to see that, um, translate into, um, the results here. So I just wanted to highlight and welcome that. Thank you. And thanks to the work of your team, Kieran, for all of your work on that. Do I have other questions? Yeah. Councillor Caddy and then Councillor Worrell. Thank you very much, Chair. Um, the first question was on the percentage of eligible people who have received an NHS health check. And it was really just that it's incredibly low. And I know the target is low, so we're, we're beating the target. But it just, it just seems like a really low number if that's something that, you know, people could be doing and, and given that prevention is a focus, I would, I wondered whether there was anything we could do to try and bump that up. And then the second one, and this might just be because I'm relatively new to the committee. Um, the number of physically active adults supported by a council funded project. I wasn't sure what that meant or why it would necessarily be a good thing. Cause it doesn't even, it sort of doesn't speak to any benefit or outcome. Um, they may have taken part, but it doesn't sort of say why that's good or, or whether it worked. Um, Shannon, would, would that be you to kind of come back on those KPIs or is it other colleagues? I can cover the one on NHS health checks. Okay. Um, so the NHS health checks indicator is actually, um, although it appears low is a positive story. I don't know where the committee remembers that we've had at least a couple of years where that indicator has appeared as red. Uh, and a lot of effort was, uh, was going on behind the scenes to try and recover it primarily, uh, from the impacts of the COVID pandemic. Uh, obviously this is the service which is primarily delivered through, uh, GP practices. Um, and, and that was impacted and we recovered that. But also subsequent to that, we've expanded the delivery model and actually commissioned some of our local, uh, pharmacies as well. Six local pharmacies to additionally deliver the NHS health checks. So, um, it, it is actually an improving, uh, picture and, and, and one that we're proud to kind of see the turn around, uh, compared to the last two years. Thank you. Sorry. I obviously wasn't aware of the history, but, um, yeah, that's great. Thank you. And who will cover the one on physically active adults? Give it a bit more context. Sorry. Councilor, could you just remind me of the question? So from looking at the numbers, it looks like we have had 849 physically added active adults supported by a council funded project versus a target of 750. But it doesn't sort of speak to why that's good or what, you know, have they said that that's helped them? It just sort of taking part in something doesn't necessarily mean it's helping. And it might just be that I, there's another part of it that I, I'm not aware of, but, you know, how, how is that sort of helping support health needs in, in the borough, I guess? Thank you. Uh, that is a really good question. And, and I recognize the fact that the indicator doesn't come with the explanatory, uh, context. Um, so this is a new indicator, uh, which was introduced this year. And it was based on the fact that, uh, particularly again, during the COVID years, we saw the impact of that, um, on the number of people who had become physically inactive. And actually Wandsworth is one of the boroughs with the highest rates of physically is the borough with the highest rates of physical activity across London. And we sought to address that through introducing some additional schemes that would support residents. So because this is the first time that we're looking at the indicator, that's why it's probably high level. And I think the next question that, that you are addressing, uh, that you're asking is the right one in terms of maybe starting to look at what impact that is having, uh, at an individual level. And some of the sort of clinical, uh, benefits that we know people being, uh, physically active will help them with. Should it say physically inactive adults in the, in the description? Cause I, I was perplexed as to, cause if it's physically inactive adults being encouraged to get active, that makes more sense. Uh, no, there isn't a typo because the number of, uh, people who are physically inactive in the borough is a national measure, uh, that is conducted by a survey. What we can more accurately measure at a borough level is the number of people that we are supporting to become physically active through council funded activities. So it is correct, but maybe we need to do some thinking. I think it would be great. Maybe next time to, yeah, come back with a little bit of detail around some of some examples, uh, of what that meant. Thank you for raising that. Councillor Caddy. And yeah, Councillor Rigby. Yeah. Yeah. Is it the, the number of adults supported to become physically active? Is that what it means? Yes, absolutely. So these are people who might not have otherwise been physically active if the council hadn't introduced them to, to the offer. So any other questions on our last paper? Yeah. Can I just ask it's about the point about the NHS check? And we've got the one that says percentage of NHS checks to identify people at high risk of, of developing type two diabetes. Is that a separate check from the one that we see at, uh, where we've got the first percentage of eligible, eligible people who have received? Or is that, is that 6.9% of 3.2%? Yeah. Thank you. Thank you. Uh, so the latter explanation is correct. They are related. The NHS health check is an initial gateway to support people with several issues, including cost cardiovascular disease, or people who might be overweight or be at increased risk of conditions such as dementia. So we've particularly decided to highlight, um, how the NHS health check is contributing to tackling diabetes because we know that this is a significant issue for our residents and, uh, it's a health inequalities issue as well because of the disproportionate impact on some groups. So it is, uh, 6.9% off the people who received the health check. Thank you. And Councillor Orell. Yes. I'd just like to pick up the point that Karen made about, um, confidence in the police and police activity and social behavior and just, um, compliment her and a team and the police in terms of work done in Shaftesbury and Queensland, for example. Some of you may know we've, in the last year we've had one person killed. We've had several people killed on our borders of, of, of the, of the ward. Um, and it has effected public confidence and it has effected the way the public feels about his social behavior. And we've seen a lot of activity from the safer neighborhood teams and from Karen herself and from other officers coming in, meeting the public, responding to their needs, setting up a bereavement, um, service, um, actively engaging with the residents associations. And I think this is a prime example and a good, and good news to show how effective those interactions can be working at the, at the grassroots level. And just, as I say, to commend her and the team in relation to the work that's been done. Thank you, Karen. Lots of praise for your team tonight. So please do take that away. Thank you. Thank you. Great. Any other questions before we close? Okay. Okay. So is the report noted, no decisions required on that. Okay. That now concludes the meeting. Thank you, everyone. That was really rich discussion. Thank you. Thank you. Thank you. Thank you. Thanks for coming. Thank you. That was very much. Great. What?