Transcript

Good evening. I am Councillor Jilani Choudhury and I am chairing tonight's meeting. Please note that we are not expecting a fire alarm test this evening, so if the alarm is sounded, please follow my instructions and evacuate the building. This meeting is being webcast to allow those who cannot attend in person to follow the proceedings. Please could I ask you to turn on your microphone when invited to speak and to remember to turn off your microphone when you have finished speaking. Please could committee members and officers introduce themselves, starting on my right, Councillor Croft. Councillor Croft, St Mary's Ward and Vice Chair of this committee. Councillor McGill Gunn, Solomon Ward. Councillor Tricia Clark, Tufnel Park Ward. Councillor Janet Burgess, Junction Ward. Councillor Praful Nargan, Barnsbury Ward. Thank you, I think officer will introduce when they do the presentation themselves. Thank you. Apology for absence. Councillor Gilligan was recently appointed as the new member of this committee. Unfortunately, he had to send his apology to tonight's meeting. And also... And also, just now I have received an apology from Councillor Ben Ali Hama-Tuz. Thank you. Any more apology? There is no substitute member for this meeting. Declaration of interest. Are there any declaration of interest? Minutes of the previous meeting. Can we all agree the minutes of the previous meeting of the Health, Wellbeing and Adult Social Care Scrutonical Committee held on 11th November 2004 is true record? Thank you. Chair report. We have managed to arrange a visit to Malmes Extra Care on 7th of January 2025 and visit will be taking place between 4.30 to 5.30 p.m. We have decided to carry out the focus group meeting during our visit on the day. Thank you to all the councillors who are coming along. If any other members are able to attend, please let Vivian know and she will send you the invite. We will also be arranging another visit and focus group meeting at Centre 404. I will let you know when date and time has been fixed. Also, we can also arrange another focus group meeting with the stakeholders, members and carers and time will be notified when it will take place. As today's agenda is tightly packed, please can you keep your presentation to a minimum and presenting only key points. And also I would like to say thank you to John and the team for doing a very hard job to award our funding, our spending. Public question. We will consider any questions from the public after each agenda item. We will consider any questions from the public after each agenda item. Item B. B. B. Scrutini Review Adult Social Care Act. We will consider any questions from the public after each agenda item. Item B. B. Scrutini Review Adult Social Care Act. We will consider any questions from the public after each agenda item. Item B. B. Scrutini Review Adult Social Care Accommodation Witness Evidence 1. Scela Magula to present key presentation to a minimum and present key points only. You have five minutes. Please come here. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Good evening, everyone. My name is Shela Magula. I'm going to present key presentation to a minimum and present key points only. You have five minutes. Please come here. Thank you. Thank you. Thank you. Thank you. Good evening, everyone. My name is Shela Mwange and I'm from Centre 404. Do we have the slides? Yes. I am from Centre 404. Centre 404 is a charity that supports people with learning disability and is based in Islington. Can I also add that, unfortunately, Sarah, who is the Head of Independent Living and Supported Services, Specialist Services at Centre 404 was supposed to present, but she's on sick leave so I'm stepping in for Sarah this evening. Yeah. So at Centre 404, one of the key, just a little bit of background, we do support people with learning disabilities. We currently have eight supported living accommodation services and across these services we support a total of 62 service users with learning disability. Can you go back a little bit on the slide before? Sorry. Thank you. So, yeah. One of the key elements of the support that we provide, we encourage people to take risk, what we call positive risk taking approach. We also use active support, where we encourage people to be involved in the support that they receive on a daily basis. We do collaborate with various local organisations, for example, Elfrida, Mencap. We also work closely with commissioning through the Partnership Board. We work very well with MECDEV Yoga Centre and as well as other community, local music, community music groups. So just to mention a few of the organisations that we work with, we offer flexible services, which involves as well choice and control of the support that people receive. And as the world is revolving now around technology, we are implementing a lot of technology as well in everyday support that we provide to our service users. We are carrying out research around AI and VR. Currently there are ongoing projects around this to, again, incorporate it within everyday support that we provide. Safeguiding as well is a key element at the bottom of our support to ensure that people are safe both at home as well as in the community. Next slide please. Again, to tie in with what I was talking about earlier around person-centered support, making sure that people are involved in everyday support that they receive. We do work closely with families as, you know, as equal partners to ensure that, again, that continuity around personalised support. So when we're doing assessments and planning, we do work closely with families and as well very close circle of support of the people that we do support. And lastly, like positive behaviour support as well, especially with people who have behaviours of concern. We use that a lot to use various strategies to ensure that, you know, people's behaviour is not just a behaviour, but it's about learning why certain individuals exhibit certain behaviours and working closely with them to improve those kind of behaviours. Yeah. So co-production, again, I mean, we work with, like I said, personalisation, personalised support is key element of our service and support. So co-production is another element where service users are involved in everyday things, everyday support, like in recruitment, where we have service users, for example, on the interview panels, being involved in kind of support workers as well as managers, different levels of managers, different levels of people who are going to be involved in their everyday support. We do have your SAIR group, which is a group only for service users. Again, in this group they meet monthly to talk about different elements of different issues going on and then through that group then feeds back into the wider organisation. We have the Learn With Us. Learn With Us is a training that was developed closely between Centre 404 and family carers. So this training we do offer this training to all our staff members. Again, to be able to work closely with families and get to understand the family's perspective and understand the history of the person rather than, you know, so for example we cannot work in isolation. So it's good to involve families. So that is another key element of the support that we provide. Annual survey is a kind of survey that we do set out annually to service users where they provide feedback about their support, care and support that they receive. And then through this feedback then we try and change things around accordingly. Yeah, again that is in line with kind of have your say and the survey where we listen to people, so they said we do, so we listen to them and then we go back, reflect on the feedback we go and then we try and act upon that feedback. And then lastly is to talk more about the accommodation that people in Eastlington that we really kind of champion our service users to have is that someone coming into an accommodation is always very good to have a home for life because the people, vulnerable people, it's not very good for them to keep moving from our accommodation to another because most of the people might have various conditions. Some of them are really vulnerable so they might have degenerative conditions. So they move in today in an accommodation but then a few years down the line they deteriorate really quickly and we kind of champion for them so that they are able to stay within their current accommodation and instead we do try and change things within wherever, where they are rather than moving them about and making sure that it's kind of fit for them. For example, if I look at the first lady there called Debbie, Debbie has a condition and she is slowly deteriorating but she is happy and comfortable where she is living so we can already make adjustments within her current accommodation. And the other gentleman called Peter, he is now 80 years old, he is really getting old. So as he gets older, you know, things are going to change for him and it's important that, you know, we can be able to adjust things for him within his current accommodation rather than thinking about moving people about. And then Jolin is a very independent young lady. She is looking to get a job as a receptionist, so recently we supported her to get in touch with SmartWorks and they have been coaching her around interviews and how to get, you know, get dressed and how to, you know, to present herself, you know, as a receptionist and also how to connect herself in the interview. So, yeah, so basically that's kind of what we do at Centre 404. Thank you. Thank you very much. Thank you. I think our member has a question, they will ask a question. And this is, how many units do you have, the accommodation unit in Centre 404? We currently have eight supported living accommodation services within Eastlington. Yeah. And, is it 24 hours? Yes, yeah, they are all 24 hours support. Thank you. Yeah. Councillor Clark. Oh yeah, thank you very much for your presentation and hearing the good work that you're doing. I'm just interested about how, so do you, the people that you're working with, how do you get in touch with them? And, so are they all in, in support accommodation in various parts of Islington or are they in one place? And if, yeah, what I'm interested in is, do you ever go to visit people and you do that? Okay. Thank you for your question. So the people that we support, we'll go through a process of call, referral process. So if we have a void, for example, we would let brokerage know that there is a void that's come up and then they will, we will tell them the kind of accommodation that it is and then they will send any suitable service users, for example. And once they do send us those service users, that will answer my second, your, I think, third question, then we will go out in the community where they live to assess them and carry out a needs assessment. And through that needs assessment, you know, it's a thorough process where we'll try and match them to the accommodation and see if they are suitable for that accommodation. But actually, before we do that, we might invite them over to have a look at the accommodation and equally, they gauge whether it's what they are looking for. Because sometimes when people come, they're like, no, no, no, it's not for me. Or they come and like it and then we go to the next step of the needs assessment. And once that is, you know, successful and feel like, okay, this person will be compatible, suitable for this accommodation and compatible with other service users living within that accommodation. And then we will go ahead with the next step, which would be like, talking about costings and how much it would cost and then we'll go back to brokerage. So it will be liaison between us, brokerage and families through the process. I don't know if I've asked all your questions. So I'm thinking about the several places in Islington that we used to call sheltered accommodation. We don't know, but there's people with various needs in those places. Do you ever work with those people in those sort of residential accommodation places? Oh, like where we would go there and provide support within those. We have provided support, what we call our outreach, Islington outreach. We have provided support in various other accommodation, even in care, people who live in care homes, for example. Yeah, if we were contacted, we will again go through the referral process and see if we would be able to provide that kind of support to those individuals. And yes, yeah, it's something that we could, of course, assess and see if it's doable for us. Thank you. Just to clarify Councillor Kirk's point. You know that you said you assess, yeah? Your nomination right, is Islington Council nomination right or you have a right? Because some housing association has a 100% nomination right. And your one, you choose the people or Islington Council, how do you choose the facility? So, I would say the commissioning, which is the brokerage, as we call it, they will send us the people who they feel need accommodation, need the service. And then through that referral process, then we will assess them and see if they are fit for that particular accommodation. For example, we do have accommodation which are very high needs, then we have one that is a mixture, then we have one that is, so we will assess people according to that. And then we have one where is really high, very high needs, where if you brought in someone who has mild learning disability, they might not necessarily fit in. So, based on the referrals we get, then we will do assessments and see if people are actually suitable for that particular. Thank you. Thank you. Thank you. You can come here. Yeah. Okay, that's it. Sorry. Other questions? Yeah. Can you identify? Hello, I'm Jodie Penning and I'm the Director of Strategic Commissioning Investment for Adult Social Care. I just wanted to add to that answer that we commission the Centre 404 services, so the nomination rights are entirely adult social cares. But, as my colleagues described, Centre 404 will agree with brokerage and social workers' suitability, but the accommodation is what we commission for. Thank you. Councillor Ngunning. Thank you very much for the presentation and talking to us about the important work that you do. Thank you. You mentioned that you have a couple, you have some projects on AI and virtual reality ongoing. I'd be really interested to hear a bit more about those projects and what you're hoping to achieve with them. Thank you. Actually, we do not have that in place yet. It's a research, ongoing research with, we are working closely with like students from UCLA, UCL and London Metropolitan. So, we are trying to develop that for our service users. So, what we're trying to achieve to try and incorporate that in their everyday support. For example, if we talk about VR and for someone who is scared of hospitals. So, kind of desensitise them with hospital and bringing that life to their, you know, their own home, their own space before actually going into hospital, I would say. And different other things around, for example, sensory rooms and, yeah, those are the two examples that I can think about now. But, yeah, it's a work in progress with one of our projects trying to work things out with that. And it's on our plan to, you know, bring that live. If I just ask a very quick follow-up, have you road tested any of it with service users? Have you had any positive? Or is it still at the research phase? You're still developing it? As I speak, it's still at the research phase. But we do have other kind of technology in place like, things like, it's gone out of my head now. It's gone out of my head. But we do have different service users who have been, who have developed different sensory systems that they are working with at their homes. But this has been in collaboration with speech and language therapies. But the name of the system has gone out of my head. But, like, that's part of their technology. But VR is something that we're very keen about. It's a shame my manager is not here because she's very, very, very enthusiastic about VR and AI. Yeah. Yeah. Councillor Coft. Thank you. I'm really interested in people participation and service user involvement and co-production and things like that. So I'm quite interested in what you were saying about the Have Your Say group. So if I was to ask anybody attending that about the service they receive and asked an open-ended question about, you know, if it was you, what could be better? Or I wish this was better. Or I wish things would be like this. What sorts of things come out of that? Off the top of your head, I'm aware you're on the spot now. But in terms of people's care they're receiving or the journey that they've gotten there or their day-to-day sort of needs or things. Is there anything specific that comes out there in terms of themes? The things that have come up for people would be around benefits system and because a lot of people who have mild learning disabilities are a little bit more independent and unfortunately they have less hours of support I would say. And they would, you know, like to have a little bit more hours to be able to do more with support, go out and do things. So some of the things that, you know, do come up around that and then employment as well, sometimes accessibility, that as well has come up in their conversations. But yeah, I think the top one would be like benefits and employment. Because that, like Jolene, at the end of the slide, she's kind of looking for employment as well, but it's not very kind of straightforward. Yeah, I was pleased to say that you mentioned about someone got a workplace in, in, in, as receptionist. I just wondered, do you, do you, do you, do you have much, um, many, uh, businesses, how do they, how do they, how do you approach, um, work placements, trying to get a work situation? You mean like, you mean like, you know, try to get people into work? Um, we do support by looking at, you know, local newspapers and approaching different, uh, for example, shops. Charities have been very, um, very good in that sense of trying to, of taking on people, uh, who are interested in, you know, volunteering even. Uh, so yeah, we do look at different, uh, perspectives on different kind of areas. Uh, I know there are a few people who have, uh, secured work in food banks. Uh, there's one person who started as a volunteer there and then eventually, uh, got, uh, hired, uh, and it's now on paid employment. Um, and a few other people, uh, another person who is working in a school as well, um, started through an agency. It's an agency and now, you know, slowly and slowly increasing hours of employment. I don't know if I answered your question. Thank you. Question. Um, one of the interesting, um, uh, in another committee, um, um, Homes and Communities Committee, um, we had, uh, community centers was, was raised. And one community center, um, one of the speakers was very interested in, um, particularly people with dementia coming forward. I just wonder, do you, like, um, Center 404, do you reach out to, like, um, or do you get a good response from community centers, say? Or, uh, does, uh, does the community, do the residents get involved in, in community centers? Because I think these are things, these are important things to link up, I think, not to work in, in isolation. Sorry. Yeah, we do reach out to community centers and we do, you know, work closely with, uh, community centers as well. Yeah. Yeah. Like, around King's Cross, there, there's one where, uh, one of our service uses, um, um, it's called a, a soup kitchen. In, you know, it's in, um, within the residence, uh, there and, you know, they do have weekly, um, market days, for example, and then staff will support them there, um, to be involved. And one, one of them is the, the, the, one of the, the support to living accommodation in, uh, King's Cross, which is called Kendall House. Uh, so one of us, one of the services is there now, does go attend that soup kitchen, uh, on a weekly basis, um, gets involved, supporting them around, um, maybe cleaning the kitchen. So, yeah, we do work closely with community centers as well. Thank you, uh, just, anyone else have any questions? Okay. Just, like, on the one thing, you know, that you go just, eight units, your, when the void come, how long does it take the void to be filled? Um, that is, that is a really, uh, good question. Um, it depends. Uh, we've filled the void before in, like, three months, four months. But, it depends on the process and the person who, or the people who is going to fill that void. Like I said, we go through a referral process to make sure that the person is suitable for that accommodation. And if they're not suitable, then we will go back and say, you know, maybe this person didn't like the accommodation. Maybe it's, you know, for higher needs and that. But, on a whole, it takes between six months to eight months, around that. But, it's something like, sometimes it's not like within our control because it could be like there has to be adjustments to accommodation. They need to, um, change different things within that setting. Maybe the person needs, I'm just giving an example. There's been in the past where someone maybe needs a ceiling hoist and has to be installed. So, different kind of, um, factors. Thank you. Okay. It is, depending on the assessment of the person's needs, you're going to fit this accommodation for. Yeah, exactly, yeah. Yeah, thank you. Yes, please. Yeah. Okay. Ah, okay. Ah, thank you. Uh, we can, if, uh, many thanks for coming here. Really good. Uh, thank you. Thank you. Thank you very much for having me. Uh, B2, uh, Jackie Miller, please come here. Uh, B2, uh, Jackie Miller, please come here. Hi, everyone. Um, I'm Jackie Miller. I'm the Extra Care Manager for Mild Mays Extra Care Is Linton. Um, and this is my acting head of care, Nikki, who's here with me tonight. Um, I'm not going to go through all my slides, because I believe you've all had a copy. So, I'm going to pick out some key things, and then, if that's okay with everyone, just use the rest of the conversation. So, I'm going to start with what matters to our residents. Um, it's quite simple. It's being seen, being heard, and being listened to. Um, and how we do that at Mild May is we have visible management who are around. Um, we are seen, and we see them, and we make sure that we interact with them, and we listen to them. Um, um, being heard, we have, uh, resident survey, which everybody has, I think, uh, quite norm, once a year, twice a year. Um, but outside of the, the resident survey, we have open door policy. We listen to our residents. They can drop in any time. They don't have to wait for a survey. That's why we like to be present and be seen, and we listen to them. And the reason they can see we listen to them is we act upon what they say, and we produce a newsletter every month. What they've told us, we will put in the newsletter, and we will put down how we've actioned that. Um, the, the other thing that's important is the, is how we promote their independence and wellbeing at Mild May. Um, we promote their independence through getting to know them, recognising if they are struggling, um, and also understanding what their aspirations are. We've got people at Mild May's who were, who, uh, were under social care. We have a chap who was under social care till the age of 50, which, which is fine. It was seen as what he required, but he made it known to us that he didn't want to have a social worker. He, he had a social worker for good reasons, but we actually worked with him over a five year period. And, um, um, at the age of 50, he was actually able to phone up ILDP and agree with them that he could now manage his own care, which was a phenomenal, um, achievement. And I hope when you visit Mild May, that you do meet that chap and he tells you his own journey because it was quite a difficult one. We had another lady from ILDP also just by chance, and she wanted to make a difference. She wanted to be seen, be heard and, and actually participate in society. So we worked with her and, um, during COVID she managed her doors. She stopped people coming in. She has speech impediment. So people, she was quite shy, didn't want to come forward, but we, we worked with her to, it's not your problem. It's our problem. You should be heard. And actually last year, she won an award for volunteer of the year in Islington. So that was phenomenal. Again, I hope you meet her when you come down. Um, how, how we try to deliver care and support that's personalised and culturally sensitive. Well, when people come to Mild May, we don't just look at the referral paper, paperwork. We actually holistically assess them. They come along. I will have read who they are and bits and pieces from, from the referral. But they will tell me who they are. And that's, and I will ask them the questions, sometimes hard questions. You know, I may have people who have attempted suicide. So I'll address that with them very, very kindly, obviously. Um, and look into the darker areas. The areas that maybe other people might skim across and just say, oh, that's, that's, that's a, that's a need or a condition. And see how we can really make a difference, see what, um, we can do to prevent these things happening. And then within Mild Mays, when you come down, those of you who don't know it, we have three buildings, two larger buildings and one small. And we will actually holistically look at that person and which building will best fit them, where they will get a network of support, where the staffing may be culturally, um, more suitable, or where the friendship groups, because there are some challenges at Mild May. We have some quite robust residents. And then we have a, a very gentle household where that may suit someone else. And we've just placed someone actually within, within that household who did have a very, um, tragic and challenging past. And we believe that's going to be a place where they can settle and they will find a home for life and friendship. Um, so yeah, that's really, really it. I think I'll just pass it to you. Thank you, thank you, thank you. You're welcome. Many thanks for your presentation. And now, members of the last organization. So I chair the Islington Partnership and the Dementia Friendly Islington. And we've had someone coming along from the Mild Mays. Hey. Yeah. And I'm really pleased that, that, um, that, that we have and that, um, we can, we can share with the Mild Mays what's happening across Islington. And it, it's a good, um, it's, it's a good forum where people talk about what they do in their organizations and help each other and say, oh yes, I can come along and do whatever. So, um, anyway, she spoke very highly of you. So, um, I'm looking forward to coming along and seeing a bit more of what you do. So, it's great. So, thank you. Thank you. Any question? Yeah. Councillor Clark. Yeah. Oh, thank you very much. So, you're, you're, like, a really, a care home, are you? Are you, and you commission, are you, you and other services commissioned by Islington? We are commissioned by Islington. We are not a care home. Right. That's really important to our residents. It's a residential place. We're not residential. Not residential. Our residents have their own tenancy within a building. So, it's like a, say, a block of flats. Yeah. Um, in that, they have their own front door. Yeah. And we respect that as their own front door. They hold their own tenancy. Uh, the difference is we have care people on site. Yeah. Who will do a domiciliary type care service. But outside of that, there will be additional hours where they can respond to falls. They can respond to emergencies. If someone's come home from hospital and needs a little bit extra care, we can usually adapt the care hours that we have to do that. So, it's, it's, it's a hybrid. It's not residential. It's definitely not a care home. And that's, that's, that's my residents talking to me. Um, but it is supported living within a community. Mm. Okay. Yeah. That's good. Oh, I left my mic on. Chair, can I just? Yeah. So, I, I'm just, again, as I've asked them to follow up, you know, how people get to know about you. How do they get referred? Because you talk about referrals. Well, who, how do people refer to you and who's referring them to you? Okay. So, um, I've worked in, in partnership with Islington Council, ILDP, um, mental health, all the heads of departments, and the commissioning team, commissioning officers, and we've put together a little road show, um, online. We haven't really gone out, and we have booked in dates and times, and we've promoted to service across other services. Um, lots of social workers call me up, but social workers are the main point of contact, of referring someone in via the brokerage team. But we, um, do go out and promote. Islington have sole, uh, referral rights to our, uh, service. But within that, there's lots of different branches, and we'd like to promote within those. Um, we are thinking of redoing another one later this year, just because we're going to have, um, I think it's 11 new commissioned, uh, extra care units within our existing buildings where we've had space that can be adapted into making new, more homes. So we want to be promoting that. Thank you very much for the presentation. Um, this is related to the question I actually asked, uh, to the previous speaker. Um, you're part of Housing 21, uh, just your guiding principles. The 21 seems to be quite exciting and futuristic and part of it. I was just wondering if you could explain how that's, you know, how does that actually apply in the real world to what's happening in the mild maze? How, uh, definitely. So how it's applying in the real world is Housing 21 took over mild maze. I think about 18 months ago from Notting Hill Genesis, who was predominantly a landlord with care. Whereas Housing 21 are a care provider and housing provider in equal parts. Um, what they've done is they've come into the mild maze, they've looked at the building, which is very, um, old. It required regeneration and they've put money in straight away to upgrade kitchens and bathrooms. They're looking fantastic. Our, our residents have actually been able to, uh, co-produce in this. They've chosen their own colors for the bathroom. They've chosen their own fitments. We haven't, it's not just a one size fits all. It isn't, um, institutionalized. It's very different. Um, in fact, one resident had a black floor and then realized afterwards that's a really bad mistake. Um, so they actually went in and they took it out because it did look dreadful. Um, but they have allowed residents to make unwise choices. Obviously we're not going to do that with everyone because it's going to cost a lot. So that's part of what, what the 21 building homes for the future is looking like. Um, we've also implemented an electronic system called Birdie, which monitors care calls, which allows us to effectively manage our care hours within a contract. And then, um, any additional hours that we have, we can then put those back in and try and block them up. So as we can, uh, put things on like additional activities. Um, where I spoke about people coming home from hospital rather than having a re-enablement service, which would cost additional cash. We can actually look at, can we do that by, uh, it's a little bit like Tetris, by jigging it around and making the blocks with spaces. Um, and that's really cost effective. Um, it's also worked really well in providing a reactive service. Uh, because re-enablement is fantastic, but it's always better that we do it where we can because we know these peoples. We know that, you know, if they don't want to have personal care, we've probably got a better chance of talking them around. We know what they like. And actually when you're coming home from hospital, there's nothing better than to come home to home and have the people that know you there. You're welcome. Thank you. Yes. If anyone is? I'm sorry. Some cushion here. How many units do you have? Um, at the moment it's 87. Um, I think it's nine, nine or 11 are under planning at the moment. Uh, we're waiting for planning to sign those offerors and we're hoping by April next year to be at, I think it's 100, 101. Um, once we get that, I'm sure we will get that. And in your accommodation, there are the 24-hour staff available? There is 24-hour staff available. We have a core care delivery within our contract and then outside of that overnight we have two staff in each unit and they will react to emergencies. There may be, again, people who come home from hospital who require, who would stay in hospital longer. But because we can maybe offer turning or we can offer, um, intermediate, uh, six-week, 12-week packages, which are quite small because we couldn't offer it for everyone. So it has to be done on a, a bespoke because we will get, with two staff, quite, condensed quite quickly. But we, we, we tend to be able to offer them an extended service so they come home. Thank you. Thank you. Just like on the, yeah, for some more questions. Yeah, uh, it's really good because you try to do the holistic service within the accommodation and also, like, uh, older people, everyone like to come to their own home, own flat. This is, yeah, this is a good thing, yeah. And, uh, I think we, uh, Edlington had before this kind of service. Just another thing, like on the, yeah, just on your report, uh, presentation, that you do provide personalized, culturally appropriate service, yeah. Um, how do you make sure that in your, uh, accommodation, uh, uh, especially, uh, culturally sensitive people, like, uh, people, Muslim people, yeah, they want, you know, Friday prayer, yeah? And do you have any facility in your place that, uh, the resident who are Muslim want to pray Friday prayer in there? Okay, because they have their own home. So we don't have a prayer room, but if our, if our staff needed a, a quiet space to pray during, uh, Friday prayer, then we would, we can provide that. During Ramadan, um, I'm aware of fasting. Um, I, I'm going to bring sort of staff and residents into that. I will support my, my staff by letting them know very sensitively that I'm aware. They really like the fact that I'm aware. Um, if they want to change their shifts, I'll change their shifts. Uh, you know, cause it can be quite tiring if you're not eating. With our residents, um, I will also, um, I, I had one chap who was mentally unwell. And there was concern being raised and safeguarding because he didn't want to take his medication. So he got together with the GP and his family and looked at everything. It was quite clear. Um, he, he, he, he said he didn't want to take it because he didn't want to take any, any food or any liquid during the, the, the hours of, um, fasting. Um, so we, we, we had the clinical professionals look at it and they decided he could change the medication during that time and take it at night. Um, also, um, also quite aware that we weren't able to go into his home with shoes. He was, he was happy with foot coverings and the same for contractors. Um, so yeah, it's just being aware and, and, and adapting to that because that actually really helped him mentally. And he really trusted me. He'd come to me with any, anything. I mean, I wanted him to go to everyone, but he made a beeline for me. And that was fine, um, because then I would pass that down. Um, and the recognition he got that, um, with me was, was, was really rewarding. And also for me, his mental health was stabilized because he didn't have these additional anxieties. Thank you. Just because, uh, when I used to work in the death center, I did explanation like, you know, and I visited, uh, Tower Hamlet to scheme. Uh, I know how, how important is the culturally appropriate service, yeah? One thing like, you know, when I used to do, did in a camp dance to work, I saw the Muslim, and especially South Asian people, when we give them play a game in bingo, they don't like it. When we introduce Ludu Karam, which is the Indian, yeah? They love it. They feel, because the older people, they want. And also, uh, I visited the Shunali garden, yeah? There is the, it's called culture, actually culturally appropriate, Kiarhum, where, uh, the older people have a facility, can do the Friday prayer, yeah? Because when people, especially, they're getting older and everything, they want to do five-time prayer, especially Friday prayer, behind the Imam and everything. And I know that, whatever you're doing is good, many thanks, thank you for that doing, but you haven't got enough space or enough residence there to do, follow up this one, yeah. But you're doing a fantastic job. May I also say that we, our residents of High Muslim do go to Finsbury Park Mosque, and if they need any assistance to get to the mosque, we will help them to get to the mosque. Um, they've got very good connection with the mosque. Thank you. Councillor Clark. Yeah, um, thanks Chair. I'd just like to ask John a question, John Everson. Um, because the, the, how widespread is extra help in our social, adult social care generally? You know, if, if other, um, residential places need extra care to go in or help, how do we work, or do we work with these organisations we just heard from, or how do we do that? Well, I'll ask Jodie to come in just to give a bit more detail about it, but obviously part of what our accommodation strategy is all about is thinking about the needs of our local populations. Mildmay is a really fantastic example of extra care housing that we've got in place, and as you've heard, we're expanding that offer, um, uh, in recognition that actually it's one of those ways that helps to maintain people's independence, uh, their lives in a, in a way that's as least restrictive as, you know, is suitable for, for that group of people. But Jodie, I don't know in terms of the sort of breadth of, of that above and beyond Mildmay, what that looks like. So Mildmay is at, is our extra care, um, provision at the moment, but we're excited to say that in, uh, Holloway, on Holloway, uh, prison site, we are developing, Peabody are developing a 60 unit, uh, extra care unit, which will open in 28. Um, so we're very keen to increase that provision because as you can hear, it's a really, really good model. Uh, of course we have all the challenges that we've talked about, uh, but we are also, uh, in constant conversation with colleagues across the council who are responsible for managing our estates and so on, so that whenever there is a conversation about future developments, uh, colleagues are very aware that extra care is something that we're very keen to develop. Um, and just to add, so Nikki Ralph, Assistant Director for Age Well Commissioning. Um, one of the things we're also exploring is, um, the model of extra care, because extra care traditionally is for over 55s. So with the new scheme, um, at Holloway, we're exploring with the market already, doing some early market engagement to look at whether or not there are benefits to intergenerational extra care housing. Um, because actually there are benefits to, um, older people's housing, but actually we hear from residents that there's something sort of less institutionalized and there's a lot more peer support and the opportunities to recognize different strengths in the community, um, in a supported living community by having an intergenerational scheme. So we can't guarantee that at the moment because that will depend on sort of our market engagement. Um, but early, early signs suggest that there are, it's a growing number of providers delivering, um, intergenerational sort of extra care schemes, supported living schemes. Thank you. Uh, I have a question with, uh, uh, that one because I knew, uh, maybe Janet can help in that time. Uh, there was a similar model extra care we used to provide in, uh, uh, Belmore and we close it, that one. Then we close all the shelter accommodation service and everything. This is a fantastic model what providing used to be, uh, a small scheme in Belmore had a, uh, uh, I don't know why, uh, because of the funding card and we close everything. Question is, as Nikki said, that we are looking to, as a providing, there is a, uh, lots of, there is, uh, I think about eight to ten accommodation available in Islington, yeah, which is, uh, housing accession, yeah. And we easily can, if we can talk to housing accession and, and make this kind of model of shelter accommodation, uh, extra care. Do you have any plan to this, uh, communicating with the ex, uh, shelter accommodation, uh, with, who is the landlord is now, uh, uh, housing association? Do you have any plan? So, currently, uh, we, we haven't approached any shelter accommodation, uh, providers. But I would say that the extra care model works on a large footprint. So, you, you're very unlikely, um, you're very unlikely to make it work financially and resource-wise. When, when, when we're talking about the Tetris model, you need quite a lot of people there to sort of bring in the hours. So, we would, 60 units is, it's probably about the smallest we go, I think. Well, maybe not. But, it's something, it's something, it, we certainly would, would not be looking at eight units for extra care, I don't think. I don't think it would be financially viable. The, uh, existing shelter accommodation, one is, uh, Councillor Clark's, uh, award is big one. Yeah, this is a very big one. And within that, uh, also, a learning disability unit exists within that, yeah. And if you think, if you want to talk to the, your partner or, uh, stakeholder, and easily everything is there. It's my understanding, because I've been to the, so many, uh, care homes and everything. And, uh, Councillor Clark visited so many times that, that place and other. We easily convert this one, like this model. Because we desperately need care homes now. Do you have any plan? I, I'm not sure how easy it would be. You've got people living there already for a start. So, I think it would be actually quite complex. Uh, we, and it's something we could explore. But I think it is complicated, particularly as people, presumably, have tenancies. So, uh, we're not going to be moving people on from, from their homes, uh, at any great pace. But it's certainly something we could explore. Um, but I just wouldn't want to underestimate how complicated it might be. Thank you. Just last question in your, uh, yeah. Uh, I, I asked before that one. You know that when you got a void in your flat, how long it takes to be void to be filled in your skin? Over the last, um, six months, we haven't had any voids. We've crossed the council, nothing in voids. Um, we aim, there is different, different levels at different times. Obviously, after the pandemic, there was a lot of crises in care and getting people back in. Prior to the pandemic, uh, we were actually looking at increasing our care hours. Um, we were hit by the pandemic, as everyone was. Um, in regards to the service, didn't get referrals in when, when we needed them because of various things. But, we aim to have, um, the void turned around within four weeks. And we have a waiting list for extra care at the moment. Um, we are hoping to get those people in. We've got some flats under redevelopment with a kitchen and bathroom. And we've got people signed up for those the minute they're ready. So, we're in a really healthy position. Thank you. Anyone has any question? Yes, Councillor? I'm, I'm just interested in, in the activities like you mentioned about the, um, self-end trips. You know, just to keep them stimulated, really. So, with, within, within a, we've got three units. They're very different. When you come down, if you, if you are one of the ones that people are coming. You will see, we've got a small house, which is very much like extended family. They, they, they just interact with each other. And, um, they, they, the staff there, in between care calls, they can also do additional things like baking, cooking, TV. And that's literally daily in that small unit. They have things happening because of the set up there. But that small unit can only exist, as, as Nikki said, because the two bigger units carry the staffing and carry the model. It, it would be very difficult to work that on its own. Within the other, the other units, we have one unit where there's a lot of people who are able-bodied and able to do things for themselves. And we have activities there. We have an activity program five days a week. And sometimes at the weekend, where we have additional hours within our block, because someone's maybe gone into hospital. Um, we will do additional activity with the care staff. In the other block, we have three rooms that during COVID we made into dining areas when you had the bubbles. And they, they continued after COVID because our residents said they really liked that. And what happens there is everybody can come out and have dinner together in, in groups of, I guess, five to 10 people on each floor. They can go to either floor or they can have it in their homes. So they have socializing there, but we also have activity there. We also have funding for activity. We get some from East Linton Council. We've had some from the house in 21. And we've put in for various other grants. We've had music. We've had poetry writing. I'm just going to promote the book my residents wrote. And I've brought one to leave with you. Um, just the one, but I want to leave that with you. You can fight over who has it. But it's absolutely fantastic. Um, so, and that came from a partnership with All Change. Um, please do try and have a read through that. Okay? Thank you. You're welcome. Many thanks. And you're doing fantastic job. And we're looking forward to see you on 7th of January. And to connect you. Many thanks for coming here. You're welcome. Thank you for having us. Bye-bye. B3 London ambulance service annual performance update. James Johnson, please come here. Good evening. Uh, the committee has had the opportunity to read through the report. Are there any update or any key point that you would like to highlight to the committee, please? Um, no, there's nothing, um, there's nothing in particular, uh, that's changed. I can go over a couple of the key points if that's helpful to start us off. Uh, so I'm James Johnson. I'm associate director of operations for London ambulance service. So the London ambulance service, um, I think people are quite familiar with lots of our work. Um, but the way we're actually the only, uh, pan London NHS trust. And so I'm responsible for the North central bits of it. So Barnet, Enfield, Haringey, uh, Camden, Islington. Um, so just a couple of highlights really from the report. So we do do, uh, quite a lot of work with, um, local partners with the aim being to use our position as a pan London organization to try and get the best we can. Uh, we are best placed really to provide, um, sort of cross organizational support. Uh, and that's whether it's between emergency departments and making sure that we can manage the demand that's coming through the, through the door, um, or to make sure that patients when they call, whether they call us or the one, one, one systems, we've got all five, uh, one, one contracts in London as well. So however they access our services that we can get them to the right place. Um, and some of that's outlined in the, um, in the slides there. Um, as a kind of headline figure, I guess, just to contextualize it, the London Ambulance Service, um, well, recently you may have seen our social media feed. We're busier than New Year at the moment, which is, um, we're under great amount of pressure. But for, um, only 50% of patients that ring 999, um, get, uh, an ambulance, uh, attend them. Uh, and of the 50% that get an ambulance, attend them, only 50% of those are conveyed onward to hospital. Um, and so actually it gives you an idea of the scale that our clinicians are out there, uh, trying to give the, uh, get the best, um, output for our patients. Because obviously a lot of services in the, um, in the wider area that they can access. And so in terms of other bits and pieces that we're doing, we've got, um, so our, um, contract is, is Pan London and we've, uh, we're delivering a reasonable level of response performance there. Like I say, we are under a great deal of pressure. Um, we are working to, uh, increase the availability of pathways such as the same-day emergency care systems that we've got in several hospitals. So we're looking at introducing the trusted assessor model. So for Northwest London, trusted assessors in everywhere, which means an, an ambulance paramedic can say this patient is suitable for not waiting in emergency department, but going to the, uh, to the SDEC. Um, and so we've got that in place at North Middlesex and we're working to improve that. Uh, in January, that'll be in place at the Whittington hospital, um, which obviously local hospitals are here. Um, and that's the product of the work of our, um, our local teams working with the three acute trusts that serve the Camden and Islington section. Um, in terms of other bits and pieces that we're, we're working on. So we've got the London lifesavers project, um, which we're working towards. I think many people will be familiar with the concept of the chain of survival. Um, so that's the early CPR, early defibrillation is what saves lives for the most acutely unwell people. Uh, so a piece of work was undertaken a little while ago, um, to identify what we call defib deserts, uh, which is areas of London where there's not ready access to, uh, to a community defibrillator. Um, so the London ambulance service has done some work to make sure that those are, are open and available. And we're currently working through training more members of the public for CFS. And defibrillation, uh, because that is what saves lives. And in areas where there's very high levels of cardiac arrest survival, it is as a direct result, um, usually of early, that chain of survival. So early CPR, early defib and so on. So there's information just as the kind of final bit really to highlight as information in the pack about how we can access that. And I would encourage anyone to do it. We're trying to get around to schools and workplaces to encourage people to, um, to do that. So, um, it's a bit of a whistle stop tour. I know that your agenda is a bit packed and there's a lot of information in the slides. I'm very happy to take any questions or any, anything, uh, you'd like to know more about. It's a big, um, big topic and a big organization, so. Thank you. Thank you. Councillor Clarke, please. Yeah. Thank you very much. So, um, you talk about you've got six mental health cars, um, tailored, tailored patient care for mental health patients and elderly and frail patients across London. I just want, I mean, six, is that across your north central London bit? You've got six cars. And just how do they, how do they work? You know, how do you, it's not that many, is it really? So, you know, do you have enough cars? So the mental health, um, joint response car is, it was a pioneering service. And so, um, just as a bit of background, really. So if, um, if an undifferentiated ambulance crew attends a patient, uh, who's in an acute mental health, uh, crisis or, or has an acute mental health condition, um, we struggle to access mental health services because actually quite often they've also got a physiological ailment. So that might mean that they, it could be as simple as being extremely drunk. Um, or they could have self harmed, um, or they could be under the influence of drugs or some combination of those things. It makes it very difficult for those people to access mental health services, which is the care they need. The actual problem, uh, is an acute mental health issue that there's just this other slight distracting thing. And so what the mental health cars do is they provide us with an opportunity to physiologically clear the person. Um, so you've got a paramedic there that is a kind of generalist, um, and they work together with a mental health practitioner to allow them to access the right level of care for their mental health condition. And so by providing the two things together, um, we can get the patient to the right place. Um, because often what we find is that we have to convey the patient to the emergency department because they're not safe to take to a mental health facility because mental health facility is not equipped to deal with their other needs. So, um, it's a pioneer service Pan-London because it is, um, it's different. And so what we're doing is we're still in the gathering information and intelligence stage of understanding whether it's a valuable service. At the moment, ambulance crews can refer into mental health pathways. And in a second, I'll talk about, uh, some of those things that we've got available there. Um, we also have mental health, um, ambulances now within the, that are being trialed at Islington. So it's one of the only sites in London or one of two sites where, uh, we're trialing these. And this is partly because mental health patients are patients first. And so they should be conveyed in an ambulance. Um, but what we're trying to do is empower, I guess, empower patient care. So they don't feel like a patient because if you're looking around in an ambulance, it can have an adverse effects on, on you. You feel like a patient or you might feel, well, this is, this is all for me. Well, actually I don't, I don't need this. I don't need this type of care. I need a different type of care. And so we've got a slightly softer approach with a, a kind of more passenger carrying vehicle. It's a veto van. Um, so a bit more like a taxi where we've got a paramedic and a technician looking after them still. So it's just a different environment. So with mental health services, actually, it's not really my party, but the, um, but at Highgate, there's a new mental health facility that's been, um, being produced, which is, uh, which fantastic. We went to visit it the other week to see how we can access that better. And that's the MHCAS, um, which I think everyone's been able to see. And if you haven't seen it, I strongly recommend it. Um, because that is exactly, um, the sort of principles I'm talking about, about putting people in an environment which is conducive to their care. They're able to take on referrals from patients that are a bit more borderline than we probably have had before in terms of physiological and, and, um, drugs and alcohol and that sort of thing. Um, so we now have, we do have access to it as a, as a route. Um, and some of the work that we're introducing around integrated care coordination will allow us to access that as well. So in direct answer to your, your original question, are they the only cars? Uh, they are the only cars. They're, they're relatively new concept, but there's an absolute wealth of work that we're, we're doing to try and improve mental health care, uh, in the pre-hospital environment in North central London. Oh, I left my microphone. So chair. Yeah. Um, so you also talk about frail, elderly, um, patients as well. So they, in the same group, how, how, you, that was a brilliant, you know, to really, it sounds like a really good idea and a really, a more softer approach and, you know, really good. Um, just wondered about this. I've got to read now. Um, yeah, elderly and frail patients. So they get, how would you, they get to use your cars, those six cars? So we've got a slightly different approach. So, so some of them will be tasked towards those types of patients because of things like dementia and, um, and other psychological, psychiatric type conditions. Um, we have some other, I think it might have been a miss, um, slight misrepresentation of that resource. So we've also got urgent crisis response cars, which are a bit different. And so that is a, a rapid response nurse and a paramedic in a similar principle, um, to be able to attend those patients. Um, and so that is a, again, a slightly different response working with our, um, our other community partners because crisis response does exist anyway. So what would normally happen is they would wait for an ambulance response. We would attend and then refer them in. Actually, we've got an opportunity to refer them first time. Um, and so there are slightly different resource and they are based at, there is a, a pile of those based at, um, um, free and Barnet, um, that work across the whole of the North Central because we try and pool our resource. Um, and we've got a number of resources that's targeted to that lower acuity of call, um, as well as such as urgent care, advanced paramedics and, and so on also in the sector. So the mental health resource typically tasks towards acute mental health, um, presentations, but there is a, there is a whole load of other, um, pioneering resources there for, for, um, other types of patient like the, um, like the elderly. Yeah. Uh, we'll ask a couple of questions. Um, the first one just in relation, because you're obviously a key interfacing provider with A&E, you know, I've heard anecdotal stories about how 111 in particular maybe adds more to the pressure in A&E than takes away from it. I'd be really interested to hear your take on whether that bears out in reality, uh, whether they are maybe pushing people into A&E that could have been dealt with in let's say primary care settings. I'd be really interested to hear if there's, you know, if you have some perspectives on how that is working in practice. Yeah, I certainly do. So, um, so the first thing I would say is that hearing treat is really tricky. Um, so actually what we are faced with when dealing with hearing treat is somebody who is trying their best is, first of all, in a situation that they are not, um, they've not been in before probably or one that they have been in before and actually they know a great deal about and know what care they need, but, but we have to go through a process in order to get them there. Now there are two processes, two triage systems, uh, in use nationally as pathways, energy pathways and, um, MPDS, uh, which, and pathways is the one we use for 111. And it comes out with a whole range of dispositions. And that, that could be something from go to a pharmacist, uh, to go to A&E. So you need a face to face, um, a face to face, uh, like say, um, assessment. Uh, and that's where, like I said earlier, our 50, 50, 50, 50, 50% of calls become ambulance conveyances, not those 50% are conveyed. So, um, the 111 system is complicated and it's not as straightforward, um, because what we don't want is, is individual, individual clinicians are having to make a decision based on very little information. So I'm not saying that they wouldn't end up there. So one of the things that we are addressing with the 111 system, um, or with all of our, um, our demand actually is something called integrated care coordination. So the integrated care coordination principle is that we have a multidisciplinary team of people that are able to, um, pick up calls from the 999 and the 111 systems. Both are LAS, um, operated. So, um, they can pick up calls from those systems. Um, and between the paramedics present within that control room, which again is based at Free and Barnet for North Central, um, they will be from January working with senior clinical decision makers, whether that's a consultant and it might be a consultant geriatrician, um, as well, uh, or a consultant GP to be able to say, actually, is there something more we can do about this patient? Um, so we're trying to introduce an additional filter to allow referral into community pathways from there, um, because unfortunately the ED is the ultimate, is, oh, the LAS tends to be, or the ambulance service generally tends to be a bit of a safety net for, for everything, and emergency departments are a safety net for everything else. And, um, and it's through stuff like trusted assessor, because, because the implication, so the, the question that you've asked is, um, and I'm not putting words into your mouth, but there is an implication that people didn't need to go to ED and so they didn't need help. And our, the facts are that people need, people phone us because they need help. Uh, we send them an ambulance because that's the tool that we've got. Um, and that ambulance might take them to A&E because that's the tool that they've got. And what we're trying to do is increase the tools available to get them to the right place. And that is through things like SDEC trusted assessor where they can same day emergency care. Uh, that's what, with things like integrated care coordination, to see if we can get them in the right place. Um, and we're trying to work with the system as well for stuff like pharmacy first, um, um, and, and other principles like that. So there's a lot going on. Um, I hope that answers your question. I feel like I've given a lot of detail about other stuff, but it's, it's a whole picture. That was very helpful. No, thank you. And just, if I could ask a second question, um, you know, at the beginning you spoke about pressures in the system. Um, you know, we're constantly hearing stories of escalating pressures throughout the NHS. Um, people talk about prevention. They talk about different integrations. Just be interested to hear from you, you know, what would be your sort of top priorities to put it on a more sustainable footing for the ambulance service? So the NHS priorities around prevention, and that's the, you know, we've recently, um, part of our, our forward view, um, and that is around prevention. So for the ambulance service, it's a bit tricky because we're quite reactive, inherently reactive. If you don't phone us, we can't arrive. Um, so I'd, I'd probably like to split the answer into two, uh, different elements. So the first one is around the high, it's very high acuity and low acuity. Um, so the very high acuity stuff, that is around the priorities for us. It is around that London lifesavers bit. That is what saves lives, um, more than anything else. It is that the early CPR, early defib. That's why we're investing a lot of time and effort into it. That's why you'll see them at London Bridge and places like that with mannequins and so on. I think there's, there's a, one at King's Cross as well, trying to encourage people to come along, um, and do that. We also would recommend signing up to things like Good Sam, um, which is where, um, the London Ambulance Service has a, has access to a system, which you've got an app on your phone. I've got it myself, um, where you will, if there is a cardiac arrest, you will get an alert that says, are you available to go and assist if you're, if you're trained in, in CPR. Um, and you can go and assist on behalf of the, the ambulance service. And again, that's what saves lives. You know, it happened to me the other day. I was, uh, at home and got a message and went round the corner and, and, um, there's a patient there who's collapsed. Uh, and that's for anyone that, anyone that has a CPR certificate effectively. So for very high acuity, that's, that's our, our priority. For the lower acuity stuff, um, actually for us, our priority really is around that integrated care coordination. And the integrated care coordination will allow us to get, to, to act as a system. Um, and it is a system, uh, endeavor for all of our, our trusts. And one of it's a, we're in a challenging position. So nationally, the, um, ICC integrated care coordination is, has been introduced in patches. It's different in different places. Uh, in London, we don't have it yet. Um, so we've got a clinical hub, um, where we do 25% of those calls, uh, that would have got an ambulance response now don't. So our paramedics are currently filtering out quite a lot of that, that already. Um, it, for us, it's a real priority and making sure that when people phone for help, we don't just send them and do what we've always done. That actually we give them the help that they need. Um, and that's because we get a whole range of that from worried wells, people living with conditions. And there's more people. I think the, the natural element of people living longer is they're living longer with conditions that need, need managing. And that will allow us to support people in their own homes and to manage their own care. Um, and then if I can add a third priority, it's around mental health, which I think the, is building on the work around, um, like I say, making sure that the, uh, attendance assessment conveyance of mental health patients is appropriate for their needs. Um, and really working with, um, organizations like in, um, like in the North Central where we've got that facility at the Whittington, I'm sorry, at, um, Highgate, um, and their, uh, systems they've got in place there to make, to refer mental health patients in crisis into the right places. I think, um, anything we can do to help that, I think is really valuable. Oh, you, you know the people you're training in CPR, the volunteers. How do you, how do they get to you to train? It's really good that you're doing that. Yeah, so we've got, um, we're, we're going through schools mainly. Um, and from that, uh, obviously for every person in a school there is, uh, they have, uh, either one, two, three parents, grandparents, uh, carers and so on, uh, that they, they can access it through that. Uh, we've got information on our website. Um, if you wanted to arrange them to come down and, and provide a session, I'm sure they'd love to come and, and support that here. Um, we also have been, um, we have pop-up sessions at, uh, places like St. Pancras, Kings Cross, um, and main hubs, um, where they will, uh, provide that, that training. Um, what we're trying to do is register people as well, uh, onto, onto the list so they can do that. Um, and so we've got a bit of a track and, and it's all about this kind of concept of defib deserts. There are parts of London where you, where there's an inequity of care. There's some places where you're absolutely brilliantly served. And again, you, the example being places like St. Pancras, which are, um, you know, massive hubs where, where you've got defib and trained staff and things. You're much more likely to survive, um, a cardiac arrest there than you will somewhere else. And, um, you know, there are cases every day of patients who are, um, who are, whose lives are literally saved by that. And so, yeah, um, it's via our website. It's in the end of the, uh, I think on the second to last slide in the deck, there is information there. So if you've got anyone that's interested at all, do get in touch with us and we'd be happy to, to provide them with, with, um, the training and support to, um, be a London lifesaver. Did you save that person's life? Uh, no, she was dead. Oh, no. She was very old. Sorry, didn't have a happy ending. That one. Um, but there was a case the other day actually, um, just, it was in the city of London, but quite near to the, the border with Islington where, um, by standard CPR absolutely saved a, a person's life. It was a, a young, young man, um, from the, uh, from the city, uh, out for drinks with friends and collapsed, um, and actually early CPR. Um, and early defibrillation, um, on that time by a police officer actually, um, saved his life. And he is awake and talking today as a result of that. Um, so you can't save everyone, but there's, the way to maximize it is through, um, is through that. Thank you. I just, I would just, one, one question to you. You know the LTN, yeah? And all over the London. Is it affecting your, like on the timing to get the resident? Any question? Yeah, so we have, um, we have a great deal of pressure at the moment that is really, um, making it a challenge for us to, um, to get to patients, um, in a, in a prompt fashion. Now we're, we're doing everything we can to, um, to draw on support from the wider system to help us with that. Um, and we've had particular help from, um, from acute trust in taking a hand over probably quicker than they would have liked, um, to, to try and balance out some of that pressure. Um, we're making sure that we do more around here and treat for patients and making sure we, we have a better balance of risks. So a patient that would be sat waiting for an ambulance for longer, actually, we're more likely to give them a ring and, and see if there's, uh, something we can do. Obviously I say give them a ring, there's a bit more structure to it than that. Um, but we, uh, you know, where we are under pressure, we're doing the maximum we can to do the best we can for the, for the most amount of people. Um, so yeah, there's a, there's a lot going on and, and we are trying to, as well, I guess, actively redistribute resource to make sure that, um, there's an equity of care there. Um, and, uh, certainly in this part of London, we're, we're benefit, we have the benefit of being surrounded by a number of very good hospitals that are, um, that are quick at turning ambulance screws around. So, um, there's, there's some information around the winter plan, particularly in the, um, in the slides there. But we've certainly been very busy the last, uh, last couple of weeks. Thank you. Anyone has any question? No? Thank you, James, for coming. Really good report. Thank you. Thank you for coming. Thank you. Before, uh, Islington safeguarding adults board annual report, I think Fiona, please come. Um, so I, uh, you've seen the, um, the report already. Yeah. So, I mean, do you want me to go through some highlights or some key points? Please just go through the key point. Very, very quickly. Um, so the key achievements, um, are on the second page, really. Um, it sort of demonstrates that we're both kind of, um, looking at what's coming up and horizon scanning as well as being reactive to new policy changes or systems changes. Um, and thinking about that across all the system. Um, there's quite a lot to support. Our structure has remained relatively stable over the, um, over the year that I'm reporting on. Um, a lot of our, what we decide to do, a lot of how we decide our focus should be is, is, it comes directly from our service user and carer subgroup. Um, things that matter to them should matter to us. So we, um, really work on that. Um, I suppose the headlines are around kind of the profile of risk is that that hasn't changed dramatically other than, um, it's got busier. Um, we're seeing a huge rise in safeguarding concerns, which might make you a little nervous, but actually is a really good news story because it suggests that more adults recognize that if there's abuse or neglect, they come and they get the support that they need. Um, we've done a bit of work, um, following on from, um, stuff that, you know, things that we were noticing around, um, kind of, you know, the equalities data, for example. Um, looking at kind of why some, um, ethnicities are less likely to come forward and ask for support. Um, so the council in particular and the safeguarding adult unit did a big deep dive into that and looking at where we need to target some resource. And, and some, you know, some awareness raising activities. Um, so that would be reported in the next annual report, the conversion rate. So this is where lots of people have concerns. They refer them in, um, and they're then looked at and triaged to decide whether actually they meet the criteria for safeguarding adult review. Um, sorry, safeguarding adult inquiry. Um, we, we, we are hoping that next year's report, you'll see quite a dramatic change in that insofar as, um, it's been stubbornly around the sort of 12 to 15% conversion rate. Um, what we want to do is work with our partner organizations, the public at large, to kind of really hammer home when the statutory duty in respect of safeguarding adults arises. So that we get referrals that are more steered towards that and a little bit like you just heard from the ambulance services where, where the need is something else, that that goes to the right path in the first instance. Um, and the reason that that matters is because if you're dealing with the kind of high volumes that the front door are dealing with in Islington, it can be very difficult to kind of really pick out the ones where you absolutely need to act and need to act urgently. Um, so that's a big piece of work that will be, well, that the council are leading on, if you like, that we're, as a board, trying to really push, um, so that partner agencies all really realize and recognize that they need to train and support their staff to, to recognize there are different pathways into support and that not everything needs to go down the safeguarding adult route, um, that there are, you know, and to use the right process. Um, the other kind of thing that I suppose really matters, um, we're still seeing a high percentage of concerns and inquiries, um, taking place where the person is at home. So, you know, you've heard about the excellent services that you have in Islington, um, in terms of extra care and, um, we're seeing a much, you know, a reduced amount, um, of safeguarding concerns arising in, you know, residential or, or, or in hospitals. Um, and, um, and why that is interesting and important is because often you see that the referral rates for those are higher, um, particularly in respect of concerns purely because people within those settings have all been trained in safeguarding duties. So if they're in any kind of doubt, they'll refer the issue in. Where things become more complex is if everything's happening in someone's own home because generally social care do not have rights to go into someone's home. They have to ask and, and that's not always, um, easy and not always well received. So it makes it more complex for people to offer, you know, practitioners involved in safeguarding adults if they are, um, having to undertake large, lots of inquiries for individuals in their own home. So that's why that's kind of a really important thing. But having said that, if you look at the statistics underneath that, where the risks are reduced or removed, that's the, that's the vast majority of cases, um, where an intervention has seen a reduction in the risk or removal of the risk. And that's a really positive. So I think, um, that's kind of it for me in terms of, we've given you a case study, we've given you some feedback that we've had around the training that the, um, council lead on, um, and sort of set out on the final slide the, the kind of next steps. I suppose, I do have a question for you guys. Is this a better format? Because last year, we felt it was quite weighty to wade through and we thought giving you the headlines was probably more accessible. Yeah. Thank you. Thank you. Uh, it's Councillor Clark. So I just need to understand about how it works. You know, where we've got Pete, because the chairs mentioned housing association run residential accommodation. And people in those, in that accommodation have social workers. Some of them have social workers. Are those social workers, uh, assigned by Islington to, to, there are residents in a housing association. Are the social workers assigned by Islington or by the housing association? And if so, we, yeah, that was. So housing associations will generally be, as Jodie was saying, they'll generally be landlords. Some will have responsibility. There's all different types in terms of, but, but they will generally be in the job, in the, in the role of providing a roof over somebody's head. And, I don't know Housing 21 particularly well, but it looks as if, to me, the model that they employ is to ensure that they also have a domiciliary care agency running alongside that. So that's a combined of both. Some people do have allocated social workers, as I understand it. This is probably John's territory more than mine, so jump in if I'm getting it wrong. But, um, but, but, but in the vast majority of people, what, what they'll have, um, including from the first speaker, is a support worker. So that's somebody who knows them well, who's working with them and supporting them to develop those skills and that independence. A social worker will be, will be monitoring that, if you like, come in and review that the needs are being met in a productive way. Um, um, but won't be there day to day. The social worker is always generally allocated by the council, and they will, it will be them that decides what kind of support would be best placed to meet that person's needs. When it comes to safeguarding responsibilities, which is where the Safeguarding Board kind of has, has a bit of an, well, not a bit of an interest, that's our main job. Um, what we're looking at is kind of how safe are people in all different types of accommodation or in all different types of situations. So, in that situation, if there is, say, for example, concerns around quality of care or concerns around, um, people being exploited in, in, you know, in their own home or in, in, in, you know, housing association properties, um, that would come in as a concern. And that would be usually overseen by one of John's staff within social care to make sure that that inquiry was robust. Um, but over and aside to the kind of individual, this person is at risk, can you go and look at what they need? What we also have is a report that Jodie, who was here earlier, um, provides to the Safeguarding Board every quarter, where she talks through any concerns that they have around quality of care, the support that's gone in to, to ensure that the, um, service is providing good quality care. And, um, and, and, and where Islington kind of stands over and above, if you like, or from my perspective as an independent person, where Islington does better than I've seen in other places, is that that's not just focused on residential care, so nursing homes and care homes, it's much wider than that. Jodie will talk about supported living, she'll talk about equipment provision, she'll talk about advocacy services. So, so you really get that sense of how safe is the system and how well are we working across, as commissioners, but also across with regulators to make sure that, um, that quality of care stays good. That was a very thorough answer. Thank you very much. Thank you very much. Um, I just wanted to ask a question about how the numbers are presented around age. I mean, you know, given your comments about care homes and obviously support needs and the relation with safeguarding, it does make sense that most of the concerns are about those aged over 65. But just, I want to just understand this grouping of 18 to 64. I want to understand if that group is sufficiently homogenous in the problems that they have, that that's a coherent, it's not. Okay. So I would be really keen to just understand the texture of that. What does that mean? And sort of why you decided to present it that way? Um, it's largely because that's how it was decided that every council should report their data in. Um, I'll put it out there as an independent person, nothing to do with Islington, but I have had numerous conversations with NHS Digital about how they've asked for data about safeguarding concerns and inquiries isn't particularly useful or helpful, but it's an ongoing discussion around how we make it better. Um, so it's classed, obviously if somebody's under the age of 18, they're a child and children's services will be responsible for safeguarding and child protection. Post-18, although to be fair, adult services are involved and we are working with the children's partnership around transitions and stuff as well, but adult services kind of tend to lump the working age and 65 plus. The reason you see much higher numbers everywhere for 65 plus is a little bit, it's kind of, it equates to kind of, um, the child protection and child safeguarding as well. Children are in universal services, they're seen more frequently. Um, 65 plus tend to touch services more frequently. And, and so are seen more frequently. So people then recognise when they're safeguarding risks and, and refer them in. Um, and if in doubt you refer it in, and that's the message we've always given. So, so that number will be sometimes much higher. Um, but no, in, in answer to your question, you know, we've just talked from London Ambulance around, you know, the, the, the, the, the complexities of working with people with mental health, with, um, substance misuse issues with, and that can be any age. Um, likewise, when you were looking at the, um, the first speaker and, and her client group with learning disabilities, again, that's going to be any age. So, so adults deal with a whole range of complex, difficult, um, and yeah, it's, it's for practicality and because that's how the home office, but we are looking at, kind of, um, how we use that information to really work out what more we need to do and who, who, who we should be targeting, um, and supporting with, kind of, raising awareness and training around, kind of keeping people safer. Thank you. Anyone? Okay. Yeah. Just talk with some questions. One is a cooking, cooking is called, yeah? Yeah, cooking. Yeah, yeah. And, uh, just lots of, uh, uh, the vulnerable people are, uh, targeted for this kind of thing, yeah, and this is like, you know, sometime is wasting money for council public funding because the, when council intervened to taking people from other place and everything, yeah. What is your plan to, and how are you addressing this one? So you're stealing the funder for next year, um, because we've done a big piece of work around, um, how good we are as a system of picking it up, understanding it, and responding effectively. Um, we've looked at, we've looked not just at, um, kind of our local data, we looked at nationally, what are the patterns, how does it work, um, not last meeting in, in October, the one before that, um, in the summer, we asked all our partner organisations to answer a handful of questions around, kind of, you know, what training do they give their staff, how do they monitor their, their service users to make sure that they're safe, how do they respond? Um, what we know nationally is one of the things that, um, makes this really difficult is that our three statutory partners, if you like, have clear priorities when it comes to cuckooing. So the police might look at, you know, dealing with the criminality side of things naturally. That's their job. Um, health and social care will also have different priorities. So, so, you know, they will be looking at kind of trying to support the individual, but there's also, um, not always a clear pathway and not always clear powers as to who acts in what way. So you might have a situation and we, we, what I would say about, um, Islington, there is a really positive and proactive, um, group of individuals working across health, social care, um, and the police, um, primarily, um, working under your community safety team, um, who are leading on this for the council in terms of halting and hosting a cuckooing panel. So they, they went out and actively said, you know, how many cases, how many, you know, houses do we think this is subject to? How do we advertise that we're doing this? How do we find out about more? Including in September, going out on a public consultation event with, with the safeguarding board to say, this is what we're doing. This is how we do it. If you know of any neighbors or if you have any concerns, this is how you refer in. Um, and so they have a really solid, um, base with, you know, professionals across housing, across social care, across, to really kind of offer that support and advice and bring together a kind of plan for each of those individuals that doesn't just look at, how do we stop it today? It then also then goes on to look at, and how do we support that person to stay safe? Um, I don't know if you know, but there was a safeguarding adult review last year published in Camden called Matthew, where the individual had been cuckooed. He'd been moved away from that accommodation in order to safeguard him. When he came back, he was cuckooed again. And, and so it, it's looking at actually the, the long term recovery, as well as the short, sharp, how do we stop it happening right now? So that's, that's kind of, we know that in Islington, there are good price pathways, good support in place, and the practitioners are talking to each other across the system to kind of identify, and that's one of the key things that, you know, you know that practitioners on the ground are going to be more comfortable to check this out if they know how to refer it on to get the extra support for them and the, you know, for, for the, for the resident, as well as for them as workers. Thank you. Thank you. I've got some more questions. One is, another one is like a scenario in my work, yeah, I can understand. Another people, especially elderly people, yeah, about, you can see some people come, be their friend or something, showing their friend about, yeah, or, I don't know how they know that the people maybe die within a year or two years, yeah? Showing their very good friend and everything, yeah? Actually, they come here to be friend, and after when a person died, yeah, they want to looking for the money, the bank money and everything, yeah? Because the, especially the vulnerable people, they are very, very, when someone offers support, yeah, they feel they are originally their friend and everything. And it is very difficult for social worker or anyone worker, they, maybe on site, they know something going on, but when I did talk to the nurse on the hospital and everything, the nurse said to me, because he identified his next of kin is he or she, yeah? But actually, he and she just came to be friend, actually, his money and everything. How you can monitor and how you can help and awareness or something, this kind of thing? So, there's, it's, you, it is extraordinarily difficult. It is extraordinarily difficult. Financial abuse is, I'm afraid, prolific. And, you know, if, we know from online scams and the fact that they target older people deliberately, we know that is a really big, but we also know that there's mate crime. I hate that term because I think it makes it sound like it's okay. And it clearly isn't. It, it absolutely devastates people. Um, again, across NCL, rather than just in Islington, but across NCL, um, just before this period that we're reporting on, we hosted a financial abuse workshop. We looked at what we know, how how we can improve the, um, the recognition and the identification when we think financial abuse is occurring and what we expect the response to be and how we can build on that response. Um, it's still a work in progress. You'll see from the data, we still have far too high financial abuse. It's one of those areas where it is extraordinarily difficult because banks will not give over private personal details to social workers just because they're worried about financial detail because they have a duty not to do that. But, but banks are getting much, much better at spotting this and actually referring in as well. And they're very keen to work with us. Um, there's the, the, the work that we did at the workshop, um, actually got picked up by the Home Office and by the Department for Health and Social Care and fed into their safe care at home review. Um, and they're, you know, so again, it's like thinking about how we then implement the recommendations on there, but it is going to take a whole system. So it'll be thinking about how we utilize, you know, if somebody moves into, or it needs social care, they, they tend to, um, they, it's means tested. So they tend to have a financial assessment. That's a really good way of being able to check and monitor whether or not there's weird things going on in their bank accounts. But again, if the individual says, yes, this is not financial abuse, I want this person to have that gift, then it's not going to be something that a social worker can say, well, I don't, so you can't do that, because that would be completely against. Do you see what I mean? So it is about raising awareness. It is about highlighting to people that, um, where the, where the red line is around criminality, um, and what the impact is on individuals when they have been scammed. So, for example, we know that where individuals have been scammed, it can shorten their lives. Um, because, you know, it means that they're more isolated, it means that they're less likely. So it has a really, you know, significant impact. Um, so it is, it's about raising those awareness, but also, and I hate to say it, we all individually have to take responsibility as well. We need to think about actually, who is it that we're appointing for LPAs? Who is it that we're, um, um, that, you know, that we're answering those calls to? And thinking about actually, as we get older, how we protect ourselves against those kinds of risks. Thank you. I think like one of us, we need more awareness, uh, to the resident and everything about this kind of thing tomorrow. I think more awareness is good. Um, I think, I think we need to harness the, um, the knowledge that the banks have, um, um, and be working much more closely with them. Um, I think we need to, there's, there's some real positive things. So the Domestic Abuse Act, um, in 2021, um, actually included something around economic coercion. So that it could be, form part of a domestic abuse response if family members are being abusive. And that matters because that means it, it's much easier for us. There's more tools, if you like. The London Ambulance was saying, if we've only got an ambulance, that's what we'll send. If we can think about it in the context of saying to people, this constitutes domestic abuse. If you do this again, we can look at a, you know, protection order. We can look at this. We can, we can think about equally if, if, you know, John's team pick up that some, somebody's accounts are not being carefully looked after. And that they're falling into arrears with their council tax or with their, with their social care costs. Then again, being able to be able to think about what is it now is now the time for us to take on as a council appointeeship or deputieship means that that person might be safeguarded against the kind of, you know, fraud that you're seeing. Thank you. Thank you. Thank you. Just last question is like, you know, that your partnership, I haven't seen any housing association representative there. Is there any reason or? Um, so we do, um, we do SHP, um, it's a very active member actually, um, on the board. Um, and, and we also, whilst we don't, we don't necessarily have all the housing providers come and sit on our board tables, not big enough to a certain extent, we go to that. So for example, um, you know about the Liam Sarr and the fire safety messages that came out of that and how important that was. So we, we've been to the forums for, for, um, all the housing providers in Islington to talk to them about actually what it is we need from them, what they need to be thinking about in terms of their work plans, um, and their awareness raising. So it's a kind of, you know, it's, they've got a conduit to come straight to SHP and to talk to us about the issues that they have equally. We can go to their meetings and say, actually, from our perspective, we want to see you're doing more of this and more of that. Thank you. Do you have anyone has any question? Yeah. Thank you. Many thanks for your report. Really. You're doing a fantastic job. Many thanks. Thank you. Thank you. Thank you. Thank you. Ten minute. Before, uh, where is Jonathan? Yeah. Yeah. Flora, would you like to give any, update anything for your, any, you don't need to, Jonathan one. Just like your portfolio, uh, do you have anything we need to know? I hadn't fully prepared for this so I'm slightly on the spot there isn't particularly anything to add other than what you said in your chair's report that we've taken on the committee's request to look at finances and bring them to the committee and so we've met with John and the finance business partner and Jelani and Councillor Ward just to go through how we might be able to do that so you're going to have court two I think at the next meeting and then after that, after each court goes to exec there will be a form that comes here so that you can actually take a bit of a look at the adult social care finances and there we go, John Clinton's here Jonathan please if you're ready tell us any main point well you certainly kept me on my toes so anyway so I'm going to just I think fundamentally I'll take the report as read because I know that you always read it I think we have highlighted again sort of very solid progress in some really important areas so I particularly highlight smoking where we've obviously had the tobacco and vaping bill first reading and we're really hoping that 2025 is going to be an absolutely huge year in terms of really singly making more price around smoking when I started working in Islington which I will tell you was about 20 years ago about a third of our adults smoked and that's now 13% and we are now very close to the national average whereas 20 years ago we were a long way off it's been so important and transformative so we're really very excited about that I think we've continued to make really strong progress around our drug and alcohol particularly about one of the really key things which is about getting the right pathways and links into the criminal justice system into our prisons we've started a new liaison service up at the Whittington as well for its accident emergency and service outpatient departments and we make very good progress and obviously both of those are in our 2026 delivery plan so they're particularly important areas of focus we continue to hold the line on vaccination but it remains really tough in terms of making progress but there's lots and lots of activity out there sort of reaching out to parents and our communities about promoting the vaccination offer we continue to make strong progress on health checks that's very much about looking at sort of key risk factors for heart disease and for diabetes and I think one of the things we've previously highlighted the scrutiny committee is that during COVID but also coming out of COVID that we saw cardiovascular mortality so sort of death from heart heart attacks, strokes etc reversed after literally decades of positive progress and it remains a key area of focus for us so I will just give that by way of highlights in this report Thank you If anyone has a question No I'll just say everything's on target isn't it you know you've got everything that would be helpful because I'm interested in that Thank you So obviously the smoking bill is fundamentally about trying to create the first smoke-free generation and it is pretty internationally I think a couple of places have started down this route but not really completely so New Zealand I think was aiming to do this but then it sort of it sort of it hasn't happened so essentially this is going to be about I think if you're age 15 now you will never be able to legally purchase tobacco products in a shop or any other venue and the idea is that the age at which you can do that will continue to increase each year every year so for us it's really important opportunity to really reinforce all the action that we've got about stop smoking I think the fact that we're already seeing more people coming into services again is probably even the discussion the debate which is going on about it raises that whole awareness of it about sort of the active offer of help and obviously one of the key things we recognise about smoking is an area where actually you know sometimes people frame us about individual choice to be honest about 90% of smokers start as children so in their sort of early mid-adolescence that's not a choice that's something about addicting young people from a very early age and we know that the vast majority of people who continue to smoke want to stop smoking the other really important thing is about vaping so I'd be really clear if someone was already a smoker and they were sort of looking at what would help stop smoking they would just say vaping I would say that's probably a good thing for you maybe if you had a bit of lung problems I would probably ask you to think about other ways to do it but it's a very effective way to help people stop smoking because if you like the nicotine is the thing in tobacco which is really addictive and that's the thing that people get in some of the vapes but it's all the tar and all the other nasty chemicals which is stuff that kills you so with vaping you've got the nicotine which is the addictive stuff in some vapes you've got the nicotine which is the addictive thing but not the stuff which is really harmful and causes cancer heart disease and a whole range of problems but it's important it's also trying to get a much bigger grip on vaping amongst young people or other people who aren't smokers and that's really because there's really two risks firstly vaping is still quite new we don't know what the long term harms are attached to it and therefore we don't want youngsters to get engaged to that and what we also don't know is whether or not it becomes a gateway to smoking in the future so the sooner we act on that the better frankly and then the other thing is it's addictive if it's got nicotine and we don't want young people getting addicted to anything and one of the things I hear sometimes when I'm talking to teachers or other people working in schools they talk about youngsters who literally have to leave the school in order to get a vaping fix because they've got such a high level addiction or who get quite agitated about it and we just don't want that so it's got two really important things firstly about really trying to head off the future smokers through that really progressive and I think pretty much internationally unique example and the second is about really addressing the level of vaping amongst young people and I think earlier this week we found that about 8 million disposable vapes get thrown away every single week in the country that's a huge amount of waste that goes into our refuges and it's a big fire risk because it's got batteries in it and it's not a safe way of disposing them thank you very much I knew that you'd have a very thorough answer to that question I really really appreciate that it's really good thank you thank you Jonathan I think no one has any other question many thanks for coming and waiting for us many thanks thank you thank you B6 work programme do committee member have any comments thank you this will be our last meeting of 2024 season's greeting to you all and wishing you all a happy new year the next meeting of the health well-being and adult social care scrutiny committee will be in the new year on 4th February 2025 and we're gonna see 7th of January to visiting the centre and there being no further business I declare this meeting closed this time is 9.30 the exact time I thought is today I'm gonna finish thanks