Transcript

Good evening and welcome to the Health and Adults Subcommittee meeting today. My name is Councillor Mohamed Belaluddin and I'm chairing this meeting. Only member in person attends can vote and does not include the co-opties. This meeting is being recorded for the council website for the public viewing. If there is any technical issue, I will decide on how the meeting should be continued after taking advice from the officer. Can I remind member should only speak on my direction and ensure to speak clearly into the microphone. Please kindly have your mobile silent. member, member, member, officer and speaker who are online, can you keep microphone on the mute except when speaking. If member, officer online wish to speak, please use the raise hand function. member, member, customer service, thank you. inform that Councillor Iqbal Hussain is running late and he'll be here shortly. Thank you, Justina. Thank you. Can you member now introduce yourself and declare if you have any... Okay, yeah. Can either committee member confirm there is a true and correct record from 5th November 2024 have been sent it? Is it okay? Okay. The action log has also been circulated as a supplement from the last meeting and there is no update on this. Can I just ask, so I think at a previous meeting, I think it was at the September meeting, we talked about whether it would be more useful to have some of the performance indicator data that's relevant to adult social care. I don't think we can deal with it in relation to the NHS stuff, but in relation to our own adult social care service, I think that we should have that data as well as having the things that are mentioned here about CQC reports and things like that. So I know that there's been some conversations that have gone on over the last couple of months, but if we can just have some feedback on that in time for the... well, before the next meeting, and hopefully we can have some data itself at the next meeting, please. Thank you. Thank you very much. Thank you. The officer will be noted. Okay. Can you remember, now introduce yourself and declare if you have any DPI, starting from myself, Councillor Mohamed Belaluddin, nothing to declare. Thank you. Starting from right. Good evening, everyone. Councillor Mohamed El-Kabir, I have no DPI. Councillor Mark Francis from Bow Eastward, no declarations. Good evening, everyone. Councillor Abdul-Mannam from Bumdi North, I don't know, nothing to declare. Any member and officer online, please? Can you introduce yourself, please? Thank you, Chair. Councillor Amy Lee, nothing to declare, and just apologies again for having to attend online this evening. Any co-opties online? Can you hear Aliyah? Good evening. Yes, I have nothing to declare. Thank you very much. Our next member, Councillor Iqbal Hussain from Lensbury Wood, I have nothing to declare for this meeting. Thank you. Thank you very much. Thank you. Our first item for this evening is focusing same-day access care, and can also be known as the same-day emergency care, SDS. The type of the healthcare model is usually designed to assess or diagnosis and treat pressure on the same day and arrive at the hospital and avoid unnecessary hospital admission and reducing the pressure on the emergency emergency department. I would particularly welcome, if you can also speak on, patient safety and quality of care, assess and community of care, and resource allocation and the workload. These are the areas that would not be interested in this committee and our residents. I would like to also welcome to our speaker on the item, Jonathan Weaver, Senior Project Manager from Primary Care. Welcome. We are also expecting the Mary Jamal Deputy Director, Head of Service, Aging Service, Aging, and the Department of Health. I have been informed that she is unable to participate to wishing you and the speedy recovery. I will hand over to you. Your time is 10 minutes. Provide the committee an overview and then it will be open to the member questions. Please start when you are ready. Thank you very much. Thank you. Yes, my name is Jonathan Weaver. I am here to present on the Same Day Access Programme. This, what you are seeing here, is a document that has been put forward to the Tower Hamlets Together Board, which is a board that brings together all of the local partners within Tower Hamlets. The programme itself is a joint working initiative between primary and secondary care. And what the programme has done, and hopefully you will see, is we have mapped out and we have taken a lot of time to map out the pathway, the patient pathway to and through the A&E Department and the UTC at the Royal London Hospital. The work programme is co-produced by myself and Julia and other members of the team. And we have been working very closely with the Royal London Hospital, who provide the A&E Department, but also the GP Care Group, who, Tower Hamlets GP Care Group, that work and run the UTC. The intention is to try and improve the patient flow and experience through the pathway, bringing, basically, redesign the process to bring an earlier redirection, in particular, from A&E to the Primary Care Same Day Access Service. At the moment, that happens at the UTC, following a rather lengthy process. And it's done within a contractual context of change. So I have set out within the slides, that there is, that the existing UTC contract and NHS 111 contract are due to expire on the 31st of March 26. So that means that any pathway changes that we introduce have to be done and have to be done and worked through over the next few months, so that we can properly pursue the procurement and appointment process for the new providers. Probably what you have noticed, in terms of the diagram, is that the current pathway is very complicated. And I just wanted to highlight the changes, the reasons why we needed to change. First of all, the current pathway is not optimal for patients. The way that it runs at the moment, patients could be redirected a lot earlier into primary care same day access. So the pathway is more repetitive and longer than it needs to be. The current pathway doesn't represent value for money, in the sense that the new pathway that we're proposing is a lower value service. And basically it means we can buy more capacity for the same money. And that's because an appointment in primary care is about a third of the cost of a UTC appointment. So if we can direct patients away, or if we can see patients in primary care first, then that's going to save money for the system. And also without changes in the pathway, then what we'll see is an anticipated growth of demand at A&E. Because of population growth, which in Tower Hamlets, as I'm sure you're aware, is growing on an annual basis. And also in terms of patient habitual use and trying to change habitual use of A&E instead of using primary care. So the pathway is very much in two phases. One, to try and stop patients from attending A&E in the first place when they don't need to. I do want to emphasise if a patient needs to attend A&E, they should. But we do know from the surveys we've done with patients and the clinical audits that we've undertaken that a significant portion of patients could have actually been seen in primary care rather than going to A&E. So point one is to stop people who who don't need to from actually going to A&E. The second is to provide a redirection route away from A&E so that the patients don't have to wait. They can get an appointment in primary care the same day. So those are some of the key aspects that we're looking to change. We have done a couple of, as I say, I referenced in my report that we undertook a review of patients seen in the urgent treatment centre and a significant proportion of them could have been directed according to the clinicians to a same-day access service run by primary care. And secondly we also have been working with Healthwatch and we undertook a survey in the A&E reception and there was a significant willingness of patients. 66% of patients said that they'd be willing to, who were surveyed, said that they were willing to be redirected away to a primary care service as long as it was safe for them to do so. And I think the important consideration of this service when you are directing away, there's a couple of key importance. First of all there are very, very strict clinical criteria which have been set between and with the clinicians in primary care and secondary care. And secondly it's always a patient decision. So patients will be given the option if they choose not to take up a booked appointment in primary care then they will still be allowed to go on and have an appointment at the UTC. So those are some of the key aspects. There's a diagram there, a rather busy diagram, which has got crosses of the various bits of the pathway that we're seeking to change. I've mentioned those. What we're trying to do is to provide a mechanism where patients can be redirected. If a patient phones a GP practice and they haven't got any appointments on the day, then they can be offered an appointment at one of our same-day access services, which is local to the practice. So we would stop situations where the practice is saying we haven't got enough appointments and sending patients to ANE or indeed to NHS 111 and we would stop people who have their own volition chose to go there rather than wait for an appointment. So number one is taking redirections from practices and overflow. Number two is taking redirections from NHS 111 when they can't find appointments in a practice. Number three is taking redirections from ANE and UTC itself where patients are willing to have those appointments. And all of those appointments would be offered in the same day with the local practices. We have a range of different locations. At the moment, previously there was only one location that patients could go. That was Cable Street. We now have sites at Park and Tyne practice, at Newby Place practice, Hospital Fields and at Wellington Way. So there's a much greater variation of places that patients can go to through the redirection. At the moment, 30 patients are redirected away from ANE per day. We're looking to try and increase that to 90 a day. That's the plan. We think based on the audit that that's achievable and based on patient feedback that that's achievable. So that's our aim over the next 12 months. There is in your pack some estimates of what might be saved to the system in terms of those changes. But I would also like to emphasize that those changes have a big benefit to patients themselves and on their healthcare. Another factor about seeing a service within our primary care same day access service is that the patients receive a much more rounded service than they do currently. The service will have access to patient records, will be able to order tests, will be able to make referrals. So this means it's much less likely that a patient will hit this service and then turn back and end up at their practice within the same week. Initial audits suggest that under the old system around 40% of patients who went to ANE or UTC or the current service were coming back to their own practice anyway within a week. A review of an audit of our pilot is indicating that that's been cut down to 20% which is evidence we're being able to provide a much more comprehensive service to patients and in one go rather asking them to re-attend. We've also got some of the risks there that were shared in your pack. Most of those risks are associated with funding and we're in the process of putting forward a business case to secure the funding and to transfer the funding from one part of the system to the other to allow this to happen. In order for this to happen we'll need to shift money from effectively what's acute care into primary care and primary community care. So this will be very much in line with the direction of travel for the NHS at the moment. Hopefully that makes that bit clear. I think that summarises the slide deck and I'm happy to take any questions. I did have some questions which were sent to me prior to this meeting and I'd be happy to answer those as a start but if you would rather ask your own individual questions first then please let me know. Thank you very much. Thank you very much. Thank you very much for your presentation. Do you have any questions? Please raise your hand. Mark. Thank you very much, Chair. Thank you for the presentation. So I think anyone who has spent any time and I would like to thank you for the presentation. So I think anyone who has spent any time at the A&E of the Royal London Hospital will understand the pressures that you've talked about in the presentation. And we see it on the news all the time about that this is a kind of a national issue about those pressures at this acute end of the service. Obviously Royal London Hospital has some particular reasons why for additional intensity I think and people would have seen that if they've been in there especially on the weekends. So this all seems really sensible and it also seems a little bit familiar and so I just really my recollection is that an effort was made in this direction around 10 or 15 years ago. The introduction of walk-in centres, we had St Andrews hospital site as well, that sort of direct access. So I guess my question, my opening question is what happened to those mechanisms to reduce the pressure on A&E and if this is just replacing those, what lessons were learned from what worked well and what didn't work quite so well in terms of those alternatives to A&E at that point. Thank you. So yes, there was a service at St Andrews. I think there is some significant differences in what we're offering now. First of all we had effectively a hub service in St Andrews that was in one part of the borough. What we're replacing that now is with a service which has locations spread throughout the borough which I think is going to provide a better and more equitable access across the borough. That's the first point. Secondly, what we have here with this service is a service which is not a direct access for patients, it's a service that you access through clinical eligibility. So a clinician makes a decision either at a practice or by NHS 111 or by the A&E. So hopefully patients will be more suitable in terms of their direction. And what this is, it's booked appointments where the previous service was a walk-in. So there won't be patients waiting in terms of accessing the service. What we're trying to do is to make sure that, you know, one of the key lessons we learned was that if you place a walk-in centre in a particular part of the borough, it's only really used by a smaller portion of those residents, albeit that those might be residents that really need the service. But what we want to try and do through this is to make the service equitable for all. We're also trying to work within the financial parameters that we have. So this service provides that capacity that's linked within those financial parameters, which is a different financial regime that was in place when St Andrews and Barkentheim were walk-in centres. So hopefully that helps. I think what we're trying to do is specifically focus on a very clear situation. We feel within primary care clinicians feel that the GP practice is the place that we should be encouraging people to go. But then we need to have a mechanism that if that practice has run out of slots that they can find somewhere locally. So it's about trying to navigate patients back to their general practice, where they can get continuity of care and better care planning. I hope that helps. Can I follow that up? Yeah, yeah. So thank you. That really does help and gives me a clearer understanding of the difference between what's happening now and what's happened before. So I think there was also a walk-in centre at Whitechapel as well, which was closed. And so you said that St Andrews is still open. I haven't been there for a long time. And obviously Barkentheim has been used for other things in recent years as well. So just as I understand, what can you remind us, I think you said it in the presentation, what is going to be available once this is rolled out borough-wide for residents? Thank you. Yes, there will be these hub-type services. One will be one at Spitalfields, one at Cable Street, one at Newby Place, one at Barkentheim, one at Wellington and one at Wellington Way. Thank you. Our next question will be our Councillor Kavir Ahmed. Thank you, sir. Thank you. Good evening. Thank you for your presentation. Nice to hear that his plan and everything. I have a couple of questions. From January 2025, there is a reduction of SDS service capacity, which is likely impact patient across and care. And how will you mitigate this, the first correction? Well, basically what we've done is the current same-day access service at Cable Street has been reduced, but it's been replaced by the pilot sites that we've got that I've mentioned before at Barkentheim, Newby Place, Cable Street, Spitalfields and Wellington Way. So we've actually built in a lot more capacity than we've taken away in terms of redirections for NHS 111 and for practice overflow. We've also guaranteed, because we've kept the Cable Street service running at the moment, the current one, that the level of redirections from ANE at 30 per day is maintained until we've established that the pilots can take those redirections or we've worked out suitable arrangements. So there should be no deterioration in service for patients. In fact, actually, for some patients, there should be more capacity than they had before. Go ahead. Yeah, I mean, how will you monitor this effectiveness of this new KPI for the urgent care pathway? There's a couple of ways that we're monitoring it. First, we'll monitor the number of redirections which are made from ANE and from UTC at the various points of the pathway. We can also monitor, and we are monitoring the number of redirections to our pilot sites and to practices from NHS 111, so we can see quite clearly whether those services are picking up more of the redirection activity from NHS 111. And thirdly, the practices themselves, or the pilots will be submitting the number of patients that they're booking in. So we will be monitoring that. Of course, we'll also be monitoring the overall number with urgent care colleagues of patients that turn up at the ANE front door as well. So we're looking at that whole picture. Probably you would also be interested to ask the pilots also do patient survey information as well to test patient trust and confidence in the clinicians and overall satisfaction of the experience of the service. That information is also being collected from the pilots, and we'll be doing some other audits and surveys as well on various other aspects of the service. Thank you very much. Next question we have, Councillor Amy from the online. Can you hear me, Amy? Yeah, thank you, Chair. Thanks very much. Thank you for the presentation. I just wanted to ask about the risks that you've outlined. So the sort of red risks that you have. And it's clear that, and I appreciate the detail that you put in there, actually. It's quite, it's very honest, so it's appreciated. But I think it is a little bit concerning that one of your main risks is that nurses just won't have time to do this. And that's a pretty big concern. And then the mitigation for a lot of the other risks is money, which I understand. But it's, you know, we will think about a business case. We're putting one together. Funding could be allocated. And I think you've already spoken a little bit about that funding has already been reallocated. And I think there's just a bit of a concern here that it's potentially quite a lot of money that we could be talking about. And is that money that comes solely from the money that you think you're going to save by doing this? I'm just unclear on the funding mechanisms here, because it seems to me like you have hit the nail on the head that there may be a time issue here. And I'm just wondering how this is all going to work, essentially, if where this money comes from, whether you will be able to get your hands on it and how that is going to support staff to make these really important decisions. Okay, thank you for your question. The vast majority of the funding for the same-day access pilots has been granted to Tower Hamlets, PCNs, by North East London ICB. They allocated £1.5 million. What we've done here is we've tried to be smart about making sure that when we've got that money, it ties in to the urgent care pathway and that we support the urgent care pathway with that. There is probably about additional £1.5 million that will be required, but that will need effectively to come from a saving or a reduction in the activity that goes through the urgent treatment centre via A&E. That's the business case. What we've tried not to do is to be too optimistic. That's why we're only looking at up to 90 redirections per day. I'll just give that some context. 600 people go through the A&E front door every day. 300 of those go to the urgent treatment centre. And we're looking at redirecting away about 90. And we're in conversations with the care group that run the urgent treatment centre about that. They feel that with the right planning they can scale down some of their workforce as long as we're, as a system, confident that the activity can be managed in a different way. So that's effectively how we would be looking to resource this. In terms of the other aspects of the pathway, effectively it's minor tweaks in terms of who does what in terms of clinicians in the pathway. It's about the initial assessment nurses undertaking more of a redirection function. And that's conversations which we're having with BARTs. And it's about a slight change in the care navigator role. So we feel that it's all doable within the resource framework that we have across the urgent and primary care sector connected to same day access. But the business case that we're making is basically about that transfer of resource and based on the planning and the planned levels of activity. I hope that answers your question. Okay, thank you very much. Thank you. Next question will be Councillor Abdul-Mannan. Thank you. Thank you, Chair. Good evening, everybody. Thank you for your presentation. It was quite thorough and quite easy to follow. My question is, how would you include or involve stakeholders' feedback on the redesign of urgent care pathway? The first one. The second one would be, how will the program tackle potential disparities in access to urgent care service among the BARA different demographic groups? Okay, so in terms of diversity in the BARA, I guess the first point is that what we've tried to do is to actually make the service more accessible by having more sites in locations across the BARA. We think that will help. Secondly, access to the service will be entirely based on clinical criteria. So it should be equitable for all who access because it's not about just the ability of a patient to pick a phone or articulate. It will be down to the clinicians with clinicians in the primary care space in the NHS 111 or the UTC to make a value judgment to make that offer to patients. When patients attend the appointment, they will have access to translators if they need them in the same way as any general practice should offer that if needed to patients. And there will be the added advantage that because the service has very good access to patient records, they'll have a lot more information about the patient, which will mean they can be a lot more sensitive to the needs of the specific patient. We are looking also about how we encourage and promote registration. We've recognised our unregistered patients in PATCH, so we're looking at how we can encourage registration in and around the A&E and UTC for unregistered patients. Because we believe continuity of care is important and trying to get people registered with a practice. So that's another aspect of it. And we monitor the information. So the attendees of the same-day access service, they'll be monitoring of their characteristics. And on the basis of that, we'll make sure that the use of the service is consistent. Furthermore, we're organising some sessions with Healthwatch to test our new model. And they'll be running some focus groups so that we can check with the local community about how perceptive they're going to be to the changes that we're proposing to make. And there will still be opportunity to tweak the pathway at that stage. I think we didn't probably get the right feedback. The feedback from stakeholders, how would you use it? And how are you going to collect that? That's one of my first questions. As the stakeholders who are getting involved, how do you get involved with them and get the feedback? Yeah, at the moment, the stakeholders that we've been dealing with are mainly the organisational stakeholders, the general practices, the GP Care Group, the Royal London and other people that are involved in the pathway. We've also have been working with Healthwatch as a representative of the population. And it is in the next stage, really, that we wanted to test some of our approaches with population stakeholders. And that will be organising with asking Healthwatch to help us with, because they have a lot more experience with that than we do. Thank you. Thank you very much. Next question, Councillor Iqbal Ousun, please. Thank you, sir. I can see different service centres have a cap on the number of patients we've seen in different centres of help. So, do you have any plan to increase the percentage of the patient reduction, redirected to same day service from the current number from 30 per day? Yeah. Yeah. In terms of the same day access, the way it's structured, you're right, there's a cap on the daily number. That's linked to the funding and the ability of the receiving primary care same day access service to physically have the number of appointments routed to take patients. So, what we'll be doing is increasing that cap from 30 to 60 to 90. That doesn't take away the fact that any number of patients who walk in through the Royal London front door will be seen by the Royal London. And if they need to go to the UTC, they'll be streamed to the UTC. So, we don't feel that capping the capacity levels will disadvantage patients specifically. If there's a need and we manage to achieve the 90 per day cap, then we'll be looking to extend that still further, but we wanted to set a reasonable planning level. Clearly, we need to give the operator of the UTC and the A&E department figures to work to in terms of the number of redirections that we can receive. And we just feel that giving a fixed number gives some certainty to the system, but we will monitor it and see if we need to increase that level. Any more questions anyone you asked? Okay, thank you very much. I would like to ask one question. Can you give me the quality of care is maintained or improved as urgent care is redesigned and is there not just a cost of cutting efficiently measured? Do you understand what my question is? No, I don't think. I think this initiative does both. I think it brings value for money. It brings benefit for patients because what you're bringing here specifically is you're introducing the ability to redirect at an earlier stage. At the moment, what happens is the patient goes all the way through into the UTC. They have an initial assessment. They have to walk down to UTC. They then have to register. They then have to have a triage session. And then they get offered a chance to go for a redirection. Now, the advantage of redirection for a patient is that they can go to a practice local to them or local to the A&E to have a booked appointment slot. And the feedback that we're having from patients is that they're very satisfied with that service. In fact, I can share some of the patient satisfaction results with this committee if you'd like after the session. So, I don't think we regard this as cost cutting. I think we regard this as trying to find appropriate value for many. And, as I say, this should really benefit patients. I think the ability of the pilots to be able to provide the more comprehensive service, which means that patients don't come back, is really critical. The fact that they can order all of these tests and make these referrals. The fact that they're having access to the patient records. This, in our view, is a far more beneficial service for the patient than the current mechanism. So, we don't view this as just being an attempt to cut costs. Thank you very much. I would like to ask one more question. Is it okay? Sure. How have you considered or incorporated all technology to assist, be a factor in that redesign for improving same-day access to care, particularly on the transaction activities? Thank you very much. Yes, a couple of ways. First of all, we're in conversation with the Royal London about some digital access at the Royal London front door. That's a conversation that's happening at the moment. That will allow patients to, or some patients, to book in quicker and save some of the queuing that might be experienced. That's in discussion at the moment. Also, as I was mentioning, we're using the best technologies now to actually allow our same-day access service to access records and be able to do all the functionality of a practice. The current service doesn't do that. They see an abridged version. They're very limited about what they can do. So, what we're doing is using that technology to try and enrich the consultation that the patient has through our same-day access service. We'll be looking, the other area, of course, is in NHS 111. I'm not part of that, of those negotiations or process. But I think, as part of that procurement process, they'll be looking to optimize the use of technology with NHS 111 to improve that service through the re-procurement. Okay. Thank you very much. Thank you, Councillor. Do you have any comment? Thank you. Thank you, Mr. Chair. Thank you for your nice presentation. Definitely, it's beneficial for us. And this paper actually shows how NHS services locally deal with patients who need to be seen on the same basis. We have population growth. We have lack of workforce. But how patients will see a better service under the new service. And I hope our discussion will be centered on looking for how patients will see a better service under the new service, new system. And it should be focused. Thank you. Thank you. Thank you. Thank you very much. And I am extremely grateful to the officer for bringing this to the committee. We can see that the same-day care is aiming to transferring the healthcare for providing timely, efficient and patient-focused treatment. reducing unnecessary hospital admission and enhance patient experience. I hope it is ensured that care is both high quality of accessible and ensure that patients receive the care that need what they need in. Thank you very much for your time. And thank you very much. Thank you. Our last item this evening is focusing on hospital discharging services which particularly impacts some of our adult and senior residents. I understand there is a number of processes that need to happen, including evaluating the patient health and care needed, and discharge plan, coordinating with the health and social care, supplying information about the medication and follow-up appointment, and arranging their transport of home or another care facility. For this meeting, I would like to welcome Councillor Goulam Kibriya, Cabinet Member of Health, Georgia Kambani. Welcome. We have to 10-minute… Julie Dublin, NH Tower Hamlet. I hand over to you. Your time is 10 minutes. Thank you very much. Thank you very much, Chair. Hello, everybody. My name is Julie Dublin. As I have been introduced, Senior Program Manager for Unplanned Care. Excuse me. So, I have been here once before to bring this particular item. It is one of the key priorities for the Tower Hamlet's Together Partnership Board. Jonathan referred to them in his presentation, so we both have to go to this board to discuss their priorities and just give an update on where we are. So, facilitating discharge… One of the key things around the discharges is that everybody is fully aware that it is one of the final things that people do on leaving hospital. And their experience after their hospital stay, as far as the discharge is concerned, can vary depending on what the individual's needs are, both in terms of the acuity of their condition on entering hospital and how they are on leaving the hospital. The other thing that impacts on their discharge will be where they are actually heading. In the paper, I've actually described four pathways. Pathways zero to pathway three. Pathways zero and one, they're really the kind of pathway whereby you're suitable to go home. You can go home and you can look after yourself. You don't need additional support. You don't need transport other than the people to pick you up, to bring you home. But those patients in pathways two or three are much more complex. They're even needing short-term beds in some more intermediate care places and short-term packages of care. But with the complex patients, it's either… They will go home with packages of care, equipment support, or they will also end up in a residential bed. So, these are the things that we're trying to address through the transformation program. We're trying to address every single aspect. But as I've said, as we progress through our caseload, we can see that some people need more support than others. I just want to flag with you at this stage that this paper only deals with adults. Children are not part of this conversation and also mental health patients. So, it's just dealing with people being discharged from hospital and they are adults. So, what you'll notice in the document, there are five areas that we… Six areas that we talk about and that we want to address through this transformation program. And addressing risk-averse decision-making and over-provision of home-caring pathway one. Then there's also improving knowledge of discharge to assess. Improving engagement with families and carers. Addressing the complex discharge issues early in the planning process. Streamlining and accelerating process for reviewing high-cost packages of care. And encouraging better use of re-ablement services. Reducing inappropriate referrals to promote goal-focused therapeutic input in re-ablement. I felt it was helpful just to remind the body about the areas that we want to cover in this particular transformation area. Just to remind everybody that the stakeholders involved in the discharge include both the local authority through adult social care. The equipment services, brokerage, and also the acute hospital, community health services as well. And with adult social care, we're also… The re-ablement and rehabilitation teams as well are also involved in this. So, you can see it's a very multi-disciplinary team approach around the discharge process. We have a discharge, what's called the Transfer of Care Hub, which has been rebranded by Royal London from the Integrated Discharge Hub. So, people may be familiar with the IDH, as it was called. And the Integrated Discharge Hub is the service where all the stakeholders are involved as a multi-disciplinary team to enable or support people to be discharged from hospital. We do, there are challenges, and those challenges tend to be around finding the most appropriate place for people to be discharged to, particularly those who are going home, be their house or a care home and the care home for the longer term. The challenges we face there in particular are around finding the most appropriate setting for those individuals and also trying to deal with their families as well, who are quite particular about where their loved ones actually go. So, it's either they want to… And if you know about our hamlets, we are quite limited as far as the stock is concerned. So, in some instances, some of these patients do end up going out of borough, but close enough to their family, if we can get that for them. So, then the other area as well is around equipment. So, last year we had some real challenges with equipment, and particularly during winter, we ran out of stock. We didn't run out of stock, but the provider ran out of stock. But this year, that has improved greatly, and there's some data in the pack to actually attest to that. So, just being able to access equipment in a more timely manner has been… … in a much more efficient way. I just want to mention that as far as some of the activities are concerned, some of the things that we've been able to complete are actually described on the project plan at the back attached as Appendix 1. There are some areas that are closed, but there are some significant areas that are in progress, and you can see that that's spread between the local authority and Royal London Hospital Transfer of Care Hub. This work is in progress, so it's not to say as if nothing is really happening. So, for instance, there's a project called the Optimum Handed Care Pilot, which is being piloted on the 14th floor at the Royal London Hospital. And the whole purpose of that particular pilot is to try and enable providers, and so will discharge patients much more sooner. We've had an opportunity around updating the patient choice policies where patients refuse to leave hospital in order to facilitate a patient's discharge. And that piece of work is complete. The hospital doesn't use the choice policy as a, you know, willy-nilly for want of a better expression. They would prefer not to if they didn't have to, but particularly during winter, it's a real challenge. So, one of the things that, you know, we've just been talking about A&E, for instance, and the activity in that department. If we can't discharge patients out of the hospital, the front door gets affected, and our ability for them to go, which is an appropriate setting for them. So, some of the things that we have to do in the, in the not-too-distant future is we need to, I've included on the final slide of this document, which includes, there's some integrated work, more integrated work with adult social care, and acute hospital come back again. Okay, thank you very much. Thank you for your nice presentation. Do you have any member, any question? Please raise your hand, please. Yeah, Councillor Iqbal, anyone? Yeah. Thank you, Chair. Thank you for your question. One second, one second. I think you've touched on this in about… Can I just take the note first? One second, please. Yes, the one man. Amy. Yes, you can, Councillor. Thank you, Chair. So, I think your complexity. So, where we have a patient who's homeless, there is the Pathways Homeless Team, which is really well established in Cowhamlets, and they're very linked into the transfer of care hub. The Homeless Pathways Team, depending on your status, so if you're known to Tower Hamlets, the pathway is that you come to the housing team here in the hospital, sorry, in the instance, and then longer term accommodation if needs be. If there is, if it's a family, then that's a little bit more challenging, but they will endeavour to find temporary accommodation. If you're not known to Tower Hamlets and you're outside of the borough, then that's much more unity, like routes to routes and praxis, so that they can identify where this person has a relationship, and then they do what's referred to as a duty to refer back to the borough. So, if you've come from Chelsea, there'll be a duty to refer back to Chelsea, and then we wait for Chelsea to say that they'll accept this individual. We do have escalation protocols in place, because one of the things that the hospital is challenged with is actually getting people at the hospital. So, they will contact people like myself, for instance, to ask for some support for us to contact our peers. Thank you for your presentations. Thank you, Chair. How does the hospital discharge service ensure effectiveness communication between hospital teams, community services and social care provider? Fortunately, the team, it sits in one service. There are representatives from each of those services within the IDH or transfer of care hub. It's a multidisciplinary team, so in terms of being able to have those conversations in the moment, they are there. I sit on an escalation call every day, Monday to Friday, for 15 minutes through the list. So, obviously, the social workers will plan ahead, so that they can be up to speed with regards to what's needed for these patients. And then, when they come on to the call, we have a much more detailed conversation around trying to, you know, put the measures in place to get people discharged. So, the communications are in place. And, obviously, the information sharing works in a way. Thank you. Next question will be our Councillor Amy from online. Thank you, Chair. And thank you for the presentation. It's really useful. You've talked about sort of being able to have trust and faith in each other. And I think that's the different organisations. And I think that's really important. And I think there's something in the papers about, as well, just improving communication, improving relationships. And the council has just touched on it there as well. So, I'd just be interested to hear from the lead member what part the council has played in this. So, what we've had to step up as a council to improve on our part. But also, overall, how we are working to make this process more streamlined and easier. Because, as you say, it's such a challenge. So, I think there's a, and there's clearly, based on the action points, there's a huge role for the council to play here. So, I just wonder if we can hear from the lead member about what is happening on our side of things, from a council perspective, and what's being done to improve this. Thank you, Chair. Thank you, Emily. It's a very important question for us. We know, is hospital discharge effective and it's crucial for ensuring patients' transition safely from hospital to home or other care settings? And mainly reducing delays and improving patients' outcomes. And our key priority is, include is timely assessment and coordinated care planning and setting collaboration between health and social care and with hospital. We are doing this. Thank you, Chair. Councillor Lee, yes, Councillor Childers has described, and what I would add is one of the ways in which we are improving communication, and I think Julie referred to this, is embedding ourselves within the hospital in terms of how we work. We work very closely with our NHS colleagues. I think sometimes it's actually quite difficult, particularly in the integrated discharge hub, to be able to determine actually who is employed by health, who is employed by social care because of the fact that we work so closely together. So, that improves our communication where we actually work as one. Whereas, if I think back to, I don't know, possibly 15, 20 years ago, there was a very, very big divide, and it was, in a sense, almost them and us. But now, that's why we use that term in terms of integrated, because actually we recognise that when somebody is in hospital, and they're going through hospital, and they're subsequently leaving hospital, you can't really separate to say these are the health components, these are the social care components, because it's one individual. So, it's important that as professionals, we also work in the same way as well to ensure that we have that integrated support offer to people. So, that's just an example in terms of how we keep that communication, and I think, as Julie's described, it's co-location where it's appropriate. We also have regular daily meetings. So, there's all sorts of things that we've put in place, and actually, we know that that works particularly well, because of the fact that our relationships are continuing to develop and continue to get stronger as colleagues across both health and social care. Thank you. Thank you very much. Thank you. Next question, Councillor, Mark Pontius. Thank you very much for the presentation and the update on where things are at with this project. So, I think, since we last talked about this, I'm aware of, I've had other experiences around discharge, and talked to other families who have similar experiences themselves. One of the things, I think, is obviously around the setting that people are being moved into, and the sustainability of that, I guess, and the range of options that there are, both in terms of the nature of the setting that people might be moved to, whether it's respite or, I guess, the extent of care needs that can be supported in each of those places. But then, the other aspect of this is about whether people can be discharged into their own home again, and what needs to be done to make sure that they are safe in their own home, and are able to, in some ways, to live independently, or to live independently with the support of care services. So, just on those two things, is the team here satisfied that we have the right range of options for people to be moved into, if the move out of hospital is into a care setting? And if not, what are we doing to try to anticipate what other options might be made available, or whether there are partnerships with other boroughs that we can undergo, or that we can explore? And then, the other thing is around the adaptations within our own home. So, my observation, as a ward counsellor, is that it can be quite a protracted process for somebody to have adaptations carried out within their home, especially if that's a housing association, but even more so if it's a privately owned or privately rented, privately owned, let's say, accommodation. So, I just wondered if there are any thoughts about whether there are any, are there blockages there as well within the system? And if so, is there anything that's being done to explore how those might be worked through more quickly? Thank you to remind me of some of those questions, if you don't mind, please. Is that okay? So, going to the first one. So, the local authority here in Tower Hamlets adopts a home-first policy. Okay? So, their first intention is, if you're from Tower Hamlets, they would prefer you to go home, wherever home is. So, and then after that, there's a discharge-to-assess model that they've adopted here. So, those discharge-to-assess principles, they'll undertake an assessment, which then determines what your ongoing needs are. And that's after that, that's post-discharge. But whilst you're in hospital, whilst you're in hospital as part of your discharge process, there are assessments that have been, that have taken place. And before patients leave, they will leave with a package of care. Well, to understand, first of all, is that level correct? Or do adjustments need to be made? And sometimes those adjustments are made down, because in the action plan, trying to address that. When it comes to adaptations, there are challenges with adaptations, because of the nature of the tenure that people may have. So, if you go into some of the social housing or private house, we need to work very… So, if that delays the discharge, we then have to think about… You know, we use HUK, for instance, they have a handyman service, and they can do some adaptations for us, not all of them. So, there are lots of negotiations that need to happen with the relevant organisations. Do you mind me some of the other questions? Well, Michael, that's a picture. So, thank you. It's really helpful to understand how it looks, what it looks like from a kind of a systems point of view. So, on the adaptations point, so I think we have a really high quality housing occupational therapy team here in Tower Hamlets. I'm, like, always massively impressed by the quality of the work that they do. They also seem to me to be a team that's under incredible pressure, just a relentless number of people that are coming to them. There's always a queue, whether that's a queue for adaptations within the home, or whether it's for assessments about whether people should have priority for a move and things like that. But I don't see… But I think, you know, within the context that there is a queue, and people have a kind of… that that's managed and prioritised and triaged. But I also see much more social landlords who are very slow at taking forward the implementation of the recommendations from our Housing OT team. And so, I guess I'm just… Like, and I've seen that on individual cases where people are waiting for a discharge from hospital, or a discharge with a package of support, but then that's not sustainable without some adaptations within their home as well. So, is that something that's being looked at as part of this to try to speed up those social landlords in the way that they implement the adaptations? Yes, we are looking at that, Councillor Francis. And, in fact, your question has just jogged my memory, because actually November or early December, actually, when I was speaking to a group of our occupational therapists, and that came up as an issue. And it's variable. Some social landlords are very responsive, some are not. But we certainly have an escalation route by which we look at it. Sometimes it's particular cases, so, you know, some adaptations are particularly complex, and so forth. But, as I said, something we do look at, it's variable. So, I wouldn't be able to give you a definitive to say there's no problems. Yes, sometimes there are problems, and sometimes, actually, you might go for a couple of months with things going quite smoothly. But I think the most important thing is there is a means by which we escalate, and then we keep an eye on terms of how things are progressing. The other question was about, so I understand, as a first, or as the starting point, it should be discharged to home. But that isn't always possible in the circumstances that some people are in, whether it's here at Royal London, or our residents that are at Whips Cross, or somewhere like that. So, are we exploring whether we've got the right range of options in terms of homes that people can move into, that provide a variety of different levels of support, whether that's sheltered, old school sheltered, independent living, whether it's higher care needs, that kind of all. Yeah. So, yes, we have sufficient range of options when people are leaving hospitals. So, we have, for instance, re-ablement, which works incredibly well. When we look at our data in terms of people's outcomes, once they go through re-ablement, they are really good. We have what we call step-down beds, for instance, where somebody might need a period of, you know, recovery. But in a more formal setting, such as a care home, for instance, the demand for the different options varies. Seasonally sometimes, sometimes not so much. And what we try to do is almost step up and step down, so that we have low levels of voids. Because what we don't want to do, for instance, hypothetically, is buy a huge amount of step-down beds, which would mean that we would guarantee that we would use them and pay a certain amount of money to the provider, and then find that those are under-occupied. So, we always try to give ourselves a level of flexibility where, if we need more, we have the ability to step up. If we need less, we step down. But, yes, there are a range of options. Extra care sheltered is one of those options for people who can no longer live at home. So, we explore our options depending on people's... Thank you. Can I just add a little bit more onto that, please, Georgia? We also, what we don't talk about here, really, is the homeless patients. So, for those homeless patients, what we do have is Gloria House, the six-bedded unit, and it's for town hamlets patients that are homeless. And they're able to stay there for a period of time. There is time limit. Thank you. I really appreciate those detailed answers. I'm going to have a think about it a little bit more and speak to a couple of constituents and other people that I've spoken to, and maybe you can come back offline on some of those points. Thank you. Thank you very much. Thank you. Our next question will be to Councillor Ahmed El-Kabir. Thank you, Chair. Thank you, Julia. Thank you for your lovely presentation. And, as you know, when we discharge patients, we have another key issue, which is transportation. And how are your non-emergency patient transportation service arranged, and how long does it take? That's the one question. And, also, I will do the second one afterwards. Or generally do it, yeah. And, are there alternatives for the patient who are not qualified for the hospital transportation, but still need assistance? So, with regards to the second question, I'm not, I can't answer that question, because I'm not aware of any challenges around transportation. So, thank you for bringing that to attention. I can go and find out an answer and come back to you if you don't mind me doing that. But, the very first question, in terms of arrangement, patients who have been discharged from hospital and require transport, that is arranged as part of their exit plan. So, they have what's called transport medication and other things that they use to ferry people home from hospital if they need to be. There are some that can make their own way home through friends and family. But, where people do need patient transport, those are definitely organised by the hospital. How does it take? How does it take? How does it take? If the patient's been, if there's an expected date for discharge, it's planned for that day. Sometimes, when we look at the medically optimised list, some of those, there are delays that are introduced because probably the transport was busy, or the transport, they didn't have sufficient people to convey that patient because patients, particularly if they're going to have to go up a flight of stairs and there isn't a lift. So, that would just be a one day delay from, and that's for the patient. Any more question? Yeah. I know, it's one day, it's very long for me, you know. Look at this, you discharge the patient and they expect to need to go home. And if you take that long, is it any chance you can improve this service? I suppose it's to do with timing, the time of day the patient is going. So, but, if we can look at that and see what improvements can be made, if they can't go at 4 o'clock today, then one would hope that they go first thing in the morning as a golden discharge. Of course, if we, I mean, improve this service, it saves the beds and saves the many things, you know. Yeah. Thank you. Thank you very much. Thank you. Do you have any question? You want to go online? Yes. Yes. Can you hear me? Yes. Yes. Go ahead. Yes. Okay. What I was going to say is like, you know, all the adults who fell and go to hospital, but they have no members at all at home to take care of them. So what happens to those patients, elderly patients to come back? Do they remain in hospital, social care, or do they send back by alone again? I just wanted to know what happens to these patients. So if a patient has fallen, what happens to them? Those patients. Aliya, can you repeat your question again, please? What I was going to say, I was saying, say like some older adults, right, they're home, but they don't have any social care to take care of them. So they are home alone and they end up in hospital somehow, right? But they do take care of hospital and everything. But they eventually they have to come home, right? How does that happen? How do they, these people, what happens to them? What happens to them? What happens to them? What happens to them? Those patients. Aliya, can you repeat your question again, please? What I was going to say, I was saying, say like some older adults, right, they're home, but they don't have any social care to take care of them. So they are home alone and they end up in hospital somehow. Right. But they do take care of hospital and everything, but they eventually they have to come home. Right. Who, how does that happen? How do they, these people being taken care afterwards when they come home or what happens to these patients? So when the patient is being discharged, social workers are involved. They are assigned a social worker and a package of care is, is put in place to support. It's put in place. Okay. Sorry, there's a big home. So does the hospital organize this for them or how does this be organized for this patient? So the transfer of care hub works in conjunction with the social workers. They've determined that a patient is elderly, they've had a fall, they're going to discharge. Hospital, OT, therapists are involved in assessing what that patient's needs are. Social worker will work with the patient to determine what level of package of care they need. So they may need a three day package of care depending on how badly they injured themselves on their fall. And that would mean that the social worker will contact the appropriate home care providers. And a home care provider will go out to them on, at particular times in the day. So they coordinate very closely with social care and the home care provider. Okay. Thank you very much. Thank you very much. Thank you. I've got, I've got, I can ask one, two questions. First question, what is the average time to take in to arrange a social care package for the patient requiring them? So, because it depends on their need. We have patients on a couple of different pathways. If you've got a really complex patient, they're on the advanced discharge planning. And so that, the advanced discharge planning for instance, is the kind of pathway whereby they will start organising your needs whilst you're still in hospital. So they can work up towards your expected discharge date. What they will then do, they will work very closely with the social worker. So the social workers in Tower Hamlets are, I have to say so myself, very efficient. And so they could turn around the package of care within a day if, you know, if they know the patient and the patient has changed to their package of care. Or they could take a day if they don't know them, if they're new. So as soon as they start working on the case, they're very, and they get familiar with the patient, they're able to turn around packages of care quite quickly. Okay. Thank you very much. Thank you. I would like to ask, what specific plans are being introduced to tackle to the delay caused by nursing and care home placement? How effective has this plan been so far? Thank you. So at this stage, I would like to say that, can I, I'd have to come back to you, Councillor. I can answer that too. Yeah. So some of the things we are thinking of doing, we are looking at a trusted assessor model. So a trusted assessor model in other areas of the country, certainly in areas where I've worked, helps to reduce delays as a result of care homes. So what you might have is, instead of having each care home coming to assess on its own. So if you had, for instance, six care homes, having six different people come to assess, you have sometimes, there's different models. So for instance, in Essex, they had a model where they had a nurse who was based in the hospital, who would undertake the assessments on behalf of all of the care homes. And they called that a trusted assessor model, and those assessments would be sent to the care homes, and the care homes would then be able to receive patients based on that assessment. So that's something that we haven't started to yet, but we are looking at different models of trusted assessor as a way of reducing that. But before we introduce the trusted assessor model, what we do do is also give care providers very clear time scales by which we expect them to come in and assess. Because sometimes, if you don't give them a time scale, they might not be, they might not recognize the pressures that the hospital are under. And they might take, it's not inconceivable, you know, sometimes three, four days, or even a week, which can make a big difference to the hospital. Thank you. Any more questions? Do you remember any questions? No? Okay, thank you very much. And I welcome to the good work we do, and for me, there is still opportunity for us to work better, and the goal must always be to ensure that our resident patient receive the appropriate care support they need after leaving the hospital so as to reduce the risk of readmission. Before we move to close the meeting, I have some updates that share under the AOB. We have the second scrutiny review, our maternity service and support for new mother, which will be taking place on the 10th of February, 2025, which will be hearing from Southwark Maternity Commission and Family Hub Service. We also have a final session, which will be on the 25th of February, 2025, which will be focused on gastroenterology diabetes impacting Bangladeshi and Somali women. I hope and I can encourage members to attend that support this. Our next normal subcommittee meeting is 8 April, 2025, so with no other business to discuss, I will call this meeting to close. Thank you, school to remember, officer, your attendance, and thank you very much for your support, and good evening all. Thank you.