Transcript

Welcome, everybody, to February Health of Hackney. In terms of apologies for absence, I've had lateness from Councillor Rathbone, who'll be joining us in about half an hour. In terms of the usual announcements, the meeting is being recorded, it's being live streamed, we've got members of the press in attendance, it's obviously a hybrid meeting, we've got members of the chamber, members online, for those online, please keep your microphone muted, unless it's your item and you're speaking, please don't start conversations in the chat, and when you are speaking, please kindly put your camera on. In terms of declarations of interest, can I take any, Councillor Lynch, I know you've indicated one, declarations of interest? It is on my declarations of interest, but just for those in the chamber and online, that I should declare an interest that I am currently employed at the London Borough of New Adults Health and Care Directorate. Thank you. Thank you. Now, in terms of the agenda, I have members, I've asked Kirsten Brown to come along, who is the new Clinical Director for City and Hackney. Congratulations, Kirsten, on that appointment. We're very happy to see you in that role. Primarily because there was some concern that we've been aware of the last few months about enhanced primary care services, and whether they were going to continue or not, and what they are. So, I've taken the opportunity to sort of bring it to the top of the agenda, because Kirsten, I think, has already done a couple, two or three late nights this week already. Because she's very kindly come to just give us a quick briefing as to where we are up to it. I'll then go through the agenda as normal, and then at the end, I see our colleagues from NHS England here. Welcome. We've obviously been in communications in terms of something you've been asking of the Commission. So, what I propose to do at the end of the meeting is just go over what I've said in relation to that, and then, Carol, I'll give you the opportunity if you want to say anything in reply. Okay, so first of all then, can we go as sort of like an unscheduled but urgent item over to Kirsten. Kirsten, could you just give the committee a very brief explanation about what are enhanced services, how much money we're talking about, why they're so important, and where we are on possible funding for the next year or so on them, please? Chair, I think we just do a quick clarification. You said we've got our colleagues from NHS England. I think you mean our colleagues from Keep NHS. Sorry, Keep NHS public, sorry. Yes, yes, because I was sort of, you know, having worked at NHS England, I was nervously looking around, thinking, do I know anyone? Thank you for the clarification. Yes, I'd be surprised if they were anyone. I'm getting my activism issues. Thank you. Right, okay, over to Kirsten. Thank you. Thank you very much. So just a clarification, currently I'm still the primary care clinical lead. I'm starting in the clinical director role from the beginning of March, but I'm very much looking forward to that and looking forward to working with you all. So an update in terms of the City and Hackney primary care enhanced service contracts. So there are 13 GP enhanced service contracts in City and Hackney, and these are commissioned locally. So they're on additional money on top of the core GP national contract. And these cover services such as duty doctor, proactive care home visiting contract, which we proactively visit our most vulnerable patients at home four times a year. Early years, long term conditions, mental health, there's a whole range, and that's just a few. These have been commissioned in City and Hackney since 2018, primarily through the City and Hackney Confederation, and now through the City and Hackney integrated primary care. And what we've seen with this additional resource is this has been invested directly into workforce. So it means that in City and Hackney, we have more GPs for our patients than not just in Nell, actually, but across London. And we're one of the highest, we have one of the highest numbers of GPs across London. We provide more appointments than elsewhere in Nell. And we are really delivering excellent outcomes for our patients as well. So not only do we have, it means we've got a really sort of sustainable model for primary care, sort of a resilient and viable primary care. It also has massive impacts on the system as well. So in terms of we have very low 111 calls in hours, we have fewer A and D attendances, and we have really high quality referrals. And the Homerton are very supportive of these contracts. And I talked to the board at the Homerton last year, and they really do see the impact these contracts have on their services and the services they can provide for patients. So these contracts have been commissioned for seven years, and the contract runs out in April 2025. So literally in six weeks time. The issue for Nell is the current financial climate, but also the fact that the seven different places within Nell have very different primary care local enhanced service contracts, and very different levels of investments across primary care. And City and Hackney is one of the highest areas of investment. And I can't remember off the top of my head what that figure is, but we are one of the highest. And I think from Nell's point of view, they're worried about that, the inequality that is creating across Nell in the primary care landscape. What we know, I don't have a firm confirmation of this yet, but what it does look like is going to happen is all local enhanced service contracts with GPs are going to be rolled over for one year from April. This is still going through the various committees at Nell level, but I'm fairly confident that this is going to happen. And so then what that leaves us with is what happens in the next year. So the primary care team within Nell are going to be reviewing all the enhanced service contracts within Nell, not just in City and Hackney, but across the seven places. And they'll be deciding, right, which contracts are really delivering on outcomes, having an impact, what should be rolled out across all places in Nell, and what should be decommissioned. There will be what the primary care team have indicated that there will be an overarching long term condition contract across all places. So that's something they're going to be working towards over the next year. And after that, it really depends on the monies. So I know that the primary care team in Nell really do want to level up the other places to the kind of investment we have in City and Hackney and in Tower Hamlet. But that will require investment. And in the current financial situation within Nell, obviously that's a difficult ask. I think it's very unlikely City and Hackney are going to get any more money in that process. What we've got to hope is that we don't have investment taken out of primary care in City and Hackney, because that's going to be really destabilising, not just for GP practices, but I would say for the system as a whole. So that's where we're at. I hope that's sort of clear for everyone, but I'm happy to take any questions that I can answer. That's really helpful because that's a great overview. And thank you very much. I think, you know, from what I've seen since 2018, this is really prevention in action in City and Hackney. And, you know, you've alluded to it as well. I mean, we have a homitom with some of the shortest waiting times in A&E and a very active GP core who are comparatively better funded. So, yes, I think just in terms, I've got a couple of hands. I know you've got limited time, but I'll just say at the outset, members, I think this is something we're going to come back and put back on the agenda in the next few months or an appetite time. So we can try and feed into that conversation as to that it should be levelling up, not us levelling down. So, Council Lynch. Thank you, Dr. Brown. And I just wanted to just emphasise having sort of professional experience in another borough. They have something called the Newham Extended Primary Care Team. And within that is like a single point of access. And then you can get in touch with the community nurses, all of the other sort of community things. And I was just wondering, in terms of what we've got in Hackley, you talked about the workforce has gone into GPs, which is great. But one of the things that I guess is probably there is around the nursing workforce and where they sit, because my understanding is that at the moment, Hamilton Healthcare are the providers for obviously acute nursing and also for the nursing as well. And I guess the model we've got, I know, probably is not to be disrespectful to any other boroughs at all. But I guess it's within other boroughs, it's just to emphasise to members that what we have in Hackney, we should try to hold on to, because you've got one provider, NHS provider doing all of that. Whereas in other boroughs, you'll have a different provider doing acute services and you're doing a different provider, a different provider doing community services. And what happens is that sometimes despite lots of thinking around having discharge hubs and stuff, it gets very, very confusing when you're actually working in that. And I think for me, I just had to do lots of steps, essentially, in my work, because there's not been that single point of where to go, even though it looks like you've got this stuff, because I think there's different, there is, like you say, inequity. But for me, I would really like to feel that we could, we could use the model that we've got here to do that, because I think for practitioners out there, if you just have one phone number to call, rather than just individually waiting for 10 minutes to call a GP, does that make sense? Because I've actually literally had to do that this week. Yeah. Can I just bring in Councillor Adebayo now as well, and then just go back to Kirsten, and then I'll draw it up. Thank you, Councillor Lynch. Thank you, Dr. Brandt. That was very impressive. And my concern is about the funding. You say the funding is coming to an end at the end of April? So, the contract is coming to an end at the end of April, currently. And it looks like that all these contracts will be across North East London will be extended for another year, although I don't have 100% confirmation on that, but I'm pretty confident that will be happening. Oh, thank you. And then, Kirsten, did you want to say anything in response to Councillor Lynch's observations? Yeah, I do agree that we are lucky in sitting Hackney with our geography, but also that we do have the second care provider we do, and the fact that they also provide our community services. I think that means we've got really good partnership working, and we can do that through our neighbourhoods. And I think what the enhanced service contracts do mean that GPs can really engage in that, and be part of that, and allow that real integrated working across primary, secondary, and community services. So, I do think we are lucky in sitting Hackney. Thank you, Kirsten. We asked you to come along for a brief period, so I'm going to bring this item to a close. I think we've obviously got Councillor Kennedy's on the ICB board. If it is going to be reviewed in the next year, I think, as I say, at a certain point, we need to see if we can actually bring some of those who are making the decision at an NL level here, and have a conversation about the possibility of levelling up. And it also feeds into the conversation we've been told that funds will be delegated to place for us to be able to choose what to spend the money on, and this is slightly countered that as well. So, I think there are lots of debates to be had there. I'm curious on just one other thing, because KMP have just been asking us in terms of any other sort of savings or cuts that are happening locally, other than this possible risk coming forward to enhanced services, from a GP primary care perspective. Are you aware of any other sort of significant cuts to services that you're aware of, or is this the most significant one at the moment on the right? This is definitely the most significant. I'm not aware of any other cuts to primary care services at present. So, no, this is definitely the most, this is where we really need to focus our attentions. Thank you. Well, thank you very much for coming to brief us, and then when you are formally in post, I think maybe in four or five months, I think, when that review is mid-go, we can bring this item back. So, thank you very much indeed. No problem at all. Thank you very much. Take care. Thank you. So, with that, I'm then going to go on to back to the agenda for the first substantive item, which was item number four on the agenda in terms of the adult social care improvement projects. Thank you, everyone, for the presentation there. We can see there are four work streams for that. And we're joined by Kat Buckley, who's the Deputy Head of Transformation, and also Helen Woodland. I understand Georgina Dibber has given her apologies for tonight. Thank you for the presentation. I don't know, Helen, do you want to say some words and then hand over to Kat, or is Kat presenting? Yeah, I'll just very briefly introduce, if that's okay. So, at the last scrutiny meeting, we talked in detail about the Transforming Outcomes programme, the portion of it that we're delivering jointly with our partners in Newton Europe. And what we wanted to do is come back and talk about the other half of the programme, which we are delivering directly through our own transformation team within adult social care. Just to put in context, although we'll talk through in more depth all of the work streams there, it's not the only work that we're doing both to deliver efficiencies and transform the way we work in adult social care. We have additional work that we have talked about around mental health, the separate work streams, which we aren't covering in this particular presentation, but happy to come back in the future to this group and talk about that if they would like. Thank you, Helen. I think we may well take you up on that, but let's move on to the full work streams before us now. Thank you and thanks, Helen. Yeah, so as you said, I'm Kat Buckley, I'm the Deputy Head of Transformation. I'm just going to share my screen and... It's lovely to see Grace, but... Hopefully. That's coming up. Slow. Okay. So I'll skip over some of the context because these are the same as Helen just outlined there. The Transforming Outcomes Programme is in two parts, and we're specifically looking at the service improvement projects today. So the four projects are as in this slide here. So looking at carer's strategy, developing a carer's strategy, redesigning our tech-enabled living service, redesigning our DFG adaptation service, and DFG is the Disabled Facilities Grant, and reviewing our care charging policies and process. In terms of where we're at with the oversight of those four areas, the two that are there kind of greyed out are those that have now moved over to business as usual. So at the end of last year, tech-enabled living is now within its procurement stage, and I'll talk about that in a bit more detail, and the carer's strategy was published in November. The other two are ongoing, and we've got clear deliverables working towards September later on this year. There's a lot of words on here, so I won't cover it off in total, but in general, we're trying to explain what it is we're trying to achieve for each of these, why it's important, and what it means for residents. So we know we wanted to develop a carer's strategy that outlines what our commitments are over the next three years. We know that carers play a massively vital role, and that the experiences aren't always as positive as we'd like them to be. Technology-enabled living, which you might have heard referred to previously as something like telecare or tech-enabled care, is about looking at how we can use technology to be more preventative. We know that nationally, we're moving across from analog to digital equipment, and it's about improving outcomes in that space. For DFG adaptations, we know that the processes are taking a long time. Currently, there's a lot of hand-offs between different teams, and part of the process is externally commissioned to a home improvement agency, so wanting to bring that all together in one place to make those adaptations to people's homes sooner and keep people safe. And then care charging, we haven't got a local detailed policy. We've had key charging decisions that were last reviewed in 2014. We want to make it really clear about how and when residents are charged for their care, but also make sure that those conversations are happening as early as possible, and increasing the confidence of social workers to have those conversations. So I'll just talk in a little bit more detail about each of the four, and then I will stop. But in terms of the carer's strategy, we worked and engaged with over 160 carers in the borough and working with partner organisations, hearing about what's working well, what doesn't work well, where are their gaps, and themed everything that we learned through that into some key priority areas, which are those that are there in the green boxes. Putting that together as the structure of the strategy, looking then at what it is we want to be delivering over the next three years. And as I said, we published and launched the strategy in November, and also developed a sort of two-page summary, which I've linked on the slides and is also on the website. That's now moved over to business as usual, so it's no longer part of the Transforming Outcomes programme. But each of the commitments that are outlined in that strategy are now being developed into an action plan that's being overseen by the Hackney Carers Partnership Board. And we'll have clear kind of, yeah, across Hackney Council, but also the other organisations that we've been working with to develop this as it's a joint strategy, clear actions, leads and timescales. Can you just give us maybe a clear example as to how that's made a practical difference, you know, with a carer or with a resident, something that's maybe tangible that we can sort of grasp? Yeah, so I think in general, I think we know that we want to be having a clear, we want the carer service that we commissioned to have a clear remit of engaging a diverse range of carers. We know that ultimately what we've heard is actually people even identifying themselves as a carer, because often you're somebody's family member or partner or friend. And actually, how are we working towards recognising and helping people kind of self-identify as a carer so that they know that there are support services available? So the carer's service is currently under recommissioning. And so we've taken some of the learning from this into that new service specification so that we can work with the new provider on doing more of that kind of awareness raising and recognition is probably one example. So, in terms of technology enabled living, we had a small project team looking at testing and reviewing some of the potential benefits. I think you can see a picture of some of the equipment there. Having digital solutions means that we can have things like GPS trackers and it's not tied to analogue equipment that's attached to somebody's phone line in their own homes. People are able to go out and use equipment in the community. The team have done a lot of work engaging staff, developing resources, training, expanding the offer of the equipment that we have available to us and now run weekly drop-in sessions within the service centre so that people can come, social workers can come, occupational therapists can come, see the equipment and try it out for themselves. The learning from that has been put into, again, similar to the carers, the new service specification. That's currently out for reprocurement. And that service, the tech enabled living service, is putting into practice a lot of the things that we've identified through this project. And we'll look at having not just the equipment, but the call monitoring and the response service, including an assisted lifting service, where we reduce the risks of long lives and improving outcomes for people after they do have a fall. So that now is being led by the commissioning team and, as I said, is no longer part of the Transforming Outcomes programme. The next one is the Disabled Facilities Grant adaptations. So I said at the beginning, it's a lengthy process and there's a number of handoffs. So part of this is currently managed within adult social care and the occupational therapy teams, which is where the referrals come from. And then the application is managed within the private sector housing teams. And then there's the Home Improvement Agency that works as an external provider. And they're bringing all of that together into one DFG home adaptation service that will sit within adult social care and alongside the OT team. So it should reduce the number of handoffs and make that process more streamlined for people, including how we use our systems. So we're going to be developing and currently building the workflow into our case management system within adult social care so that we can track cases. We know when somebody's circumstances have changed and we can respond to that quicker. We've agreed to increase the means test threshold for people contributing to adaptation. That means that there's less residents that will need to go through that part of the process, which sort of makes it quicker for them. And we were able to do that because in practice, there's a very, very small number of people that do contribute to an adaptation after a means test. We've put that together into a new policy that's been drafted and will be subject to approval at Cabinet. And I've worked together with the council stock adaptations team so that we can make our approach to adaptations the same and not sort of tenure specific. And we've also done some one to one interviews with residents that have recently had an adaptation to their home, hearing from them about what's working well. What hasn't been working well and have developed a new sort of customer service customer survey form so that we can build that continuous improvement into the new team as part of our business as usual. The big bits now is bringing all of that together. So from April, the team that currently sit within housing are going to be transferring over to adult social care as part of the first phase. And then we're working with the incumbent home improvement agency provider so that we're in sourcing that service. And that will be the second phase happening over the summer. And then just developing and finishing a business case, which will go through procurement channels around what model we use for actually procuring building works in terms of the actual adaptations that happen to people's homes. We are piloting using a dynamic purchasing system for that. And so the learning from that will feed into that business case. Pat, before you move on, just so I've got that clear, at the moment, the facilities grant, so when there are home improvements made that outsourced to a private provider, but the plan is to essentially insource that entire service. So essentially it's done in house, is that right? So it's insourcing the home improvement agency, which does the like supporting people through the process, being the advice, doing the grant adaptation forms for the actual kind of contracted building work. So actually procuring a stair lift or converting a bathroom into a wet floor shower still needs contractors. So that procurement part that I mentioned at the end is about using sort of a dynamic purchasing system or similar and drawing off that to get the actual works done. So that would be the only part that's sort of still outsourced. Thank you. And then the last area and the last area is the care charging review. So we identified early on kind of issues where things we didn't have clear processes or guidance for social workers in terms of having conversations at the first possible point about care charging and how we could make changes to our core pathway and our mosaic set up. To help staff have those conversations. So we've put in those change requests and they were launched earlier this year and have developed clear staff resident staff and resident guidance and leaflets about charging and about how and where that needs those conversations need to be recorded to show that they've happened. We then looking at, as I said, we've done a comms campaign with staff to make sure that they're increasing the confidence for social workers to have conversations about charging with residents. We've also identified an opportunity to explore doing light touch financial assessments, but the learning and the work that we started to do with that, I think, was picked up that that has a much wider benefit that could work across the council. So that's been handed over to the corporate transformation team. We're now looking now that we've got those changes made onto the system, we can develop a dashboard view so that our care charging team can see earlier where people have been had their support plan put in place. They've got care going in to their homes and then know that they can start their procedures. And we've also been trialling a new finance panel, which will be going on for six months. I think we're in month three now. And that's bringing together operational staff, operational heads of service and care charging staff to manage some of those where our standard interventions aren't happening. So I think some examples are particularly where we're not able to make contact with somebody's financial representative and then agreeing some actions and taking those things forward. So the big, big next bit for this is finalising the care charging policy. So we've done a lot of work looking at what currently are chargeable services, how much of people's income is taken into account. And then we'll take those key decisions to Cabinet in April, May, I believe, and then leading into public consultation so that we can publish a clear policy later on in the year. I think those are the main things. And then the last bit, as Helen said, kind of this is the second half of the Transforming Outcomes programme. And two out of those four work streams are going to be rolling into phase two. And then we're picking up some of the other things that are in our three year plan from March onwards. So I'll stop sharing my screen. Thanks. I've certainly got some questions, but I'll let members go first and then I'll come in. So I saw Councillor Lynch and Councillor Lucas. Councillor Lynch. Right. I've got three very, very simple questions here. I'm actually quite shocked at some of the stuff that is probably just business as usual in most other boroughs. Could you please give me the members assurance that you have an updated eligibility criteria policy and that that includes very clear instructions to practitioners of what is inside the Care Act and how they are able to identify when care provision being provided is outside of this. And I think the LGA recommendations is very much having having a good hard look at hospital discharge arrangements and ensuring there's a fair appointment of costs between the council and the NHS. And actual panels, I would have assumed that these were being done weekly and that in case there's any request for a package of care to be increased, that there is panels very much with the model that you've made up. I was shocked these aren't in place. And also, I think there's something around looking at having a robust sort of brokerage financial team where you are having those early assessments of people. So my professional experience is this is done. This is done regularly, if not on a daily basis, that somebody is looking at those high cost care packages and any social care practitioner that has to go to ask for an increase in package has to go through very senior practitioners themselves. And that there is an absolute exhaustion of other forms of funding. The thing that is inside me a little bit today is around some of the stuff around the uses of technology and stuff, because actually that's actually about promoting people's independence and making sure people can do as much as possible. And that's a quality outcome for people as well, not just a financial thing. For me, I don't see any outcomes that are based on patient experience, resident experience. I don't see any outcomes that have got a financial gain. You are the biggest, the social care is the biggest demand and pressure on this council at the moment. And for me, some of what I'm hearing is, is, is stuff that probably should have been done a long time ago. I'm shocked that the, what was it you said, the 2014 stuff hasn't, is only just being looked at now. Like that isn't just about the fact that we were in a financial difficult position. It's actually about how are we practicing just to get our, for our residents to live long and healthy lives as well. Because I'm, I'm really concerned that it feels to me that these people haven't even been looked at. I'm sure they have, but I just, it worries me when you, when you've heard that we've got this service around the enhanced primary care team. And actually what we've got as well is we've got a service that looks like people have just been on very high cost social care packages without any intervention. I find it incredible that you're having to do training for social workers for them to have that conversation around income. It's, it's part of the, the act like that people are means tested for their care. I find it incredible. I've stopped that. Let Kat come in to reply to that and then I'll bring in councillor Lucas. I think it might be me that's better to respond to that one. So councillor Lynch, I think there might have been a bit of a misunderstanding around what Kat's been saying. So we are absolutely character compliant. When we're talking about financial panels or assessments, we're talking about the financial assessment element, not about the care act assessment element. So we absolutely do have quality assurance management panels that happen on a daily basis where multidisciplinary groups of professionals look at support plans that are being proposed and discuss, test and improve those to make sure that they're both value for money and providing good outcomes for our residents. We similarly have also had and continue to have social workers who are trained to give financial assessment information to our residents. What we're talking about is the fact that we haven't reviewed the policy, the charging policy since 2014. So we charge for a number of things, but there are a number of things that when we were in a better financial position as a council, we didn't charge for. So, for example, we have not in the past charged for pendant alarms, which means we have a substantial number of people who are in receipt of pendant alarms who aren't being asked to pay or contribute towards them at the moment. It's not a large charge, but given the financial position we're in, we may want to, and what we're doing at the moment, reconsider that and weigh up, I suppose, the preventative benefits that they offer to our residents with the likelihood of putting some of our service users who are not actually care act eligible off if they're being asked to contribute a small charge towards those types of things. So I hope that provides some reassurance for the points you've raised there. And Helen, just in terms of the other point Councillor Lynch made in terms of sort of an outcomes analysis of the technology in terms of increased personalisation and quality of life. What are assessments being done that? Are you looking at the outcomes there? Yeah, so at the moment, our technology enabled care strategy focus very heavily on what has been a very traditional offer of a pendant alarm system, which I do have to say our health partners contribute to. So it's a jointly funded and commissioned system. What we are looking to do is to move towards a provider who wants to work with us in partnership to develop more innovative offers going forward, because obviously the world of technology enabled care has moved on significantly. So also in partnership with Oparma and our IT department and Rihana, there is digital strategy that I believe will be going to Cabinet in June of this year, part of which is then looking at what types of new technology solutions are on the market can help us reduce care package costs, but also to support our residents to live more independently. And some of those things we are piloting now, for example, to give our mental health service users more independence over taking their medication. We have apps that can support that rather than having to pay for a care worker to drop in and visit someone. And what we're doing at the moment is piloting some of those proposed solutions to see whether they do in fact reduce care costs and enhance outcomes for our service users. Thanks, Helen. Thanks, Helen. Thanks, Helen. Thank you, Cat and Helen, for coming back to the Commission to give this update. I wanted to ask a question around the Disabled Facilities Grant Adaptation Workstream. I think this is a really important one in keeping people in their homes, making sure they're comfortable, safe, etc. And I appreciate this is why the government has recently announced that 86 million boost on this financial year, which I'd be interested to hear actually as a side note how that's kind of feeding into the current work you're doing. But I was quite struck by the presentation that you shared with the Commission around the current home adaptation timelines. And it says in there that it's taking on average 368 days under the current system. And I just wanted to really drill down into how the Transformation Programme aims to address that and whether you've had a discussion internally on what the optimum sort of... Pardon? Is it a year to get some bedrails and handrails? Yeah. Just what you've had a discussion on in terms of what the optimum time for those adaptations to be turned around? Like, is there a target that's in mind already as this is going forward or is it something that we've been working towards? Just be interested for your thoughts on that. Thanks. Yeah, no, absolutely. So I think in terms of the timeline, yeah, we work and have been working closely with foundations who are an organisation that... I don't know what the technical term is for them, but they work with all the other councils and look at what the best practice is in terms of DFG adaptation. So we work and meet with somebody from there quite regularly. What they have is sort of best practice guidance and it's based... There isn't a fixed timeframe, but there is for depending on the level of complexity of the adaptation. So there's four different levels and then different timeframes connected to that. So ultimately what we're looking to do is to be able to build then once we've got this on Mosaic and part of the workflow that we're building in is to be able to... for the OTs to categorise which level of complexity each case is, we can then monitor against the best practice guidelines about where we're meeting that criteria. So I haven't got the number of days, but there's a fixed number of days for each stage in the process. And obviously, yeah, just to highlight, obviously the 368 days is from the point of referral to... and sometimes kind of substantial building work, but we want to be making that shorter. But we also want to be able to sort it and understand, particularly for those that should be much simpler. It's putting in a stair lift, for example, and being able to target and look at our data in that level of detail as well. The point on the funding, yes, that's been really positive. So I think we, as I said, the demand for DFG adaptations in Hackney has increased, and we have been working over the last couple of months looking at budget pressure in that space. And obviously with the announcement that was made early on in January for the £86 million next year, but also this financial year has meant that actually we've been able to continue and focus in on the project. And so, yeah, I think that's the main thing is that we know that the demand is increasing. So we want to be able to do those things in the most timely way, making the best use of that grant and not causing delays, because ultimately, in terms of outcomes as well, the longer that that takes, the more likely it is that the adaptation isn't going to meet the person's needs in the same way as it would have at the point of referral. And do we just note on that, because it's quite an alarming amount of time, how we benchmark with other boroughs. And I suppose both to you and Helen, I mean, do you have a real corporate priority here to get that down in the near term? Or is that, is that, is that, is that unrealistic because of financial constraints? So, yeah, we absolutely have a commitment and a corporate commitment to support to bring it down. One of the really exciting things about this particular work stream is us bringing together colleagues who have been working in housing and bringing them into adult social care. We're also transferring the financial management of the DFB budget from housing into adult social care. So there's a, I suppose it's a good example, I think, of us breaking down some of the traditional silos that have existed in acne and working in different ways for the benefit of our residents. Thank you, Helen. Next, I saw Councillor Adams and then I've got Councillor Tobias along as well. Thank you, Chair. My question is on the, I just want to know how does the, an assisted lifting service work? And what type of support do they actually provide to individual? And the second part of it is the third champions. How are they selected? Thank you. I missed that second bit of the question, which champions? Tell the champions. Okay. Yeah, absolutely. So I will try and speak to an assisted lifting service, but Helen might have a better idea. But I think as I understand it, obviously tech enabled living is equipment that people can use in their home and out and about. It's not to prevent people having falls, but it does raise the alert when people do have falls or have gone and needs like the GPS trackers supporting people that are at risk of wandering. So what happens in the current contract with the response service is there isn't an assisted lifting service. So you can respond, but the person might still be lying on the floor and that happening for a long time and they're not able to do the lifting. So it's about actually having a contract that it not only responding, but it'd be able to support people off the floor and therefore having increased better outcomes following a fall. But Helen, I'll let you correct me if I'm wrong on that. So the contract that we've had to date where people receive their pendant alarms and they often get quite a lot of security from having those alarms as do family. The challenge we have is that if you press that alarm, it doesn't automatically necessarily mean that someone will come out and help you. So what we then do is alerted to a call centre and the call centre may then have to call out an ambulance. Obviously, what we want to do is to get support to people as soon as possible and avoid them going into hospital if we can do that. So as part of this contract, there is an element to it so that it still goes to a call centre. But what we'll do is be able to make an assessment around whether the assisted lifting service is best placed to come out and support you. They will still call an ambulance obviously if they get there and someone needs that intervention. But it means that people are helped up and helped to get kind of back into their normal routine and avoid hospital admission, if possible, if we can do that. Thank you. And then next, Council Terminal. The second paragraph which is telechampions. I think they were just dealing with telechampions there. So the tech enabled living champions, when we have done our communication and the OTs joining people's team meetings and stuff, people have self nominated themselves as telechampions within teams. So we have team members of teams across adult social care that are tech enabled living champions. And that's how they were nominated. And Council Terminal. Thank you, Chair. And thanks, Karen and Helen. Clearly, you explained it very well, but it's quite shocking. And I think members in this room, we are a bit shocked to hear what we're hearing because this is scary. My 106 year old auntie fell on a stay for over 12 hours on her own and it was only found by a family member because of the independent living agenda that is going on because of lack of resources. I understand we're doing the best we can. But it's really concerning to hear that residents could be in distress for so long and, of course, there are no resources. My question is just a bit related to what Councillor Lucas asked earlier. And this is about adaptations. From residents that I have represented, we have had, and people that we kind of supported with independent living, wet rooms seem to take over two years. And I just wanted to check if this is just to understand why is it? We have a 368 days, so average delay, but wet rooms can take over two years. Could you tell us a bit about that, whether this is related to the Disabled Grants Fund or if it's because it comes from the HRA and if there are some issues? And in the second question, very sorry, because I'm not sure there will be time for more questions, but just quickly. Could you tell us as well, what is it? Sorry, sorry, just very quickly. Oh, yes. Can you give us an example, a practical example on how the technology enabled living will make residents safer in their home? Just a practical quick example, please. So we understand that. Thank you. Thank you. Yes. So in terms of wet rooms, yep, that's part of the adaptation pathway. So we do have a lot of residents that require a wet room. I don't have the data in terms of exactly how long those take. But what we've been trying to do is understand the information that we do have, bearing in mind that it's across different systems at the moment. And there's still some some legacy problems following the cyber attack. But we are now categorizing things in the same way, as I said, against that foundation's guidance. So wet rooms is something in particular that we know we do and do quite a lot of in terms of the ability to make that a quicker process. I think where we are moving the home improvement agency function and the procurement of the building works into this new team, whether we go and use and recommend that we use a dynamic purchasing system or a framework, we will have more control over the contractors that we're able to use and score those. I think the DPS trial that we're using at the moment scores those things based on kind of quality, timeliness, et cetera. So I think we can that's definitely something that we're looking at as part of the project. And your second question was about technology and an example. I think so. Yeah, I think in particular, one of the things that has been used and set up, I think on the slide, I refer to it as sort of data informed assessments. But using this technology and there are lots of different ones available, but just checking is one of the names of them. So you can put in equipment into somebody's home over a period of two weeks and it helps social workers analyze. So putting a group of sensors in somebody's homes, whether that's sensors on the fridge, in the bed, on the floor, to be able to understand and help social workers and the families look at what the right sort of long term care package need is. So thinking about people's movements overnight and being able to then potentially show that people are safe and happy remaining in their home as opposed to moving into residential or giving the carers peace of mind. So I think that trying to capture lots of different outcomes and whether that's outcomes for residents, outcomes for carers, but using that equipment over two weeks to give that data to be able to inform an assessment is one thing that happened within that project. Sorry Chair, can I just very quick follow-up, I'm very sorry. Thank you. But what is happening is the sensors will be censoring or detecting the page or the resident in their homes. And I'm guessing that's collecting data. So we also need to understand how that data is managed, where does it go and actually how accurate that is. So is this being tested already before it's implemented? Thanks. Can I come in Kat? Yes. Can I come in Kat? Yes. So it's really helpful, Councillor Turbot Diloff, where we've got a dispute with the family, for example. So our strategy is we want to keep as many people at home and safe in their communities as we can. And where someone has dementia, for example, a family might be saying, we're really worried about mum or dad wandering at night, or even just wandering around the house, you know, they might turn on the gas stove without knowing or they might open the fridge door or they might leave a tap on. So the sensors allow us to, as part of the assessment, get a full picture of what that person's activity is at night, to be able to have those conversations with family to say, we know you're worried about it, but actually mum tends to get up at two o'clock in the morning and she does this. And here's how we can create a care plan that can help mitigate this. As part of that care plan, it might well be, for example, that we put equipment, not necessarily technology equipment, other equipment we've got on a gas stove so someone can't turn it on without a code or on a fridge, which would then mean that rather than us saying your parent has to go into a residential care home because we don't know that they're safe overnight, we can work with the family to say this is how we will keep them safe and how we can keep them at home longer. Did that answer the question, Councillor Terbittor? Yes, Helen, I left me more concerned. I've got Councillor Patrick now. Thank you. So many equipment that you're talking about and services have been around a very long while. I know when I was involved boys, I was such as they were around. So, but you talked about more technology and new technology. You talked about an app that would remind people to take their pills. Could you explain a bit more about the new technology that you're talking about? Because an app might remind somebody, but it doesn't presumably make sure they take them. We can all set alarms on phones or whatever. I'm not saying people with mental health differences may not do that. But if a care worker comes round, they can ensure that the person actually takes their tablets rather than just remind them. I'll be interested in the new technology. I'll be interested in the new technology that you're talking about and also how you've seen the technology we've got, how much we have used it and whether it's been positive, whether you think it saved money or kept people in their homes over the years, because it's not new. And we are seeing a new group of people coming forward with dementia. We know dementia is on the rise as well as other disabilities. So I'd be interested. And also the charging, how we're going to charge. My other question is about, you're talking about closer working with other agencies. There's been a problem in the past, certainly, depending on what tenure you live in. So whether you're in your own home, you're a house association tenant, or you're a hackney tenant, about what expectations you get and the timelines. And I know in the past, I've had cases where people have been house association tenants, and their bathrooms have been too small to change. And the house association refused to do anything about it. And they've been left basically unable to have a bath because the bathroom has been too small. And the house association has just washed their hands of it and said, well, nothing we can do, your bathroom is too small. We can't change it. I'll let Pat and Helen come in there for those two, technology and the housing association point. Okay, so on the equipment point, Councillor Patrick, just to be really clear, the procurement we're going through now is largely procuring a different telecare provider with the existing types of equipment that we use. What we're hoping to do is kind of phase two of this and to tie in with our digital strategy is look at more innovative use of technologies going forward. Now we're piloting some of those at the moment on a very small scale, which then gives us that evidence base on does it work for particular groups of people? Do social workers fully understand how to use it and prescribe it? What are the outcomes? So the just checking tool that you were talking about, the app, works particularly well for some of our mental health service users, whereby actually it's not the least restrictive option for them to have that they're perfectly functional and they need to take their medication. And having someone kind of pop in three times a day to see them doesn't enable them to live their most independent life. So it may not be for everyone. And that's the trick and the skill of a social worker is prescribing it in cases where there are safeguards, where we are able to check on someone, where we are able to ensure that this particular solution works for them, but being clear that it won't work for everyone. So there will still be some people that we will physically have a care worker go around to make sure that they are taking their medication. So that's kind of that bit. The housing association point I recognise completely. And yeah, that's an ongoing challenge, I think. So the DFG service itself, as we are intending to create it, the housing adaptation service is kind of tenure blind. That doesn't mean it will automatically resolve the issues that we have with different types of landlords. We also have challenges where people live in rented accommodation in the private sector, and we need landlord permission to make adaptations to that home that can add time and delay into the system as well. What we are hoping is by bringing all of the kind of different parts of the service together into a single coherent team, what they'll be able to do is to build stronger relationships and networks with both our private landlords and our housing association landlords, both to resolve those issues, but also to provide information wherever possible. They also may well be able to do some advocacy on behalf of the individual where we have landlords of any persuasion who are not keen on adaptations going ahead. So I'm not in any way promising that this team will magically solve those problems with the various landlords that we have, but it should make communication much smoother. Thanks, Helen. Just before I bring in Councillor Rathburn, just on the technology, the paper that you alluded to that was going to Cabinet to run in the year, was that the recommissioning of the tele-services or was that the more innovative purchasing strategy? I see you're nodding your head, it's more innovative. It's a more digital strategy. It's not just for adult social care, tele-care, it's how, as a council, we are going to look at how we use technology going forward, as part of which we are doing work with Rihanna and her team specifically around technology-assisted living and enabled solutions and what the potential is going forward. And is there sort of like a leading council in the country or a leading organisation or perhaps somewhere else in the world that has put technology into adult social care in a way that is both improving people's lives and in long term is a cost saving? Is there something you're looking to that could change the picture here? Yeah, I think there's lots of good examples. So Japan is often looked to as a country that, as you would expect, I guess uses technology in health and social care settings in a very innovative way. Within the country, there are a number of councils that have kind of focused their transformation around technology-enabled solutions. Hampshire is one that's commonly talked about that has invested a lot of time and effort. I would just say as a word of caution, how you use technology also depends on the makeup, your demography and your geography. So it was very important for Hampshire to look at technology-enabled solutions because of the amount of cost in their system, because their service users are so spread out. So having very low numbers of care workers, they couldn't necessarily recruit enough care workers to be able to meet the requirements of their clients to have care calls at the time they wanted them. So there was kind of a different impetus for them to look at that. The solutions that we might want or need in Hackney, we need to co-create with our service users in Hackney so that they meet our needs, obviously drawing on best practice from around the world and around the country. Thanks, Heather. Councillor Rutherford. Thank you, Chair. I apologise for arriving a bit late at a school governor's meeting. If you don't mind, I've got two questions. One is on page 18 in item 03. It talks about carers should be able to shape their experiences. And one of those bullet points is through peer and community support. And I wondered how that exactly worked. And I'd just like to insert personal experience here because I'm a deputy carer to my 93-year-old mother-in-law. And I felt myself, my wife less so, that it would have been useful to have been able to have a group who you could just share experiences with, even if it was online, rather than attending anywhere. So I just wondered how that was working, how that was going to develop, because I think that is incredibly important in terms of sharing, just sharing, let alone sharing any experience and learning from one another. And then, sorry, secondly, which is more of the macro question, which is what we're supposed to be discussing. Considering the financial challenges with demand up by 45%, but the budget only increased by 25%, how do you prioritise the elements of care as strategy, technology enabled living, DFG adaptions and care charging? Thank you. Thank you. Thank you. Thank you. Okay, so I might start with a second question first, if that's all right, Councillor Rathbone, and it's, yeah, very much a challenge. There's so many things that we would, in an ideal world, want to do, but we have to balance that with the financial envelope that we have. So, largely at the moment, what we do is work within the existing financial envelopes that we have. So, for example, the re-procurement of our technology enabled living support is done within the financial envelope of the existing contract. What that doesn't stop us doing is creating business cases going forward if we find there are other technology solutions that we would put forward to our finance colleagues as a kind of investor's aid. So, if we did our exploration and discovered something that we genuinely felt would improve outcomes but would also benefit our budget financially, we would put that as a business case to our Section 151 officer and our corporate leadership team to ask for further investment in that going forward. So, I think we have talked before about carers and, you know, adult social care, however challenging it is as a statutory service, is nothing compared to the number of people we know who are unpaid carers and the levels of care and support they are providing for their family members and friends. So, it's vital really that we support our caring community, whether they self-identified or however they come to us in that way, because apart from anything else, it's the preferred form of care for most of our residents. They want to be cared for by someone they know and love, but if we didn't, that cost would be picked up by the adult social care budget and that demand would increase. So, in a way, supporting our carers is a kind of preventative measure in a sense. One of the kind of more practical things we've done, as you pointed out, carers said to us, and we did talk to a lot of them for a long time, was the ability to talk to someone who understands what they're going through and share their experience and actually in quite specific ways. So, dementia carers tell us that they very much benefit from talking to other people who are caring for a loved one with dementia. Not that they don't want to talk to other people who are in caring roles, but actually the challenges are the same and the solutions sometimes are the same. So, we've done a number of things. We've recommissioned our carers service and within that recommissioning, we have developed some specific provision. So, our new family friends and carers hub within our mental health trust went live in the summer. So, that's to support carers of people with mental health needs. And we're also working with our mental health trust and our voluntary sector around developing things like memory cafes. So, we have a few of those in Borough, and to be really clear, the majority of the memory cafes we have, we don't fund. So, where we talk about Hackney as a system and a network, and our carer strategy not being about Hackney Council necessarily buying things, but helping coordinate things, that's a really good example of that. So, they've sprung up organically, we're able to facilitate them and put the right people in touch, but we don't necessarily fund them. And the carers and the service users who use them can arrange them to suit their particular needs in their particular locality. And just on that point, Helen, I mean, is it in terms of sort of like that soft, how do you try and facilitate sort of like WhatsApp groups between people in local and local vicinities who may sort of have similar caring needs? I mean, I mean, that doesn't presumably cost very much, but could be incredibly valuable. Yeah, so the new carers service is charged with effectively understanding those needs and where people are asking for something and helping facilitate. And where we can as a kind of public sector response, we will do that. So for example, it might be that we can say, well, we've got a room in a day centre here that you can use for that. Our NHS colleagues have done the same, depending on which locality. So they're much more locally responsive, and they're driven by what carers are telling us that they want and need. Thanks, Helen. We're at time on this item. I think two sort of things that have struck out, stuck out to me as sort of follow up is one, obviously, there's a lot of concern amongst colleagues in terms of the DFG adaptations and the understandably and the waiting time for that. I think six months is probably too soon to ask you to come back on it for a year. And it may even be that that is an item in and of itself with a clear dashboard of how many people are waiting. Are they waiting for an assessment or are they waiting for actually for their facilities to be changed? And how things have changed from now in terms of that wait time. So if I could ask, John, if we put that down through a review in a year's time, it may be we just have an item solely focused on that to try and get to grips with have we tackled that issue. And I think the other issue that's particularly had a lot of potential is obviously how technology can help. And the point that you've put together that paper going to Cabinet in terms of what could be more innovative solutions, undertaking research for other people, it may be that that itself is an area where we can come back and learn about what we're planning and whether it's a spend to save case and what you're planning as well. So those are two particular areas, I think, action points to go forward. But with that, then I will bring that item to a close. And thank you both for presenting on it. Can I then move on to the next substantive item on the agenda, which is item number five. This is the housing with care verbal update. This is because we've recently had an inspection of our housing with care service. As I understand it, and Helen, you'll tell me wrong, it was last inspected in 2020, some four or five years ago, and had a requires improvement rating. As I understand it, we haven't yet got the report, but you will have been given some verbal feedback on it. And also, and we've got sort of 15 or so minutes for this item. Can you also just give us a brief update as to the adult social care CQC inspection you've just been informed about that will happen in early course as well? So over to you, Helen. Okay, thank you. So we last had an inspection, it's actually, I think, 2018, of our housing with care service. And you're quite right, it was requires improvement. So I suppose to give some context and reassurance to members. Obviously, from that point, we had an action plan. And we have been working on delivering the action plan since then to improve the service. Usually, with a requires improvement rating, you would be due a reinspection within about two years. Obviously, that took us into the kind of beginning of the pandemic. And therefore, we didn't have one for quite some time. And CQC actually came back to us in November of last year, 2024. The inspection that was undertaken in housing with care was actually over four or five days. And it was under the new framework. And I think we were one of the first local care providers to be inspected under that framework. So it was a bit of trial and error, both for CQC and for us. The challenging issue we are now faced with is that we actually have had no feedback from that inspection. So usually, at the end of an inspection, you would get at least some verbal feedback to say, this is what we think, which would then be followed by a report, which we could then comment on. And once that was then agreed, that would be published. Possibly because it's under the new inspection framework. Possibly because members may have seen CQC are struggling, I would say, a little bit at the moment. There was a report recently that they have lost 500 reports, I believe in an IT issue. We haven't had that feedback. So we have chased repeatedly and we were told only this week that there is a significant backlog and they can't give us a timeframe for when they are likely to be able to provide us with that report. That being said, in the summer of 2020, in preparation for CQC and Housing with Care, we undertook our own commissioned mock inspection. So we asked a consultant who has previously been a lead inspector within CQC to come in and undertake a mock inspection with the service. And she did provide us with a report and feedback, which was very helpful. Which was overwhelmingly positive. Similarly, the brief discussion we were able to have with the lead inspector who came in to us from CQC in November, mentioned specifically that as part of the inspection framework, they talk directly to our carers and our family members. And they were all overwhelmingly positive in the feedback that they provided. She was, in fact, a little taken aback because one of our family members of one of our service users had threatened that if we didn't get a good or outstanding rating, that she would be writing to complain, which is lovely to hear and hopefully give some reassurance that we believe we are going in the right direction. We are, however, unfortunately waiting for formal feedback for that. To be clear, we have been continuously working and continuously improving since 2018. And the service has, I would say, improved dramatically since then. We believe that we should be due a good rating. Obviously, I can't guarantee that, but we have all the evidence in place to say why we believe we're a good service. Helen, just before you move on to the, can you just give members an overview of the Housing and Care Service? So how many different care homes or houses, how many people are in that service? Can you just give us that broad overview so we just understand? So it's 16 different schemes scattered throughout the borough. The schemes are a mix of size. They're also a mix of tenure. So some of the schemes have just general tenants in them alongside people with care needs. Some of the schemes are specifically for people with care needs. We also have a mix depending on the scheme of the type of care need that they support. So some of our schemes specifically support older people, often with early stages of dementia. Some of our schemes also support people with a learning disability or with a mental health issue. In total, I believe we've got 273 units. And the largest scheme is about a 40 bed scheme. And the smallest, I think, is seven or eight. And all in borough or some outside? No, no, these are all in borough. Sorry, it is important to mention we don't own any of the buildings. These are housing association owned buildings. We deliver the care element for the people in those schemes. Thank you. And then if you just can give us a brief update of the wider CQC inspection you're informed about, and then I'll throw it open for very quick questions and then we'll move on to the next item. Great. After having done this. Thank you, Chet. So hopefully panel members, elected members will know that as a result of change in government legislation in 2023, it was brought in as an extra duty for CQC that they would undertake not just inspections of care provision, but also of adult social care. And it's been a long while, I think over 15 years since adult social care had any formal inspection body. Although obviously we do work with CQC who regulate and inspect our providers. So this is the first year that the inspections are taking place. So every local authority adult social care department is due to be inspected. It was supposed to be by the end of this year. I'm not sure whether there's a slight delay to that. So I'd say about half the country probably has been done. In London, the whole of the northwest region and currently the, I think the central have been inspected. So they are moving region by region. In January, the first local authority in northeast London was notified that CQC intend to come to us in the kind of medium to near future. And that was actually barking. Since then, City and Newham have also been notified and we received our notification on Monday morning. So what that means is that we now have three weeks from the point of notification to submit the various paperwork, including our self-assessment that CQC require. At the point where that paperwork is submitted, CQC can then come on site any time from six weeks to six months after that point. So it's a little bit hard to pin down when we actually think they're going to be on site. What we're proposing is that we come back to a future scrutiny meeting to talk more in depth about our self-assessment and the CQC process. Thanks Helen for that update. Councillor Adebayo. Thank you so much, Helen. You've answered one of my questions and that is the unannounced visit by the CQC here. And with the inspection, any glimpse of hope when you are likely to get the feedback? We are chasing it almost daily, Councillor Adebayo. As you can imagine, the Housing and Care staff have worked incredibly hard and are, and rightly should be, incredibly proud of the work that they've put in. So they are really keen to have some external validation of all the work that they've done. And they're really keen also to continue to improve. So if there are areas where CQC feel that we should be doing better, we would like to know what they are to validate what we think they should be doing. Literally, the head of service spoke to CQC today, again, and they were very clear that at the moment unable to give us a timeframe on when we're likely to receive the report. Thank you. I saw two hands and then I'm going to close the eyes. And Councillor Turbott-Low and Councillor Lynch. Councillor Turbott-Low. I see another one who wanted us to follow up, I don't know. I'll continue. Thank you, Helen, for that. I do have just a quick question with regards to the threshold of within houses, sorry, home free care, where there are residents that have acute challenges, mental health challenges, and where they live independently, they do have the support, they have the visits, but their behaviour becomes a risk to residents around them. We have two cases here in Victoria and actually Councillor Kennedy has tried to support us with that as well. Why should we ensure when we have residents that actually maybe should be in another level of care, if you could kindly tell us on that. And then just because what I'm hearing tonight from very helpful reports is that it cannot make sense to have, well, it doesn't kind of make sense to me that we're acting or we're stopping, and it's not because comrades in here in this chamber, about the falls prevention programme when it helps us to keep residents to avoid falls, which will later cost us more fun as well to support. Just I hope this makes sense. Thank you. And Councillor Lynch. It was just an observation really, Helen, is that I was just thinking around the themes that come with the assessment framework, which is, you know, I'm sure you know them, you probably recite them in bed at the moment. But I was just thinking about the previous item that we talked about, the service improvement work, and I was just wondering around whether or not it'd be really helpful for members for you to, what it's next presented to us where it actually relates to the CQC framework, so around working with people providing support, safety and leadership, because I think it would be really useful for some of this service improvement work to be put into the context of where it fits in, in terms of the CQC requirements. Because I just think that would be really, really useful to bring together what we're doing and how it actually isn't just there for a financial thing, but actually is there because it's going to meet the statutory requirements of the CQC. And lastly, Catherine Adebayo, do you really want to come back to Helen on something? I quickly just, it's not, it's not a long one. It's just about the housing element. Because Eileen mentioned that both, you know, all the existing schemes are being owned by housing association. Just wondering if there is any plan, because obviously, in terms of saving money, is there any plan of encouraging the council to own its own property for this scheme? Yeah. Okay. So working backwards, if you don't mind, Councillor Adebayo, yes, that's our capital build program. So we actually want to own, build, buy up to, I think, about 500 units in the next 10 years to develop our own provision. And we're very, very keen to have that and to develop that. I think that links slightly to what Councillor Turbot Diloff was talking about. So to be clear, Councillor Turbot Diloff, there is no kind of published threshold as such. The criteria for housing with care at the moment are it works primarily with older people, regardless of whether you have a mental health issue, a learning disability or any other need. So at the moment, I believe, and I'm sorry, I'd have to double check, but I think you have to be over 60 to be eligible, to be offered a tenancy in one of our housing with care schemes. What we'd like to do and what we're doing at the moment is working with the registered providers to bring that number down to 55. But also we then want to develop, as I've said, our own schemes and supported living services, which we can offer to working age adults as well as older adults in the borough. I think you mentioned about the Falls Prevention Service. I'm not sure that links in any way to housing with care, if I'm honest with you. I'm more than happy to have a separate discussion with you about that service. But the majority of people who are in housing with care provision who are requiring support will get that from the care provider, not from an externally commissioned Falls service. And then the question from Councillor Lynch. Yeah, absolutely happy to do that, Councillor Lynch. My suggestion would be in the first instance that actually we might want as a committee to look at our self-assessment, because what the self-assessment does is draw some of that parallel between the improvement work that we're doing and how that then fits into the CQC themes already. And very quickly, because Councillor, before you haven't asked a question yet, so I'm keen to bring you in, if you could just ask to make it quick, because I want to bring this item to a close, please. Thank you very much, and just a quick one. Helen, I'm just, I don't know if you have any rough idea about the profile in terms of ethnicity of your service users. In housing with care or in total? In housing with care. In housing with care. I do, I don't have it to hand, Councillor, before, so I'm more than happy to send that to you outside the meeting, if that's okay. Thank you. And I'll get, with Jala's making a note of that now, to add to that. Thanks very much for that, Helen. I think you've clearly given us, which I agree with, an action point when the self-assessment form is done. And obviously, as you've indicated, we're in a bit of an unknown as to when the actual assessment will take place, and liaise with Jala's to an appropriate point to review that self-assessment. So, at that stage, I'm going to bring that item to a close, and thank you very much for your contributions this evening. The last substantive item is Healthy Weight, and the Joint Strategic Needs Assessment. And we're grateful to be joined by Donna Dorsey Kelly, who's the Principal Public Health Specialist, and Jane Taylor, who's a Consultant in Public Health. And I'm grateful for the presentation that you've provided, and also a summary of the Joint Strategic Needs Assessment. So, Donna, are you going to walk us through the presentation, and then we'll open it up? Yeah, that would be brilliant, thank you. Jane's going to hopefully help me share the slides. So, thanks everybody for inviting us to your meeting tonight. We're here to talk about two related pieces of work that we've been doing over the last year or two within the public health team in partnership with the system. And one of those is a review of our whole system approach in Hackney to Healthy Weight, and City in Hackney to Healthy Weight, sorry. And the other one is just to let you know about the findings that have come out of our recently published Healthy Weight Joint Strategic Needs Assessment. So, all the details in the paper, and this is just sort of a brief introduction to some of the detail. Next slide, Jane, thank you. So, in terms of the context, as I said, it is in the paper, but we thought it would be important to just pull some of this out to help frame the discussion as well. So, I'm sure a lot of you know this, but obesity is a significant thrive for poor health, and it increases the risk of many physical and mental health conditions. And there's a lot of inequalities in relation to obesity in terms of children, young people and adults. And we'll see that in a bit more detail when we look at our local data in a minute. It's important to sort of point out at the start that obesity is a really complex matter to address. There's lots of different things that can influence our weight, including our genetic makeup, the food that we eat, our physical activity levels, how we think, believe, and our knowledge around food and physical activity. How are foods produced, and the environment in which we live in, and our sort of social influences as well. So, there's a lot of things to think about there in terms of obesity, and it's definitely not a simple thing to consider. And I guess we sort of recognise that complexity locally in terms of preventing and reducing those harms related to obesity. And we understand the need for a whole system approach to addressing this. And it's not a new piece of work for City and Hackney. We've been working on this whole system approach to obesity since 2016. Next slide, please. This is sort of just a visual map of the complexity of those factors that I just talked about, and how they sort of interplay together. This map was drawn up quite a number of years ago for a foresight report that just sort of maps out, you know, across the system, the variables that sort of interact with each other and the complexity of thinking about obesity. And it really demonstrates the sort of need for that whole system approach, because a lot of this isn't to do with just individual behaviour change. There's a lot of factors at play here to think about. And while, you know, the report acknowledges that sort of eating healthily is individual behaviour, the environment that we live in, it's really, really hard to do that, especially around the availability of calorie dense food, basically. So it can be hard for people to maintain those behaviours. Next slide, please. Within your paper, you'll see that there are national and regional strategies and policies in place around healthy weight and food. Locally, we also have our own priorities that we have been working towards over the last number of years. Our ambition is to improve health and wellbeing by making City and Hackney a place where everyone can be a healthy weight. And we sort of think about that in terms of these five priority areas. So working together, targeted help for those who need it most, having easy access to affordable, healthy food, having a healthy environment that makes it easy for people to be active and easy access to information. So in these two pieces of work that we're going to talk about today, that's how we've sort of framed the evidence and or actions around next steps as well as thinking about these local priorities. So we've got a few slides in terms of the data that we've pulled out in the JSNA that we thought might be helpful to go over today. And again, some of this is in your paper. So with children, we have got a program called a National Child Measurement Programme, which measures children in school, in primary school. So that happens in reception and year six. And we know from the data that we have that one in five children in reception and two in five children in year six were above a healthy weight in 2022-23 in City and Hackney. So when we looked at this data reception year data was similar to London and England, but it's actually risen a lot since this data was captured. And we know in year six as well that our obesity prevalence rates are above London and England averages. Next slide, please. There's lots of inequalities within that data as well. So boys, those living in areas of higher deprivation and certain ethnicities are associated with higher levels of obesity. And we can see that particularly in the year six data. So whenever we've looked at that ethnicity adjusted data in reception year, boys and girls from all South Asian ethnicities combined, and boys from white non-British backgrounds had a higher than average prevalence. And then when we looked at year six, boys from Bangladeshi, Indian, Pakistani and white non-British backgrounds, and girls from Bangladeshi and mixed white and black backgrounds had a higher than average prevalence of obesity. Sorry, I know that's a lot to take in and sort of process. And then if you look at the maps on the left hand side of the slide that sort of gives you a geographical breakdown of the profile as well. So the areas that are sort of in the darker blue are areas where obesity is more prevalent. So you can see from these maps that there's a little bit of a different picture from reception in year six, but across both maps, Shoreditch Park in the city is the primary care network that has the highest levels of obesity. But you can see, or maybe you can't see because the data is quite small in this slide, but there's quite high levels across the boroughs. Next slide, please. And then if we move to sort of think about adults, the data that we have is within primary care, and it's when people are measured in primary care. So it's not an accurate picture across the whole of Sydney and Hackney, because not everybody is measured. But with the data that we do have, we know that around one and two sitting in Hackney adults with a BMI recorded were above a healthy weight in 2023. So it's just over half, 54% for Hackney residents. And apologies, this is a different figure to the slides in your set. It's been updated since we sent this across. And a big number of those are actually recorded as obese or severely obese in Hackney, so 24% of those. So quite stark figures there. Next slide, please. And then just another sort of slide around our local data as well. Similarly to children, sex, ethnicity and deprivation were associated with higher obesity prevalence among Sydney and Hackney adults, but for sex, it was actually women who had higher prevalence in adults, which is different from the picture that we see with children. And there's other data that we thought might be interesting to present here as well. So one in two pregnant women were above a healthy weight at their first booking appointments. And we also noticed inequalities within that data as well. And obesity prevalence was also higher than average among Sydney and Hackney adults with a recorded learning disability or severe mental illness diagnosis as well. We did look at data for behaviours as well, so diet and physical activity, but the data that we have is pretty limited and it's self-reported. And the data that we have for children and young people is quite old now. It's pre-pandemic, so it wouldn't really be an accurate picture of behaviours now. So yeah, that's a sort of quick snapshot of some of the data that we looked at, but if you wanted to find out a bit more, we've got lots of information in our chapter in the JSNA. Next slide, please. So another thing that we looked at within the JSNA, alongside the data and the evidence, was what we're doing locally around this, what interventions, policies and strategies to support healthy diet, healthy weight and physical activity. And we understand that there's a lot going on at the minute that does support this agenda. There's lots around the food environment and food support. So thinking about food poverty, food vouchers and practical skills such as cook and eats, starting solid support for parents and support around breastfeeding and diet. And also support for food businesses around healthier catering as well. Lots going on around our environments as well. So creating spaces that do activate play and physical activity, interventions such as low traffic neighbourhoods, schools, streets and transport strategies that encourage active travel as well. So lots going on there. And policies around health and wellbeing that support physical activity, active travel and restrictions around hot food takeaways as well. There's working on around the climate action plans on food as well, sustainable food. And then we have also got targeted interventions for those residents who are above a healthy weight. And to sort of support all of that, we have got a range of programmes such as community champions and making every contact count. And resources such as find support services that help people understand more about diet and exercise and where to get support locally around that. I'm sure I haven't mentioned everything there, but there's lots more in the GSNA. That just gives you a snapshot of everything that is going on. There's quite a lot taking place already and lots of practice to sort of build on. Next slide, please. So I've just got a couple of slides now around the key messages from some of this work. And then I'll talk about our next steps and what our recommendations show. So we know and you've now seen as well that a large number of local residents are above a healthy weight and there's really stark inequalities there. We spoke to so many residents during this process as well. And they've told us about how they really struggle to eat a healthy, affordable diet and to be active as well. And there's lots of barriers and also enablers within Hackney to help sort of think about food and physical activity as well. And when we looked at the evidence, there were certain interventions that had a good evidence base for achieving and maintaining a healthy weight. And the two that we're pulling out here are supporting women to breastfeed for longer and medication combined with behaviour change interventions can help people lose weight as well. Next slide, please. And there's also evidence around school based interventions. So making changes to the school environments to either increase healthy eating or reduce unhealthy eating and making changes to the wider built environment to increase physical activity by sort of default as well. And there's also evidence emerging on a number of initiatives that some of these we run locally and some we don't. But lots of approaches like the removal of advertising of foods that are high in fat, sugar and salt, whole system approaches in general, health promoting planning policies, interventions such as school streets, low traffic neighbourhoods, healthy start schemes, healthy early years and healthy school award schemes and daily miles. So although the evidence is emerging, it is important to say that some of these schemes are not specifically around weight. So sometimes some of those outcomes aren't measured as part of this. So it's not to say that they're not effective. It's just that sometimes they're tailored locally and they can be difficult to evaluate as well. And then the impact or the evidence on the longer term impacts of weight management programmes is mixed in terms of sustained behaviour change. And there's limited evidence on programmes that work for our local communities as well. Next slide. So I guess just to wrap up this section, we understand, you know, national government do hold a lot of the levers to influence some of these drivers of obesity that we're talking about. But we do think that on a local level, there's so many opportunities that we have to influence the built environment and or the behaviours of residents, including, you know, what they eat and how active they are as well. And I'm not going to name out all of these different opportunities. They sort of come up in the recommendations in the paper too. But there's lots to think about in terms of our next steps with this work, which we've hopefully pulled out in the recommendations in your report. Next slide. So again, I haven't, I'm not going to run you through every single recommendation because there's a lot within the report, but the themes of the report, as I say, are sort of based on our five local priorities. But there's also some thematic, there's some themes here that stand out that the recommendations sit under. So ones around making sure we've got really strong system leadership on this to help drive this work forward. Making sure we're strengthening our local evidence and our data around the interventions that we have and evidence that we have and the insight that we have locally. Building up and supporting our system to be able to have the confidence, the knowledge, the capability to be spotting opportunities, to have discussions with residents and offer them support around diet and exercise. And really thinking about our food environments and our environments where we could be active and could be playful within as well. And thinking about the opportunities that exist there. And thinking about inequality, inequity and weight stigma across all of the work that we do. So that's sort of a cross cutting theme. Considering taking a settings and life course approach and starting out as early as possible. Preconception or maternity onwards and just supporting people to make the right to healthy behaviours as early as possible. And really building on the work we're already doing to make sure there is cross sector collaboration and people are working well together. And drawing our assets that already exist within the voluntary sector in the community. And supporting them to be able to work with us on this agenda as well. And making sure that we have got effective tailored communications and engagement that are co-produced with the community in the voluntary sector. To make sure that people have the right information should they want to make changes to their behaviour as well. So yeah, I think I'll stop there. That's sort of a pretty high level tour through where we are with those two pieces of work. But the next step is bringing those recommendations and bringing them into a system delivery plan. And that will keep us busy over the next few years, I'm sure. And I would like to say this is not something that, you know, public health can solve on their own. It is really important that we do take a whole system approach to this work. So, yeah, if there's any opportunities that any of the members of this board are aware of, we're more than happy to sort of think about that as well. Thanks, Donna. I can see, thanks for the overview, several questions. So, Councillor Lynch, Councillor Tobias and Councillor Lucas. So, Councillor Lynch first, please. Thanks very much for this. I'm going to probably just bring it all into one question. But essentially, you've given us stuff that we probably knew already because we know our patches. The thing for me that's coming out glaringly is that an absolute need to triangulate this population health data with what the council's delivering, because it's quite disappointing to see that Shoreditch Park and City have some of the worst areas. You know, the levels of obesity that we've got a nice, big, shiny, big leisure centre there. And I've said this consistently, Chair, is that there's an overarching need for us to start triangulating what our population health data is saying with what we are commissioning to do. We have currently 20 interventions to deal with this. And for me, there's a cost associated to those. That's 20 interventions. And I can't see where we need to see deliverables for this stuff as well. So what do we want to see? My other question is just to bring in the BCFS sector, because there's a lot of people already, you know, going to stuff where they're teaching mums how to cook, you know, how to prepare stuff. And I just wanted to just to link all this into the fact that we have food banks and they, my understanding is that the commitment there is to provide healthier food as much as possible. Again, it's very limited in terms of stuff, but I just, again, it's just an example of how there's excellent work that your team are doing. But how are we linking that into what else we're doing? So how, you know, like all the stuff that you've done over the top, I'll just refer to it. I think it's on all of these interventions. So for me, I want to see the outcomes for people for LTNs and school streets. Is that, one, impacting on people's weight, a little bit of exercise for the kids? Is it reducing respiratory consultations? There needs to be a really clear plan for all of these interventions of what they are delivering, because it's very nice to have them all. But actually, we need to, we need to have KPIs for this. We need to have a commitment that by such and such year, the percentage of our children are going to, are going to have like less weight, like we need to have target weights. For me personally, I think this is a, this is an opportunity to look back at whether or not we have school nurses back in doing this stuff. And also, is there something commitment around doing from an early age, going back to the old days of home economics as well? Because for me, there's an over reliance on fast food. And I think that's something that is because people have forgotten how to create and do stuff. And I'm not sitting here as a nice privileged person that knows how to cook. But there's something around the fact that a lot of our parents are doing two or three jobs. There's there's that it links to all of the issues around poverty, this is about poverty, essentially, this is about poverty, we can call it all it is. But this is about poverty, it's about poverty of opportunity to learn skills, it's poverty, poverty for families to have time with their children. People are working so much that I think this is just literally this is about poverty. This is simply about poverty, and access to stuff. And then I'll come back for the other questions. Thank you. I'm back. Did you want me to come in now? You're coming now to lose quite a bit there and then I'll then I'll bring out the other questions. No worries. I agree with using the suggestion of using the data that we have now to think about where we target our interventions. I think hopefully that will be something we'll be able to do in partnership with our colleagues across the system. So I do agree with that and hopefully now that we have this data to hand and we can see where the areas are that require more and interventions that will be useful as well. And yeah, I agree with you about around working with the VCS that that is a recommendation that has come out of this report as well. And I agree with you in terms of the link with food poverty, you can see that in the GSNA as well. And residents told us that one of the biggest barriers to eating a healthy diet is the affordability of food locally as well. So I agree with that. And I think, yeah, obviously, the earlier we can get in with the intervention, the better. And again, another recommendation in the whole system approach is thinking about the suite of interventions that we have and what we can do to sort of measure the impact of those more widely as well. When do we expect to see sort of firm outcomes and KPIs attached to the different suggestions? I think we're working up the delivery plan at the minute. Yeah. So I'm not sure what the timeline is on that. We're just having a look and we obviously need to chat to our system partners as well to see what is doable within each area too. No, no, when you talk about the system, are you talking about NEL system? Because I think we just need to look at what we're doing in our own council, really, because of all these 20 interventions are just what Hackney does. It does link to other stuff that outside providers are doing. But I do think we just need to really just because when you're saying system for me, I'm thinking, are you talking about the NEL system? Are you talking about the system just entirely? Apologies. I am talking about City and Hackney as a system and I definitely include our colleagues in the council within that as well. We've got, yeah, partnerships across the council and with colleagues outside the council as well. Okay. Well, it may be an action following up to sort of in due course, maybe offline and then maybe at a future meeting to sort of, when we have got a clear timeline on sort of the KPI outcomes to sort of, to actually have a look at that so we can, or maybe if it's say reviewed in a year's time. Councilor de Lobo next. Thank you, Chair. Thank you, Donna. Actually follows up a little bit to what Councillor Lynch was saying in terms of poverty. One of the, within the themes for recommendations within equality, something that would be good also to hear is about, we are a borough of right to food, meaning that we are, you know, we don't want to see children in, you know, with food poverty. But it would be good to see the connection with the preschool meals or lack of preschool meals or especially the, yeah, preschool meals. And also a large proportion of residents in Hackney live in overcrowded facilities or housing. And lack of housing, lack of cooking facilities also leads to, you know, buying this fast food, which is cheaper but also not healthy at all. And often, at least in my neighbourhood, I find that there are more stores that sell very expensive vegetables, I cannot myself afford either. So can we, can we hear a bit on that please, on the connection to obesity, and whether this can be taken as recommendations to look at as well. Thank you. Just because I've got a lot of questions, I'm going to take Councillor Lucas at this time. We'll answer them both and I'll do another round. Thank you, Chair. Thanks very much for the presentation. I think I echo a lot of what Councillor Lynch said around it being around poverty. And it's also really important, I think, in the context of what the government's talking about in terms of the prevention agenda and how essentially this can, you know, this can free up capacity down the line. It can stop problems from happening in the first place if people generally live a, you know, healthier life. But it's interesting, you know, the point around KPIs, I echo that. But also, it seems to me from, you know, your presentation and the report that there's, you know, there's a whole amount of data on, you know, identifying the issue, identifying the locations. But there isn't a whole amount of data on the actual solutions and the recommendations that you've set in your action plan. So, I just wanted to firstly ask how you plan to record data going forward and what the feedback mechanism is so that you're prioritising the right things and deprioritising things that aren't working within Hackney. And then also, it's interesting when you talk about re-establishing the Healthy Weight Strategic Partnership. I'm just interested to hear how that sort of faltered in the first place and also where that sits in, you know, we've heard a lot at this commission around where public health is going and happening, some of the challenges faced, et cetera, et cetera. Where does that sit if it does return within that broad spectrum of priorities, you know, funding and otherwise? I'd be interested to hear a bit more about how that would work in practice again, where this all joins together. Thank you. So, Donna, if you take those two now, please. Yes. So, going back to the second question about the right to food borough and the free school meals. So, we do look at the evidence for free school meals within the GSNA. So, I'll definitely make sure everybody has the link for that. We haven't looked at what your point around overcrowded housing and the facilities, but we have heard that as feedback when we've spoken to stakeholders in terms of people's ability to cook, you know, fresh meals within their homes. Sometimes that's just not something that people can do. So, I think that we'll have to, yeah, we'll have to think about what the approach is to some of these barriers and what we can realistically do. I know there is some separate work going on with the policy team in Hackney Council around food as well. So, we'll be joining up with them and seeing what the next steps are. And there are some recommendations coming out about working closely with the food banks around thinking about what the offer is there as well. And maybe we should think about other community models where fresh fruit and vegetable is more readily available through partnerships in the community too. So, that's sort of my feedback on that question. In terms of the next one around recording feedback and the feedback mechanisms, I'm afraid we're not that far forward in our thinking for that. We've just recently come up with this whole system approach review recommendations with colleagues across the system and the JSNA recommendations. So, we might have to come back at a later date and sort of fill you in on plans for that. So, that's not fully thought through at this stage. So, in terms of the future of the Healthy Weight Strategic Partnership, again, I think we're just at the point where these recommendations have been pulled together. There'll need to be some thinking about the leadership of this work going forward and the governance around that as well. Yeah. So, I'm trying to think if there's anything else. Thank you. Go on, go on. Do you want to finish off? No, I think that's all sort of the information we have at this stage. Unless Jane wants to come in with anything else on either of those points. I've got quite a few members, Jane. So, I'm going to... I just did go. So, I've got... I've been noted through a Councillor Adebayo and Councillor Adams, and I've got everyone else who wants to speak as well. Councillor Adebayo first, please. Oh, thank you, Donna. That was very interesting. But my concern is the availability of the fast food restaurant on our high street, sometimes these fast food restaurants are very close, too close to the school. Is there any plan or any recommendation or any, you know, anything that you are planning to do to actually make a proposal on this? Because on the high street, it's too much fast food and sometimes too close to school, which actually encourage some of our young ones. And the second one is about the open gym. And our open space. If we do have open gyms, maybe we can also look into that. I'm going to plug my pencil here now. Thank you. Thank you, Councillor Adebayo. And Councillor Adams? Yes. You just said, I think Councillor Adebayo was kind of touched on what I want to talk about. You know, in the presentation, you're talking a lot about physical activities. And we have gyms in the borough that's not affordable for people living in the borough. So that's an issue. So when you talk about physical activities, I don't know how people living in the borough can actually access that. I live next to the brand new leisure centre. And Shoreditch Park is in my ward. Most people in that area, they cannot access, pretending the leisure centre is too expensive for them to go there. So that's an issue, you know, so talking about poverty. So that needs to be looked at. Thank you. So Donna, over to you. I think on the first point around, yeah, the availability of fast food and restaurants, I do think that, yeah, this is a problem. There is an oversaturation of fast food locally. In terms of what we do around that locally, we do have planning policy that helps us object to any new applications for fast food takeaways around schools. So we do use that and public health do object to any new applications. I guess that doesn't do anything about the ones that already exist there. But I know in terms of national planning policy frameworks, they are really strengthening that restriction of new hot food takeaways around schools. And they've also included other places that young people go within that policy now as well. So, you know, thinking about the other settings outside of schools where young people might be influenced, you know, such as youth centres and the likes as well. So I think, yeah, it has been strengthened on a national level. We might want to look at that again when we're reviewing our local plan. In terms of gyms, I agree with the feedback. Sometimes they are not affordable and we've definitely heard that from residents as well. They can find it, yeah, it's too expensive when you've got other priorities. I think from a public health perspective, you know, we would encourage people to try and build physical activity into their day as much as possible and to think about the opportunities within our environment, you know, outside of the gym if they can't afford that, to be able to be active as well. So, yeah, trying to make the most out of the green spaces, green and blue spaces that we have within the borough and thinking about just building small steps into their day as well. And presumably that links in the Council Adder Baer's point about open gyms and advertising these. Yeah, where those, you know, where those are available as well. But I do recognise it as, yeah, it's expensive to have a gym membership for sure. So I've got, I've got three final questions. I'll take them in around Councillor Patrick, Councillor Rathbone and Councillor of the Four. So Councillor Patrick. Thank you. Thank you. I agree with most things that Council Lynch do. But I represent King's Park World, which is in the Hackney Marsh area. And obviously it's got a very high incidence of obesity, especially in Year 6. But the obesity in reception isn't as high. So I wonder what the difference is between what happens between reception in Year 6 increases the obesity. But also, people do, some people obviously can't cook and don't have the time to cook. But some families do cook. But also, I wonder if we've spoken to schools because there seems to be a prevalence, especially of teenage children coming out of school and finding the nearest chicken shop or McDonald's or whatever, fast food shop and piling in there because they're obviously hungry. So are school dinners enough? You know, are these, are these children going in these chicken shops? Is it their dinner or is it a snack because they're not getting enough food at school? So do we need to speak to the schools about the size of school dinners? Have we actually spoken to families and asked what help they need? There seems to be lots of strategies in there, but I'm not sure that we've actually spoken to people and tailor-made strategies to help people. Because what will help, what will work for some families in parts of Hackney won't work for other families. Also, you know, my area of Kings Park is a food desert. We've got lots of convenience shops, but they're, well, not that many, but they're very, very expensive. You know, food in them is double the price almost at some things of the local, of the supermarket. But, you know, if you have to pay £3 or more than that to get a bus to the supermarket and back, then it's the time and the effort. And Ridley Road is even further where you get cheap food. It discourages people. So people do need to know one needs. We need to find out what we need to do to help people and make it what they need rather than come up with strategies that may not help people. So there is subsidised gyms and whatever, but it's also the time, the effort, getting there, childcare, and also people don't feel comfortable often in gyms and things. We have to make it, all these, this healthy weight structure, we have to make it accessible for people and make it as easy as possible for people to access what they need to access rather than put in place what we think they need. Thank you, Councillor Patrick. Councillor Raffbone and then Councillor Perforin. Councillor Patrick has pretty much taken quite a bit of my question. But, yeah, I just wondered on page 36, where you do have all these interventions, whether, Donna, whether you could just identify a couple of ones that are very effective, and a couple that maybe you think are difficult. And I'd just like to make a couple of comments. I mean, obviously, my observation in various areas around schools is that whatever it's called, the fast food buffer zone doesn't work. And I can remember about 12, 14 years ago, sitting in a scrutiny commission, discussing this. And I can remember that teachers from Jack Petscher used to go out on the streets at lunchtime and after school, and parents complained about them interfering with their children's eating habits and so on. And it doesn't, it strikes me that not much has changed since then. So I'm just wondering, how are those fast food buffer zones, or whatever you want to call them, actually working? Because as far as I can see, they're not working. And, I mean, point about Councillor Patrick's made about school dinners. I think also, I think kids just need somewhere to go after school and be together. They hang around outside the shop. In Well Street. Yeah, in Well Street, particularly. And then just lastly, I just wanted to see what you thought about a particular project that my church is involved in with the food bank and feast with us. It's a healthy eating on a budget course. And I've sort of just observed and actually consumed some of their products. It's very good. It's absolutely wonderful for the people. They get to know one another. They get to talk about their problems. But only eight people can take part. And it's only sort of once a term, because you have to have several sessions. So I'm wondering, is that one of the ways forward where you've actually got those three things? Eating on a healthy eating and on a budget. And also in partnership with a food bank or somewhere else, which helps you to understand about the value of food and how much it can cost and so on. And obviously, understanding how to cook might make them the most effective use. Those three things on this particular course seem to work very well. So it depends on what you thought about expanding that. Thank you. And Councillor before last last question, then I'll wrap file to Donna. I always come the last. Yeah, thank you very much. I know from some of the constituents I've spoken in terms of being obesity, the outcome of a result of being high cholesterol and diabetes kind of issues. And they've been enrolled or make a recommendation to the, what's it called, the gyms. But most cases, they don't get enrollment from the gyms. And is there any chance that can be reviewed as to how many people that has been recommended and not get access and the outcome in terms of people, so that most of the people can get access to the gym through the GP system? Thank you, Councillor before, Donna. There's quite a bit there for the final reply. Yes, where do I start? Yes. So taking the first question around the food environment and food deserts and whether we've spoken to people, we spoke to a lot of people when we developed the S&A and also organisations working with people to build some of these recommendations. as well. So we have spoken to people and the biggest theme that came out from speaking to people about this, as I said, is around food access and food affordability. So there are a number of recommendations around the food environment in the report because of that. And I think we're just about to start a whole year long piece of co-design work with residents as well to think about what it is in terms of the next steps to support their needs for them to be able to be a healthy weight and to be physically active as well. And in terms of your question around what changes from reception to year six, I wish I knew the answer to that. Unfortunately, we don't track people from reception to year six. It's a snapshot in time, but you could make an assumption that, you know, as people get a little bit older, they might be, you know, those impacts might be seen more and they might be putting on weight as the years go on through the school years. We're not sure we can't really answer that question at the minute, but we do know from this year's data that's been recently published that reception year data for obesity has also gone up. So it is a concern for us. In terms of identifying interventions from the slides that I think are effective, I think that is what we're trying to say, it is tricky to sort of pick some of this apart on a local level because they are pretty tailored and some of them aren't specifically weight interventions. But I think if I was going to do something locally, I would be trying to support and promote breastfeeding and thinking about our support as early as possible and building in that early intervention from day dot really so that we can support those healthy behaviours. I can't answer your question about fast food buffer zones, maybe Jane might be able to, but I definitely don't have the detail to hand around evidence for that, but I will have a look and get back to you on that. And I love your idea around the food bank intervention and we do already provide support around eating on a budget. But yeah, as you say, places can be limited. And I do think people do find something from the social connection aspect, as you said as well. And we hope to do work in partnership with food banks going forward as well. I think you'll be able to see that recommendations. And so I think it really is important to educate people, you know, where they can buy affordable food. I know there's not that much, but where the opportunities are within Hackney to do that and think about the food voucher schemes that we have already got in place and making sure that they are really targeted as effectively as they can be. And then in terms of the last question around residents getting access to gyms, I think via GPs, I'm not quite sure what that is in relation to, but it might be through our Healthier Together Hackney programme, which is run by Better Leisure. And as part of the support for some of that programme, there is access to the gym. So I'm not sure if that's what you're referring to, but there are eligibility criteria for the adult weight management and the exercise on referral programme. So potentially that's why some people are not able to access it. And Jane, just before we wrap up, Jane, do you want to come on the buffer zones? Well, I was just, I've got three very, very brief things on that. I think you're talking about the policy around not being able to open a new fast food taker in your schools. And yet I completely agree. The ones that are already there, we don't have the powers to shut them down. What we try to do is to work with those sorts of outlets. We've got a healthier catering commitment scheme that Environmental Health Deliver on our behalf is funded by Public Health, which tries to basically change the offer so that it's a slightly healthier offer. It's a bit of sort of like health promotion by stealth by putting a little bit less, a little bit less, better fat, having instead of salt shakers with loads of holes in the top. This isn't about obesity, it's general healthy diet. You have one with tiny little hole. People just use less of the unhealthy stuff and about where you place fizzy drinks in a fridge. So we try within the powers we've got very briefly on one other thing, two other things. One on that, I just don't want to get you overexcited about KPIs measurement. It's so hard to measure the impact of individual interventions on obesity, particularly when a lot of the levers aren't really in our control locally. And you saw that foresight diagram that Donna presented. It's really hard to know what's affecting what. So what we're really committed to is working out how we can measure and monitor the impact of the things we're doing in terms of what's meaningful progress towards achieving positive outcomes. And then finally, you heard from Lola Akindoyan, I think previously about the Kings Park Moving Together work. So on all the stuff you mentioned about physical activity, we're working very closely with that with that team to understand how we can use the learning from that to improve the sort of ability of people who won't be able to afford to go to the gym, don't want to go to a gym. That's not their thing to be able to be more active as part of the day to day by addressing some of the barriers and some of the enablers that were identified through that work. So all of this is joined up. But this is like a huge agenda and we just don't have time to tell you about everything that we're doing today. But we really appreciate all of your questions and attention. Thank you. Thank you. I think you get the sense that members have got several observations and feel strongly about this. And, you know, the Councillor Rathbone conversations 15 years ago on the same, on some of the same areas. I think, yes, I appreciate your point on KPIs, but however that the outcomes are monitored, so it's not just, you know, sort of a set of suggestions so we can actually see what benefit. However, you work out a way to measure those outcomes when you have thought that system, I think we would benefit from it coming back so we can understand it. So we can hold ourselves accountable as a council, so we can hold partners accountable. That would be much appreciated. But thank you very much for your time. Sandra, very quickly, would you like to come in on? Yeah, just really briefly on the KPIs thing. We're not saying we don't plan to monitor the impact. Well, I think the key thing is that you won't see the difference at a population level in terms of a healthy weight in the kind of timeframe in which you might have. You might expect to measure KPIs. So we will be monitoring healthy weight. We'll continue to measure the, do the child measurement programme and measure children in primary school at reception in year six, but also through the general health survey, looking at the trend in overweight and obesity in our adult population as well. But that's not something that we're going to come back in a year and say, oh, look what we did to obesity. But what we can do is come back in the year and say, look what progress we've made on delivering what we said we're going to deliver. I understand. Thank you, Sandra. Thank you for putting it in that context. So with that and with our thanks, I'll draw that item to a close. So thank you. Members, the future work programme is in the back of the agenda. Minutes item eight. Can I have those as agreed, please? Please. And then the matter I said I'd raise at the start is, um, college and keep our NHS public are here just to, um, put it on the record. You have, um, emailed me and the commission in terms of the, um, savings that may be having to be made both locally within Hackney and within the in-el print. Um, in terms of those locally on a primary care level, um, we're constantly asking about them as we did with, um, Kirsten. And she's flagged with us as we already knew the biggest issue we're concerned about is enhanced services going forward. Um, I'm going to continue to keep that under review, um, and try and have as much influence as we can in terms of the future commissioning in respect to that. Um, obviously another aspect where, um, if there are efficiency savings or in the budget overspends, it's the secondary care in the hospitals. Um, and that's a question as I've indicated, I can ask, um, Henry Black and who's the financial officer for, um, in-el and the chief execs at the in-el meeting. Um, in-el meeting as to, um, if, if we, if they were at month seven, 80 million overspend of a 4 billion budget, where, where, how about 80 million was made up? Um, I know from sort of my previous experience, it can be all sorts of things in terms of month seven might not be representative of month 12, whether NHS England picks up any overspend, whether you defer a slight capital budget, whether you cut down on agency staff. Any number of things can actually happen at a sort of quite a small one or 2% budget differential, which actually means there's not been a massive cut of a massive service, which I think you understandably were concerned at. So I think I can ask Henry for the clarification in relation to that. Um, but you know, in terms of, I think the, the, the gist of it in terms of us writing to sort of the secretary of state or, you know, what have you, I mean, I understand your role is a lobbying one. We're here for a scrutiny one. And when we find, um, if there are service changes, either at primary care or secondary care, we look into them and we constant, and we constantly do that. So Carol, I don't know. I think you've always been here for meeting. I don't know if you want to send and reply, and then I'll bring the meeting to a close. Oh, to put up. Right. And yes, our point is really that we want this committee to be looking at what is the actual impact on the ground of the cuts. So not so much, you know, it's, um, this line from the budget so much has been taken out, but what that means in terms of reductions in the number of staff or reductions in access to services. And we just believe that this is the committee that should be really scrutinizing that and looking at it. You've explained that in terms of local enhanced services, and that's very helpful your, what you've said about that. But undoubtedly, there are going to be other services that will be reduced, reorganized, there will be fewer staff, and there will be less access to services as a result of the, um, the savings, i.e. the cuts that will be implemented over coming months. And we want that fed up through political channels to, um, well, through the Labour Party to the Prime Minister to West Streeting, and to make sure that that message is known, um, the impact across the country. So we would ask that, um, members are in contact with members throughout the country, looking at the impact elsewhere as well as in Hackney and feeding that collective impact, um, up and, and challenging that and saying that we need to defend our health service. And I, I, a few, a few things there just to sort of, um, uh, bring it to a close. I mean, this is obviously a, this is a non-partisan political scrutiny commission. Um, and so that's an important point to be made. And there, obviously there are other channels that people are a member of political parties to make political party points, but that's not the function of this committee. In terms of sort of reduction services, there's 21 billion extra as a, as a fact in the autumn budget going into health services. Um, that is nearly a three to 4% more than there was. North East London has a growing population. So in actual fact, um, where even in the last few years when there have been cuts, more money has still been coming into the borough, but you've got to meet that with a, with a population decrease. So as far, as far as I'm concerned, actually next year and the year after more money, I think we'll actually be going in. So I'm not actually necessarily sure there will be per se cuts. There might be things that certain services are decommissioned and another one comes or things are reorganized. That is constantly happening. You'd expect that to happen in a 4 billion pound budget with multi, many secondary trusts and hundreds of GP practices. And that's how the system works. So I understand you have a different role in terms of sort of lobbying. Um, and please, if you find out about something we don't know about, either on private care or secondary care, about a significant service change that we don't know about, please let us know and we can look into it. But, um, I think, you know, I respect your different role to our role, but yes, on your core point, if we know about service change, we do look into it. So I'll, I'll, I'll leave it there. But I do, you know, on the, on the other thing, we do look into service changes when we know about them. So with that, I'm going to, um, close meeting and thank everyone. Sorry for overrunning for 17 minutes. I don't know. Yeah. I'm, uh, okay, it's great. It's great. Thank you very much. Motherwell questions! Okay. Hello. Yeah. Hello. Thank you, Madğı. So welcome to Dr. Andre. Awesome. Thank you. Hi. Great. �.

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