Transcript

Good afternoon and welcome to this meeting of the Health and Wellbeing Board. I'm Councillor Una O'Hallon and I will be chairing this meeting. Please note that we are not expecting a fire-line test today, so if you're lonely standing, please follow my instructions and evacuate the building. This meeting has been webcast to allow those who cannot attend in person to follow the proceedings. Please could I ask you to turn on your microphones when invited to speak and to remember to turn off your microphone when you feel it. I will finish speaking. I will start asking my fellow members and officers to introduce themselves, starting on my right. I'm Councillor Floor-Williamson and I am the Executive Member for Health and Adults Social Care in Nislington. Hi, I'm Mike Lewis. I'm Chief Executive of Islington's GP Federation. Hello, I'm Claire Henderson, Director of Place for the ICB in Nislington. Hi, I'm Jonathan Gardner. I'm Chief Strategy Officer at Whittington Health and I'm here for Claire Dollery, the Chief Executive. Unfortunately, Chair, I need to go at 2.30. Sorry. Hi, Councillor Micheline Safi-Ngongo, Lead Member for Children, Young People and Families. Hi, Nora Saxena, Chief Executive of Health Watch, Islington. Jonathan Agneson, Director of Public Health at Islington. Jonathan Agneson, Director of Public Health at Islington. Jonathan Agneson, and I'm still Director of Children's Service, if I can remember. I've got some way late there, but yeah, good being here. And I'm Jonathan Agneson, I'm the Corporate Director for Health and Social Care. Fabian Agneson, Senior Democratic Service Officer. So, we've had apologies from Claire Dollery, and we've got her, I shall say, standing. Is there any declarations of interest? So, order of business. The orders of business will be set out in the agenda, but I will be taking B3 and B5 together, if that's okay with everybody. Can we agree that minutes of the previous meeting held on the 12th of November, 2024? Thank you. Discussion items. The members have had an opportunity to read through all the presentations and reports provided in the agenda pack. Please keep your presentations to a minimum and present key points only. And we will go to B1, the Pharmaceutical Needs Assessment 2025. Charlotte Ashton to present. Thank you, Cheryl. We've actually got a slight change in personnel, because Charlotte is not able to be at today's meeting. But I'm very pleased to introduce my colleague, Robin Stevenson, who's one of our fantastic public health strategists, who's representing Islington in our work across North Central London Councils on this piece of work. So, I'm going to hand over to Robin for this item. And you're very welcome, Robin. Hi, good afternoon, everyone. Thank you. So, this report provides information on the process for conducting and publishing a new Pharmaceutical Needs Assessment by the nationally set deadline of 1st October, 2025. Since 2013, health and well-being boards in England have had a statutory responsibility to publish and keep up to date a statement of the needs for pharmaceutical services for the population in its area. And the Pharmacy Needs Assessment is a key document for those wishing to open a new pharmacy. The main objectives of the P&A are to provide a clear picture of the current services provided by community pharmacies and to identify any gaps in service provision, to be able to plan for future services and ensure any important gaps are addressed, and to provide robust and relevant information on which to base decisions about applications for market entry by new pharmacies. P&As are required to be completed every three years, and Islington's last P&A was published in 2022. Islington is working with the other four boroughs across north-central London integrated care system to ensure efficiency and consistency in our approach. And in line with guidance from the Department of Health and Social Care, a P&A steering group has been set up with representatives from the NCL Integrated Care Board and Medicines Management Team, Health Watch, the local pharmaceutical committee, and Islington Council Public Health. To prepare the P&A, data is gathered from pharmacy contractors, commissioners, pharmacy users, and other residents, and from a range of sources, including demographic data, joint strategic needs assessments, and performance data. And the report also includes a range of maps assessing factors, such as the location of pharmacies and travel time. The regulations require health and wellbeing boards to consult with a specific range of organizations, including the LPC and LMC, Health Watch, neighboring health and wellbeing boards, and NHS England, for a minimum period of 60 days. Working to the deadline of 1st October, it's anticipated that stakeholder engagements, including surveys, will be completed by April 2025, with a draft version of a P&A made available for consultation from June to August 2025. And guidance recommends that the Health and Wellbeing Board has a named board member, such as the Director of Public Health, to take overall responsibility for ensuring the document meets the regulatory requirements and is published in a timely manner. And it's also recommended that the board provide the chair of the Health and Wellbeing Board with a delegated authority to approve the P&A prior to consultation to ensure timelines are met. So given the regulatory time frame for publishing the P&A and considering the schedule of Health and Wellbeing Board meetings for 2025, the Health and Wellbeing Board are asked to note its statutory role in relation to the Pharmacy Needs Assessment and to note the work that has been undertaken so far, as well as the plans in place to produce an updated P&A for Islington by 1st October and to delegate approval of the draft and final 2025 P&A to the Chair of the Health and Wellbeing Board. Thank you. Thank you. I believe Councillor Safi Nogongo, you would like to speak? Thank you very much, Chair. I would like just to double-check with you because thank you for the report. It's a really comprehensive report. But of course, I want to check a question regarding the protected characteristics because here is under the Act, Equal Act 2010. However, in September last year, we have a motion if we can nominate our young care experience to become a protective characteristic, but they are not under the Equality Act 2010. I wanted to see if we can include them really because, you know, health-experienced young people, they are very venerable in that way because we know pharmacy is something really they need really when they are getting their medication. Just a question if we can include them to become as a protective characteristic. Thanks for that question, Councillor. Yes, is the short answer. The assessment hasn't started yet, but that can be fed back to the steering group and we can include it as part of the assessment. Thank you, Chair. Thank you. Jonathan. So, absolutely. Thank you, Robin, for that presentation and also for that answer. I think one of the things here, Councillor Nogongo, is obviously this is a national requirement and therefore the pharmaceutical need assessment statutory reflects all the statutory rules. But, as Robin says, I'm very happy that we will include that group and also consideration of other vulnerable groups, which are also important. Has anybody else got any comments, questions? If not, shall we agree to note this report? Next item is B2, Islington's Annual Public Health Report 2025. Jonathan O'Sullivan to present. Thank you so much, Chair. So, I think we've got some slides to put up. But, Babri, I'm going to do the thing that you were talking about earlier and ask you to skip over the slides quite quickly. So, anyway, so just by way of background. So, remember, the Annual Public Health Report is a statutory duty of the Director of Public Health. It is an independent report. So, it's not a report of the Council. It's not a report of the Health and Wellbeing Board. It's a report of the Director of Public Health. And, therefore, really, the way in which we use these reports is to dive deep into an area which we think is really important to the health, well-being and inequalities experienced by people living in the borough and our communities. And also to bring the sort of analytical lens that you would hope public health would bring. Take a look at examples of good and effective practice. look at the evidence base and also use it as a way to develop the skills and experience of the public health department in the way in which it tackles these issues. And they're usually cross-cutting issues that we identify. But also as a way to really prompt debate and discussion. And I think one of the things I'd like to ask each of our organisations represented around this board is that we'd be delighted to come and talk to your boards or other sort of groupings around this annual public health report is an important way in which we share the findings and some of the, socialise some of it and about some of the advantages. So, this year's report, which is suddenly not coming up on the screen. Apologies, Jonathan. Is it okay that I send someone out because we're having some technical issues here? Is it possible just to get someone from facilities? Because I know it's good to talk through you slides even quickly. And we have had a test before this meeting, so I don't know what's going wrong. It's okay. I'm an IT jinx, I think, as most people know as well. So, people also can look at the slide sets within the papers. I'm going to sort of talk to it. So, this year's theme is healthy environments. Why healthy environments? Really, I think, probably sort of twofold. Firstly, originally we were actually going to just focus in on climate change as part of this report, which was a big area of focus for the department, working with colleagues across the council and the community. We were a big part of the resident forum citizen panel about climate change and really focusing on that. But as we were looking more widely, we thought, actually, there's real advice to talk about healthy environments. So, for example, last year I'm running a public health report about young people and asthma. Couldn't help but talk about damp and mould in people's homes, as well as the need to really review and look at how care is provided to those groups. So, taking a much more holistic and diverse views. So, we're looking at the indoor environment, so where people live, their houses, which in many regards in terms of environment is the one which has the greatest impact. The public realm, which is basically another way of saying public spaces in your neighbourhood. Looking at the commercial determinants, particularly those which have some of the greatest impacts on health. So, food, alcohol and gambling. And then finally looking at climate change in that regard. And for all of that, we've taken a lens across our population and looking at what data and insights exist around that. So, the first area that we look at is housing. Oh, and we're up. So, if we go to slide six. That would be great. So, housing in our Let's Talk engagement that we carried out with our residents in 2020 and 2021 came up as a single greatest area of concern in our wellbeing surveys, which we carry out annually across the council. Housing is invariably top three issues for our residents. And in the report, which will be shared sort of at a slightly later date, we've really dived into issues around affordability, housing insecurity and homelessness and housing quality as being those areas which residents tell us are really important and which from a health perspective are also really important. So, if we move to... Oh, we've got the right side up. So, as I say, it's importantly rated by residents as being a really important part of their wellbeing and it is one of the most important facts that people have in terms of a good life. We have a very distinctive pattern of housing in Islington. There's an awful way in which housing shapes the demography and in turn shapes the health and health inequalities across the borough. So, about 40% of our population live in social rented housing, 25% is in council housing, 15% by other social landlords. About a third of our population live in private rented accommodation that has actually increased in the last 10 years and we have a very low proportion of owner-occupiers or mortgage properties which is just over a quarter of residents. So, that is really distinctly different from the rest of the country. And underneath that, in terms of our demography, what is going on is that given the pressures on social housing, you've got a weightiness of around 15,000 to 16,000 households. Households that go into new properties are generally more needy than the ones that they're replacing. Similarly, as house prices go up, it means that people that move in, once people move out, tend to be wealthier than the ones that have left. And that really drives that sort of whole sense of sort of a borough where we've got extremes of poverty and extremes of affluence. Sometimes living very, very near by each other, even on the same street, which is another very distinctive feature. And within that, we can see how our inequalities, our pattern of life expectancy follows. We also know that sort of the private rented sector is a big focus for us at the moment. We have a selective licensing scheme, which is intended to drive up the quality of private rented, how to make sure it at least makes minimum standards around safety and sort of liveability. But what we can also see as part of sort of general cost of living, house price changes, is there is a big increase happening in private rented accommodation at the time, and that is driving demographic change, which is at the moment being felt within the borough, and is likely at least in part to be driving some of the changes we're seeing in our children's demography in the borough at the current time. We also, we're not immune in Islington to the big increase in demand around homelessness and people in temporary accommodation. So Islington's got the seventh highest rate of families and households living in temporary, who have become homeless, and it's also seen by the highest increases in London against that particular metric. And we're also more likely to have households presenting as homeless at the point at which they are already homeless or imminently homeless, so what we call that odour relief, adjusive relief, than at risk of homelessness where one could act preventively. And that really drives a huge pressure in our population. Temporary accommodation is not associated with good outcomes. We are very pleased that the council, where it sees children and families, do not place in bed and breakfast accommodation. That is a very serious, significant risk factor for health and well-being, particularly in young families. But it is also a sort of a really key issue that we are grappling with at the current time. And if we move to, sorry, I've lost my screen. If we go back to the previous slide, sorry. Previous slide? Sorry, that's it. And overcrowding is a key issue in the borough. So, in the census in 2021, when it was carried out, suggested that 9% of our households were living in overcrowded accommodation. That compared to a national average of 6%. We've been doing work with academic partners to actually drill into the data in a deeper way. It's not straightforward to calculate who precisely is in overcrowded conditions. And we actually now calculate it's more like 13% to 14%. That rises to one-third of children and families. So, whilst we tend also to talk about affordability as being a really key driver around housing, there's also something about the housing stock. So, about 85% of our housing are flats. About 80% are one-bedroom properties. So, if you're in a family with more than one child, the risk around overcrowding increase, and you can see that. So, if we move on to the next slide. Next slide. So, we then also look to the public realm. So, open spaces or public spaces, which are publicly available. So, Islington has the second lowest proportion of green space in the country. We've just got about 2.83 square metres per resident. But, most residents can reach a public part of green space within a 15-minute walk. Linked to that, we're also one of the most densely populated boroughs in the country. We are the second highest density borough in London, just behind Tarahampton in the country. And if you look at us in terms of square miles, Islington's the third smallest borough in the country. We're tied with the Isle of Cillies. But Islington has 100 times the population of the Isle of Cillies. So, we are really concentrating it in. But, what we do have is where we've got green space, we really maximise the benefits of it. So, some of the key findings about how green social prescribing, the quality of our green space, the importance that it has, is really accentuated within the borough. And it's still a really important asset. And a very high proportion of households access that. We also, in spite of that limited outdoor space, at least 71% of households do have access to outdoor space. That might be shared outdoor space. It might be directly attached. Let me just go back there. So, if we just jump over further to the commercial environment. So, next slide. So, the commercial environment is another important determinant of health. We've focused in on food, alcohol and gambling. So, in terms of our key findings, we looked at the availability of healthy, affordable food in the borough. And the key message in a borough, which is quite small, which is that most of the population live in very close proximity to such sources, although some parts of the borough have less access than others. We also looked at fast food or hot fast food outlets and mapped them across the borough to look at how they correlated with deprivation. And there were two correlations. First is to deprivation. And the second is to the busiest parts of the borough. Islington has had for some time now a licensing policy which seeks to exclude new takeaways from at least 200 metres away from secondary schools. Because, obviously, one of our key concerns in the annual report shows about patterns of takeaway consumption by secondary school pupils. And you can see there on the map, sort of those 200 metre zones around the schools. And where you do have takeaways within those zones, it's because they're long established at zones. And the thing about licensing around areas like food or alcohol or gambling is that they are permissive in the sense of there is a presumption that a licence will be granted unless one can demonstrate harm resulting from that. And then, finally, we also looked at gambling locations and we've seen a dramatic reduction in numbers of gambling locations above in the last 10 years. Sadly, that is almost certainly because of online gambling, which has replaced physical locations. And we can see, again, that they are concentrated into some of our most deprived areas. Next slide. Next slide. Next. Thank you. So, the final area that we look at is around climate change. We can see that commercial and domestic buildings account for 70% of greenhouse gas emissions with transport being the next largest element of that. We've seen that in the commercial sector, we've seen a 56% reduction in greenhouse gas emissions over the roughly a decade. That is largely because of the decarbonisation of the electricity grid. So, now we no longer have coal-fired electricity stations, etc. Islington's reduction in greenhouse gases has been higher than the rest of London. So, we've seen about a 20% reduction in about the last five years. But we can still see that in terms of fine particulate matters, that this kind of stuff that gets deep into your lungs causes heart respiratory conditions as associated with increased risk of dementia. Not good for the unborn child or child development. We can see our rates are still higher than London and England. Partly simply just because of where we are in London. We are surrounded by sort of polluting areas. We've got big roads and arteries going both through the borough, but also alongside the borough. But we have seen a truly impressive reduction in that period of time. We're also a very active borough. So, around 50% of the borough is living in low-traffic neighbourhoods, which is being shown to significantly increase cycling, walking and wheeling. We also have high levels of active travel in the population. These are people who are sort of walking, cycling, etc. Amongst the highest in the country. But we also have about a quarter of the population who are not very physically active. It's about one in eight are not physically active at all. And that's a really big focus for us about improving physical activity levels where you get the greatest benefit, not least through green social prescribing. Some of the work we're doing for the GPs about how we motivate people. And what we're finding is that where people have been very inactive or becoming active, walking and every day of life is really what's driving that. And that's really important. And I always get a plug-in of every 2,500 steps that you manage in a day, you're beginning to make a difference to your cardiovascular and your spiritual health. And everything over and above 2,500 is a pretty good going. So, it's all bank that in terms of good levels. But we've got, as I say, high levels of walking and cycling. Around 50% of adults are regularly physically active at least five times a week. Where we do not do so well is around children and young people. Much less likely to be physically active as adults. There are different standards. So, we want children to be playing and active about an hour a day. For adults, it's roughly, it's probably about 30 minutes, five times a week. But when we look at Islington, either we are worse than the national average or we're about the same. There's one of those ones where the national average is only about 45% of children and young people are actually physically active enough. And when we correlate that against some of the big risks that we've got in terms of the future, such as rising levels of people who are not a healthy weight, then physical activity is a really powerful way to address that and has huge benefits regardless. If we go to the next slide. Next slide. So, just in sort of summary, underneath that analysis, all the way through, we've identified key public health approaches which we think are really important. We detail a range of work that we're doing with housing colleagues about improving the internal environment. We've got doing work around different ways to address damper mould needs, looking at vulnerability about how we build our knowledge about vulnerability and respond to it. Big push on private rented housing where we have the highest proportion of non-decent... Private rented sector where we've got the highest proportion of non-decent accommodation. We are working very closely around public realm and really maximising the gains of the public realm that we've got, whether it's green space, outdoor space, to benefit health and wellbeing. In terms of licensing, we're ensuring that public health is a key part of licensing decisions, working very much with planning and policy and licensing bodies around looking at cumulative impacts, harms which can arise in terms of access to those resources. And equally, we can see that there's new legislation coming in around promotion of, let's say junk food, particularly to children and young people. Those are already embodied in policies which Islington have, but as those come through, we need to stay up to date with that. And in terms of climate change, as well as really helping to push for further improvement around air quality, really helping to reduce the direct impacts of climate on our population, whether it's around sort of heat or what have you. We're also looking to maximise the benefits in terms of wider health and wellbeing through things such as low-traffic neighbourhoods. I will end there. Has anybody got any comments, questions, Claire? Thanks, Jonathan. I'm really good to see sort of healthy environments as being a focus, because as the NHS moves to thinking about neighbourhood health, obviously the sort of physical environment is really important. So lots of links there. I was really interested in the rise in private sector, rented, private rented. And do you know much about the sort of demography of the tenants in the private sector in terms of just because in other boroughs we know that, you know, we have some quite a bit of deprivation, if you like, in that sector. But services don't... So wherever you have social housing tenants or whatever, there's quite a lot of support that comes from their landlords around cost of living, healthy living and so on. But less so, obviously, in the private sector. So I just wondered if you have sort of knowledge about the demography of the people who live in the private sector, private rented sector, sorry. Okay, so we have some insight, but it's probably because of the nature of the private rented sector, we have less insight, particularly about the dynamic which is going on. And I think one of the reasons, one of the advantages of sort of the selective licensing approach, which covers almost all of the borough now, is it will build up our knowledge about what the housing conditions are and who's in that housing. I think in general, there's quite a large student population living in some of these premises tends to skew towards younger adults, often single or couples. We have a reasonable proportion of housing with multiple occupancy, although it's perhaps not as dominant as one might think, but it's definitely concentrated that in the borough. We can also see some of the impact coming through in terms of our demographic changes. So particularly as the affordability of private rented properties coming up, what we are seeing is sort of young adults, young families, with young children being more likely to move out of the borough and stay in. And I think one of the key things that you can see in terms of the pressures going on is that it's moving in a similar direction about creating that greater divide between affluence and poverty. So as the costs are going up, we're in the private rented sector, and this is my point about the fluidity, is that other things being equal, you would expect, again, poorer households to be moving out, moving to other parts of London or even outside of London, and looking to see others coming in who have got more financial resources. Just before I take Jonathan, I'll add to that, because I head housing, we've done a lot of work, and that's why the licensing schemes, you're right, we've done it with some of the younger people from the private renters, but we're also reaching out, so when we add things like a hardship grant and other things, it's borough, it doesn't matter if you're in private renting or council property. So we are collecting, and so we were, I think it's like a bit of a game changer, the work that's done on that, because they're collecting all this evidence, because we like to do it borough-wide, and the more evidence, because some people are frightened if they're overcrowded, living in a poor condition property, reporting their landlord, and we're saying, no, you have a duty of a high standard. So there is lots of work, and I think some of the work Manaz is doing as the state of the borough, and those reports are really going to help. I take Jonathan. Thanks, Jonathan. Always incredibly comprehensive, and I suppose one of the points was a great offer to our partners to go and present this and have a conversation at an organisational level, I suppose, also with our other partnership arrangements locally in Islington. But I wonder whether you'd, I know you would have done, but what sort of consideration in terms of the asks of our partners around the table that could help address some of the sort of maybe underlying issues that you've raised in the report? Okay. So, at the risk of an essay answer, which I will not do, I promise, is a fundamental cross-cutting thing. So, at the end of the report, we talk about all the different ways in which you can influence health and well-being and improve lives. Environment is a really key one. So, one of the examples, I haven't done it here, but one of the examples that we give very early on is about the huge progress we've made in the world about smoking. So, some of you have heard me say this before, but a generation ago, more than a third of people in Islington adults smoked. That's now below 10%. Huge, huge achievement. It remains the single biggest cause of inequality, still lots more to do, but it remains fundamentally important. The thing which really prompted that big reduction wasn't knowledge that smoking is not good for you, because people have known that for a long time. Long time. It wasn't having great stop-smoking services, although we do have great stop-smoking services. It wasn't the wonderful work we do in terms of maternity and really raising awareness about the importance of not smoking in the household, etc. What prompted it was about smoke-free in the workplace legislation. It was about protecting people exposed to passive smoking indoors as part of their work. And there were many people who died each year or became measly ill on the back of that. But the way in which we actually work with that in Eastlington and elsewhere was to really grab, firstly, the community conversation, the popular sentiment and imagination about really getting that message out there, out into the population, and really driving a sea-changing attitude. And one of the things I really remember, particularly given that we're now looking at smoke-free generation, was doing some engagement in Bunhill, which was some of our older residents and part of a regeneration project. And they didn't like the smoke-free legislation because they saw it as being part of, if you like, a nanny state. But what they didn't want, universal, was for their grandchildren to smoke. Now, I hope we've really helped them with that, given the reduction that we've seen. But it's actually about changing that sea change of population. So all of those different elements, in this case, we would not have had that huge debate and that huge denormalisation of smoke, that huge reduction, without that healthy environment lens. Now, that's one very particular example, but about how we bring this all together. So my general ask of the board is to think about this as we're developing the action plans around all of our strategic goals, is to think about what is the healthy environment offer that we can actually build into that because we need all the levers at our disposal to really effectively drive up health and, importantly, to reduce health inequalities. I'll take Councillor Nogonga. Yeah, thank you very much, thank you, Jonathan, for the presentation. I wanted to check when you said about the healthy environment, I feel like we didn't mention anything about pavement because as it's linked, if you are disabled, you need to go outside, including for your mental health. If the pavement is not really in good condition, it's causing quite a lot of problems. I'm very curious to know about the quality of environment physical environment on the pavement in general. Thank you. So, it's quite a long report, so we weren't able to cover everything in terms of the presentation. We do talk about healthy streets, health environments. So, it's been, I think, four years in a row, sort of healthy streets awards for London, of which the state of the pavement is being called. We do talk about the state of the pavement. We talk about it in connection with people who are disabled, people who are older, other Ron Wall Street users and about the importance of people feeling safe and being safe in terms of use of pavements. So, some of that is indeed about the quality of the pavements. And I notice that we've now, as well as having the helplines, we've actually just launched an app which encourages people to be able to report problems with the pavements, which I think is a really positive thing. If you really know about the issues, we can act as a council regarding that. But we also talk about other things such as obstructions or things which can be great. So, again, thinking about, for example, e-bicycles or e-scooters which can be a block to pavements. Again, one of the reasons why we're acting to get voluntary agreements with our providers of the bike is about having bays where those bikes are put so they're not in the way of vulnerable users. I think one of the advantages we develop our liveable neighbourhoods and our low-traffic neighbourhoods further is actually we will be changing the streets, they've improved the streets. So, hopefully, the idea that you might get blocked in a narrow pavement will become less of the case in the future as we redesign. But that's a long-term ambition. But, yes, we do talk about pavements and it is something that people tell us about and which you can also see in the literature has been important. Has anybody else got any comments or questions? I would just like to add, when you said about the environment, about the smoking, I thought that was a game-changer, you know, like the people weren't allowed if you were a non-smoker and people weren't polluting you. I think there is more we can do because we're a child-friendly borough. with children. Like, I would love to see children out playing away from their devices, you know, because you did say that more people walk in and out there, but we've really got to. We want to work together. And the liveable streets and the friendlier neighbours and where there's less traffic, people do feel a bit safer playing out, but that's where I really would like. And I agree, the takeaway's away from 200, but it's still not enough. It's still not, you know, if we're really going to look after our, you know, the next generation. But really, well done. Is this support report agreed and noted? Thank you. Now we're going to take B3 with B5 together. So it's the Health and Integrated Partnership working across health and social care in Islington and also the Better Care Fund. And I believe, Jodie, you're going to do both reports. Thank you. Yes. I'm Jodie Pilling. I'm the Director of Strategic Commissioning and Investment for Adults and Children in the Council. And I am also going to do that annoying thing where I try and get you to jump across slides. Sorry. So this is a really long report and I'll try and very succinctly describe what I think are the really key points for the board to note. Critically, Integrated and Partnership working is really important to us all for achieving our strategic objectives. The Health and Wellbeing Board is required to have oversight of the formal integrated arrangements for, between the Council and the ICB in our Section 75 partnership agreements and also in the Better Care Fund. But this report intends to broaden out that oversight for the board so that you can see the arrangements in the broader context of integration and partnership working. And we're proposing that we report annually on that broader picture. We're also proposing that there's a follow-up report that comes before that annual report where we'll set out more clearly some impact measures that bring together the impact of integrated and partnership working. The report links to the Better Care Fund report that I was going to say comes later but it actually comes next which is very helpful. And that report will set out a high-level overview of the arrangements for 25-26 for our Better Care Fund and I'll talk a bit about that when we get to that report. But what's really critical here is that we're proposing that we bring the reporting for the Better Care Fund into this wider report. so that you can see the Better Care Fund in the context of the wider system work that we're doing. So if we go to the next slide we talk a lot rightly so about our long and proud history of integration here in Islington and I think what's really helpful about that long and proud history is that it's a really good start for us in supporting the government's new shift to the left vision of providing care closer to home supporting prevention and announcing technology and our integrated teams and poor budgets that we've had with the NHS and the council for a long time really do bring those arrangements together. But if you set those alongside those long term ways of working alongside the changes that we're navigating then we really have a challenge responding to those changes. the report notes that the ICB in response to that has a new operating model and that has changed the way that we're doing our joint commissioning for example but we're working really closely together to ensure that that aligned commissioning model really works for our residents and would form part of this reporting. And as you've seen in the report there are a number of other really important relationships that exist both within health across health across health and social care across the council and health partners that we think it's important to bring into that kind of over borough wide sort of vision. So if we go to slide six I'm not going to teach the board if go one before to suck eggs these are visions you're all very familiar with they're what drive the way we work and fit really well with the government intentions as well which is really useful for us. So we start with our north central London population health and integrated care strategy which really begins to define how we're working across the whole of NCL both as a system and then as a borough partnership at place and then even down to neighbourhood levels. So if we go to slide eight which is the next slide it would be remiss not to mention our joint health and wellbeing strategy the integrated and partnership working is really critical in ensuring that we do deliver on the improvements that are set out in that strategy. So again another really strong reason why we should be reporting to the board in this way and on the next slide of course we also for the council really important in the delivery of the 2030 plan. So if we skip all the way to slide 13 which is one before please back one that's okay okay so the governance arrangements go across all of these boards meetings etc but I think what's really important to pull out here is that our integrated care and support arrangements sitting at place and at system level this board plays obviously a really critical role in overseeing those arrangements not just as I've said formally through our section 75 and better care fund but also that broader length. So if we go to the next slide the report outlines the range of things that we're doing together it's likely not to be exhaustive and it's trying to be quite high level because there is actually so much going on in the borough but we talk about the integrated front door which is our no wrong front door approach and that's a partnership between Whistington Health and Adult Social Care and a single point of access for adult social care, urgent community health and hospital discharge and there are a range of different ways that we're working together that really support the team to work in a more integrated way. We've got joint working in hospitals with the discharge service working collaboratively with our acute hospitals and our intermediate care hospitals with on-site social workers the Islington Learning Disabilities Partnership has been around for 25 years and has a range of both health and social care staff in it supporting our residents with learning disabilities. Our mental health services are a fully integrated model of medical nursing and social care in a multidisciplinary team. I think it's worth noting there that we're working towards strengthening the social work function within that team and that we do need to recognise as we integrate that it's really important to maintain professional identity within that and we need to keep that in mind. For our children and young people there's a whole range of different integrated services so our social emotional mental health partnership is made up of health council and voluntary sector partners and deliver a range of services including a multidisciplinary central point of access where young people are triaged by a multidisciplinary team. Our iThrive framework is a system-wide framework for supporting young people with mental health support needs. We're collaboratively addressing our systems challenges so for example the therapist waiting list is a real joint piece of work across the system and we've got clinical therapists embedded in our children's social care and other council teams supporting young people. With our public health services not only do our colleagues in public health provide significant analysis and insight that underpin a lot of the working that we're doing but they also convene a range of partnerships that improve health and well-being for our residents so we've got the Islington Active Together partnership, the Combating Drugs partnership, Camden and Islington Suicide Prevention Group, Smoke Regeneration partnership and I'm sure that's not all of them but that's a little taster and then the move to the neighbourhood or localities model, really important and as we're all aware it's been an ambition in Islington for a very long time and that's evidenced through our integrated care network teams that bring a multidisciplinary team together in localities or for example in our home care commissioned contracts that are all commissioned on a locality's basis as well. We have the advantage of having co-terminus localities or neighbourhoods which I think will be really useful to us in the future but there's a lot of work to do and so our integration has to focus on that kind of neighbourhoods localities model which we've been doing anyway so I think we've got a good head start. So if we go to slide 16. So in 4.3 can we go back one? Thank you. So in 4.35 of the report it sets out the current reporting sort of talking about measuring impact of our work with people with mental health support needs within the 2030 delivery plan the metrics that we use for the better care fund not all of them but some of them are outlined there the outcomes that we use from our health inequalities fund that we measure and then our SEMH partnership for children and young people where we're developing a whole suite of indicators that will hopefully show the direction of travel for that work and also the measuring of the impact for example of implementing the iThrive framework. What we're proposing is that we bring some of these measures together and identify the ones that we think best are specific to measuring the impact of integrated and partnership working and that's what we're proposing we bring in the next report if the board agree. on the next slide it's just really important to say that a lot of that was quantitative data and the resident voice and the carer voice is really important. Here of course we've got the advantage of having an adult social care outcomes framework and carer survey but of course there'll be other ways of collecting that feedback from our residents and that will be really critical in measuring people's experience. and then if we go to the next slide what's really important is the long-term impacts and we think that the well-being index will help us measure those and it will be challenging I imagine but to identify things in the well-being index that talk to the impacts of integration would be very helpful if we're able to do that. So if we just go to the last slide and finally I guess in next steps really what's important here to know is that there are a range of drivers, activity and changes that are coming our way as we are aware. For example the NHS 10-year plan but also the development of the National Care Service and all of these will shape how we move forward so I think it will be a bit organic and a bit iterative as we have new demands placed on us externally and again that becomes even more important that the board hold oversight of the progress of integration in the light of those things that are coming down the road. Thank you. Any, Jonathan do you want to come in and can't see you go and go after that? Thank you. A really great report and I guess I just a couple of things to highlight from Whittington Health point of view. I guess our view is we really, really appreciate the integrated working that is happening across the borough and you mentioned a few of them such as the social workers on our site such as the integrated front door and all of that so I guess just to reiterate from a partner the importance of it and the gratefulness of the way that we work as a borough. I guess what I want to do is just pick up a little bit on your point about the outcomes data and the next steps and I just wonder whether I was looking at some of the other data and there's data in there that we never report to our board but we really should. So sort of some of the outcomes of how the impact of this integrated care is impacting on the population of Islington. So there's something about how we as Whittington Health perhaps link in with some of the data that you produce on a regular basis. Partly also the population health data that Jonathan was previously referring to. So there's something about how do we get that aired in different organisations around the place. But then secondly there's something about how do we, and I think you were sort of referencing it in a slightly different way just as you finished, how do we understand almost a logic model between the actions we're taking and the outcomes we're expecting or the actions we're taking and the outcomes we are measuring. Because we can't always measure every outcome that we want to just because it's hard to do. But I just wonder as we go through iterations of this how do we refine where we're putting our efforts so that we actually have the outcomes that we want to achieve and where do we say actually we we don't have anything that's working on that outcome should we do something. And it's just a build for future working. So I think it's a really good question and I'm hoping Jonathan's team have got the answer. I think it is challenging and I think that's why I think it's going to be an iterative process and I think that in Islington because it's so rich we're all doing a lot and unpicking the impact of X and the impact of Y is quite challenging. So I think the logic model approach or something similar would be helpful. I'm hoping Evidence Islington might be able to help unpick some of this at some point. But I think that that's why we didn't come to the board now with outcome measures. We started to think about it and when we come next time we will propose some but I think as I say it may well be organic and iterative and we will have to recognise that a lot of the measures will have a number of different things that create hopefully a positive impact. And I think the idea of bringing the outcome to different bits of the borough is a really good one. I think the borough partnership will be a really strong place to take that and then asking colleagues to disseminate. But on the other hand as we're iterating the process I think direct conversations with partners would be really helpful as well. I suppose I was just building on Jodie's point and we are in the process of finalising our sort of, for want of a better word, integrated care sort of dashboard for the borough partnership and I think it needs to connect with the children and families board too that helps us demonstrate as a system the change that we're driving and I think having that at that level and developing it at that borough partnership level but with the health and wellbeing board being the space where as strategic leaders we have oversight and a drive on that will one I suppose help us identify where we're doing really well but also thinking about how we might work going forward as a health and wellbeing board help us think and tackle some of those really knotty problems that we've got as a system where it actually will require us to think maybe differently about what we do. So I think it's a really good challenge for us and I think that's why we wanted to bring back the conversation to the health and wellbeing board but I think we need to have it you know our various partnership groups too. Now I thought it was a really good challenge. Councillor Zogongo you were going to ask on page 78 for 412. Yeah thank you very much I think Jonathan you answer one of my questions for us to join both with children and family boards because all of us we are aware about comes young people's mental health really for us to see how we can tackling especially the waiting list and also the number increased number on stands you know when we say the bus starts well and the services across I know it is across the country but we can focus about how can be our immediate response on in its linked on especially on those two topics mental health and science assessment really causing cancer serious problem. Did you want to come in? The only thing I was going to say is the data in the PACs on 82 and 83 I think indicates that integration is broadly working but obviously in cancer I'd like to see what we can do better and the avoidable emissions is hugely off target. I guess why is that and what can we as a whole system approach be actually doing or doing differently to reduce the amount of avoidable emissions to hospital? I'll give it to one of the Jonathan's or John? Well shall I start because I think it's a really good challenge and it's a challenge to everybody around this table which should be the strength of the health and wellbeing board shouldn't it going actually we've been looking at this for a while we know we've been off target and think Claire can probably talk better to this than maybe I can but for quite a long time so one of the pieces of work that we're doing as part of the borough partnership is to really try and get under the bonnet of that data to understand who is it because avoidable emissions can cover a whole range of residents in Islington who is it that we could be doing something differently alongside to support that so I think it's absolutely fair challenge and probably one that is something we should bring back through this conversation and definitely one that we're having at a borough partnership level but colleagues will have views on this I'm sure. I was going to take Jonathan and then Claire. Yeah I was just going to say I think that sort of goes to my logic model question because I've noticed that data and then I was thinking well actually do we have a programme of work on avoidable emissions now yes we do a lot of stuff but are we connecting that work to our avoidable emissions are we doing a sort of a regular check to go well did that change last month or are we doing the wrong stuff and I don't think we're quite connecting and hence why saying we need to take it to our board you know because we're not connecting the end result which is avoidable emissions to the work that we're doing all the time and we are sometimes in the borough partnership but just not all. And I guess I'd agree because I think in the better care fund we also look at avoidable emissions quite closely and I think I suppose from an NHS perspective the whole sort of one of the drivers for that sort of neighbourhood health service that you know we're being asked to sort of move towards is that whole capturing people who are rising risk so the people who are you know starting to sort of get less well that we really need to work across health and social care to sort of hold at home and de-escalate and I think from a population health perspective using our ability to use data as professionals if you like on the front line needs to improve we are getting better sort of data analytics and I think one of the potential game changers is having better data around our local populations and what's happening with those. Do you want to come in? Well I suppose I'd just add to that that in terms of the better care fund so some of this is not in depth at all addressed in the next report because avoidable admissions is forming part of our transformation work that we're doing across north central London around the better care fund so hopefully that works who at some point can join up with this and report back. Yeah I just wanted to say obviously the focus of that report was integrated working between the NHS and social care but there is also a BCS role within that which was sort of discussed in the report but maybe not fully and in terms of joining up data sets and thinking about outcomes the sort of data that we're holding in the third sector needs to be factored into that and how we use it better obviously evidence islington is looking a bit at that but there's a wider conversation there that needs to happen I think. Thanks. Is there any more questions? It's just a suggestion chair but maybe one for a discussion afterwards but whether it makes sense for support like just think about the forward plan to actually we have some of that data each time so that we're at least looking at that avoidable emissions data and the second one whether we need to look at possibly having a report which is what each bit is doing around avoidable emissions or whether that's better to go to the board of partnership and I'm making sure that we're taking an integrated approach but happy for discussion outside this room but I just... I think it's important that we well when we do take it to the board of partnership it's definitely a bit and better conversation there absolutely but I think this us as a health and well being board should definitely be part of that conversation to look at how that's progressing so if we look maybe as you said the forward plan think about that towards the sort of after this summer. I think I mean from a children's perspective and getting that data and data protocol it's the same fact of some of the data can be quite challenging and I think that's what Jonathan's sort of alluding to if we could see it and then see where the gaps might be and for us in our eyes we've gone from a very low base like what can we gather and what can we get that also includes other statutory partner police but some of those arrangements across London but also locally just means some of the data it needs to be timely otherwise it becomes irrelevant and I think you know having that ambition is absolutely right but I would say it's been like pulling teeth to get the right data that then is useful so I think the ambition is right it may be maybe different than the other safeguarding board but for us it's start low and then let's build it up from there. I think it is a good challenge and we should be looking at it if we really want to reduce what the table says or if there's something we're missing everybody's doing things but if you don't know then you don't have the right data yeah so now shall we B3 which Jodie's presented and B5 the better care fund shall we agree and note the reports together and we'll do it separately oh sorry yeah sorry sorry that's my fault jumping so I'll wait and then we'll agree them both. Thank you largely because it's really important that the board signs off the better care fund and we're in an unusual situation with the better care fund at the moment so I'll be very quick though I promise so it's the health and well-being board is expected to have oversight of the better care fund and sign off the better care fund this year we've had some very challenging punchy time frames given to us just shy of two months from getting the guidance to having to submit the report which when you're meant to deliver develop something as a full partnership obviously that becomes pretty difficult and but again because it's in quite a strong position and a lot of our delivery within the better care fund this year actually helps us to achieve the objectives the government wants and needs us to be looking to we I think we are able to meet that challenge in terms of delivering the actual plan fitting it into the governance timelines unfortunately is slightly more challenging so what we've brought here is a very high-level paper explaining what the better care fund is what the new objectives are so the board is really well cited and we're asking for the board to agree that outside of the board the chair and obviously the chief executive of both the ICB and the council approve the final document because timings just wouldn't fit for this this board we have submitted a draft to the london better care fund team we've it definitely was a working draft but we've had some really helpful feedback from colleagues in the london better care fund team so we we are absolutely looking like we will hit the deadlines which is great given that the better care fund obviously being a national pool budget which forms part of our other pool budgets but is a really significant budget for us I would say that we work really really closely with our colleagues in the ICB and across NCL so both Islington and the broader NCL piece we meet once or twice a week at the moment to go through both the narrative and looking at the schemes that we're going to deliver on and the metrics that we've already discussed really largely the better care fund needs to reflect the shift left for sickness to prevention and hospital to home and the report does outline a range a high-level range of the things that are contained within the better care fund that help us get there so for example with sickness to prevention we've got things like social work support in hospital pathways re-ablement and with adaptations and tech we fund the community equipment and therapists who create rehabilitation and re-ablement plans we support unpaid carers in through the carers hub for hospital from home we've already talked about the avoidable admissions and recognize that there's more we need to be doing through the transformation program but we've got rapid response and virtual wards for our timely and effective discharge we have the take home and settle service which has really effectively supported people to leave hospital in a timely way and hospital social work teams again and reducing long-term residential nursing is another target and we are delivering a really good home care contract and using technology to help people we've talked about the metrics so I won't go into lots of detail but just so you know as headlines and what will form this wider report we've just discussed we need to look at emergency admissions into hospital average length of discharge delays and long-term admissions into care homes and nursings all of which should be reducing over time so the health and well-being board's oversight on those metrics is really important the report sets out the types of services that we think will help us achieve this but as I say it's not the final we wrote obviously for submission for the board we wrote this some weeks ago and so it has been iterative it won't be significantly different because so much of what we do within the better care fund already helps us meet those metrics that the government have set out so to finish I suppose we I would like the board to agree that the chair can sign off the final report so that we can submit it on the 31st of March in a timely way and that we can report the progress and work on the better care fund through that wider report that I just spoke to any questions comments so I'm going to take them one at a time then so that we've got it clear so B3 for health and integrated partnership working across health and social care in Islington can we agree and note that report and the better care fund firstly thank you for all that work because then you're doing things under pressure and you know I know how important it is to to keep the fund to the work we're doing so can we agree the better care fund 25 26 agree and note so the chair can sign it off thank you we're going to go to B4 the annual safeguarding adults in Islington 23 24 report Fiona Bateman to present and thank you Fiona mindful of the request that we do this briefly and that everybody's had the opportunity to report um you'll note that the report this year has changed its structure and it's more concise um more succinct um I think it's probably worth highlighting though both the slides to be up if that's okay um uh just that it is a statutory partnership um that there are some statutory responsibilities that the board conducts um I mean the first one is to publish a strategic plan and do this annual report and it does need to come to the um to this committee each each year um this needs to be health watch I don't know if you're aware of that but um but but but actually one of the major functions that we do is commission safe letting adult reviews um and these are undertaken where an adult has died or suffered serious harm um and agencies could have worked more effectively together to prevent that so it kind of really feels like it feels like a golden thread that has been through donovan's report and jody's everybody's that whole idea around actually how are we working more collectively how are we working more effectively and actually our said cutting adult reviews have picked up all of the issues that you guys have already spoken about and and made very clear particularly around the context of um looking to avoid harm and looking to avoid harm for those who are most vulnerable um we have in the period that we're going to report about which feels like a very long time ago now if i'm honest um completed and published a safe planning adult review in respect of a gentleman who died in a fire all of which was wholly avoidable um there has been significant work uh to to to take forward that um learning but i want to pay tribute to his family who um were engaged with that report and really helpfully um talked to us at a time of real significant distress for them um they were really quite in inspirational around how they wanted to kind of take forward and make sure that actually we understand the risks particularly for non-mobile adults of fire safety um so you're more than welcome to flick to the third slide if that's okay our key statistics um for this period so 2023 to 2024 as with the national kind of response there's been an increase in safeguarding concerns um in islington we have it's not much of a surprise to be perfectly honest year on year since the care came in we've seen an increase in in concerns it doesn't mean that people are less safe it just means that people are more aware that they shouldn't be subject to abuse and neglect so i see it as a good thing actually that people are saying this is happening what is more concerning is that the conversion rate has remained stubbornly low um in islington so whereas we've had 2396 people put forward as at risk um only 15 or so percent of those actually end up as an inquiry so looking into what what do we need to do differently what do we need to do better um we have seen during that period and since quite a rise in referrals in for safeguarding adult reviews so where the outcomes have been really put nothing like in those numbers but it shows again that awareness that um across our partnership and across our public that actually we we need to be thinking about how we do things differently um how we work more collegiately including with the voluntary sector and your point about utilizing the data from the third sector is a really critical one our board would would benefit so much from that not least because you're our eyes and ears and you're also doing an awful lot of the early intervention and a lot of the prevention um and the voluntary sector do a huge amount in terms of as a trusted friend if you like or a trusted service so so thinking about that and how we feed it into and support it once it does come to the statutory partners notification is really crucial um one other thing to note is and again this is very similar to national kind of data um whereas pre-covid most of the concerns were raised in respect of people in institution residential care home care you know where and that wasn't just to be clear that doesn't necessarily mean that people were not safe in those settings it means that those are places where people are very well trained well you know understand the duty to report are required in some instances to report in so whereas that the cases might not been substantiated we were seeing a large number happening in an environment where people would know what they were looking for would know how to provide that support and carry out those inquiries that's changed quite dramatically post-covid we're seeing a much higher percentage happening in people's own homes and that's much harder for us to understand and to influence and intervene in a way that's really positive so we are probably seeing um things at a later stage um where abuse and neglect is at a more severe um situation that means that the response to that is more complex and the the ask i suppose of partners is to to understand that and when when the safeguarding teams or they you know the social care who will take the lead in these ask for support because they need more information or they need that partnership plan to help support the adult in terms of not just staying free from abuse or neglect but recovering from the abuse or neglect they've suffered um that is really critical um and we've seen a lot of change in a very short space of time which means that sustaining that partnership approach could become more challenging in the future um that said in 90 of our cases um the individuals and the practitioners that were involved reported that the risks were either removed or reduced through those safeguarding actions um and um yeah i mean the demographics haven't changed very significantly um the types of harm haven't changed very significantly i think we're still under reporting domestic abuse because people tend to put it down as physical abuse or financial abuse or psychological abuse and not think about the um intimate relationship that would mean it should be categorized as domestic abuse but the partnership is working really really closely with the board board um and we've done a significant amount of work in the year that we're reporting but also since to to really think about actually how we support the early identification and the recognition of older adults at risk of domestic abuse not least following a domestic homicide report which somebody else will come and talk to you about probably another time um but that was um finalized this year um which is why it's not in this point um some of our key achievements if i can just go to that um we were asked and gratefully received the opportunity to engage our services group which and carer subgroup which is really active really vocal um with jody's work around dignity and care or not just jody's work but you know the local authorities the joint commission work around you know what should care look like how how should that be um shaped and that that subgroup felt really that the changes that were being introduced the way in which it was going to be monitored the oversight that would be had in respect of that was um really robust and really respectful and really respectful of their input so that was a real positive and they've continued to engage in that um work throughout 2023-24 and right up till now so um that's been really positive um the count of the the partnership also gets quarterly reports in in respect of all provider concerns which is why i can quite confidently say that actually we there is that um senior leadership overview of how good our services are and whether or not adults are at risk of abuse or neglect um it doesn't feel some it feels very um robust the oversight and the quality assurance of that of of our provider services um in in islington so that is why our focus has shifted to individuals who are at risk of abuse in their own home or who have no home um and that brings us on to the right care right person so that was introduced during this period um that it was introduced shall we say at pace um and it was going to make a big impact we felt across and be felt across our partner agencies including um and we probably most likely emergency responders um and the um and the mental health trust um we set up a task and finish group we have been working with all our partners looking at the data looking at thinking about how that has been implemented and we've also fed into and helped support the development of pan london policies um so there's been a lot of work that sits around that policy and thinking about how that's going to be like how that's going to land on the ground how that's going to work um and how the changes will be felt um and i think having taking that partnership approach and being comfortable and confident to ask for the data and actually get it um has really kind of been something you can say you know something that i i don't know has happened in any other borough in london for example um and i think it's a really positive thing that we've had that partnership approach to it and we've been able to think very carefully about what that's meant not just for the um for the services that are leading on that but also that the wider ramifications for for example um for having services who have felt it most keenly if i'm honest um the fab also gets uh got um did a specific piece of work around people in position of trust and following a review that have been done by the disclosure barring regime just to really ascertain whether we have the right approach here um and i think most people will know that if a young person is perhaps at risk because of a person who works for children is maybe has done something that would cause harm that the most the first thing that people do is report it through to the ladder um and they get that specialist support to make sure that those processes are right there isn't the equivalent of a ladder for anybody um an adult who cares what needs to do is um at risk from a person in position of trust and so we're we're looking at how we manage that and um given that there isn't that statutory responsibility to to have that um extra support if you like in that situation and and i've sort of set out quite well i have we have as a partnership set out some of the other things that we've done we've done a huge amount of work around multiple disadvantage looking particularly at homelessness thinking about how we do that and popping in to see you at the end of the week to talk about it even further and so we carried on that work and we're continuing to um engage and think about actually how do we really support frontline practitioners to to really implement the lessons from safeguarding adult reviews um and then yeah a lot of the stuff is developed and delivered through our website because that's our tool if you like to disseminate information i think that's probably it yeah i've just set out some headlines from the safeguarding adult reviews for for information more than anything else but if anybody has any queries or questions happily take them anybody got any before i take questions can you just we'd like just to know from all of this board our condolences and thank the family for that engagement so it's so important and probably the worst time for them grieving and to engage for lessons learned so that's if you can pass that on from all of us here thank you laura um i was just going to just talk about this um and i guess um implementation across the system of outcomes how do you think do you think things are being implemented and is there anything more that could be done it's interesting because i suppose when we were drafting this report we talked about the things that the board has achieved so the the board has presented like you know produced some documents they've produced some guidance they've produced um the statutory duty is actually for partners to say what they've done to learn the lessons and change their practice um that's much harder to secure actually and much harder to um to understand the impact unless it's very obvious in the data so where we do get data where we can demonstrate that it's really positive so for example with um um with with fire safety where people have done organizations have done internal audits to see are our staff taking this forward fantastic we can demonstrate that that's working really well in that particular organization or we can say you know fire brigade can report in and say we're seeing a lot more referrals coming in from xyz for home safety fire visits um but but we are we that's not universal our partners aren't yet quite in the place where they recognize that the safeguarding responsibility isn't owned by the board it's reported to the the board it's owned actually by the organizations and that is i think not just a challenge in islington it's a challenge nationally but we have not during this year and more and into 2024 2025 we shape the way that we ask for those insurance reports so we do um do topic based meetings where we say these are the three questions for partners what have you done where's your data how do you demonstrate the impact and we report those then at the board and we discuss those then at the board so what we're able to demonstrate is for those topics we have some input from partners that are able to say x y and third but we can't compel all partners to do that it is a an information exchange if you like so it's yeah it's a work in progress but we are pushing as hard as we possibly can yeah i had just one question really so you've talked about the conversion rate from um safeguarding alerts that are raised and then how many translate into inquiries and obviously that's quite low so i wondered and you also mentioned an increase in sar's so i wonder whether has the work been done to see whether some of those that ended up in having to become safeguarding adult reviews began as alerts but then weren't acted on have you kind of looked at the narrative of that and how it connects but also what the thinking is behind why there is such a low conversion rate so the the reason that there has been a lot of work done on why there's such a low conversion rate and actually i think you should i hope um these are conversations that we are having frequently you'll be pleased to hear um we should see a shift in that um we are expecting to see a shift in that partly it's recording okay partly it's um really getting people to think about how they refer in the concern so i'm really worried about x isn't going to be able to be unpicked by you know even if it even if there is no wrong front door if there isn't the situation there that demonstrates why this person is at risk of abuse or neglect why they are a matter of the claim and support needs it can be really difficult so one of the things that has happened to really that might see a shift in this is that police have um introduced and um disseminated a tool for their officers to say don't just send in a notification to to the council to say this is an adult who we think um has come to our notice because that's not hugely helpful it doesn't tell us what the safeguarding risk is and so they are training their staff to differentiate between um kind of where you are asking for a review of their care or review of their needs versus where you need a safeguarding alert and a response very similar to what you'd expect in in children's safeguarding and children's uh protect child protection that's been kind of you know that that approach being taken in respect to adults will hopefully help um but we are also kind of very mindful of the fact that there are some communities we're not touching and we're not reaching at all and um again a big piece of work which will be reported in the next annual report um looked at why that was looked at what we want to do differently to reach particular communities and one of them is work more closely with the voluntary sector which is the most surprised but but again ensuring that we've got that resource is critical too so those conversations are happening but yeah would really welcome would really welcome to take this outside and have that conversation again with more people because i think where we've kind of tunneled it through one or two they are obviously spread very thinly and what we really need to do is think about actually um working with you guys and thinking about how we you know how we touch the lots of different parts of the voluntary sector because that would benefit us i think significantly there's no more comments or questions um so the annual safeguarding adults in islington 23 24 report is it is the report agreed and noted agreed b6 is the draft annual health and well-being board work plan 25 this report is for noting i'm not sure if jonathan if you'd like to have anything to it so i think one of the um just thinking about sort of last year's annual public health in terms of uh young people and their emotional health and well-being and also thinking about some of the uh well-being aspects around um around health environments for young people we've previously done deep dives into areas which are particularly important um and i suppose i wonder if there would be an interest to look at young people's mental health and well-being ranging from the things which help to keep people young people uh you know in terms of good mental health well-being through to what happens at times when people are unwell and thinking particularly around um how our schools and our health services for example responding what public health and children's health services the councilman are what they're doing in that space yeah i'd welcome that for young people and children i don't know if parents want to add anything yeah thank you very much my question is to be when we are talking about mental health can we keep an eye also on sense because sometimes we can see the number of our sense young people i don't said everyone have mental health but sometimes it's very difficult really to differentiate that mean it will be a good idea to try to do it as they feel together that may help has anybody else got any comments or anything so that that's just for noting i've had no questions from any members of the public so the meeting is now closed and thank you for your time today thank you chair