The Health Overview and Scrutiny Committee (OSC) met to discuss mental health services provided by the South West London and St George's Mental Health NHS Trust (SWLSTG), a draft public mental health action plan, the Care Quality Commission's (CQC) assessment of adult social care, and the annual complaints report for adult social care. The committee noted the reports and discussed next steps.

South West London & St George's Mental Health Trust Report

Philip Murray, chief finance officer at Southwest London and St George's, and Dr Razvan Guti, clinical director, presented the South West London & St George's Mental Health Trust Report which provided an overview of mental health service delivery, workforce development and wider community programmes delivered by the trust.

Key points raised:

• The trust had 85,000 referrals last year, with less than 2% relating to inpatients, with the majority of care happening in the community.
• There has been an increase in members of black and minority ethnic communities being seen through talking therapies, from 24% to 28%.
• Since the opening of new facilities, the numbers of black populations being over-restrained within inpatient settings have reduced by about 40%.
• The trust is focusing on the length of stay of inpatients, and have reduced the average length of stay by about 20 days in the last nine months.
• There were about 6,000 bed days in non-trust beds that related to Wandsworth residents last year, and this year it is forecast to be under 4,000.
• Referrals relating to Wandsworth residents have increased into community services and the incidence of referrals into psychiatric liaison services.
• The Adult Patient Journey programme brings together community acute and specialist services with the aim to improve the full mental health care pathway.
• The trust launched a seasonal campaign called Know Who to Turn To, to help people understand how to quickly and confidently access the right mental health support when they need it.

Councillor George Crivelli asked about improving mental health care in emergency departments, and the rapid assessment pilot at Kingston Hospital¹ to support patients arriving in emergency departments. Dr Guti responded that the pilot had been stopped as the outcomes were not as expected, and the resource is being integrated back in the crisis pathway.

Councillor Kate Stock welcomed the trust's focus on tackling health inequalities and becoming actively anti-racist. Philip Murray responded that the trust maintains the mantra that they are anti-racist and will not tolerate inappropriate behaviour. He added that the trust seeks the advice of staff members from the global majority² and has a diversity in decision-making panel that works with executive colleagues.

Councillor Sara Apps asked about community support once a patient is discharged, and what the key partners are to delivering that. Philip Murray responded that the key is open dialogue with all council partners, including social care, housing, education and the wider health community. He added that the trust has monthly multi-agency discharge events.

Councillor Steffi Sutters asked how the trust is working with families, and how they deal with elective treatment. Philip Murray responded that each of the wards has a nominated discharge coordinator, and the wards encourage families and carers into the ward rounds and to be part of the discharge planning where they feel able.

Councillor Clare Fraser asked how progress on the plan will be monitored and reported on moving forward. Dr Guti responded that the trust has set ambitious targets that they are consistently monitoring, including reducing the average length of stay, reducing the reliance on external beds, and reducing the number of patients attending A&E.

Councillor Daniel Ghossain asked about access times to tier 3 CAMHS³ services, and whether young people were mainly waiting for titration⁴ to start or whether they're in titration and they're waiting for a review. Philip Murray responded that demand outstrips capacity, and the trust is one of the few in London that still have an open waiting list.

Councillor Stock said that the average wait for treatment in CAMHS was over 20 weeks, and asked how the council can make sure that they are prioritising investment. Philip Murray responded that the council has a shared endeavour with the trust, and the integrated care board also puts young people first. He added that the trust has put a lot of infrastructure in to ensure that people are waiting well, with regular check-ins.

Councillor Crivelli asked about recruitment and retention, and how the trust intended to meet targets while navigating the challenges of the new visa rules. Philip Murray responded that the trust has reduced both the vacancy rate and turnover rate by 10 percentage points, and they are now both hovering around 10 percent.

Stephen Hickey, Chair of Healthwatch, asked about community hubs, and whether they will become part of the neighbourhoods. Philip Murray responded that the trust's vision is that the integrated recovery hubs will be aligned with integrated neighbourhood teams.

The committee noted the report and Councillor Lizzy Dobres suggested that a more detailed update on CAMHS be included in the next report.

Public Mental Health Action Plan

Dr Ramia Ravindrain, consultant in public health, and Graham Markwell, senior public health lead, introduced the draft Public Mental Health Action Plan, which is a whole council prevention focused approach to improving the mental health and well-being of residents.

Key points included:

• The plan recognises that mental health and well-being are shaped not just by clinical care but by the everyday environments that we create including housing, education, employment and community life.
• The plan is a whole council commitment to prevention, equity and resilience.
• The plan brings together departments, partners and communities under a shared vision to improve mental health and well-being by addressing its root causes.
• The plan sets out a framework for action that is ambitious, inclusive and grounded in evidence, contributing to a healthier, fairer Wandsworth.

Councillor Stock welcomed the report and the cross council approach. She noted that in her ward there is a particularly high level of families in temporary accommodation⁵, and that the decent home standard doesn't necessarily always have to apply to those in temporary accommodation. She added that the education and skills section and the eat well section concentrate quite a lot on what we're doing in terms of children rather than adults.

Councillor Apps expressed her appreciation for the report, and said that there is an opportunity with the new place and growth strategies and directorate to look more closely at how we can co-produce with residents. She also noted that off licenses are more common in areas with higher levels of deprivation and betting shops too, and that there is more that can be done on that.

Shannon Katiyo, Director of Public Health, responded that the action plan will be delivered in conjunction with the council's prevention framework, and that the mental well-being impact assessment provides an opportunity for the council to explicitly consider the mental well-being impacts of the council's decisions and plans and policies.

Councillor Crivelli asked if the preventative plan will have something that focuses on tackling the issue of suicide. Dr Ravindrain responded that she chairs the Wandsworth suicide prevention group, and that they have an active suicide prevention strategy in place and are currently in the process of refreshing that to include more of the latest evidence.

Councillor Ghossain asked what the genuinely new, substantially expanded element of the plan is. Dr Ravindrain responded that the evidence shows that up to 70 percent of health outcomes are around social determinants are around lifestyle and around environment, and that it was really important for the council to say this is where we are in that system, this is our place.

Stephen Hickey commented that the sheet on housing focuses on the physical side of housing, but there's another whole dimension in relation to mental health which is about the services and the collaboration not just across the council but with other services like mental health and physical health.

Councillor Graham Henderson, Cabinet Member for Health and Social Care, said that the report reflects much of the manifesto that the administration was elected on.

The committee noted the report, and Councillor Crivelli requested an update when the suicide prevention strategy is ready.

CQC Assessment in Adult Social Care

Claire Two, assistant director for assurance and innovation, gave a brief summary of the CQC Assessment in Adult Social Care. She said that the council got a good score, and the CQC highlighted the preventative approach, a strengths-based approach, very good joint working across the health and care system, clear co-production and the fact that equality's diversity inclusion work really well embedded.

Councillor Henderson thanked all council officers and partners who worked on delivering the successful CQC assessment.

Councillor Apps congratulated the team on the good report.

The committee noted the report and asked for the action plan and next steps to come to the next committee.

Annual Complaints Report Adults Social Care 2024-25

Nancy Carissa, statutory and corporate complaints manager, gave an overview of the Annual Complaints Report Adults Social Care 2024-25. She said that the report provides a brief overview of complaints received and handled through the adult statutory process, highlighting adult services commitment to transparency, learning and continuous improvement.

Councillor Fraser asked about any of the issues that have been identified and how they're looking to be addressed moving forward. Nancy Carissa responded that the themes that jump out are the themes that they expect to see every year, including delays, quality of assessments and communication.

Councillor Stock praised the adult social care team for the CQC assessment results, and noted that the complaints team also won a staff award within the organisation.

Stephen Hickey asked whether there is a process in place for when lessons are learned and changes are made to follow up to check that those things have actually been implemented and carried forward downstream. Nancy Carissa responded that they work with the principal social worker and professional standards team, and they go to them each quarter with the learning and the themes and they triangulate it with the work that they're already doing.

The committee noted the report.

Work Programme

The committee noted the work programme and agreed to a request for a slightly more in-depth report on CAMHS.