The Healthier Communities Select Committee met to discuss the Lewisham Unpaid Carers Action Plan 2025-2028, the University Hospital Lewisham and Community Services in Lewisham update, and the Lewisham Safeguarding Adults Board Annual Report 2024-25. Key decisions included endorsing the Unpaid Carers Action Plan and supporting its awareness-raising efforts, and agreeing to continue collaborative work with University Hospital Lewisham on their community mental health centre model.

Lewisham Unpaid Carers Action Plan 2025-2028

The committee received an update on the development and completion of the Lewisham Unpaid Carers Action Plan for 2025-2028. This plan, developed through extensive engagement with unpaid carers, aims to make carers in Lewisham visible, valued, and supported. The core priorities are:

• Visible: Improving the identification of carers across all services, developing a central Lewisham Carers Hub with neighbourhood-based support, creating a consolidated list of carers for better communication, and launching a communications campaign to raise awareness.
• Valued and Respected: Enhancing carer involvement in service planning and improvement, ensuring feedback is acted upon, improving communication from the council and its partners, and ensuring healthcare providers recognise carers as partners in care, particularly in hospital discharge planning.
• Supported: Evolving the carer wellbeing and support offer to be personalised and meet the diverse needs of Lewisham's carers, and improving the carer assessment process, including timeliness, communication, and outcomes, with a focus on increasing the number of carers receiving one-off payments.

The committee was asked to endorse the plan and support its awareness-raising efforts. The plan acknowledges the significant impact of caring on individuals' health and wellbeing, with over 90% of unpaid carers in Lewisham reporting negative impacts. It also highlights the diversity of carers within the borough, with over 25% identifying as Black African or Black Caribbean, and addresses potential barriers faced by different groups, including those related to age, gender, ethnicity, disability, sexual orientation, religion, and socioeconomic status. Mitigation strategies are outlined to address potential negative impacts and ensure equitable access to support.

University Hospital Lewisham and Community Services in Lewisham

The committee received an update on the performance and developments at University Hospital Lewisham (UHL) and its community services. Significant progress has been made in reducing elective care waiting lists, with the overall waiting list decreasing from approximately 70,000 to 55,000 in six months. The number of patients waiting over 52 weeks for treatment has more than halved. The Trust is focusing on reducing waits for first outpatient appointments and is working towards a one queue approach, offering patients choice across LGT and community locations.

In cancer care, improvements have been made in diagnosis times, though more work is needed to treat patients within the 62-day standard. The Trust has invested over £1 million into oncology services and is collaborating with South East London partners on shared pathways.

Key developments include the opening of the new Lewisham Surgical Centre in January 2026, which will increase capacity for Ear, Nose, and Throat (ENT) surgery. A new Urology Investigations Unit is planned for Summer 2026, aiming to consolidate elective services at Lewisham and repatriate local patients who currently travel to Guy's and St Thomas' NHS Foundation Trust (GSTT) for treatment. The new Urgent Treatment Centre (UTC) at UHL, opened in March 2025, has significantly improved patient flow and access to urgent care.

Challenges highlighted include front-door pressures at the Emergency Department, with increasing attendances, particularly for mental health presentations. Bed occupancy remains high, necessitating the use of temporary escalation spaces. The neurodevelopmental pathway for children and young people is a significant challenge, with approximately 950 children and young people waiting over a year for assessments. The Trust is investing £0.5 million into this pathway and is working with partners to redesign clinical pathways and expand the workforce.

The Trust also faces considerable financial pressures, with a requirement to deliver significant savings. They have outlined asks of the local authority, including support with improving discharge processes, developing future strategies, and collaborating on integrated neighbourhood teams.

Lewisham Safeguarding Adults Board (LSAB) Annual Report 2024-25

The committee reviewed the LSAB's Annual Report for 2024-25, which details the partnership work carried out by the board and its agencies. The report highlights an increasing volume of safeguarding activity, with a trebling of recorded abuse and neglect cases in seven years. This is attributed to improved recognition and reporting, as well as genuine increases in abuse and neglect, particularly within adults' own homes, driven by factors such as austerity, the cost of living crisis, and pressures on services and unpaid carers.

Key areas of work included Safeguarding Adults Reviews (SARs), with two published during the reporting period. The board delivered a record number of learning and development activities, receiving positive feedback from delegates. The Safeguarding Adults Partnership Audit (SAPAT) is an annual quality assurance process, with a heatmap indicating the performance of key public sector agencies. Community engagement events were held to gather feedback from the public and those with lived experience.

The report notes challenges in public awareness, particularly among seldom heard groups, and the need for greater professional curiosity across agencies. The LSAB is working to address issues such as self-neglect and hoarding, with the introduction of a self-neglect high-risk panel. The report also details engagement with various partners, including those experiencing homelessness, individuals with learning disabilities, and care leavers.

The committee was informed that the LSAB has a strong focus on learning and development, with a significant increase in professionals attending training. The impact of SARs, such as the Joshua SAR, has influenced policy and training within the Metropolitan Police Service and the London Ambulance Service. The report also highlights the importance of a trauma-informed approach in addressing issues like hoarding.

A particular concern raised was the lack of a dedicated single point of contact within the local authority for modern slavery and human trafficking, which limits proactive prevention and victim support. The report also notes the significant increase in safeguarding concerns, which, while demonstrating increased awareness, places considerable pressure on services and budgets.

The committee was assured that recommendations from SARs are being actioned and that there is a continuous process of learning and improvement. The importance of professional curiosity and avoiding compassion fatigue were also emphasised. The report concludes with the LSAB's structure and strategic business plan for 2025-26, which includes an ambitious work programme focused on prevention, accountability, partnership, mental capacity, and the voice of the adult.