The Health and Wellbeing Board meeting on Tuesday 17 November 2020 focused on the ongoing COVID-19 pandemic, the council's health and wellbeing strategy, and safeguarding concerns for both adults and children. Key discussions included the local COVID-19 situation, vaccination plans, and the impact of the pandemic on homelessness and vulnerable individuals. The board also reviewed progress on the health and wellbeing strategy, with a particular emphasis on achievable priorities and integrated service delivery.

COVID-19 Update and Vaccination Programme

Dr Somen Banerjee, Public Health Director, provided an update on the COVID-19 situation in Tower Hamlets, noting that case numbers were increasing, with higher rates observed in individuals of South Asian ethnicity and more deprived groups. He highlighted the expansion of local testing sites, including new facilities at the Arts Pavilion and Jack Dash House in the Isle of Dogs, and the ongoing pilot of rapid testing. Dr Banerjee also shared encouraging news about the development of highly effective vaccines, with a rollout anticipated between January and April 2021. He stressed the importance of encouraging people to get vaccinated, particularly at-risk groups, and highlighted that testing and tracing remain crucial in controlling the virus.

Concerns were raised about negative publicity surrounding a testing centre in Watney Market. Dr Banerjee explained that testing centres were strategically placed in accessible locations to encourage uptake, and that Shadwell was chosen due to existing high case levels and lower testing rates. He assured the board that queue management and booking systems were in place to ensure safety.

Discussions also touched upon the challenges faced by care homes, with ongoing work to enable safe visits for relatives. The board acknowledged the mental health impact of social isolation on residents and their families, and the need to learn from pilot programmes using rapid testing to facilitate visits.

Health and Wellbeing Strategy

The board discussed the development of the draft Health and Wellbeing Strategy, which is intended for public consultation in early 2021. Key priorities identified for the next five years included tackling the impacts of poverty, mental health and emotional wellbeing, physical activity, and social isolation. James Thomas, Corporate Director for Children and Culture, advocated for poverty as a core priority, while Randal Smith emphasised the importance of physical activity and social isolation. Gavin James, Division Manager for Children's Services at the Royal London Hospital, suggested coupling physical activity with weight management.

The discussion also explored what is achievable within the council's influence. James Thomas highlighted the importance of addressing diet, nutrition, and healthy weight for children as a means to mitigate the impacts of poverty. Alison from Tower Hamlets Council for Voluntary Service (THCVS) raised the issue of digital inclusion, noting its increasing importance in accessing services. Christabel Shawcross linked social isolation, disability, mental health, and dementia to safeguarding concerns, while Denise Jones emphasised the broad impact of mental health and social isolation.

The board agreed to focus on achievable actions and interventions, with a workshop planned for January to detail the action plan. There was a strong emphasis on board members taking ownership and accountability for priority areas, with a commitment to focusing meetings on specific questions and acting as critical friends.

Safeguarding Adults and Children

Christabel Shawcross presented the Safeguarding Adults Board annual report, highlighting a significant increase in concerns raised, from 720 in 2016 to 1115 in the past year. She noted that while awareness of abuse reporting is improving, underreporting, particularly of domestic abuse, remains a concern. The report detailed that 75% of people had their risk reduced, but not removed, and 15% had risk remaining, prompting further investigation into these outcomes. Key learning from six published Safeguarding Adult Reviews (SARs) focused on learning disability, complex health needs, homelessness, and self-neglect, particularly hoarding. The board is working to establish multi-agency panels to support professionals dealing with complex cases.

James Thomas and Keith Makin presented the Safeguarding Children's Partnership annual report. They outlined the transition to new safeguarding arrangements, with shared leadership between the council, police, and CCG, and the introduction of independent scrutiny through Keith Makin's role. The report highlighted the continued focus on managing risk for children and young people through a supportive response, with relatively low rates of children in care or subject to protection plans. Key areas of focus included education safeguarding, joint domestic abuse training, and addressing exploitation. Looking ahead, the partnership aims to increase the rigour of its work through improved data usage, quality assurance, and incorporating the voices of children and young people.

A key ambition for the Safeguarding Children's Partnership is to develop an all-age exploitation strategy, working jointly with the Safeguarding Adults Board, and to improve the transition process for young people moving into adult services. The involvement of GPs is also being strengthened.

Special Educational Needs and Disabilities (SEND)

James Thomas and Warwick Tomsett discussed the SEND system, acknowledging significant weaknesses despite many strengths and outstanding provision. Families often struggle to access services in a timely manner, with delays in completing Education, Health and Care (EHC) plans, long waiting times for Autism Spectrum Disorder (ASD) diagnoses, and challenges in providing adequate therapies. The transition for young people into adult services was also identified as an area needing improvement, along with weaknesses in data collection for tracking outcomes.

The board heard that a local area inspection of the SEND system is anticipated in April 2021. Offers of support and collaboration were made by various partners, including the CCG, Royal London Hospital, and the Mental Health Trust, to address these challenges. Sam from primary care proposed extending multidisciplinary team meetings to include children and young people with complex needs, similar to existing arrangements for mental health and older adults. The need for integrated responses and easier pathways for families navigating different services was emphasised.

Tower Hamlets Together (THT)

Amy Gibbs, Independent Chair of Tower Hamlets Together (THT), and Warwick Tomsett provided an update on the partnership's work. They highlighted the success of THT's rapid and impressive partnership work during the COVID-19 response, which unlocked previous barriers to integrated care. THT has reframed its governance to focus on strategic priorities and urgent system-wide problems, with a dedicated executive group and a broader operational group driving delivery.

Key priorities for the winter period include the integrated discharge hub, home monitoring services, rapid response provision, support for care homes, end-of-life care, and CAMHS crisis services. The importance of maintaining inclusion and user voice at the heart of THT's work was stressed, with user representatives present at board meetings and a focus on embedding the outcomes framework shaped with local people. Examples of user voice influencing practice included feedback on the shielding programme and digital inclusion projects.

Discussions also touched upon the ongoing challenges of data sharing, financial pressures, and the need for individuals not to have to repeat their stories multiple times when accessing services. The importance of engaging smaller voluntary sector agencies and rethinking how to engage the wider THT workforce at a frontline level was also raised. Shoman shared a reflection on learning from COVID-19 data sharing, suggesting its application to understanding and managing epidemics of non-infectious diseases.