The Health Overview and Scrutiny Committee (HOSC) of Wandsworth Council met on Monday 21 September 2026 to discuss the performance of St George's Trust, the future of reablement services, and the council's budget for Adult Social Care and Public Health. Key decisions included the proposed move to a fully commissioned reablement service and a forecast overspend in Adult Social Care and Public Health.

St George's Trust Performance Update

Ms. Kate Slemick, Site Chief Executive Officer of St George's University Hospitals NHS Foundation Trust, provided an update on the Trust's performance. She highlighted strong performance in emergency care, elective recovery, and cancer pathways, while acknowledging challenges in diagnostic waiting times, particularly for non-obstetric ultrasound, due to recruitment and retention issues. The Trust is also addressing summer challenges related to extreme heat, with aging buildings not designed for such temperatures. Plans are underway for a new Mental Health Emergency Department, a collaboration with Southwest London and St George's Mental Health NHS Trust. The CQC Adult Inpatient Survey results showed positive patient feedback on respect, dignity, kindness, and compassion, though areas for improvement include ward noise at night and discharge planning. Winter preparations are well underway, focusing on system working with local partners and encouraging flu and COVID-19 vaccinations.

Reablement Services: Supporting Independence

The committee considered a report on reablement services, which aim to help residents regain independence after illness or hospitalisation. A deputation from Ms. Eunice O'Deane, representing UNISON, raised concerns about the proposal to close the in-house KITE Reablement Service and move to a fully commissioned model. Ms. O'Deane questioned the justification for closure beyond financial savings, the lawfulness of the proposal concerning employment protections, and the equitable impact on staff, particularly older workers, women, and those from minority ethnic backgrounds.

Ms. Lynn Wild, Assistant Director of Health and Care Integration, explained that the current KITE model is not financially sustainable due to its small scale and higher hourly costs compared to commissioned providers. While acknowledging the impact on staff, she assured that a comprehensive support package would be offered, including consultation, redeployment opportunities, and well-being support. The proposal, which aims to save an estimated £1.150m annually, will see reablement services dispersed across existing commissioned providers, who are already rated 'Good' by the CQC and have sufficient capacity. The committee noted that this key decision would be considered by Cabinet on 12 October 2026.

Adult Social Care and Public Health Budget and Quarter 1 Monitoring

The committee reviewed the Adult Social Care and Public Health Directorate's revenue position for Quarter 1 of the 2026/27 financial year, which forecast an overspend of £3.477 million. This overspend is primarily driven by increased demand and complexity of need in care services, particularly for older people and adults with learning disabilities, as well as market pressures leading to higher care package costs.

Councillor Mrs. Melanie Hampton expressed concern about the consistent overspends and called for a greater focus on efficiency and innovation. Councillor Will Sweet questioned the deliverability of savings outlined in the transformation programme. The committee discussed the importance of ensuring that efficiency savings do not compromise the quality of care for vulnerable residents, with officers assuring that eligible care needs would continue to be met in accordance with statutory duties. The transformation programme, which aims to improve financial sustainability and resident outcomes, is being supported by an external delivery partner, Newton.

Concerns were also raised about potential cost shifting between health and local authorities, with officers explaining that efforts are being made to ensure correct funding responsibilities are applied and that disputes are resolved constructively through established escalation processes and partnership discussions with NHS partners. The Neighbourhood Health model and its potential for efficiencies and improved outcomes were also discussed.

Outcomes of the Spending Review

An additional report on the outcomes of the spending review, relevant to Adult Social Care and Public Health, was presented. Ms. Evans highlighted that the proposals aim to maintain safe, quality, and lawful services while supporting residents' independence and ensuring effective use of resources. Key themes include prevention, reablement, neighbourhood working, integration with health services, and the use of technology. The report also addresses improvements in service redesign, commissioning, and care purchasing, as well as fair charging and NHS funding responsibilities.

Councillor Stephen Worrall raised concerns about the late circulation of the report and the clarity of financial figures, particularly regarding inflation estimates. Ms. Evans committed to providing a detailed breakdown of these figures. Councillor Mrs. Angela Graham inquired about telecare services, and Ms. Parker, Assistant Director for that area, explained the ongoing upgrade of telecare alarms to digital systems and the modernization of technology to support residents' independence.

Work Programme

The committee reviewed its work programme for the upcoming year, considering potential areas for scrutiny based on performance information, financial reports, complaints data, and the Forward Plan of Key Decisions. The importance of pre-decision scrutiny and the potential for Task and Finish Groups were also discussed. The committee noted that the Neighbourhood Health model is likely to be a significant topic for future discussion.