The Health & Adults Scrutiny Sub-Committee met on Tuesday 04 June 2024 to discuss workforce shortages, the achievements and priorities of health and care partners, and accessible sports and fitness initiatives for disabled residents. Key decisions included noting the committee's terms of reference for the upcoming municipal year and agreeing to progress recommendations from a scrutiny review on empowering disabled residents.

Workforce Shortages Across the Health and Care Sector

The committee received an update on the action plan addressing workforce shortages across the health and care sector. Gareth Noble, Deputy Director of Workforce Programme at NHS North East London, presented the progress made on several recommendations.

• Recommendation 1: The Integrated Care Board (ICB) is collaborating with the Tower Hamlets Together (THT) Board to develop workforce intelligence. While progress is being made on data sets, challenges remain due to differing data collection methods and timeframes. Additional capacity is being sought to expedite this work.
• Recommendation 2: The ICB and THT Board are working with the local authority's Health and Wellbeing Board to develop shared communications and engagement strategies with residents. The careers ambassador programme is ongoing, linking in with local activities.
• Recommendation 3: The ICB and LBTH are incorporating integration into their health and care workforce strategy. Place-based input into the strategy development has occurred, and the strategy was signed off by the ICB Board in January 2024. A delivery plan with resourcing asks is being developed.
• Recommendation 4: The ICB and THT Board are partnering with wider health and care employers to co-design job roles. The ICB will share good practice, and THT will determine the co-design process.
• Recommendation 5: The ICB and THT Board are partnering with LBTH's Education and Careers Service, Adult Social Care, Primary Care commissioning, and Barts NHS to develop experiential learning opportunities for young people. Barts Health has existing programmes, and the ICB is funding a pilot programme through Barking Havering and Redbridge to support those not in employment and to retain staff.
• Recommendation 6: The London Borough of Tower Hamlets (LBTH) has reviewed the feasibility of incentivising key worker accommodation, council tax reductions, and parking provision. While the social housing allocation scheme prioritises key workers, and council tax support schemes are in place, the council has concluded that introducing reduced parking fees for health and care professionals is not feasible due to parking stress, equality impacts, and legal challenges. Existing provisions include doctor's permits and the Health Emergency Badge Scheme.
• Recommendation 7: The ICB is working with Barts Health and Queen Mary University London to explore options for supporting medical students in their final two years of study.
• Recommendation 8: The ICB is collaborating with local Further and Higher Education institutions to pilot Degree Apprenticeships and T-level placements. A T-level co-ordinator has been appointed, and work is ongoing to identify demand and develop pathways.
• Recommendation 9: The ICB is recommended to draw on international recruitment options while developing its growth model from local labour. Trusts continue to recruit internationally for short-term needs.

Cabinet Member and Corporate Director Reflections and Achievements, and Priorities for 2024-25

Councillor Gulam Kibria Choudhury, Cabinet Member for Health, Wellbeing and Social Care, and Dr Somen Bannerjee, Corporate Director for Health, Adults & Community, presented an overview of their directorate's work.

• Reflections and Achievements: The directorate has managed over 1400 adult safeguarding referrals and over 14,500 contacts into Adult Social Care, completing over 2000 assessments. They support 3250 service users with long-term care. Improvements have been made to the Mosaic system and resident-facing web pages. CQC readiness activities have been undertaken, including a successful peer review. A new Adult Social Care Joint Strategic Needs Assessment (JSNA) has been completed. 86% of people report positive experiences with home care services, and over 1200 people have been supported to quit smoking.
• Priorities for 2024-25: Key priorities include preparing for the Care Quality Commission (CQC) inspection by streamlining activities into business as usual, improving reablement and hospital discharge offers, and enhancing the Direct Payment service. They will also be updating the charging policy for community care, finalising the 'Housing with Care Strategy', and planning for more supported accommodation. An enhanced Technology Enabled Care offer will be implemented, and the new Combatting Drugs Partnership strategy will be launched.
• Ongoing Pressures and Challenges: The directorate faces increased demand and complexity in Adult Social Care, leading to budget pressures. They are preparing for the CQC inspection, noting the lack of progress on national Adult Social Care reform and funding. Entrenched health inequalities and the impact of the cost-of-living crisis, alongside changes in the NHS, also present challenges.

Tower Hamlets Together Board Partners Reflections and Priorities

Representatives from various health and care partners presented their reflections on 2023-24 and priorities for 2024-25.

• Integrated Care Board (ICB): Charlotte Pomery, Chief Participation and Place Officer, highlighted the development of an ICB financial strategy, the initiation of the Big Conversation with residents, and the adoption of the North East London People and Workforce Strategy. The system has successfully moved out of Tier 1 for Urgent and Emergency Care. Priorities for 2024-25 include developing a commissioning approach focused on population health improvement, taking forward Integrated Neighbourhood Teams, responding to population growth, improving support for children and young people with special educational needs and disabilities (SEND), and sustaining improvements in urgent and emergency care.
• Primary Care: Roberto Tamsanguan, Clinical Director, reported on achievements such as digital exclusion policies in every practice, cloud-based telephony, and the Pride in Practice initiative. The winter Acute Respiratory Hub provided additional appointments, and extended access provision increased significantly. Priorities include finalising the Same Day Urgent Care model, supporting digital engagement, continuing work on children and young people's healthcare rights, and planning for potential industrial action. Pressures include rapid population growth, high patient turnover, workforce crises, and hospital waiting lists.
• Acute Care: Neil Ashman, CEO of Royal London & Mile End Hospitals, noted collaborative work with partners and the ongoing pressure on the NHS, particularly in urgent care. New models of care are evolving, including hospitals at home and a new diagnostics centre at Mile End. Priorities for 2024-25 include improving service quality, patient flow, urgent and emergency care, reducing waiting lists, and focusing on prevention. Challenges include workforce retention, increased demand for urgent care, meeting patient expectations, and delivering excellent maternity care.
• Mental Health: Richard Fradgley, Director of Integrated Care and Deputy CEO at East London Foundation Trust, highlighted strong partnerships, the rollout of the 111 crisis line, and successful Talking Therapies services. Priorities include improving staff experience, continuing community transformation with new models of mental health care, improving the experience of care through prevention, and reducing inequalities. Challenges include sustained pressure on inpatient mental health services, increased A&E waits, and difficulties with discharge due to homelessness and No Recourse to Public Funds (NRPF) issues.
• Tower Hamlets Together: Quirk, representing the partnership, outlined its vision for integrated services and resident-centred care. Priorities include improving access to primary and urgent care, building resilience, implementing a localities and neighbourhoods model, facilitating hospital discharge, being an anti-racist and equity-driven system, ensuring the best start for children and young people, and providing integrated mental health services.

Empowering Disabled Residents: Accessible Sports and Fitness Initiatives

Councillor Ahmodur Khan presented the findings and recommendations from a scrutiny review on disabled residents' access to sports and fitness initiatives.

• Key Findings and Recommendations: The review identified six key recommendations:
  1. Disability Representation: Prioritise initiatives to enhance the visibility and representation of people with disabilities within the leisure workforce.
  2. Data-Driven Evidence: Develop a comprehensive approach to collecting and analysing data on disability access and usage to drive improvements.
  3. Communication Channels and Campaigns: Engage community disability groups to co-design robust campaigns promoting sports and exercise for people with disabilities.
  4. Sports and Exercise Disability Forum: Establish a forum to empower residents with disabilities to review provision and make recommendations.
  5. Collaboration: Establish joint working protocols with primary care, NHS, health partners, and the voluntary sector to widen access and become a referral provider.
  6. Transitional Arrangements: Create protocols with specialist community gyms to support residents transitioning into mainstream leisure facilities.

The committee noted the report and agreed to submit it to the Mayor and Cabinet for an executive response.

The meeting also included the appointment of Councillor Iqbal Senbai as Vice Chair for the 2024-25 municipal year and the noting of the Health and Adult Scrutiny Sub-Committee's terms of reference, membership, and meeting dates for the upcoming year. Members also discussed potential topics for future work programmes, including free community care, housing with care strategies, combating drugs, and autism and ADHD services.