The Health & Adults Scrutiny Sub-Committee met on Tuesday 04 June 2024 to discuss workforce shortages in health and care, review the council's health and adult social care priorities, and consider initiatives for empowering disabled residents. Key decisions included noting the committee's terms of reference and agreeing to submit a report on accessible sports and fitness initiatives to the Mayor and Cabinet.

Workforce Shortages Across 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 plan, highlighting initiatives such as the Career Ambassadors programme to support young people entering the workforce and the development of medical degree apprenticeships in collaboration with Queen Mary University London. The workforce strategy was approved in January 2024, with a delivery plan to attract and retain staff across North East London to be implemented.

Councillor Marc Francis raised concerns about housing allocations for key workers, requesting an update on housing allocations for key workers over the last four years and further details on council tax income streams. The committee also requested Healthwatch consultation data regarding Tower Hamlets figures for review.

Cabinet Member and Corporate Director Reflections and Achievements

Councillor Gulam Kibria Choudhury, Cabinet Member for Health, Wellbeing and Social Care, and Dr Somen Banerjee, Acting Corporate Director of Health, Adults and Social Care, presented reflections on the past year and priorities for 2024/25. Councillor Choudhury emphasised a commitment to prioritising healthcare in the borough, with ongoing preparations for the Care Quality Commission (CQC) inspection of Adult Social Care (ASC) services and the completion of the Joint Strategic Needs Assessment (JSNA).

Dr Banerjee highlighted achievements including positive feedback from 86% of residents receiving domiciliary home care and the development of a new model for this service. A needs assessment for ASC indicated an increase in demand from under 65s and more complex health issues for those over 65. Key priorities include addressing funding concerns and transforming the ASC service. The borough's health and wellbeing data shows increased health disparities, substance misuse, lower healthy life expectancy, and issues with overcrowding and homelessness. Workforce pressures and the impact of the pandemic were also noted as challenges. Plans are underway for culturally sensitive care homes and Housing with Care initiatives to reduce reliance on residential and nursing homes. Technology Enabled Care is being enhanced to support independent living and reduce costs. Prevention initiatives focus on the Vital Five to improve physical and mental health, including smoking cessation, obesity reduction, blood pressure and diabetes checks, and reduced alcohol intake.

Members were informed that many residents, particularly men, are unaware of high blood pressure and do not attend check-ups, necessitating further awareness campaigns. A needs assessment on substance misuse, conducted with the Combating Drugs Partnership, revealed high levels of misuse in Tower Hamlets, with a rise in synthetic substance use. Substance misuse services will be recommissioned for all age groups. Preparations for the CQC inspection include a self-assessment and a peer review by the Association of Directors of Adult Social Services (ADASS), which identified strengths and areas for development. A joint Quality and Improvement Board has been established to oversee performance and service quality. The issue of residents with long-term conditions not accessing primary care, and the linkage of data across systems, were acknowledged as areas requiring further attention. The committee requested details on staff retention percentages compared to national averages and noted the ongoing recruitment campaigns for clinical and non-clinical roles.

Tower Hamlets Together Board Partners Reflections and Priorities

Representatives from the Tower Hamlets Together (THT) Partnership and the Integrated Care Board (ICB) presented their reflections and priorities. Charlotte Pomery, Chief Participation and Place Officer for the ICB, outlined the development of a financial strategy and the encouragement for residents to use primary and community services. Priorities include improving urgent and emergency care, implementing a commissioning approach focused on population health improvement, and developing Integrated Neighbourhood Teams. The challenges of population growth, high service demand, and limited funding were highlighted.

Dr Roberto Tamsanguan, GP and Tower Hamlets Place Clinical Director, discussed achievements in primary care, including the Pride in Practice scheme for LGBT+ patients, cloud-based telephony, Respiratory Illness Hubs, and extended access provision. Priorities include finalising the Same Day Urgent Care service and improving primary and secondary care interfaces.

Fiona Peskett, Director of Strategy and Integration at Barts NHS Health Trust, highlighted the Women's Hub and Children's Hospital at Home services. Priorities for acute care include reducing waiting lists, implementing a diagnostics centre, strengthening the workforce, and enhancing mental health pathways. Maternity services will continue to focus on community feedback for improvement.

Dr Richard Fradgley, Director of Integrated Care and Deputy CEO at East London NHS Foundation Trust (ELFT), detailed achievements in mental health, including the 111 Crisis Line, the Children's Home Treatment team, and Talking Therapies services. Pressures on inpatient services and the neurodiversity service were noted as significant challenges.

Warwick Tomsett, Joint Director of Integrated Commissioning, provided an overview of the THT Partnership's collaborative approach and its seven priorities. The committee requested further information on ASC key performance indicators and staff retention percentages.

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 exercise in Tower Hamlets. The review involved site visits to leisure centres and engagement with disabled residents and older people's groups. Six recommendations were made, focusing on:

1. Disability Representation: Prioritising initiatives to enhance the visibility and representation of people with disabilities within the leisure workforce.
2. Data-Driven Evidence: Developing a comprehensive approach to collecting and analysing data on disability access and usage.
3. Communication Channels and Campaigns: Engaging community disability groups to co-design campaigns promoting physical activity.
4. Sports and Exercise Disability Forum: Establishing a forum to empower residents to review provision and make recommendations.
5. Collaboration: Establishing joint working protocols with primary care, NHS, and voluntary sectors to widen access and act as referral providers.
6. Transitional Arrangements: Creating protocols to support the transition of individuals from specialised fitness gyms to mainstream leisure facilities.

The committee approved these recommendations and agreed to submit the report to the Mayor and Cabinet for an executive response.

The meeting concluded with a discussion on future work programme development, including a briefing on health inequalities data and a review of the reinstatement of free home care.