The meeting will include a presentation on the key mental health priorities of the South West London & St George’s Mental Health Trust. There will also be a report on a recent assessment of the health needs of people experiencing homelessness in the borough, which outlines a number of recommendations. A number of public health topics will also be included for discussion, including the commissioning of extra care services in Chestnut House and Ensham House, the continued participation of the council in the pan-London sexual health e-service, and the roadmap for health and care integration. The meeting pack also contains an annual report on complaints in adult social care for the previous financial year and a financial update for the second quarter of the 2024/25 financial year.

Homelessness in Wandsworth

A report has been prepared for the committee that sets out the findings from the Wandsworth Homelessness Health Needs Assessment, which has been carried out for the borough. The report notes that London has higher rates of homelessness than other parts of England, and that Wandsworth has higher rates than the London average. The authors highlight the well-known relationship between health and homelessness, observing that poor health can cause homelessness and being homeless has serious health consequences.

The report includes a number of recommendations, many of which are intended to improve the provision of healthcare to people experiencing homelessness, in particular rough sleepers. One example is the recommendation to [i]mprove access to preventative health support including dentistry, podiatry, and musculoskeletal services particularly for rough sleepers. The authors highlight the difficulties faced by people who do not have a permanent address in registering with a GP and accessing appointments. They also suggest that there is a role for the Council in advocating for the provision of more good quality, secure and affordable housing, and in particular social housing, for Wandsworth residents.

The report notes that the average time spent in temporary accommodation in Wandsworth is 43 months, and that a large number of those in temporary accommodation are children. It quotes from research carried out in 2004 by Shelter, which showed that 90% of the families included in the research felt that their children's health had been negatively affected by living in temporary accommodation, and that a number of families reported that pre-existing conditions such as asthma and depression had worsened since entering temporary accommodation.

Mental Health provision by South West London & St George’s Mental Health Trust

The report pack for the meeting contains a report on the key mental health areas delivered by the South West London & St George’s Mental Health Trust. It describes the trust's work to [t]ackle health inequalities and become actively anti-racist, and to [m]ake the Trust a great place to work. It also summarises the services provided by the trust in a number of specific areas, including:

• Adult Eating Disorders. The trust provides an outpatient service for adult eating disorders, which has been enhanced to include a team providing intensive support and treatment in patients’ homes and communities.
• Forensic Intellectual Disabilities. The trust has created a unit at the Shaftesbury Building in Springfield University Hospital that offers low secure care for patients with intellectual disabilities. The aim of the service is to enable patients from South West London, who may currently be receiving care out of the area, to live closer to home.
• Perinatal Trauma and Loss. A new team is working with women, mothers and birthing people who are experiencing mental health difficulties related to birth or perinatal experiences. This includes issues like birth trauma, fear of childbirth, and perinatal loss.

The report also highlights a number of initiatives designed to improve access to the Trust’s services for members of the public. These include:

• The creation of a new website that makes information about the trust’s services easier to understand.
• A pharmacy helpline that provides advice and information about mental health medication to patients, carers, and healthcare professionals.
• A programme of Mental Health First Aid training funded by a charitable donation.
• A public awareness campaign on mental health in partnership with the South West London Integrated Care System.

Commissioning of Extra Care at Chestnut House and Ensham House

The agenda for the meeting includes a report on the commissioning of Extra Care services at Chestnut House and Ensham House. Extra Care housing is a type of supported housing that allows people with care and support needs to live independently for longer. It typically caters for older people with varying levels of care need, but it can also support working age adults in some circumstances.

The report notes that current arrangements for Extra Care in both buildings are due to expire on 31 August 2025, and seeks approval for a procurement exercise to identify a new provider or providers. It states that the council wants to establish a strategic partner relationship with a care provider as well as the housing providers (landlords) who share its vision and values to support people in living independent lives. The chosen provider or providers will need to demonstrate that they are able to deliver a flexible service that meets the diverse needs of residents.

The report also outlines plans to deliver more support for health and wellbeing through an expanded programme of activities. The current provision of activities was highlighted as an area of concern by a number of the existing tenants. The report pack includes an equality impact assessment that sets out the potential impact of the changes on a number of protected characteristics, including age, disability, sex, and race.

Continued participation in the London Sexual Health and Contraception e-Service

Another topic for discussion is the potential for the council to continue its participation in the London Sexual Health and Contraception e-Service after the current contract expires in 2026. The service is provided by a company called Preventx and is commissioned by the City of London Corporation on behalf of 30 London Boroughs. It offers remote testing and results management for sexually transmitted infections (STIs), HIV and blood-borne viruses (BBVs). It also provides access to contraception. Wandsworth currently only commissions the STI testing element of the service.

The report notes that demand for sexual health services has risen in recent years and is projected to increase further, and that the e-service provides a cost-effective alternative to face-to-face appointments for residents with uncomplicated needs. It states that STI tests conducted via the e-service are typically 70-80% cheaper than those carried out in clinics. It therefore recommends that the council continue to participate in the scheme when the new contract begins. The report states that the council’s 2026 Integrated Sexual Health service model, which is currently in development, includes plans to commission the contraception element of the service in the future.

Roadmap to Health and Care Integration

The meeting pack includes a report on the roadmap to health and care integration. The authors note the challenges faced by both the Council and the NHS in the health and social care sector, including rising levels of need and complexity, increasing demand, and recruitment issues. They state that these challenges require a collaborative approach from partners across the health and care system.

The report lists five key priorities for integration. These are:

• Prevention and Early Intervention. The report highlights a number of challenges in this area, including rising demand for Occupational Therapy services, increasing needs for long-term social care, and higher rates of hospital admissions, particularly for older people. It lists a number of initiatives designed to address these challenges, including the expansion of services to increase capacity, the optimisation of the Council’s community equipment contract, and the provision of more support for carers.
• Hospital Discharge. The report notes that avoidable delays in hospital discharge can have a negative impact on residents’ independence and lead to increased readmission rates. It states that the Council is working in partnership with NHS colleagues to address these challenges through a number of initiatives, including the integrated Transfer of Care Hub at St George’s University Hospital, a new mental health hospital discharge/reablement team, and more support for carers.
• Intermediate Care/Reablement. Reablement is a form of care that aims to help people recover their independence after illness, injury or a stay in hospital. It can be delivered in a person’s home or in a specialist facility. The report states that the Council is working to streamline access to reablement by integrating its provision with community health services, and is exploring options to increase the use of virtual wards, which enable people to receive hospital-level care in their own home.
• Mental Health Services. The report highlights a number of issues in this area, including growing numbers of people with mental health conditions, increasing admissions to mental health hospitals, and the knock-on impact of mental health issues on emergency departments in acute hospitals. It lists a number of initiatives that the Council is working on in partnership with its NHS partners to address these challenges, including a new Mental Health Reablement Service pilot, a public awareness campaign on dementia, and the development of a mental health commissioning strategy.
• Integrated Neighbourhoods. The report identifies several challenges related to the provision of integrated health and care services in local neighbourhoods, including a focus on services rather than places, pressure on budgets, and difficulties in communication and collaboration between different parts of the health and care system. It lists a number of initiatives that the Council is implementing or piloting to address these challenges, including greater collaboration with GPs and other community providers, the development of family hubs, and pilots for outreach services in areas with high levels of health inequality.

Quarter 2 Budget Monitoring 2024/25

The report pack contains a joint report by the Executive Director of Adult Social Care and Public Health, Jeremy DeSouza, and the Chief Executive, Brian Reilly, on the projected expenditure for the second quarter of the 2024/25 financial year. The report notes that the committee’s remit is currently projected to overspend by £2.739 million, with the biggest pressures coming from adult social care services, which are forecast to overspend by £2.836 million. It states that the main reason for the projected overspend is increased demand for services, more complex care needs, and the rising cost of care provision.

The report identifies a number of risks to the budget, in particular the interdependence of the Council’s social care services on the NHS. The authors note that efficiency savings in health services could lead to increased costs for social care if, for example, people who previously received care funded by the NHS no longer qualify for NHS funding. They also highlight the risk that budget pressures could force the Council to focus resources on meeting the needs of residents with complex needs, leaving fewer resources available for early intervention and prevention work.

The report lists a number of initiatives intended to mitigate these risks and reduce the projected overspend. These include:

• Reablement First. The report notes that the Council’s reablement services have achieved good outcomes for residents, with 89% of people needing less or no ongoing care following a period of reablement. It states that the Council is working to increase referrals to reablement, both from hospital discharge teams and from community social work teams.
• Digital Care Technology. The report states that the Council’s digital care technology service is well established and is helping residents to live independently. The service uses technology such as sensors, alarms, and medication reminders to monitor people’s wellbeing, identify risks, and provide support. The authors note that 59 care and support packages have been avoided this year to date as a result of interventions from the service, and that a business case is currently being prepared to allow for further expansion of the service.
• Streamlining Processes. The report outlines plans to improve efficiency by streamlining processes. This includes the implementation of new technology to better manage referrals to the First Contact Team, and a pilot scheme to accelerate decision-making about safeguarding referrals.

Annual Complaints Report Adults Social Care Wandsworth 2023-24

The meeting pack contains a report by Jeremy DeSouza, the Executive Director of Adult Social Care and Public Health, on complaints made about Adult Social Care services during the previous financial year (2023/24). The report notes that the Complaints Team responded to 63 formal complaints during the year, in addition to swiftly resolving 52 low-level concerns and dealing with 97 enquiries or representations about issues that fall outside of the formal complaints procedure. It states that complaint numbers have gradually decreased in recent years, suggesting that Adult Social Care teams are getting better at resolving issues quickly without the need for formal complaints.

The report lists the most common reasons for complaints. These were:

• Quality of Care. Complaints about the quality of care provided by domiciliary care agencies and supported living placements.
• Finance. Disagreements over care charges and outstanding debts.
• Lack of Support. Complaints that the Council is not providing enough support.
• Delays. Concerns about delays in providing assessments, delivering services, and making decisions.
• Communication Issues. Complaints about poor communication, lack of clarity, breaches of confidentiality, and failure to work effectively in partnership with other organisations.

The report notes that 48% of complaints were partially upheld, 30% were fully upheld, and 22% were not upheld. Of those that were fully or partially upheld, the most common issue was the quality of care provided by external providers. The report states that the Council’s Quality Assurance and Contract Monitoring Team successfully managed 257 service concerns during the year, preventing these issues from escalating to formal complaints. It also provides several case studies demonstrating how the Council has learned from complaints and implemented changes to improve services.

The report concludes with an overview of the Complaints Team’s key achievements during the year. These include:

• A New Complaints Policy. The creation of a new publicly accessible Adult Social Care complaints policy.
• Improved Reporting. Stronger quarterly reporting on complaints to senior management across the directorate.
• Better Partnership Working. The establishment of procedures to identify and manage housing-related complaints in collaboration with the Housing Directorate.
• Enhanced Support for SEND Teams. The introduction of fortnightly meetings to discuss complaints and provide support to SEND teams in Achieving for Children.
• Complaints Training for Staff. The delivery of comprehensive complaints training for staff across the directorate.

2024/25 Wandsworth Corporate Plan Actions and Key Performance Indicators

The report pack includes a report from the Chief Executive on the Council’s progress in delivering its Wandsworth Corporate Plan (WCP). The report lists a number of actions related to the work of the committee. These include:

• Delivering the Wandsworth VAWG Strategy. The Wandsworth Violence Against Women and Girls (VAWG) Strategy was signed off and launched in 2023/24. The report lists a number of activities intended to deliver the strategy, including the provision of a drop-in Safe Space in Clapham Junction on Friday evenings; the continuation of the Safe Havens Scheme, which offers a safe space for women and girls at risk in shops, bars, and other businesses; and the provision of specialist domestic abuse services.
• Responding to Neighbourhood Crime. The report states that the Council is working in partnership with the police and other agencies to respond to neighbourhood crime, including anti-social behaviour, violence, and high volume crime. This work includes targeted interventions and multi-agency working.
• Preparing for the Care Quality Commission (CQC) Assessment. The Council is preparing for an assessment by the CQC, which regulates health and social care services. The report notes that a dedicated project group is overseeing this work, and that extensive engagement has been carried out with staff, partners, and providers to ensure that they are ready for the assessment.
• Developing the Care Market. The Council is working with the Integrated Care Board (ICB) and other partners to develop a strategic approach to supporting the local care market, including a focus on workforce capacity and retention. The report notes that the Council has received requests from some providers for uplifted rates above the current inflation offer, and is reviewing these requests on a case-by-case basis.
• Improving Support for Vulnerable Adults. The Council is working to improve support for vulnerable adults through a number of initiatives, including Mental Capacity Act training, bespoke training on issues like modern slavery and hate crime, and the provision of support for carers.
• Delivering Integrated Health and Care Services. The Council is working in partnership with the NHS to deliver more efficient and effective health and care services. This includes a focus on improving outcomes for people at discharge from hospital, supporting more people to live independently using reablement and digital technology, and delivering the joint local Health and Wellbeing Strategy.
• Embedding Prevention. The Council is working to embed prevention principles across all of its departments. The report lists several examples of this work, including the inclusion of the Council’s Prevention Framework in the Adult Social Care Services Commissioning handbook, Public Health’s leadership on the Project Board for the new Council Leisure, Sport, and Physical Activity Strategy, and the development of a Heat Health Plan.

The report also presents the latest results for a number of key performance indicators (KPIs) related to the work of the committee. These include:

• Rate of admissions into residential and nursing care. The rate of admissions into residential and nursing care for people aged 65 and over fell to 227.2 per 100,000 residents in the second quarter of 2024/25, compared to a rate of 479.7 per 100,000 in 2023/24. The target rate for 2024/25 is 257.5 per 100,000. The report notes that extra care is playing a vital role in reducing inappropriate residential care placement and that people are staying in their own homes for longer as a result of the services provided.
• Percentage of carers who received an assessment. The percentage of carers who received an assessment from the Council rose from 33.8% in the second quarter of 2023/24 to 41.5% in the second quarter of 2024/25. This puts the Council above its target for the year to date of 35%. The report notes that the Council is continuing to invest in the delivery of carers' services including respite breaks and is supporting a South West London initiative to increase the number of carers who are identified and provided with support.
• Percentage of section 42 safeguarding enquiries where a risk was identified, and the reported outcome was that this risk was reduced or removed. The percentage of safeguarding enquiries where a risk was identified, and the reported outcome was that this risk was reduced or removed, rose from 96.1% in the second quarter of 2023/24 to 98.5% in the second quarter of 2024/25. The Council’s target for the year is 94%.
• Median average wait for an Occupational Therapy (OT) assessment. The average wait for an Occupational Therapy (OT) assessment fell from 71 working days in the second quarter of 2023/24 to 45 working days in the second quarter of 2024/25. However, demand for the service is still high and the report states that the service is actively looking to increase capacity. The report notes that the OT service plays an essential role in supporting people to maintain their independence through the provision of equipment.
• Number of people quitting smoking through smoking cessation service. The number of people who quit smoking through the Council’s smoking cessation service in the first quarter of 2024/25 was 45, compared to 93 in the first quarter of 2023/24. The report does not include a target for the year to date, as this is the first year that the indicator is being reported.
• Overall crime rate. The overall crime rate in Wandsworth fell to 39.72 per 1000 residents in the second quarter of 2024/25, compared to 82.56 per 1000 residents in 2023/24. This puts Wandsworth below the average rate for inner London, which was 42.8 per 1000 residents in the second quarter of 2024/25.
• Number of referrals into commissioned VAWG services (Independent Domestic Violence Advisors). The number of referrals to the Council’s commissioned VAWG services was 472 in the second quarter of 2024/25. This is above the target for the year to date of 440. The report notes that the service is on track to achieve above target referrals for the year, following a programme of work to raise awareness and promote the service.
• Percentage occupation of refuge spaces. The percentage occupation of refuge spaces in Wandsworth was 97.4% in the second quarter of 2024/25. This is above the target for the year to date of 90%. The report notes that there is a constant demand for refuge accommodation in Wandsworth, and that the Council is working with partners to ensure that there is enough capacity to meet the needs of vulnerable residents.
• Number of community triggers (ASB reviews) received. The number of community triggers (also known as ASB reviews) received by the Council was 10 in the second quarter of 2024/25. This is a fall from the number received during the COVID-19 pandemic. However, the numbers still remain higher than pre-COVID levels. The report states that this is likely due to an increase in public awareness of the ASB review process.

Overall, the report suggests that the Council is making progress in delivering the Wandsworth Corporate Plan and is achieving positive results for many of the key performance indicators related to the work of the Health Committee. However, there are some areas where challenges remain, such as the budget pressures in Adult Social Care. The report highlights the importance of partnership working and the need for continuous improvement to address these challenges and ensure that the Council is able to deliver high quality services to residents.