Transcript

Hi, good evening, everyone. Welcome to Health Committee, alphabetical order, and if you could just turn on your mics and say good evening and that you're here. Councillor Cromelli. Good evening, I'm here. Thank you. Councillor Davies. Good evening. Councillor Della Sajul. I'm also here. Councillor Gossain. Good evening. Councillor Marshall. Present. And we have apologies from Councillor Rigby and Councillor Stutters. Councillor Varatharaj. Good evening. Councillor Worrell. Good evening. Also in attendance is the Cabinet Member for Health. Would you like to introduce yourself? Roman Singh, good evening. Lovely. So we'll move on to the contents of the evening, starting with the first item. So are the minutes of the previous meeting agreed? Lovely. I'd also like to welcome Stephen Hickey, Chair of Health Watch, who's attending virtually at the meeting. I'll ask Stephen to comment on any item he's indicated that he wishes when we get to that item. I'd also like to welcome Kate Semak and Natalia Henry from St. George's Trust, who are attending on the trust item, just at the back there. Thanks for joining us. And we've got Philip Murray and Priya Samuel from the South West London St. George's Mental Health Trust. And we've got Mark Creelman and Kate from the ICB. So thanks, everyone, for joining us this evening. We've also got a number of officers present who will be attending in person and virtually, and they'll introduce themselves as the committee goes on. Does anyone have any declaration of interest that they'd like to make before we get started? No? Okay, lovely. So let's move on to item three, report by St. George's Trust, an update on performance and key issues. I think Kate and Natalia, you're going to welcome this report if you'd just like to introduce yourselves and give a brief introduction. And thank you for coming to see us this evening. Thanks, Councillor Dobrez. My name's Kate Semak. I'm the Managing Director at St. George's, and I'm with Natalia Henry, who's the Group Chief Midwifery Officer at St. George's. And we've provided quite a broad report in the usual way, covering a whole range of areas of how we're doing performance-wise, our financial framework that we're operating in at the moment. We've provided a fuller update on maternity following the CQC visit, and Natalia will be happy to take any questions on that. We've had quite a lot of CQC activities, so happy to discuss and share anything that would be helpful for you to hear tonight with regard to that, and the usual quality and workforce updates. So I think in the usual way, I wasn't going to go through anything in any detail, unless you would like me to, I think, hand over to any questions that people have, because I know you've read the report. Yeah, we can go straight to questions, if everyone's happy. I think we've got a lot on this. So, yeah, Councillor Marshall, straight up. You go first. You know, while there's been very good progress on the elective surgery waiting list, we've been inducted to my colleague to point out that three wards have had to be closed due to norovirus, and I'm just wondering what the knock-on effect of that has been generally, but particularly on the waiting list for elective surgeries. Yes, I think, as you've probably both read in the news and also sort of heard more locally with St. George's, we have been impacted by norovirus, and it does change. We've probably got about 30 beds closed in the organisation on a number of wards, which norovirus prevents us from emitting into those wards. We've actually had very little impact on our surgical wards, interestingly. It's mainly impacted our medical wards. We keep our surgical ward complement very separate from our non-elective emergency wards. So, at the moment, it hasn't had an impact on elective surgery, but obviously, we have to be very, very vigilant around norovirus because, obviously, it spreads very quickly. But so far, no impact, I'm pleased to say. Thank you. Yeah. Councillor Crivelli. Can I just ask a question, building on the elective treatment? You've said on page 8, paragraph 3, sorry, that you've talked about the consultant-led elective treatment waiting time remains a priority for the Trust. And you have said that you are performing better than your peer average. Obviously, that's commendable. But you pointed out there's 31 patients waiting 65 weeks or longer, and 858 patients waiting 52 weeks longer. I appreciate if you were one of these patients that was waiting that length of time. Obviously, the fact that the peer average doesn't mean anything to them. And I was just – you say we do have a detailed plan to mitigate the growth of that. I was wondering, out of curiosity, is there some particular form of treatment that makes up the bulk of these patients, or is it just scattered all over? Is there one particular thing that you need to focus on as a Trust to address these waiting times? So, in terms of the 65-week wait – and I totally agree with what you say. I mean, waiting that length of time for your elective surgery is really distressing for individuals, and we absolutely – so whilst we're ahead of many other organizations in a way that's absolutely irrelevant, we want to bring those waits right down to where they used to be. We're teetering around the sort of 30, 40 patients who've been waiting over 65 weeks. The intention is to get that to zero by the end of March. I think that is quite challenging, but we're certainly aiming to do that. The key – we have a number of services that are key drivers for those waits, so it isn't spread across a lot of specialties. But neurosurgery is one, as is general surgery and gynecology. So there are particular areas where we are having to do a lot of work to make sure we're bringing long waiters in. We're also really focused on bringing our 52-week waiters down. We have brought the number down since the report was written, and the sort of government intention is to have only 1% of the people waiting over 52 weeks by March 2026. We're really confident about hitting that. We're about at 1.5% now. So – and, of course, then it's also looking at how we go back to the standard of measuring how long generally people are waiting and bringing that sort of up to a higher level so that less people are generally waiting long period for their surgery. So we've got lots of programs of work in hand to address that, including validating our waiting list and making sure people are still waiting for that procedure, because actually that is an issue in itself, because often people are on a number of waiting lists at the same time. Look at how we're utilizing our theater lists, making sure we're booking in chronological order. So, obviously, particularly around long waiters, we have to get our emergencies in quicker, but making sure we're dealing with patients in chronological order. So – and just generally improving our productivities. And I'm confident we're going to get there, but we need – you know, we need to try and get there as quickly as possible. Thanks. So that's reassuring to know that there are lots of plans in place around that. Councillor Gussain. Thank you, Chair. The Trust reports a 14.3 million deficit. I mean, the information is probably available elsewhere, but there's no breakdown in the report about how that deficit came about. There's mention of a review by Deloitte. Would you be able to say what structural financial issues were identified by that report and how much additional public funding may have been allocated to cover deficits? And there's mention of a cost improvement program. Are you able to tell us how much cost cutting has been achieved and, if so, what the impact on patient care is? So I'll try and answer most of those questions. So I'll start at the end. So in terms of a cost improvement program, so just first and foremost, we have to go through a quality improvement assessment of every cost improvement program that we do. And depending on the size and the quantum of that cost improvement program depends on where that's reviewed within the organization. But it involves a clinical review with an operational management review as well. We are on track to deliver up to £60 million worth of cost improvement programs this year, which is a significant increase on last year. It equates to about 5%, so better than we've achieved before. And a lot of those, you know, they're things like reducing temporary staffing, looking at nursing rosters, improving our consultant, the way we work with consultants. And actually, the job plans are done, a whole range of things, obviously, procurement. And there have also been some benefits on the income side where we've delivered a higher level of activity, which links to improving our waiting times. We have got, in terms of structural deficit, we've got an underlying deficit at St. George's. And some of that is, we just, we had an underlying deficit pre-COVID. We managed to get things back on track, and post-COVID, that has returned. I think there's a whole range of reasons for that. And when we deliver cost improvement programs, they're not always recurrent. And that, of course, then you carry that deficit through to the next year. And, I mean, this coming year that we're about to move into is incredibly challenging financially. I think it's probably one of the most financially challenging years we've probably ever entered. So, we will still have a deficit going into next year. We have a deficit, agreed deficit plan within the system and with NHSE. But we do need to work through how we're going to close that deficit over time. But that's going to take a number of years to achieve. So, just to remember if there's anything else I haven't answered from what you asked me. No, I think you pretty much covered everything. Just related to that question. So, it's mentioned that the use of private beds is still sort of happening. How much of the budget is spent on outsourcing to the private sector? Is that growing or is that diminishing at present? It's diminishing. We use very little private capacity. I'm not sure we use any private beds at all now, actually. Probably the most recent we're now no longer using was in cardiology because we had a big cardiology backlog. We've managed to clear that down. So, we work really hard not. Obviously, we have the plurality argument that actually we should be allowing people to have that choice, which is there. Most people don't want to go into the private sector because they want to have care at St. George's. And our waiting lists aren't so long that generally people want to do that. But we have very little of our budget that goes into the private sector. I think Councillor Marshall, were you next? Do you still have a question? Oh, no. You go for it, Pat. Thank you, Chair. So, I just had a question on the paediatric cancer care. So, our Mayor of London, Sadiq Khan, he said in recent press releases he wants to see the paediatric cancer care at St. George's to be strengthened. So, just on the back of that, have St. George's received any guarantees from NHS England on continuing paediatric cancer care at St. George's or kind of what's going to happen in the handover period or kind of just what's happening? Thank you. So, I know you're aware that obviously paediatric cancer is moving to the Evelina. And we will still be undertaking outpatient cancer care. We are working with NHSC about becoming a POSCU enhanced, I'm going to have to remember that, a paediatric oncology care unit of a higher level that we currently are. So, we're in negotiation about how we land that post the service moving to the Evelina. Sorry, could you explain for committee members what that means? Yes, it's a paediatric oncology shared care unit where children would come with a higher level of need but not need an inpatient bed or inpatient treatment. So, it would enable us to support, continue to support children locally with a higher level of cancer need with the right conditions and services available to support them. I was just trying to remember what it stood for. I'm so used to calling it POSCU, sorry. So, we're in discussion with NHSC about what else we can work with them for St. George's to make sure we're maintaining high levels of tertiary care for children. But we won't be delivering inpatient cancer care. That will be moving to the Evelina. And who's next again? Councillor Horrell. Thank you, Chair. First, just some feedback. St. George's often gets a bad rap in terms of the press. And I recently, in fact, this weekend had an MRI at St. George's. The waiting time was about three, just under three and a half weeks from referral to actually getting the test done and an excellent service. So, it's nice to have some good stories around St. George's. And a big thank you to your staff in terms of the quality of care that was actually delivered. And I would be grateful if you could feed that back to the MRI unit, how pleased I was from the moment of contact all the way through. So, it was great to see a coherent pathway in place and a really good pathway. So, a big thank you for that. In terms of your report, I just want to go back, go to one. On page eight, you talk about the transfer of care hub. And I was just wondering, what was, if someone comes into that, what's the average time for discharge that somebody could actually expect? And what might be the particular challenges? I mean, the press is often full of stories around bed blocking and no packages of care being available, et cetera. And we know that the press often spins stories in the negative lights. It's often sell papers. So, I'm just trying to get an idea, what is the real picture in terms of discharge time and the weights, but also a realistic assessment of what the challenges might be and how we might be able to help you. Thank you for that positive feedback. I will make sure we feed that back, and that's always appreciated. So, the Transfer of Care Hub is a multidisciplinary, multi-agency team, I suppose, who are hospital-based, who work with the wards to support discharge and flow out of the organizations. They become experts on discharge, particularly more complex discharge. And we have social workers, voluntary sector, nurses, therapists, and our community provider within that hub. So, it's a sort of center of knowledge and support. In terms of, I mean, it wouldn't be right to say we don't have any issues with flow, because we absolutely do. And I work very closely with Wandsworth, obviously, my colleague, Mark, behind me, about what can we do to take out delays in the system, both internal and external delays in the system. When somebody needs a three times a day or four times a day package of care, that can take longer than one would want it to, to organize. And obviously, people who are on what we call a pathway three, when they're waiting for a home, I think people end up waiting quite a long time for that as well. So, I think it's still a bit variable, more variable than we want it to be. The transfer of care hub and the teams and the way they work try to reduce lost days at various points of the pathway to at least make sure we're working really hard to notify social care early in a patient's pathway, rather than at the point that they need to be discharged so they can start planning their discharge earlier and start negotiating with packages of care, et cetera. We're getting better at doing that. So, it's about being more joined up, trying to take out those wasted steps, and obviously acknowledging that some bits of the pathway do take longer than one would want them to, because actually setting up the care takes longer than ideally it would do. But that sort of joint way of working in the moment on the site makes a big difference. Thank you. Any further questions? Yeah, Councillor Crivelli, go for it. Can I just ask, going back to the paediatric services and the fact that it's being moved to the Evelina, correct me if I'm wrong in saying this, but is there not a transition cost involved in moving these services in the first place? And I make an assumption that, in effect, you're just going to have to bite the bullet on that one. Is that correct? Are you getting any assistance? Quite surprisingly, both ourselves, the Marsden and the Evelina, have been given quite a reasonable amount of transition money to enable us to both appoint program managers, additional HR support, and to free clinical staff up and backfill them in order for them to engage more fully with the transition. So, that bit has worked well. The area that we're in, I've got a meeting tomorrow with NHRC that we really need to land is the stranded costs that St. George's will experience as a result of losing that service and how we replace that with equivalent activity that should be happening at St. George's with the type of work we do there and maintaining some of the expertise we have locally as a result of many years of delivering that service. And we're moving slower with that, but I think we're beginning to make some progress. So, that's the area that we really need to land, but the transition support has been good. And I'm just going to bring in Stephen Hickey, who has, I believe, a question on this paper. Thank you very much. My question was actually also about the 52 weeks, and I very much welcome the fact that the numbers are apparently coming down. That's really good. I just wanted to, if you could just clarify something you said. You said that the government is setting a, I think you expressed it in percentage terms, a target, an aim for a year, well, just over a year from now. But I wasn't clear. Could you explain roughly how that percentage relates to the sort of numbers you've currently got here in terms of how many, in broad terms, you would expect on that assumption to be still waiting 52 weeks? Yes, I think, I mean, I could probably get you the exact numbers, Stephen, outside of here, but the expectation is it should be no more than 1% of your RTT list should be over 52-week waits. And we're just around 1.5% now. So, I'd say it's probably going to reduce down probably around to around the 300 mark. But I can get you the exact number. But we'll be aiming for lower than that. But that's, and that's a reflection that many trusts have thousands and thousands of thousands of 52-week waiters. And, again, totally agree that the comparator is not helpful in terms of the individual patient. But it gives you a sense that we're nearer to where we need to get than perhaps some other organizations. Thank you. And, Natalia, while you're here, would you briefly mind touching on the CQC report and kind of, you know, plan next steps to reassure the committee around maternity services? Yes, thank you. So, you may know that we had a CQC inspection back in 2023, March 2023, to be exact. And we've been working through those actions. We received some must-and-should-do actions. And we've made really good progress on those. And we expect that those should be completed by the end of March. And then we had another inspection in October 2024. We received some immediate feedback on that, which, again, we are working through. But some of that we had already made progress on from the previous inspection. So, some of the areas that they had concerns around were our maternity to triage process and how women are able to access the service, either because we also run a helpline. And it was how we are able to distinguish between the helpline and the triage service that we provide. And also ensuring that we have the right level of staff to see women in a timely manner and that they are reviewed by our medical team appropriately as well. So, that's one aspect. There was also some concerns raised around our governance process in terms of how incidents are graded, such as postpartum hemorrhage in particular, and third- and fourth-degree tears. And we've done a lot of work on that. So, we were able to make some representations to the CQC about what we had already done and achieved in that area. Lots of improvement in terms of classification and investigation and sharing of the learning so that we are improving as we move along the journey. There's also, in this recent inspection around medicine safety and how we are managing that process. And we're working really hand-in-hand with our pharmacy colleagues to get that process right across our different services within maternity. Thanks so much. And thank you so much both for coming and speaking to the committee this evening. You're very welcome to stay. But if you would like to go and enjoy your evening, then please do that as well. Thank you very much. Thank you. Is this report noted for information by the committee? Yeah, great. Okay, moving on to South West London and St. George's mental health report. We've got Philip and Priya. Do you want to come and sit around the table? This was just to remind committee colleagues, this report was deferred from the November meeting and we did send around some questions that the trust answered via email. But if people have further questions that they would like to ask colleagues now that they're here about the report, then please do so. But I'll just let them introduce themselves. Philip, do you want to go first? Thank you, Councillor Dobres. And good evening, ladies and gentlemen. Firstly, of course, profuse apologies for being ill in November and not being here to present to you, for which I'm sorry. Rather like our colleagues from St. George's, obviously, you've seen the paper, you've had a chance to read it and hopefully you've digested that it covers largely our main initiatives or two of our main initiatives, our adult patient journey and making our trust a great place to work. And then goes on to give you more detail in some of our performance indicators. And as Councillor Dobres said, you did table or give us or share with us, as I should say, a few questions which we have provided written answers to. So really, rather than present any further, I was going to open up to you to ask us any further questions you have, which either myself or Priya will try and answer. Priya, do you want to just briefly introduce yourself? Thank you, Chair. I'm Priya Samuel, Integrated Partnerships Manager at South West London and St. George's Mental Health Trust. Great. Do we have... Come in. Oh, straight away. Yep. Councillor Gray. I'll strike where the iron's hot. Thank you for the report. It's very comprehensive. And you've talked about a lot of really important issues in mental health and the tremendous work that you're doing to try and tackle mental health issues. Can I ask you, you're talking about the adult patient's journey and you've talked about a number of things here that are really good in enhanced crisis support family placement scheme. Can I ask you about something that isn't touched upon in the report? And I talk from a personal point of view because I work in the courts and every day on a near daily basis I come across people who are in mental health crisis and that's why they're in trouble with the police. That's why they end up in court. And I was interested, if you could just explain, do you have any interaction with the liaison and diversion teams that appear at court? Because obviously a lot of the people that are in effect answering to the court for issues, criminal offences, there are people who have been led there because of their mental state. And obviously if it was the case that there was intervention to address that issue, a strong possibility they wouldn't be in court in the first place. And I was just wondering, you'd say how you interact with that? I'm going to be honest, I'm probably not going to be able to give you a detailed clinical answer of how they operate. But we absolutely do run a liaison and diversion service, which is part of our forensic division, if you will. The forensic services operate across the three mental health trusts in South London, so South London Immortally and the Oxleys Trust. And what they do is they run all of those services as a triumvirate, if you will, to make the best of the resources they've got. So we share the beds and provisions to ensure that we make the most of those resources. And indeed, our liaison and diversion teams work together. Indeed, I can probably say, without breaking any confidence, we've just recently submitted a joint proposal to expand those services to NHS England colleagues. We await to see whether we're invited for interview. And through that, we would look to be enhancing that interface. What we've also run in the past are street triage services, so proactive work, going out, trying to work with the police to identify people that might end up in the situation that you've said, so that they don't end up in the courts. And obviously, as I know you will be aware, things like the Section 136 suites, we hope, working with the Metropolitan Police, that they will divert patients into the Section 136 suites, rather than coming through a judicial process. Obviously, as you say, unfortunately, we do find ourselves with a number of patients that have come through the judicial process, and indeed, a number of our patients under Ministry of Justice sections, because of their activities and the unfortunate illness that goes with it sometimes. Do I have further questions from the committee? Councillor Worrell? Yes, thank you. Sadly, around the world, there's been a big attack on EDI work and EDI initiatives, and in fact, a lot of organisations are rolling back their initiatives. I'm just wondering, in terms of the trust itself and its anti-racist agenda and equality work, what might be the principal challenge – sorry, let me start again. What are the principal challenges at this moment in time, and actually taking forward this area of work and strengthening it and allowing further integration within the trust? I mean, it's a really – as you've really alluded to, it's a really complex thing to look at the many inequalities that exist. And we need to remember that, actually, just suffering from a severe and enduring mental illness means that you do, in yourself, suffer inequality. You will have a life expectancy probably 20 years less than the rest of the average population. And then, if you have other comorbidities, physical health ones, et cetera, that worsens that inequality. So, everything we do is targeted, in a way, at reducing inequalities. But, of course, that's a slightly trite answer. What we're trying to do is to then look below the data to understand – and one of our initiatives is our MHIP project, where we're working in Wandsworth initially, and that's expanding across the other boroughs, looking at some of the particular inequalities that people experience. So, we know, for example, that young black men are more likely to be sectioned in our beds than other sections of the population. We know that some sections of our population, Asians, are less likely to access talking therapies. So, we need to understand and work with our communities as to what the specific interventions are, such that we can get a better representation, the more appropriate representation. Some trusts – so, Mersey Care is a really good example, a way ahead of many trusts in this. So, we're trying to work with others, like Mersey Care, to understand how they're using the data to what they would call identify an actionable intervention, because there are many, many inequalities. And, obviously, we could spend many, many years researching them and make no difference. So, I think what we need to do and what we're trying to do is to use the data to identify the biggest areas of inequality and then find some key interventions to make a difference. The MHIP project, of course, is one where what we're hoping to do is, now it's been running for some time, get some review, independent review of its – the efficacy of it. So, we can then evidence it and roll it out and, hopefully, show to other areas, other geographies as well, the benefits of it. So, that's what we're trying to do. We're trying to use the data, do small projects to evidence the practicality and the efficacy of the intervention and then roll it forward. I think we have made progress, but is it enough? Of course, it's not enough, because we've still got many, many inequalities. But, I think – I do think – I'd like to think we have made some positive progress. I'm not going to say it's easy, and it's going to be a long journey, I think, before we can really say that we've made a big difference. Thank you. Mr Miller, did you have a – okay, perfect. Any further questions? Councillor Kassain? Thank you. The first question is about the Adult Patient Journey Program. You know, I'd like to reiterate what the other counsellors have said about the good work that you do. So, if I'm focusing on the negative stuff, you know, that's my job. It's not to diminish the good work that you do. But there is a deterioration from 1,715 to 1,784 occupied bed days, and the target to reduce the average length of stay from 44 to 38 days hasn't turned out, as you would wish, and it's actually increased. So, what are the explanations for this deterioration? So, again, I'm not going to bore you with statistics. So, some of it's an artifact of the way that these things are measured. So, for example, what I can say to you is that one of our problems is that we suffer from a 50% greater than the national average number of patients that are clinically fit and ready for discharge, but are still residing in our beds. So, we have about 15% of our bed days that are lost to patients that might reasonably be elsewhere on a clinical basis and aren't. When we discharge one of those patients, it then artificially changes the average length of stay. So, we know that over the last few months where we've been working with colleagues in the community to find more appropriate placements for those patients, that that has pushed our length of stay up. In addition, what we're also finding is that the complexity of some of our patients means that they're coming in through, say, A&E departments, ED departments. They're coming into a psychiatric intensive care. They may be going to a working-age adult, what we call acute mental health ward, and then into rehab. And the case mix is becoming more and more complex so that the average length of stay is increasing. Now, some of the things that we've done have, I suppose, exacerbated that to liken it to physical health. Where you introduce day surgery, you take some easy surgery patients and you put them into day surgery. So, what's left coming into your inpatient surgery is, by implication, more complicated. So, in 2016-17, way before the numbers you're looking at, I appreciate, we introduced the Lotus suite. And that took out most of our zero to three length of stay. So, that pushed our length of stay up. And what you've seen in our reports is that we have been relying on some private sector beds. And as is typically the case, when we seek a private sector bed, they review the patient. And they will normally take on those that are less complicated because they don't have psychiatric intensive care units. So, of course, what that's done is taken the next cohort, i.e., normally 0- to 30-day length of stay, and move some of those to the private sector. So, we've further exacerbated our own complexity. And what we have seen, particularly since COVID, it's both complexity and comorbidity. So, the nature of the mental illness is more complex, but the associated comorbidities, so physical health needs, et cetera, have also become more complex because that's what's left. Nonetheless, we obviously need to look at what we're doing because that isn't acceptable. You asked our people in the seat previously. You asked St. George's about their use of private beds. We are having to use private beds, and, of course, what we'd rather be doing is spending public money on NHS facilities, not private facilities. So, what we're looking to do is to – that's why we call it adult patient journey, because it isn't about only when someone's in bed, if we can – in a bed, one of our beds. If we can intervene at the start of the pathway – we've had the question about liaison and diversion, but picking up people that might end up in the judicial process, picking people up before they end up in A&E departments and needing to be sectioned, but then equally being able to pick them up at the end of the pathway such that we can bring them out, not when they're perfectly well, but when they're well enough to be cared for again in the community such that people have a more acute episode in the hospital and we manage them more in the community. So, that's why we're focusing on the journey, not our length of stay, and the impact of those, we hope, will be to bring that length of stay back. I think, because we will be focusing on trying to move some of the longer-stay patients into the more appropriate settings, we might see periodic blips up, but when they're normalised, which hopefully we can present that data more clearly, and we'll need to internally, I think, we'll be able to understand and share that with you, what's really going on. What our chief operating officer told me today was that when we take out these extra-length-of-stay patients, our length of stay actually is in the 40 days, which is a lot lower than the headline number, considerably lower. Thanks for that very thorough answer. Can I ask another question or two? The other question is about MHIP, and we'd all agree about the important value of this work, but I was wondering whether you could say something about the metrics and how reductions in disparities and use of coercive practices and detentions is measured, and whether you have any of that data at present to demonstrate whether the current approach is working. I think Priya's got some of that information to hand, so I'm going to ask her to take that. Thank you. Since the report was published, we have received data in terms of the key interventions, and I would be happy to convene those against each key intervention and share that with the committee. We have got further developments, as you can imagine, over the period of time. Recently employed an officer within the trust to support the family emplacement scheme, so that work will be progressive in terms of engagement sessions, cultural awareness, and development. So that's just one example, but again, more than happy to obtain some recent data and information against performance and share that with the committee. Can that be in the next report? We can do that in the next report. Equally, I can provide something outside of the committee in advance of the next report. I believe the next report is due in November. Yeah, we can arrange for something outside and circulate it to committee members. Okay, thank you. Does anyone have any further questions, or should we move on to the next paper? Okay. Is the report noted for information? Thank you. Oh, yes, Priya, do you want to come in? Apologies. I just wanted to confirm with the committee that Councillor Davies had asked some questions around CAMHS. The responses haven't been included here because we had a further meeting to obtain further information, and once the responses have been gathered, I'll share them with the committee to be published. Thank you so much, and thank you both for joining us this evening. Again, welcome to stay if you'd like, but equally, go ahead and enjoy your evening if you'd like to do that as well. Thank you. Lovely. Okay, moving on to our ICB report. Mark, Katie, I think we've got Katie online, is that right? Hello. Yes, I am here. We've also got my colleague James Walker online, who's been instrumental in this work so far as well. Great. Hello, good evening. Mark, would you like to briefly introduce the report? Yes. Now, I'm going to ask the committee to bear with me as well, because I think one of the questions from the report was around the work of the ICB. So I was just going to give you a two-minute snapshot of what the ICB is doing. So you've heard from parts of the ICB already tonight. So George's and South West London and St George's are very much part of the ICB. But in addition to that, it works at two levels. South West London ICB, and then the PLACE, which for us is Wandsworth. And that's really including things like primary care, our community services. Also, we've recently had the delegated authority around pharmacy, optometry, and dentistry. And really for PLACE, it is about bringing that together into kind of an integrated way of working. Now, in the paper, we say team, but actually it's about integrated working, not necessarily teams of people. There is new operational guidance out for the NHS. There are four key targets, really, and that's about reducing A&E and ambulance response times, reducing planned care waiting times, which I think Kate previously touched upon, access to primary care and urgent access to dentistry, and then improving patient flow and care for mental health and learning disabilities. So the ICB is the kind of catch-all. So we work with our providers within the local system to ensure that we really are kind of trying to improve the health outcomes for local residents, to tackle inequalities and target services to those. You've mentioned MHIP. I'm the SRO for MHIP, so I'll make sure we get the data for you. And I think overall, what we are trying to do is move that, the dial from treatment to prevention, analog to digital, accepting that not everyone has access to digital, and also moving services from our acute into the community. And that's probably the ICB in a snapshot. I'll hand to Katie just around the paper, but we will be brief and take questions. Yeah, thank you, Mark. As Mark says, I'll assume the paper has been read, but the one thing I did want to flag up is that in the deluge of paperwork that we received from NHS England and the Department of Health two weeks ago in relation to kind of the guidance that the NHS needs to follow over the next year, there was a significant amount of new information around how we should be developing integrated neighbourhood working, which is what this paper focuses on. However, the good news is, having read across that guidance, we are absolutely going in the right direction in Wandsworth and are actually ahead on a number of the areas that it focuses in on as well. So I just wanted to flag that up as a real positive position that we're already in, in terms of what we need to deliver over the next year. James, did you want to add anything just up front, or should we go straight to questions? Great, OK. And thank you so much for coming. I think committee members were really interested in the work of the ICB, and hopefully we'll have a good discussion this evening. So we'll go to Councillor Davies first. Yeah, thank you for the paper. So I'm interested in, yeah, a few different aspects. So paragraph three, it says that the ICBs receive annual resource to cover the costs of providing the health services. And I just wondered, like, what kind of balance is expected in the distribution between the different sectors? So I wonder if that's one for Mark, actually. Are you there, Mark? Yeah. So I can absolutely go back and get the exact figures for you. What we do know is that the majority of spend is in the acute trusts. We have ring-fenced spending in mental health and then primary and community services as well. I'll get the exact figures, and there's a lovely pie chart I can send to you that tells you how it's distributed. I think as an ICB, a paper went to the ICB, I think, October of last year, saying that ICB is really committed to moving some funding to be more focused on primary and community services. And I think it's probably one of the only ICBs in the country to make that statement. Financial challenges across many public services make some of those mechanisms quite difficult. But I think the commitment is there to shift the dial, so to speak, in moving money towards community services. Yeah, so I suppose on that, I'm just thinking about the voluntary sector as well as being, yeah, just one extra partner. But then I'm also interested about the, yeah, the enriching the collaboration between the organisations. I wondered if you could just expand on that. You know, it's great to hear that, you know, Wandsworth is a bit ahead of the curve there. But I just wondered whether there's any kind of maybe a pan-London framework that you can work within, where, you know, partners are learning from each other. It's something that's still quite new, really. Or whether you know of councils that you think are very much the beacons of the best practice and, yeah, can support you. Thanks. Shall I start, Katie, and then I'll hand to you. So I just think in terms of the voluntary sector, when we talk about moving it from treatment to prevention, the voluntary sector are absolutely key to that because actually many of our residents will access their services before actually coming to kind of traditional health services. We do have a London integrated neighbourhood framework. I think it allows flexibility for us to reflect Wandsworth in that. It's still at its early stages, and what we're trying not to do is be held back. We want to kind of move forward. And then I'll hand over to Katie just for some of the specifics around particularly the partnership approach. Yeah. So you mentioned how we are enriching things. So partnership working isn't new in Wandsworth. So we have over a number of years had successive initiatives and contracts in place that have incentivised particularly our general practices to work together with their partners to look after the patients who we know are frail, who are elderly and most at risk of going into hospital. However, what we've identified over the years is that that poses some challenges, particularly for both health and social care partners that operate at a wider scale than GP practices to actually be able to meaningfully engage in those conversations. And we know that true integrated working requires not just GP practices and their staff to be around the table in those conversations. We need a much wider group of people, including the voluntary sector. And so what this new way of working will do is bring those groups of people together to look after communities on a wider geographical footprint than just an individual GP practice and make use of a number of additional staff who have been employed over the years through practices to actually look after those patients in a more coordinated and collaborative way. So, for example, we have social prescribers employed by our primary care networks and they can support patients that need to access voluntary sector services to access those services effectively and to get access to them when they need them. We also have health and social care coordinators who are working out, particularly in Battersea at the moment, to really connect the people in the communities with the services that they need that are there. But often it's just a challenge in actually putting the two together and getting people into the right service when they need it. So that's what this new way of working will focus on. Thanks. Thanks. I'm just going to add to Councillor Davie's question there. So in terms of integrated neighbourhood teams, INTs, what will that mean in practice in Wandsworth to actually take that from a kind of integrated working and working together to actually to that next level? You know, in some areas of London, in Camden, you know, they've got a big neighbourhood kind of building in an estate, you know, the James Wig practice where you've got social workers, children's services, et cetera, all in the same building, you know, providers, local authorities. Is there anything like that that we will be able to expect or I know the committee members were interested to maybe go and visit any kind of projects that really bring it to life? And the second part of that question is, how will this be different, you know, to actually to patients and to people? And what will people actually notice that that's kind of any different in this approach? Because as we said, we've been kind of doing integrated working for 10 years. You know, how will this be different? So I'm going to ask James to respond to this one, because he's actually out there in the communities working with the practices and the health and social care partners to bring it together. Yeah, thank you all. Thank you very much. And thank you very much for inviting us to this really important discussion. I think in terms of the to the ambitions that we have, we want to ensure that the neighbourhood health services that we are developing for Wandsworth fit really well with the local communities and the local geographies that exist. And we want to make sure that those services are really readily built around sort of true neighbourhoods that exist within this area, rather than drawn upon lines that have been made for sort of organisational boundaries. So what we're really keen to do is to start our work in three particular areas. We've already heard mention of Battersea, and we also want to ensure that we're commencing work within Tooting and commencing work within Roehampton. And what we want to ensure at that point in time is that the groups of professionals that are looking after these very vulnerable people in the first instance truly know those individuals and feel really, really connected to them and understand sort of the broad range of needs that they have. And really want to make sure that there's sort of a wider determinants of health approach taken with this, not just sort of an illness based approach. It's also really important for us that we want to make sure that we don't just put everybody into the same building and think we've solved the problems of integrated working. What we feel that we could see with that is just groups of professionals that are siloed within a smaller space. So our work is very much going to be focused on establishing a really good working culture, establishing trust between different providers, between different professionals, and making sure that the patient and citizen interest is at the heart of everything that we're doing. Any further questions? Councillor Avera Farage. Thank you. I just want to firstly really quickly say a huge thank you to the ICB because they were one of our partners when Wandsworth was developing our borough of sanctuary strategy and they still come to our regular Wandsworth migration forum. So just a huge thank you and to show our appreciation for that. My question was just around the areas. So the neighbourhoods, I think the proposed places are Battersea, Roehampton and Tooting. When I think of a neighbourhood, I think Roehampton kind of feel like a neighbourhood, but Battersea and Tooting, they're two very big constituencies. So how is there any scope for that to kind of change or into smaller like neighbourhoods or just kind of why Battersea and Tooting and then Roehampton? And just because Battersea and Tooting seem like very big places. Thank you. Sure thing. I think that's a really, really, really important question. And we've been very much sort of, in some respects, we've been data led. And in some respects, we've been sort of led by where the level of need is that we know and understand that a lot of the planning assumptions that we make are working on a 30,000 to 50,000 population level. And that is purely from a sort of primary care network health basis. However, the footprints that other services work to, whether that be our partners within adult social care or whether that be our partners within sort of our community health services or our partners within the acute services work to different levels of sort of population management. What we want to do is make sure that we're providing services that meet the needs of absolutely everybody. And we know that there will be some services that are provided at a really hyper-local level. As Mark has mentioned previously, the voluntary sector will be absolutely instrumental in doing that. But there will be some areas where we need to think about planning at a different footprint and delivery at another footprint as well. What we wanted to ensure that we were doing was providing coverage for the entire – providing coverage across the north, west and south of the borough, so that that's recognised by the local authority localities. We wanted to ensure we were providing support in those areas that, based on sort of indices of multiple deprivation and number of people sort of living in a 20% most deprived population and sort of diversity mix as well, were receiving support. And from there, over the course of the next five to 10 years, we want to continue to build upon this approach to develop, as is signalled within Neighbored Health Services guidance published at the back end of January, to develop a comprehensive set of services for Wandsworth that will facilitate those moves that Mark spoke about. So from analogue to digital, from acute to community and from treatment to prevention. I hope that answers your question. Any further questions? Yeah. Caps or all? Thank you. I'm not too sure who's best to answer this question, whether it's you, Katie, or you, Mark. You mentioned a whole range of guidance coming down from central government and from NHS England. And I'm wondering about the impact on the new planning guidance that's actually been issued in terms of the financial stability of the ICB to meet the requirements, and especially in terms of Wandsworth on the ability of the ICB to commission services at the Wandsworth level. So I think I'll probably take that one, Katie. So within the planning guidance, there is a very, very strong emphasis on the NHS living within its budget. And like many other public services, that will be challenging. So we do anticipate, and I think Katie alluded to it earlier, this year we are expecting a really quite challenging financial environment to work within. And so that some of that might include some quite hard decisions to make. But I think actually our relationship with our partners is such is that we want to be transparent when we get to those decisions and give people the rationale for those decisions, but also make sure that we've done that kind of quality impact assessment. And what does the impact of any of that decision make on the residents of Wandsworth? So we need to put every decision kind of through that process. We are at an ICB level. There is a place committee. There's a Wandsworth committee. So the plan is to take any decommissioning plans through that committee, which is attended by officers and councillors from the borough, so that we can actually share some of the plans ahead. What we aim to do, though, is to try and minimise the impact of any savings plan that we have on direct patient care. So we will be going forensically through our spend to ensure that we are targeting the savings in the right place. And we've got a question from Stephen Hickey as well. Stephen, would you like to answer your question? You're on mute. Sorry, thank you. I double clicked. Thank you very much. My question actually was really in some ways building on yours, Chair. It's about how wide the multidisciplinary group might be and how you would actually operationalise that. I mean, you said you didn't envisage a single building or a single room necessarily. But I'm thinking, for example, in some cases, housing might be a really important issue. In other cases, it will be the voluntary sector. But the voluntary sector, we know, is at least 800 organisations, I think, in Wandsworth and probably more. So actually making this work in practice strikes me as quite, well, clearly is very challenging. And I wonder if you could put a bit of flesh on how wide the net might go and how you would actually make that work on a practical sort of day-to-day level. Thank you. So shall I take the question about how wide in the first instance? So we've had a steering group running in order to get this off the ground. And the key partners we've had around the table at that steering group have been GP practices. We've had community services. We've had social care. We've had a representative of the voluntary sector. We have had St George's and we are engaging with the Southwest London St George's Mental Health Trust as well. So that's kind of the key organisations that we're looking to start the conversation with. And as I mentioned earlier, the fact that we also have social prescribers operating in each of our primary care networks at the moment mean that we have a practical means of making the links to the wider voluntary sector when there's a need to for specific patients. And I think in terms of the actual coordination and delivery of the service, a lot of it, I think, in the initial days is going to rely on good IT and software solutions. So, you know, since COVID, we have all been working in a far more digitalised situation. There are pieces of software out there that specifically enable multidisciplinary working. And what we're looking for, some of our phase one sites, as we're calling them to do, is test out some of those. It may be that we already have. So we always use Microsoft Teams at the moment in the NHS, but there may be alternatives out there that we can explore. So that's one very practical means of doing it. We also out in our primary care networks have health and social care coordinators. And we think that that role is going to be absolutely intrinsic to bringing the relevant people together to discuss a group of patients and then making sure that the outputs of those meetings are fed back out to the relevant parties and the actions are taken forward. But I don't think we're kidding ourselves that this isn't going to take time to evolve. And as James mentioned earlier, those kind of relationships and trust are going to take time to evolve as well. So this isn't going to be done and dusted in a year, I don't think. Thank you. Any final questions before we move on to the next paper? OK. Thank you, Mark. Thank you, Casey. Thank you, everyone. Is the report noted for information? OK, thank you. And I think we'd love to hear from the ICP again soon. So hopefully see you again soon. Happy to come back on the next paper. Thank you very much. Thank you, Sirena. Thank you. Bye-bye. Bye-bye. OK. So now we've got first report for decision. We've got the CCTV strategy. And we've got Tom Crawley ready to give us an introduction on that. We've also got Kieran able to answer any questions around wider community safety issues as well. So I'll hand over to Tom. Thank you, councillor. So I'm Tom Crawley. I'm assistant director of resident and estate services. Now, the council's CCTV network is managed by the Joint Control Centre within the housing department. But given the CCTV's important role in community safety and helping to protect all residents, it felt it's appropriate to bring the strategy to this committee rather than the housing committee. So when considering the strategy, it's important to note the use of CCTV is just one part of the council's response to issues of antisocial and criminal behaviour. Indeed, most antisocial behaviour issues can be successfully resolved without the need for CCTV. To add some further context to the report, Wandsworth has over 1,200 cameras, and those cameras are parts of an upgrade programme that's nearing completion. In addition, we have a growing number of deployable CCTV cameras for use across the borough. So this strategy sets out the council's plan for that CCTV network over the next five years. It will help the council create safer neighbourhoods where communities feel confident and protected. So in order to achieve that, it covers three key themes. The first is to ensure the effectiveness of CCTV. So that's making sure that deployment is intelligence-led, the infrastructure is maintained, and the impact is evaluated. So a key example of that is that we introduced a CCTV monitoring pilot in October 2023, which was a significant investment. And what that's done is that's placed CCTV monitoring officers within the control centre to monitor the CCTV at peak times and work with a police officer there. And they've done some fantastic work in preventing and detecting crime and also locating vulnerable people. We're also starting to utilise those officers to help identify and prevent environmental crimes, such as fly tipping. So I will be returning to this committee later this year with a proposal to make that pilot permit. The second theme is to do with the growth and sustainability of the network. So that's really in relation to prioritising resources to make the most impact. So that may not mean increasing the number of cameras, but it's making sure that we have a sufficient number and in the right places. An example of that is where on our housing estates when we were upgrading, we actually ended up with fewer cameras in some locations because we had cameras that kind of tilted and zoomed and could cover a greater area. We've also, as I say, increased the number of deployable CCTV cameras. So we have 24 at the moment, but we'll soon have 38 across both boroughs. And they allow for much more kind of flexible deployment. We can install them quite quickly to address antisocial behaviour hotspots. We also continue to look at different types of new technology. So an example is pattern recognition software. So, for example, if it's a police we're trying to locate a vulnerable person, we could search for their details and that would pick up people matching that description across the network. We'll also be maximising income opportunities. So we've already increased the charges to insurance companies and we're looking to offer some services to other housing providers and possibly retailers in our town centres. The third theme relates to the usage of CCTV being lawful and justifiable. Obviously, we have to ensure the council's compliant with the relevant legislation. And that means ensuring there's sufficient evidence and operational requirement to use CCTV and that the deployment decisions are regularly audited. And there's obviously a risk to the council not complying with that legislation in terms of fines and potentially reputational damage. So to ensure that we meet all these objectives, we've set up a new CCTV steering group with a range of representatives from different council departments, but also external partners such as the police. And there's a single point of contact that's the principal liaison for requests for new cameras. So following the approval of this strategy, a guidance note will be issued to all members. I'm just explaining the process for requesting new cameras and just giving you an indication of the kind of timescales involved in that and the decision-making process. So I'm happy to take any questions. Yeah. Councillor Adela Sasshoor. Thank you. I was actually rather baffled reading the paper. Because I felt that you're asking us to approve a strategy, but from paper to me, it's unclear what the strategy actually is. I don't understand. In your mind, what does success actually look like by 2029? Are there any KPIs that you can use, hard, tangible KPIs, to actually measure progress on that five-year plan? And my last question is, if I were to vote in favour of this strategy, it feels to me like I'm giving you carte blanche to do whatever you want. Is that right? So in terms of measuring success KPIs, I mean, a lot of this is to do with compliance with legislation. That's what we're bound by in terms of where we install CCTV and how we use the data that we gather. And this is the first CCTV strategy that the council have had. So it's really setting out much of what we do already in terms of those operational requirements. But also, I suppose, a plan to make sure that where we have lots of cameras, which we do, we have more than most other London local authorities. We're using them as effectively as possible. That they're not just kind of sitting there and not being used when they shouldn't be. We're making sure that we're using the data we get from the police or from community safety to ensure that the cameras are in the right place and that they're helping the police to prevent and detect crime. It's very difficult to produce KPIs for something like this because the best guide, I suppose, is probably crime statistics. But CCTV, as I say, is only a small part of that piece. So I couldn't be able to say, you know, in 2029, these are the KPIs and these are the performance stats that this strategy has produced and this is the success we've had. But I think it will make sure that our communities feel safer and it will have an impact in terms of the work that the police do with us to make sure and try to reduce crime and antisocial behaviour across our borough. Thanks, Tom, for setting that out. Yeah, do you want to come back briefly? Thank you, if I may. In terms of numbers, KPIs, et cetera, whatever, what does this strategy mean in terms of potential numbers of cameras within five years? I think you said you were at 1,200 right now. 1,200, sorry. How many could we get to within five years? There isn't a target of a number of cameras that we wish to meet because, as I say, we already have very good coverage in terms of fixed CCTV cameras across the borough. We've increased the number of deployable cameras because they are more flexible. You know, if there's an issue in a particular place, we can get a deployable camera there relatively quickly and then deal with that particular issue because, obviously, antisocial behaviour and crime move around. So, they're a much more effective way than probably putting in more fixed cameras than we have already. We will be undertaking periodic reviews and audits. So, it may be that that number of cameras even reduces because, at the end of a year, we may see that a camera in a particular location just hasn't been used at all and, therefore, it doesn't appear there's an ongoing need for it. So, there's the potential to decommission. However, on the flip side, there is the potential to put more cameras in if we were to find there was a particular area where we kept putting deployable cameras, for example, and it, therefore, made more sense to actually increase the network and put more fixed cameras in that location. Councillor Davies, I think you had your hand up. Yes, thank you, Chair. Yeah, I mean, I can think of one example of a deployable camera being used for a short amount of time working with the police as well, you know, using a range of options and the problem just dissipating. But I do wonder what the possibilities, you know, you know, there are occasionally limitations like, you know, the lamppost can't be adapted or, you know, it's a slightly awkward position or something like that. And I don't know whether there are, it's possible to consider how to increase flexibility here and how to manage that. Yeah, thank you. No, as you say, I mean, I think the vast majority of lamp columns can be used to put deployable CCTV cameras on, but we usually have to fit what's called a commando socket to kind of enable them to do that and just do some load testing to ensure they can carry the weight. There are sometimes other options. So, for example, putting a camera on the side of a building. But you're right. I think there will always be some locations where CCTV just isn't possible because of the location, you know, the kind of geography, the physical layout of it. And that comes back to, I think, the work that Kiran's team and my team would do in terms of the other options, you know, working with the police and making sure that if you can't put CCTV there, you're doing other things to solve that problem and to reduce the risk of antisocial behavior and crime in that area. Thanks. I think Councillor Gussain and then we'll come to Councillor Marshall. Thank you, Chair. My question is really about the governance structure. I'm really concerned that there's a lack of democratic accountability. If you look at the membership of the steering group, for example, there's not one elected representative on there. There's no description of any formal review processes for councillors or the public to raise concerns. There's no requirement of the steering group to present annual reports, let's say, to full council or to an appropriate OSC like this one. And, you know, my concern is that without this democratic accountability that the interests of residents won't be served and, you know, there will be no or limited opportunity for residents to raise concerns. So, are my concerns justified? No, I mean, if this is an overarching strategy, so it's a fairly high-level document looking at our general approach to CCTV. If, for example, we were to introduce something that, you know, like facial recognition, which we have no intention of doing, we would, that's clearly a significant change in policy that we would come back to a committee to seek approval for. Likewise, if there was to be a significant growth in the network or if we were to need to renew all the cameras and change the way in which they work, those kind of significant changes we would obviously come back to a committee to seek approval for. The steering group is really to oversee the content of this strategy and make sure that it's implemented. And much of that, as I say, relates really to regulations and making sure that we're compliant with regulations, yeah, and using the network as effectively as possible. So, my concern there would be that it's very much dependent on the steering group to, you know, come to the OSC or to come to full council is something to report, but it isn't a requirement. So, essentially, that they will come whenever they see fit rather than the public through democratic mechanisms, you know, making that request. And, you know, we're here as elected representatives to do that for them. So, is there really no scope for councillor involvement or democratic processes within this? I think there's scope for resident involvement, certainly. The use of CCTV is broadly guided by legislation rather than kind of political steer. But, as I say, resident involvement is a fair point, I think. And I think that's something that we can have a look at, whether we can have a resident that's a member of the steering group. Obviously, there might be data protection issues involved in that, but it would be interesting to have their input and probably quite helpful. Thank you. I think legislation is political. Well, yeah, I mean, yeah, I mean, yeah, it's almost the definition of political. So, I don't necessarily see that distinction between legislation and the political. Thank you. Okay, thanks. Councillor Marshall? It's all over the place and a very small number of eyeballs looking at them. I'm just wondering how that gap gets bridged and what the strategy for that is. And one of the ways I would have thought, for example, was face recognition. As a magistrate, I can think of lots of ways where that could have been used. You could set curfews or bail conditions. Say somebody's not allowed to come into a particular shopping centre where they're prolific. It could be picked up by cameras, for example. But I'm also looking at some of these case studies where you talk about page, this is page 66. You identified a vulnerable person. You were observing two suspects. Presumably, that was done by operators sitting behind the camera saying, well, that looks like a vulnerable person to me. Is there no scope for face recognition at all? Is it considered a complete violation of civil liberties to ever use it? It seems a bit extreme. You were very emphatic about it. You weren't considering. And secondly, really, I suppose, behind that, what's the general strategy for AI here beyond just face recognition but identifying patterns of movement, context, predictive things rather than something happened. And let's go back and look at the footage and see if we can find out who'd done it. I think Kieran has her hand up. Would you like to come in first, Tom? Yes. Yeah, of course. Yes, I say there's no plans for facial recognition. And that's obviously the case. But as I say, if it was to be something that we would consider, we would come back here to discuss that point, I think. We have, as I say, introduced a CCV monitoring pilot. So previously, you would have all these cameras, and the vast majority of kind of viewing of it would be reactive and kind of after the event. So a crime would perhaps happen. The police would ask us, was there CCV covering this? We would then go and have a look and show them the footage. Whereas the monitoring pilot has meant that we now have CCV officers in the control room, and they are there during peak hours. So that's kind of basically the evenings, and later on the evening, on Friday, Saturday. And that means that they're kind of looking out and kind of digitally patrolling, if you like, to see whether there's any particular kind of incidents going on. And they have direct contact with the police radio as well. So a lot of that is if there's a live incident that the police are reporting through their radio, they can ask if there's cameras covering that, and then those officers can help the police to follow that incident and track a suspect, for example. And the same applies for a vulnerable person. If there's a call out that there's a missing vulnerable person, which we've had several of, they can help find that person and then direct the police to them. So I think there's already really good systems in place to kind of find vulnerable people, but also locate people that we think might be involved in criminal activity. In terms of AI, as I said, we'll kind of always be looking at what technologies there are available and considering whether they might have a use in the Joint Control Center. One of the examples I mentioned was the pattern recognition software. And that could be used where, say, for example, there's a missing person that has a white shirt and black trousers, you could refer to that, and then it would search the network for anyone who has a white shirt and black trousers, and that would help you locate that person. So there is some technology which is already being kind of considered to be used in that way. Karen, did you want to add to that? Sure. I thought I'd just pick up the point around facial recognition. So the police have piloted facial recognition on our borough at Tooting and Clapham. It's a whole operation that sits behind that in terms of what you're using that facial recognition for, uploading the information, et cetera. So there's lots of lessons that can be learned from that. However, as I said, that's been very, very targeted in terms of how it's being used. So it has been used on the borough, but not by the council. But as Tom said, it's certainly something we will keep our eye on. I think just in terms of governance, just to also add, we have the Community Safety Partnership Board. It's a statutory board with partners, and the steering group will feed directly into the statutory board. Also, as part of the Code of Conduct for CCTV, we have to publish the Code of Conduct. There has to be clear signage up where we've got public safety CCTV. There also has to be a point of contact in there where the local community can get in touch with us if they've got any concerns around CCTV as well. And I thought I'd also just add that there's a whole partnership effort to support how we deliver on CCTV in terms of making sure it's very intelligence-led, because there's a fine line between directed surveillance, where we need certain authority, and then just general public safety surveillance. So the police meet every two, three weeks. It's a precision crime-fighting forum. My officers attend that meeting. They go through all the various crime areas across the borough. They feed through those hotspots every two or three weeks to the control room, where we sort of direct our surveillance in particular hotspot areas. So there's a whole piece of partnership work that operates behind the monitoring that takes place in the control room. And obviously, the operators that we have there, it's in consultation with the police. It's looking at our crime data for the last year or two and making sure that we are there at peak time. So there's a clear accountability that we have to make sure that it is intelligence-based and led. So it's not a free-for-all that we can just go in and do whatever. There has to be some checks and balances in place in the way that we operate and sort of focus our surveillance. Thanks, Kieran. Really good point about the Community Partnership Board. Councillor Corelli? Can I ask a question here that might be aimed at Kieran? It's the data that's on page 75 of the report. And you've given a list of tackling and reducing crime. You've produced this list of figures about crimes in there. But there doesn't seem to be any correlation between what you've produced in that report and any correlation to CCTV. What you have said in the monitoring outcomes is the group evaluates the outcomes of CCTV deployments by reviewing available data. And then you've got to see what that data is. Isn't that data something that we should be considering as a committee so that we can have a look at the data and make an evaluation about how that correlates with CCTV? Kieran, do you want to come back in on that? Yeah, sure. So the crime data table, that shows the relevant crimes that we think potentially CCTV can impact on. It will be difficult to find correlation of activity as such. What we have correlated is the days, times that particular crimes take place. For example, robbery would be one. Drugs, vehicle crime might be another. Burberry may not be because that's inside the house potentially and it may not get picked up. And a question was asked earlier around what does success look like? So the kind of successes that we would have is where, for example, and I know there's some case studies in there where we've sort of the police have sort of there's been a crime that's been committed and the police have sort of attended the scene. And they are, you know, in real time, directly liaising with the operators on the radio who are navigating to them potentially of where this individual has ran to or where the car has gone. So there's some real time activity that takes place here, which is the value of this, which is, you know, what Tom alluded to earlier around those KPIs. Arresting two or three individuals, which which has happened a lot more than that, they might be responsible for 30 to 50, even 80 other crimes that have taken place. Arresting one individual, there's an example at a bus stop where actually our operators picked up on an assault that took place on a female because around safety, around women and girls. And it was our service that called the police emergency service in to attend at the bus stop and then navigate them where to go. So, you know, you can't put a number on that when you've got that incident where you've actually caught somebody who primarily you couldn't have caught if those cameras weren't on. And if the operators hadn't picked them up, who knows how many other victims they might have been with that individual. So it's very difficult to correlate like that, which is why the case studies have been provided in the report. Obviously, we can't go into a lot more of the case studies because some of them are still subject to a judicial process where there's been an arrest. We're still waiting to go to court for them and the criminal prosecution around around them as well. I hope that's kind of like answered your question. It has partly. I mean, I fully accept the point that you've taken about the data on page 75 that, say, for example, somebody doing an online fraud, CCTV is completely irrelevant in respect of that sort of thing. Somebody committing an assault, a domestic violence assault inside a house or something like that, CCTV is completely irrelevant and wouldn't assist. I fully accept that point. The point is that you're monitoring outcomes and you're saying CCTV deployment, the group evaluates the outcomes of CCTV by reviewing available data. Isn't it possible that we can have a breakdown of that data saying that say something like there were four street robberies on Tooting High Street. The CCTV, the CCTV, in that respect, assisted the police in ensuring that those robbers were apprehended. There was a criminal damage in the Thamesfield ward which involved cars being damaged. The police were able to detect who committed this criminal damage by doing that. There was drug dealing on Carlton Drive in East Putney. Certainly such and such was prosecuted as a result of the evidence used from it. There must be some way. I mean, you're talking about reviewing the available data. Surely there must be some way that we as a committee can have that data. Can we not? Yes, so we are capturing that information, as we said. So Tom said that, you know, in terms of us doing some form of an annual report, the pilot's been running for a year. There have been outcomes like that. We aren't in a position to put that in front of the committee today. But as time goes on and some of those convictions, judicial process have completed, et cetera, I'm sure we will be able to provide that detail. But also just to say, as Tom said, we've brought it to this committee because this committee also scrutinises community safety. There's a separate piece of work happening with community safety where we do annually a strategic crime needs assessment, which does number crunch in that way, which does bring in all the other interventions that we've put in. So potentially when we come back to this committee at a future date with an annual report on community safety or some of that, we'll draw some of that data in. But I think, you know, it's been a year. There have been successes. But as time gets on, we'll certainly be able to share some of that information in that way. Thanks, Kieran. I think it would be really good to see the impacts and the outcomes of CCTV presented in that way, you know, which crimes and which interventions, you know, have been related to CCTV and which haven't, because I think there's clearly been some really good case studies. So that sounds good. OK. Dick, can I just check, did anyone else want to come in before we go back to Councillor Crivelli? OK. Can I ask you a question that's in the report? Again, you've talked about growth and sustainability of the network, and you talk on page 79. The cost of the CCTV system for one's worth is £280,000. That's the year 2023-24, and that's obviously not including staffing costs. There was a discussion that we were having about deploying cameras at the request of if councillors brought to the attention of the council that there was a particular issue with antisocial behaviour or fly tipping. Can we have more information on the specific cost of the cameras overall? I appreciate that that's a global figure for how much it costs, because obviously, I don't know, I'm just speculating, say it costs £2,000 to deploy a camera in one street. Is that not part of the evaluation process overall about whether or not it's worth deploying the CCTV in the first place? Matt? I can tell you the capital cost of one deployable camera is about £2,500. I wouldn't be able to tell you offhand what the cost of each deployment is, but I can come back to you with that. I make an assumption here. I mean, that was quite a good guess on my part, £2,000, I wasn't far off here. But I make an assumption that having deployable cameras fixed and mobile, there's a difference in cost, I make an assumption there. The second thing is that some places where you have a camera, it costs more than others, depending on the number of cameras you have in the street and so on. That's the sort of thing I was just wondering, is that something that we can have a breakdown on? Because obviously, if we're being asked to approve how much overall budget for this sort of thing, if we're being asked that, it's better to have an idea about how much each camera costs and whether or not that's cost-effective overall strategy. Yeah, I do. I think obviously each case is different. There's obviously the capital cost of deployable camera I mentioned, and then there's where you would place it, whether you need a commando socket fitted to the lamp column, whether any changes to the lamp column might be required. But I can provide you with some sort of indicative costs of roughly how much it costs to do that. I think also it's part of the operational requirement consideration, I suppose, is how much is this going to cost to do? Is it feasible? As well as is there an evidenced need for this camera to be put in place? So for each operational requirement for each camera, there is that kind of consideration made. I think just, Graham, did you want to come in? Oh, sorry, we've got a question. Go for it. Do you mind if I just ask a question of Councillor Crivelli? In the line of your questioning, it sounds to me like you were saying we want to know the cost of deployable cameras in particular areas and then equate it to results in different crime areas. And if that is the case, I'm just questioning whether it's possible to put a sort of value or a judgment on different crimes. I don't think you can put that sort of value on it because, again, I don't know how much, I took a guess at £2,000 and wasn't far off it, but the point I'm making is how much does each camera cost to deploy? We don't have limitless resources. So say, for example, you had an area where there was a lot of antisocial behaviour and you had another one where there's less antisocial behaviour, you may have to make a decision about how you're going to deploy the cameras. That was the point I was making, whether or not there is a difference in the camera price. That was all that you did. Thank you, Chair. I think the first thing to say to get this in perspective is that CCTV user monitoring since 2022 has improved immeasurably. The pilot project to employ more people in the Joint Control Centre has been an overwhelming success. And I think the proof is in the pudding. The police originally said that Onsworth was one of the worst performing councils in terms of providing CCTV to them for operational reasons. They now consider us to be the best. Kieran's cited two examples. There were a number of other examples which were actually set out in the community safety report which actually came to this committee. So I think, first of all, we've got to say that the system is – it will never be perfect, but it has made enormous strides forward. The CCTV strategy is certainly a reflection on that. As Mr Crawley said, amazingly, we never had one. We didn't have one under the previous administration. I understand some of the issues they raised, and I'll try to address them. But what the CCTV strategy is about is demonstrating that we actually deploy cameras according to the law, that we actually have a defensible position should anyone actually challenge us in terms of how we go about that. I'm certainly grateful to Mr Crawley and also to Mr Crawley in terms of their explanations. Certainly, Kieran in particular covered a lot of the points I was going to mention, particularly around the Community Safety Partnership Board, because all this is being done in partners with the police and other agencies as well. Let me address the issue of democratic accountability. First of all, if you hadn't been into this paper, there would be very little democratic accountability. We have actually brought it to a scrutiny committee, which would never have been brought before. And indeed, it is the scrutiny committee which actually represents that democratic accountability. You've already heard from Kieran that we intend to submit annual reports. I stand by that. I think it's absolutely essential. These will come to the scrutiny committee for their comment. And finally, of course, I am the cabinet member for community safety, because ultimately I am responsible for what actually happens. And I'm prepared to stand up and say that. The buck ultimately ends with me. But I am certainly proud of the very considerable advances we have actually made. In addition, Mr. Crawley mentioned that there is our intention that councillors will be given guidance on how to ask for CCTV coverage, which has never existed before. And indeed, the original criteria for deployable cameras was essentially a police requirement, a police request. There was no involvement from councillors, no involvement from members of the public. We are rectifying that. We are giving councillors and potentially members of the public the opportunity through their councillors to ask for CCTV cameras. In addition, in terms of the actual quantity involved, and given the significant improvements in technology, as Mr. Crawley said, in some areas, we have been able to reduce the total number, simply because CCTV cameras have improved considerably. But to give you an example, in 2022, there were 12 deployable cameras for Wandsworth and Richmond. And Mr. Crawley has pointed out we increased that number to 38. And I think, finally, in terms of this paper, I think Mr. Crawley would certainly acknowledge that there was very considerable discussion on the part of myself and also my Cabinet colleagues in terms of this final report. I think the final point in relation to democratic accountability, the suggestion that the councillors should sit on the oversight committee. I mean, frankly, there are just so many of these covering a multitude of different issues across the council. I mean, it really is, in my opinion, quite impractical for councillors to sit on things like that. Ultimately, a vaccineeering group is responsible for providing the legal oversight to ensure that we are deploying cameras properly. But, ultimately, if people have a particular issue, they can certainly raise it through their councillors and certainly with me. Thank you. OK. I'm conscious of time. OK. A quick comment. Can I say, I think the rolling CCTV out in the bar is excellent. It is a very good safety initiative. The issue about the democratic accountability, I think it's a fair point. The way that Wanserth wants to address this is that councillors will feed in and say, well, I think a camera is needed to be deployed in my street. There's a lot of antisocial behaviour. I'd like to see it in this area because there's a tremendous amount of fly tipping. And it's sort of, the officer said, you know, it makes sense to have resident input. I appreciate that we can't expect councillors to sit on every single committee there is. But does the cabinet member not think? What would the harm be in the cabinet member sitting on the CCTV steering group? Because you would give that feedback about councillors and residents while you start on the steering group. And I don't think it's an onerous commitment. Is it? I think it meets quarterly. Yes, certainly. And I think, councillor, that is a reasonable approach. Certainly, I envisage that those reports would actually come to me, particularly in terms of anything which may be controversial. But I'm certainly prepared to consider that. Yes, certainly. OK, let's move to a vote. So, does the committee support recommendations in paragraph two? I wanted to move an amendment in relation to the CCTV. And we wanted you to try and commit to a couple of actions here. I don't think these are unreasonable overall. We wanted to present an annual CCTV report to the full council on an appropriate overview and security committee. I don't think that's difficult for you to comply with. The issue that we talked about, the CCTV steering group, to include elected councillors, you've said that you would consider that. We wanted to see the publishing minutes of the key decisions of the steering group maintain public accessibility to list of the active CCTV locations and introduce a formal process for residents and councillors to challenge the placement, use or misuse of CCTV cameras and commissioning the independent audit of CCTV at regular intervals. I appreciate some of this. The last one is a lot of statutory regulation already, but I can't see why you would disagree with, say, for example, presenting an annual CCTV report to the full council or this committee, or, say, for example, considering reforming the CCTV steering group to include elected councillors. Are you willing to accept some of those, or would you want every single one of those of us to agree now? I would very much like compromise on this if it were possible. I think I've already given a commitment and a report on CCTV, and I must confess I thought it was somewhere in the actual report. Either way, Kieran said that that was the intention. I see absolutely no problems with that and I'm quite happy for it to come here and to be subject to the normal processes of the council. As I said, I'm more than happy to consider my attendance on the steering group. I certainly intended to give it considerable oversight. I think some of the information you were asking the council earlier around statistics, I mean, I really would have... I can't give you an answer on that. I really would have to ask officers in terms of the practicality and complexity of that. But, I mean, certainly quite happy to produce an annual report and, I mean, through the guidance to councillors. Councillors will actually be able to raise issues, which, particularly in circumstances where they feel a deployment or other camera may be necessary, but for one reason or another, it has been refused. And certainly that process I do envisage will come through councillors and ultimately to myself. So will you be willing to accept those for us too? Can I just ask you about the process for residents and councillors to challenge the placement of the CCD? Because, obviously, a lot of it is about us feeding back information about where we think they should be deployed. It doesn't seem clear anyway. If, say, for example, residents want to raise objection about that, how does that process come about? We certainly envisage that because this is certainly a very high level and, I mean, clearly, you know, we've got quite extensive CCTV coverage, the best in London. Nonetheless, these things do actually need to be approved according to statutory requirements. We don't intend that the public should necessarily be able to require CCTV. I think that any administration, any future administration, would find that exceptionally onerous. But what we are suggesting in the normal process is that members of the public can contact their councillors, as indeed happens at present. I mean, this certainly happens with me. And through councillors and through the guidance which will be issued to councillors, they can actually raise these issues as members' inquiries. They can write to myself as a cabinet member. And if they do not get satisfaction, clearly, I will look at it. And if I think it appropriate, we'll institute a further consideration. OK. So, just to be clear, you are quite happy to produce a CCTV report for this committee. You are going to consider reforming the steering group, potentially the cabinet member sitting on it, if that's possible. and the process in rigging... I mean, publishing the minutes in key decisions in the steering group, does that get done anyway? Well, it should be. Mr Crawley, perhaps, you can have eyes on how you envisage a process will actually operate. They're obviously minutes in the meetings, but those minutes aren't published, certainly, as yet. I think, as Kieran says, the feedback from the steering group would feed into the community safety partnerships. They'd become available in that way. So, they are available? Well, they're not at the moment, no, but they will feed into the community safety partnership, and so there'll be an element of scrutiny that comes up at that meeting, and they'd be available through the minutes of that. OK, great, thanks. OK, are you able to take those as agreed actions? Yeah, if there's agreed actions, then... We're happy to take that. We're happy to agree that as a comment. Thank you for that. OK, take it to a vote, then? Are the recommendations agreed? Agreed, great. Thanks, everyone. That was nice and collaborative. OK, moving on to the ones where sexual and reproductive health strategy report from Executive Director of Adult Social Care and Public Health. We've got Ramya and... Sorry, I don't have the name of... Oh, and Kate Jennings, sorry. Would you like to introduce the report? Yes, absolutely. So, I'm Dr. Ramya Rabindrain, consultant in public health. I'll just give you a brief introduction to the strategy. So, it's the Wandsworth Sexual and Reproductive Health Strategy for 25 to 2030. It's a really collaborative, action-focused strategy developed alongside our health and volunteering community sector partners. It's based on the findings of the Wandsworth Sexual and Reproductive Health Needs Assessment that we undertook in 2024. And this includes not just quantitative data, but a really extensive array of qualitative data that came about through engagement with those that live, work, study, and socialize in Wandsworth. The strategy takes a life course approach, which means that it takes into account the differing needs from young adults through to older people. And we endeavored to make sure it was aligned with existing strategies both locally, across London, and nationally. So, for example, on a local level, it has strong links with the violence against women and girls strategy and the youth strategy. And it also links very closely with the HIV Action Plan for England and the women's health strategy as well. And we got very valuable feedback from Councillor Worrell in relation to aligning strategies and also in regards to particular groups facing inequalities. So, that's embedded within our approach. In terms of the structure, the strategy is based on the WHO, so the World Health Organization Framework for Sexual and Reproductive Health. And this framework has eight key intervention areas that cover the breadth of sexual health and reproductive health, from education and prevention through to treatment, looking at, for example, antenatal, intrapartum, and postnatal care, all the way up to sexual function and psychosexual counseling. So, it's a very broad range of interventions. Each section within the strategy takes one of these key intervention areas and then breaks it down in terms of the data, what the community is saying, what's already happening in Wandsworth in regards to these areas, and where the gaps are, so what our priorities and next steps should be alongside the key owners of these actions. Really importantly, and what I alluded to before, is that each section has a big focus on reducing health inequalities and creating a very collaborative and joined-up approach between partners, so council, health, volunteer, and community sector. The strategy has clear actions to implement, and the implementation will be overseen by a multi-agency partnership group called the Sexual Health Implementation Group that was also key in developing the needs assessment and the strategy. And we're going to be evaluating the implementation over the five years of the strategy as well. So, happy to take any questions. Great, and thanks for all the work that's gone into this. Councilor Rural? Yeah, you'd expect me to have a comment on this. I just want to bring to the attention of my fellow counsellors the amount of work that's actually gone into developing this. I mean, it's a very comprehensive strategy. A lot of consultations gone into it, a lot of research, and sexual health, unfortunately, is one of the areas that is often marginalised, but actually has major impact on the health of our population in many different ways. So, I said a big thank you to you and your team for bringing this together and the way that you've actually worked to align it with different strategies as well. I would recommend that. I also just want to highlight the way that it's laid out in terms of the linkage of actions with priorities and developing a matrix that can be measured and rolled out across the borough and the voluntary sector and our various partners. So, as I said, there's a lot to learn from this strategy that other strategies can look at in terms of the way it's actually worked and brought together. So, a big thank you for that. I just want to bring... There's just one point of clarification in this. In paragraph 22 and on page 29 you speak... I'm sorry, page 139 you speak about the issue of data gaps. Now, I recognize that often in this strategy we're talking about very marginalized communities. So, we're talking about people who might be sex workers, for example, have a stigma associated with drug use, come from other communities as well and gathering that data is often quite difficult and quite controversial. But, if we are to be data-led and rolling this forward I would just wonder how are you going to go about ensuring that those data gaps are actually filled? Would it be through training or a change in system? Just some ideas around that. Yeah, absolutely. That's a really good point. It's something that we picked up during the development of the needs assessment and the strategy and, as you said, it's referenced in the equality impact assessment. At the time of both those pieces of work we worked with partner organizations who work with those marginalized groups so we took a qualitative approach where we couldn't necessarily use quantitative data because the numbers were so small we spoke to individuals from those communities and an example would be we even had a sex worker who represents that group and does work with our integrated sexual health service come and speak to the sexual health implementation group to get their perspective on their needs, essentially. So that's an example of what we had done in terms of going forward to make sure that we continue to address the gap when we implement the strategy. Again, we're going to look at the qualitative data when we can't get the necessary quantitative data so continuing to have conversations, focus groups, etc. with those relevant communities. We can also look at what we can do around the numbers the quantitative side so for example looking at London level data where you can get larger numbers which we could use extrapolate and apply to us in Wandsworth or we can look at combining years so therefore we get larger numbers and we can draw some conclusions from for example a three year rolling period rather than the one year so that we can avoid the small numbers issue. but again it will be something that we work on through the sexual health implementation group so like you said sharing knowledge and understanding and there's always new innovation so as services develop and they look at their data gathering and data sharing that's something that we will raise and so for particular groups for example ethnic minority groups LGBTQ plus that's something we'll focus on and then where there's intersectionality so where for example you're part of multiple groups and the number is even smaller that's an even bigger focus for us because obviously their marginalisation is heightened so that's something that we'll continue to focus on and hopefully improve over time. Thank you. Oh Councillor did you want to come in on that point? Yeah go for it Shannon. Yes thank you. The other opportunity that we use when we want to focus on particular issues in terms of data collection is to use contractual levers so for example we'll probably be looking to renewing our locally commissioned services with GPs and pharmacies and I'm sure within the sexual health contract as well the main contract when it comes up so there's an opportunity to look at incentivizing collecting certain types of data so that you know clinicians can be more focused where they think those issues are relevant to ask the right questions and enter a code that will help us to capture that data so we'll look at that as well. Councillor Corelli. Can I just say thank you for your reports there's so much work gone into it and the research is superb. I just want to ask you about part of the report on page 125 if I may and you've talked about prevention and control of HIV and other STIs and you've said what does the evidence tell us and one of the features that you said was STI diagnosis in Wandsworth in 2022 was 1,900 per 100,000 residents that's 1.3 times higher than the London rate and then you go on and say that there's 14,336 per 100,000 were tested for STIs and again that's 1.6 times higher than the London rate looking at that looking at that bare figure you might think there's a problem with STIs in Wandsworth but am I correct in saying that actually what's happening is you're doing more testing is that why the figure looks higher have I got that right so it's a combination of things more testing Wandsworth to a very mobile population it's a very young population as well which will affect the numbers compared to other boroughs at a London level my understanding is that there has been an increase in STIs so this reflects some of that I don't know if my colleague Kate wants to add anything yeah I think well we do know we do know nationally that the STIs are increasing and you know I think that I really want to kind of add to that is you know a strategy such as this it may not you won't bring it down to zero but it goes some way to work to reduce it and to continue with that kind of preventative angle on STIs and that hope that it would continue to start to go down in addition to that when you look at some of our benchmarking data I mean obviously if you test more you're bound to find more but when we do that comparative analysis looking at other boroughs it gives us an indication of where our testing rates are in comparison to those areas so if we're seeing that despite the testing we're still detecting more cases but our testing rates are potentially lower than in other areas it means that there is a genuine issue in terms of the increase in the incidence Councillor Corelli did you have anything yeah just basically to understand okay some of it's coming because we're doing more testing but you think it's the demographic composition of Wandsworth and that's not something we can do a tremendous amount about if it's a more transient youthful population as compared to other boroughs which are less transient and have the older demographic is that the long and short I mean we can do all the preventative work but we have to accept that no matter what we do the demographic composition is going to make it more difficult for us is that I think the demographic composition is something that we have to recognise when we're developing a strategy like this because it is one of the underlying principles of or you know things that we have to address that we have a young population I mean there are sexual and reproductive health needs from young adult up to older age so it's not saying that it's the only population that will be reflected in these numbers but it is something that we have to take into account in terms of what services we provide how we do our health promotion education so the channels that we put messaging through we want to make sure it's targeted to the younger population that we have but also make sure that it doesn't marginalise other groups as well it's not to say that we can never improve this it's to recognise that this is a contributing factor and therefore we need to tailor the strategy and our interventions to address that I hope that makes it a bit clearer yeah Thanks and we've got a question from Stephen Hickey from Healthwatch Yes thank you very much indeed and a very comprehensive strategy in paper so thank you my question really was about working with partners in particular a lot of these issues clearly sort of straddle between public health and various aspects of the health system the mainstream health services primary care acute care mental health and so on and I wonder if you just say a little bit about how you how you in developing this strategy and going forward are you working well better with those various partners how because the strategy depends to a large extent on that I wonder if you could just talk a little bit about that yes absolutely that's a really really good question the strategy was developed alongside partners in health and volunteer and community sector but also for example school representatives as well because a lot of the education is productive and sexual health within schools so they're part of the development and they're also definitely part of the implementation I can give you a few examples so RSE the syllabus in schools is something that we we don't have direct control over as a council but we've been influencing and providing support on and also getting feedback from people that work with young people on that we work we obviously commission the 0-19 service and so we've been working with our NHS providers on that in terms of antenatal visits perinatal mental health that kind of area of intervention going forward working with St. George's on the midwifery offer and what that would look like so there's been a range of partners that have been engaged and will continue to be so through our sexual health implementation group great thanks so much so does the committee support the recommendations in paragraph 2 yeah okay supported unanimously and this has moved thanks everyone thank you so much for all the hard work that's gone into it again really appreciate it great we're getting there with the papers and now we've got a verbal update from Jeremy D'Souza on CQC's local authority assessment of adult social care thank you chair so I'm going to give an update on the council's preparation for our forthcoming assessment by the care quality commission and just by way of background the health and care act 2022 created the new performance assessment regime so there was a new duty on the care quality commission to review and assess how the local authority is performing in delivering our adult social care duties under the care act so that's the main focus of the performance assessment framework and when the CQC carry out their assessment they'll be looking at the council's adult social care services in terms of four themes so the first theme is how we're working with people and broadly that covers our functions in terms of our assessment and review processes so how our social workers and practitioners work with our residents to look at their care needs and how we support them the second theme is about providing support and in summary that's around how we commission services to support our residents and our partnership arrangements so we work with a broad range of partners health voluntary sector in providing our services the third area is how the local authority is ensuring safety within the system and this includes the council's arrangements for safeguarding adults and the council's role in as the lead agency in setting up the safeguarding adults board and our work to keep residents safe and then the fourth and final theme is around our leadership so how the council is working in terms of our leadership role in how we provide adult social care so CQC started their assessment process in 2023 and they've now completed a number of assessments in England and also in London now a number of London boroughs have been inspected and the assessment reports are gradually being published so we're able to look at them and they're on the CQC's website so within the southwest London region now five of the six southwest London boroughs including Wandsworth are now in the process of the assessment so Wandsworth council received our notification just before Christmas on the 9th of December and then we had a period of time to submit our evidence which is a very comprehensive information return and effectively our own assessment of how we're performing and that was submitted to the CQC on the 10th of January we're now waiting the next stage will be notified of when the on-site visit will take place by the inspection team and we anticipate that will be within a few months of that earlier notification so when CQC arrive for their on-site inspection they're going to talk to a whole variety of people so including senior leaders frontline staff most importantly people with lived experience who draw on care and support services our local residents our care providers our partners particularly in the health service and the voluntary sector and health watch and also elected members and specifically regarding elected members they'll be particularly interested in talking to the cabinet member the chair of our council dobra is the chair of our health committee and councillor crevelli is the opposition speaker for health so at the moment we're focused we're ready for the inspection team to arrive and we'll keep the committee updated as that process unfolds and the report we're going to bring back to committee and could you just remind us of when we expect to see the results of that yes so I mean clearly the whole process takes a few months but we anticipate that we'll the report will be published and we'll be in a position to bring that to committee in the autumn so hopefully for the September committee committee members satisfied with the update and to bring the report in autumn yeah okay fantastic thank you so much for that update okay moving on to adult social care outcomes framework annual report we've got Claire who's taking a seat now assistant director of assurance and innovation to give a really brief overview to the report and then we'll go to questions thanks very much good evening everyone so this is the annual report which measures our performance against the adult social care outcomes framework and it benchmarks us against all the other London boroughs it's made up of a service user survey a carer's survey and a set of performance indicators it's very positive with 17 of the 22 indicators in the top two quartiles and also feedback from people who draw on care and support was very positive this year where we've improved in five of the seven indicators the report is presented really for information only and I'd be very happy to take any questions thank you any questions cap thank you chair I've got a question about the ask off indicators it mentions that four indicators have been removed because they're not being monitored nationally anymore and they're all very important metrics so the proportion of people use services that make them feel safe and secure the proportion of adults with learning disabilities in paid employment the proportion of adults in contact with secretary mental health services in paid employment and the proportion of adults in contact with secretary mental health services who live independently are those indicators still being measured even though they're not part of the ask off indicators no they're not being measured the government this is a central national change we don't know the precise reasons for why they've removed them it's part of the national work and they review these indicators every year so they have been removed from the whole framework we think that part of the reason is that some of these were quite challenging indicators to measure so for example the one around learning disabilities and paid employment didn't show the full picture so we also want to be looking at a number of people with learning disabilities in voluntary employment so there were some indicators that weren't as relevant anymore as you've seen from the report they've replaced them with three other indicators that are very relevant and are most relevant in terms of CQC assessment so these are indicators that will be fed into the CQC assessment so they've really just nationally updated the framework and keeping it up to date but is there any value of tracking those indicators locally still I know you mentioned that there is some difficulty in terms of getting data for some of them but I mean I would have thought that it may be that particular metric for determining the proportion of adults with learning disabilities in employment didn't quite gather the data that you needed it to but I would imagine that's a pretty important metric to measure locally so we do we bring up a report later in the year which is our performance metrics internally which are not benchmarked against London and we do have some similar KPIs that we look at on a local basis but obviously then we won't have the data to benchmark nationally so it's this bit of it is really about the benchmarking the ASCOF ratings have improved considerably since 2022 which is of course fantastic and what are the principal reasons for these improvements principal changes in the so I guess the indicator that I think we can be really proud of is the one around feedback from people who draw on care support in terms of overall satisfaction of people who use services with their care and support obviously that's great news that that's gone up so significantly it was around 55.6% in 2020-21 hopefully that's as a result of all the work we're doing around supporting people to live independently and all the work we're doing around our strengths-based approach to work very closely with people who draw on care and support thank you councillor mine's not a question it's just a comment really is that tables like this are numbers on a page but they don't really show the amount of work that's been done behind the scenes by members of staff in the front line services working at various levels and often working with sometimes very complex needs and I hope I can speak on behalf of all the councillors around this table to say a big thank you to those staff members and congratulations for the amount of work that's being done to keep us with these good results but also just to say to recognise the often very difficult circumstances that some of these services are delivered in and I would like to if possible for you to convey hopefully our combined thanks to the members of staff either through the internet or something like that about the work that's being done in relation to keep us up thank you very much that will be very much appreciated by staff we will certainly be doing some internal communications around this and indeed external communications as well so thank you for that comment thank you very much councillor Carelli can I just ask you about one of the performance indicators that you mentioned the percentage of people in direct payments you said it just slipped from the second quartile to the third quartile and it looks as though it's a rather harsh measure because you've said only four more people receiving support via direct payment would have seen you maintain the second quartile performance you talked about the shortages in the personal assistant workforce and the efforts the council is trying to resolve that is it fair to say that this is a resolvable blip is that one of the ways to describe it well I haven't got a crystal ball and as we've mentioned in the paper it's a challenging market but as you've noted a number of these indicators are not perfect in terms of we're looking at quartile benchmarks and we haven't got any margin for error so that's one where we have slipped we monitor this regularly so we will keep it on review and update you at forthcoming committees thanks very much yeah of course Graham come in thanks chair yes if I can just make a general comment I'd certainly like to endorse what councillor Worrall said about the very considerable efforts that our staff and indeed our service providers our contractors have actually undertaken to deliver these results and to deliver them in what can only be described as extremely challenging circumstances to actually improve our performance it is obviously relative to other councils in London but to do that so significantly over the past two and a half years I think is very significant and I think in answer to Councillor Varath Raji's question I think it really does come down to commitment we have invested in adult social care and also public health but we have invested in adult social care and that I think is the most important lesson to take you seriously and have a genuine commitment not just in words but also in deeds particularly in terms of providing the necessary money for adult social care to thrive thanks great so can the committee report this note this report for information great okay moving on to our final item of the evening thank you so much Claire really appreciate it and thanks from all of us we've got Sarah Evans who's going to give a brief intro to the budget report and then we'll have time for questions thank you good evening everyone so this report covers the quarter three budget monitoring position for 24-25 and also the 25-26 budget including the annual review of fees and charges as at quarter three the forecast out term position for the services within the remit of this committee is 2.7 million compared to a revised budget of 102.7 million as at quarter two there are significant budget challenges within adult social care and public health around the budgets largely for our care services where all client groups have experienced increases in care needs leading to increases in fee rates required by the provider market both complexity of need and market conditions are leading to increased prices within the market along with the significant pressure within the NHS which is impacting adult social care with patients being discharged more quickly into the care system there's been minimal change in the forecast since quarter two because we built in some resilience into the forecast for growth in the later quarters of the year year the report does set out mitigating actions to address the position along with the continued risks and challenges that we're facing in this service the 2526 budget along with future year's budgets are set out in appendix D and take into account demand led pressures through growth along with future efficiencies services and for adult social care services service users most of our service users make a contribution towards the cost of their care based on an individual financial assessment so takes into account personal circumstances the report does set out in the appendix the charges that are not based on a financial assessment that they are minimal I would say so yep I will stop there happy to take any questions thank you very much do I have any questions from committee members councillor Crovelli sorry can I just ask a question about if we go to page 183 care home providers and home care providers and the rising costs the local government association said that the changes in national insurance would cost councils about 637 million in direct costs another 1.1 billion in indirect costs now last night I was at the children's committee and we heard that the government is actually going to introduce a grant and distribute a grant to schools to try and cover some of the cost of that I mean I know we've had the figures in the settlement this year but is that it there's not any more money in the pipeline similar to there is for education for this as far as you're aware as far as I'm aware that there is no more money other than the additional 880 million which is set out in the paper which came in between the provisional and the final local government finance settlement but yeah I'm not aware of anything else can I ask another question a bit built on that just looking at from what a lot of it's mainly what the LGA and other some of the county councils have said that the private providers are saying that they're struggling to provide contracts to councils under the existing financial disciplines that they have because of increased cost there's the national living wage they've got increased cost for insurance then they've got the national insurance and I think a survey said that 75% of private providers were we're talking about either cancelling contracts or not renewing existing contracts have we had any feedback from private providers that might be a problem in Wandsworth along these sort of lines and our commissioners are meeting with providers to discuss the situation and to try to work together to resolve it going forward we haven't had any contracts handed back in Wandsworth today or any indication that they will be but I think that process is continuing in terms of discussion with providers the commissioners are working at a south west London regional level to try to get to a coordinated approach around the uplift process for next year as well can I just ask I mean I'm not really familiar with what the contracts are with the private providers but I assume that if they have got additional costs they're going to come back to us and ask for increase in fees that's par for the course if they have an additional sort of cost but do the contracts that we have with these private providers do they already have inflation linked increases within them and things like that because I was just wondering if it is the case they come back and they say well I need more fees we don't have contingency in the budget for that do we? No so there would be two types so there will be some contracts actual contracts that we have out there which as you described will have an inflationary clause in there and that inflationary clause would hold but we do have a number of spot purchases where we're purchasing care for individuals in specific homes and that's the uplift process which will be impacted by this. I have to say it will differ in different markets and we are doing some modelling on that there's a wealth of information out there so LGA have provided a model care analytics and we are looking at that because we do think that it will be important to look at the different markets and come up with different uplifts this year in 25-26 to reflect the employer's national insurance. And just to add to that point about uplifts they're not for most of the contracts where the labour intensive they're not predominantly CPI they're a balance between uplifts in the living wage plus CPI to reflect the fact that the prices are you know and the changes are different so we've already taken out that risk through the contract process. Councillor I'm just intrigued just looking at appendix B which shows that the number of people receiving services is actually very similar to what it was in 2018 clearly there's been fluctuations over the years but I was just wondering the budget right now is 102 million or thereabouts. What was it in 2018? This is what context challenges you're facing right now. Sorry was the question? What was the budget in 2018? Sorry I don't have that figure here but you're right back in 2018 we had 3,387 people at that time it was we were the directorate we're working on implementing promoting independence program so actually looking at introducing a strength based approach so working as part of our transformation to look at how we could promote people living more independently at home and that's the kind of slowdown in the numbers that we see in those early years. Then 2020 we had COVID and since then we've seen that increase in demand but it isn't just about the numbers it's about the complexity of needs and that is driving some of the costs in the later years. Thanks. The report noted, oh not noted, no no it's for decision sorry. Does the committee support recommendations in paragraph two? Agreed okay. E and NMC agreed. The report is carried. Okay. Thank you very much everyone for attending the meeting and for a really great contributions this evening. Have a lovely evening. Thank you. Thank you. Thank you. Thank you. Thank you.