Transcript

Good afternoon. Welcome to this meeting. I am Councillor Graham Henderson and I am the Chair of the Health and Well-Being Board. Members, as usual, I will now call your names in alphabetical order. Please switch on your microphone to confirm your attendance. Once you have confirmed your attendance, please remember to switch off your microphone. Jeremy D'Souza. Good afternoon. Abby Carter. Good afternoon. Mark Creelman. Good afternoon. George Crivelli, Councillor Crivelli, are you present? Okay, not in the room, but okay, we'll... Robert Gile, who I believe is joining in virtually. Good afternoon. Good afternoon, excellent. Stephen Hickey. Welcome. Thank you. Shannon Cattillo. Good afternoon, Chair. Philip Murray. I think we're expecting him to join us at some point virtually. He does have a conflicting meeting. Mike Proctor. Apologies. Okay, fine. Dr. Wacker Shah. Good afternoon. Good afternoon. Kate Slomack, I think also joining virtually. I'm present, Chair. Apologies for being virtual today. We have the CQC here today. Yes, and I... Thanks. Thanks, Dr. Kay, for attending. Councillor Kate Slomack. Good afternoon, everybody. Thanks, Jess. Please, can I ask, as usual, when you are speaking, please could you refer to the page number at the top of the agenda pack and the paragraph number so the members of the public can follow the discussion. Please also indicate, if you wish to speak in the usual way by raising your hand, I will be reliant upon Laura to tell me who are people who are sitting behind me because I don't have eyes in the back of my head. Rather embarrassing bald patch, but not eyes in the back of my head. And, again, once you have completed speaking, if you can turn off the microphone. We also have a number of officers present who will introduce themselves when they address the board. So the first substantive item, well, apologies, and apologies for absence have been received by Dr. Arianna Chagaya, Dr. Nicola Jones, Emma Popovici, and Brian Ryan Wiley, and also Tia Mara Orban. And I think we had one other from Michael Proctor. So, moving on to item two. Actually, we're just dealing with members present, and Councillor Crivelli has just joined us. He has taken that as you being present. Thanks a lot. So, if we can move to item two, which is declarations of interest. So, are there any declarations, either pecuniary, other registrable, or non-registrable interests? Please declare any interest, quoting the item and paper number in which you have interest, and are describing the nature of your interest, including whether or not you'll be taking part in the item. Can I ask if there are any declarations of interest? Excellent. Thanks. So, we can now move up to the third item, the minutes of the last meeting on 21st November 2024. Are the minutes of the previous meeting held on the 21st November agreed, and can they be signed as a correct record? Any comments on the minutes? I do actually have one. Being a fully sort of paid-up member of the Graham's Union, I did notice that the Mr. Markle's name was spelt incorrectly. Apart from that minor change, I think we can take the energies as being read. Abby, sorry, yes. I share your pain in having your name constantly misspelt. My name is always, it's not. But my, it was kind of a question, really, there was an action for Isabel Shawcross to come back to me on something, about why no autistic people have been registered as dying in Wandsworth, which hasn't happened, and I'm just wondering about the process that that should go through to ensure that she does come back. Do I, should I, I would assume I shouldn't have to contact her directly, but is that the way to do things, or does it go through Laura, for example? Thank you. Thanks, cheers. Good, okay. So, I think I can sign the minutes as a true and accurate record. Shall I do that now? Do you want me to do that? I've got a black pen for a blue one. Thanks, Lord, cheers. Okay, thanks, cheers. Thank you. There are quite a number of officers who may be presenting in relation to the various topics. I won't read out all their names because it's actually quite a long list. But anyway, over to you, Shannon. Thank you, Chair, and thank you, everyone. We're really pleased to present this afternoon for the first time an update on the Live Well section of our joint local health and well-being strategy. And for this afternoon, you were presented with four of the steps within that section, covering adult immunizations, cancer screening, climate change, and air quality. I will ask our step leads to maybe just briefly introduce each of the highlight reports in turn, and then hopefully take questions. And I also want to extend my thanks to the step leads and the step sponsors for all the work they've done in preparation for the report. So if we're okay, we'll start off with adult immunizations, and I think we've got Holly Stone and Pugia Kerker joining us. Thank you. Thanks. Apologies. We've got Melissa, who is here in person, to present that one. Thanks. Thank you, Shannon. I'm Melissa Barker. I'm a public health lead at Richmond Wandsworth Councils. I am also joined by Holly and Pugia. They are joining virtually. They are the step leads on this. To give a couple of headlines about adult immunization, this update focuses on the 2023 winter vaccination program, in which, despite a declining national trend, Wandsworth actually saw higher flu vaccination rates than in the previous year. And within the individual eligible cohort groups, uptake was similar to or better than rates in London. In the 2023 program, a number of activities were delivered by the public health team and by the ICB to improve coverage of this vaccination program. This included comprehensive community engagement to bring vaccines into our communities, with over 80 outreach sessions delivered through the public health bus and through community clinics and community events, with just over 580 vaccines delivered, to create an accessible vaccine offer for residents. Thank you, Melissa. I mean, we do have a number of different topics. Adult immunization, cancer screening, climate change, air quality, et cetera. I think it will probably, if the board agrees, if we take each topic in turn. Otherwise, I think the discussion may get rather complicated. So if we can, first of all, take the report on adult immunizations, a very comprehensive report. In fact, all of the topics are covered by a quite comprehensive report in the appendix. So can I, first of all, take any questions or comments in relation to adult immunizations? Stephen. Thank you very much for the report. I just had a question on the page 24, where you give the statistics about Wandsworth, which look, as you say, very encouraging. My question was, do you have data about areas or ethnic groups, as it were, relatively deprived? Because I'm conscious that the averages in Wandsworth can hide where the real problems are. Yeah. Melissa. Thank you for your question. That is data that we hold internally, but it's not publicly available data. So each year, we carry out an evaluation within the public health teams to scrutinize and evaluate the data that we see in this program, and that covers things like ethnicity data. And we use that internally when planning for the upcoming year's program. So, for example, that's the kind of data that we can use when designing outreach clinics and the location of those clinics to ensure that we're putting them in spaces where those offers are most required. That's encouraging that you've got the data. That's encouraging that you've got the data. I just wonder whether, maybe in future reports, it would be useful to have the sense of spread. I mean, you know, the average can hide a multitude of sins, be useful to have some sense of, you know, where, what's the worst 20%, best 20%, something like that, either by area or whichever ethnicity, whatever metric seems most useful. Yes, certainly, Stephen, I mean, we can discuss the sensitivities of the data, but certainly for future reports, I think, at the very least, we can actually send it to board members in confidence. But, obviously, between now and whenever we come to discuss this again, we'll have a discussion over any sensitivities that may exist around the data. But, certainly, Stephen, yeah, entirely accept the point. Abby. Thank you. And, yeah, thank you for your report. I've got a few questions, but that's because I found it so interesting. So, first up, I'm the volunteer sector rep, so this is some feedback, or I was kind of interested in your insight, but based on the feedback that came from some partners yesterday who have been partners in delivering immunisation in the community. And there's a feeling that COVID is, immunisations are really putting people off, and there's a high sense of fatigue amongst kind of really at-risk members of the community. And, like, because of the, I guess, the reputation of the COVID vaccine, for want of a better word, that's also putting people off things like measles. I was just wondering, I appreciate that this data is actually from, like, now two winters ago, and this might be, that feedback might now be a bit more upstate and relevant. But I just wanted to understand if that is something that you recognise, and if it is, is there a, what your thoughts are on kind of improving that? And if it's not, then would it be helpful to maybe, for me to be able to provide a bit more kind of on-the-ground insight into what people are seeing? So, to help you kind of, as you go forward. Thank you so much for sharing those insights, firstly. It's really helpful to hear what's being seen and discussed within our communities. So, we'd be very welcome to hear any further insights that you have and any further detail around that. It's certainly something that we are aware of with the fatigue around COVID, and it's certainly something that we have seen reflected in this year's campaign, as well, from the early data that we are seeing. So, it's certainly something that we are aware of and will be considering going forward with the spring campaign and with this year's autumn campaign, as well. There's, at a London and at a southwest London level, there's a host of communications and outreach that's being done around the winter vaccines, and that's certainly something that I think we need to be looking at further when considering future planning for these engagement activities. Thank you, please. And it wasn't clear to me kind of how long those sessions were and whether, for example, a return of, you know, 58 vaccines being administered in seven health bus sessions is something that you consider to be, like, successful and a good return on the time and resources or not. That just, that kind of, that analysis bit I wasn't quite sure about and it'd be really helpful to understand a little bit more about that. I think that's a really helpful comment that you have raised, and I think, particularly when we think about the health bus, it's really valuable to think beyond just the number of vaccines that are delivered at these events. The health bus, the health bus, the health bus, has many benefits that, by bringing these vaccines into community locations, and for the health bus specifically, those locations are selected based on areas where we've seen lower vaccine uptake or where there might be less provision available in that area. So, they really help to improve that accessibility. So, it's an opportunity for people to come forward and have a discussion, and so, that might not be replicated, that might not be showing in the numbers, but it's that opportunity to have a conversation in a convenient and in an accessible location, as well as also catching people opportunistically, for example, at a community event where they're already in attendance, that they might not otherwise be looking or thinking about vaccines that that offers there. So, I think that the health bus offers a really wide package of support and a range of benefits that extend beyond the number that are specifically delivered at those events. Thanks. Kate, Kate Slimeck. Thank you, and thank you. That's a really good report. In fact, one of my questions is very much along the lines of Abby's around, because I think there's roughly eight vaccinations per session for the health bus. So, I was interested to know, but as you've rightly described, it has a wider benefit. So, I think, you know, that's really good to hear. And I suppose my other reflection was, obviously, we've seen a lot more flu – sorry, I should have said I'm the managing director of St George's – a lot more flu coming through the hospital this year, a significant rise compared to previous years. And it would be interesting to see whether that has a positive impact on vaccination uptake in the next season, because I think a lot more people have been affected by it. It's been a bit more in the news, et cetera. But, yeah, so I just wanted to make those two points. Thanks. Thanks. I saw Sharon next. Okay, George. I think this has been addressed partly by some of your answers, but I want to ask you about the point you make on page 22, about the wards that you've targeted in the borough. You mentioned five wards, Graveney, St Mary's Park, Roehampton, and Queenstown, and Latchmere. My interpretation of that, upon reading it, is that the social deprivation goes hand-in-hand with low rates of immunisation. Have I got that right, or is there anything in particular that I'm missing there about that? No, your understanding is correct. We see that correlation with areas of deprivation, but also see a trend between vaccination rates and ethnicity as well, which also correlates with those areas of deprivation. Thanks. I'm Kate Stock. Thank you. Thank you very much for the report and the update. I'm really pleased to see us outperforming London and England in terms of pregnant women and two- and three-year-olds. I was just interested in a little bit more information about what the barriers, what, you know, it's still less than 50% in both of those categories. So still kind of what the barriers are there, are they some of the issues that we've already touched on? And then a second half, really, just looking if there is correlation between pregnant women and three-year-olds and some of the wards that you've highlighted on page 22. Kind of whether there's been any consideration about expanding the offer into our family hubs and our satellite children's centres or co-locating the health bus, there is kind of an alternative offer of bringing the offer out into the community, as you've highlighted on page 23, whether that's been explored at all. Thank you. Thank you. Thank you. Starting with your first question, there are a real range of reasons why barriers as to why people are not coming forward for vaccinations. There's also specific London factors. We see that London has lower rates of vaccination than across the country, and reasons for this includes the vaccine fatigue that's been brought up earlier, also includes factors such as mistrust. In London, there are specific issues related to population mobility, which means that people miss invites for vaccination and are less likely to be registered with a GP, as well as a trend around lower uptake amongst people from ethnic minority groups as well. So there's a real range of different reasons that are preventing and causing these barriers to vaccination. In terms of your second question, this isn't any analysis that we have carried out to date in terms of specifically looking at the eligible groups of pregnant women and two to three-year-olds and the location, but it's certainly something that we can seek to investigate this year within our evaluation when we are carrying that out of the programmes. And certainly something that we can look into in terms of co-locating those community offers in spaces such as the family hubs going forward to help drive that up. If I may, I just wanted to add a bit more context around the co-location. Public health have been linking in with children's services to talk about, you know, additional services that can be supported by the family hub model and what we can put into there. I think there is a bit of a complexity and a challenge around the immunizations because obviously the local authority is not in control of some of the operational and logistical arrangements around that. It's certainly something we would look at. I think the other complexity as well, particularly in relation to the health bus is the sources of funding that are supporting the health bus then determine what are some of the priority areas for the health bus to go into. But as we're looking at the procurement of a permanent health bus model, we'll definitely be looking at further opportunities to support wider coverage and uptake. At the moment, the health bus only goes around once or twice every couple of weeks. So there's not a lot of scale. But as we're scaling it up, we'll be looking at those opportunities and the funding as well. Good. Thank you. Oh, Mark. So thanks for the report. And it's really encouraging to see that one's worth the kind of bucking national trends. I suppose the reality, though, is we've got two thirds of people kind of immunized, which leaves the third unimmunized. And we know just in terms of whether it's the 10 year plan or the new administration actually moving from treatment to prevention and immunizations is the way that we can prevent ill health. So it's really, really important that collectively everyone gets behind that kind of vaccination message. And just to support Kate's comments, really, we've had a winter of extreme pressure in acute services and community services and GP practices. Actually, immunizations is one way to help relieve some of that. So actually that those services can cope. Yes, certainly, I did see, I think, Abby and Stephen ask questions. Obviously, I'll have to move on at some point. But as you say, Mark, I mean, this is a very important issue and goes very much to the heart of the preventative agenda. Abby or Wacker? Thank you very much for a great report. We've now got another vaccination called the RSV, the respiratory syncytial virus. And I just wondered, looking ahead, whether you will be adopting a similar strategy as you have done with flu to improve the uptake of this vaccination. And, again, in subsequent years, will we have access to the kind of data that you presented in respect to flu? Thank you for your questions in terms of our approach to the RSV vaccination going forward. We will certainly be incorporating that into our package of activities, particularly communications around this to help encourage uptake. In terms of data, I think that's a question that we can take away. It would be a national decision as to how much granularity of detail. We currently receive data at a national and at a regional level for the RSV program, but not borough-specific data as of yet. But we can certainly take that question away to find out if that's something that could be made available. Thank you. Thanks. Abby, Stephen, do you? No? I do have one final question. Sorry, I'll be quiet soon. Obviously, one of the things that seems to have gone well is the fact that you've been delivering in community settings and with charitable partners, which is great. I guess the question, whether it's for you or for NHS colleagues, is kind of how much planning ahead happens there, because if it does work, it's obviously super helpful for charities to know, you know, going forward that they'll be recommissioned for that or not, because there was some uncertainty around that when we spoke to colleagues in the charitable sector yesterday. So that was just a request as to how far ahead you know, like, who you'll be partnering with. Thank you. I think that is a question that would be best answered by our ICB colleagues. So I don't know if my colleague, Pooja, is online. I don't know if you have any comments, or otherwise we can take this offline and provide an answer in the minutes. Thank you, Melissa, and thank you, Abby, for your question. I mean, we, so we received funding from, the immunization team did receive some amount of funding for Wandsworth Care Alliance this year. But, you know, having said that, this funding came from a pod that the IMSS team applied for. And this, unfortunately, we don't know if will be repeated. And there has been a cut in the access and inequalities funding as well that may impact on the outreach that we are able to do. So, but, yeah, we would be trying different avenues to get funding from the different parts of funding from NHSC. Thanks. Thanks, Pooja. Let me say, I don't wish to curtail our discussion. This is a very important topic, as I think we all agree. It's good to see that there are improvements in the rate of immunizations, particularly amongst adults. But clearly there is considerably more work that needs to be done. And that is obviously something that we are fully committed to doing. But anyway, Melissa, thank you very much for coming along, presenting the paper, and also answering various questions. If we can move on to an equally important issue, in fact, they're all important, but certainly cancer screening. Shannon, who have we got still presenting on this issue? Thank you. So, for cancer screening, can I call on Sophie Ruiz and Dr. Lucy Sneddon? Hello. Hello. My name is Sophie Ruiz. I'm the program lead for early diagnosis. And Lucy Sneddon, unfortunately, can't attend today. But we do have the GP cancer lead for Wandsworth, which is Dr. Maria Wallace. So you should hopefully be able to see her in the corner of the screen that you have up there. So I'll start off with just with a few key points. Really, our own partners, working collaboratively with the ICS, we have developed a dashboard which provides really granular information about those populations that are not accessing both bowel and cervical screening. We are looking likely to have something similar in case in place for bowel cancer screening. So we'll be able to really, really delve into and work with those communities that we know that aren't participating in those screening programs. The update that I've provided provides a sense of actually a lot of robust community engagement pieces that have been happening across all three screening programs. So our health promotion specialists at St. George's that work for and that work on bowel screening as well as breast screening have been really proactive around working with specific community, specific communities in Wandsworth, as well as general practice around raising awareness and around the screening programs, around bowel and breast screening programs per se. And we also are in partners commissioned our own grants program, again, working with communities to raise the profile of the importance of all cancer screening. And we had 10 community organizations in Wandsworth delivering a range of activities to support their communities. And lastly, in relation to both bowel and breast screening, our GP colleagues did have an inclusion within their contract around how they can support greater uptake for both bowel and breast and working on those specific patients that hadn't previously responded to their invitation. So, yes, in my report, I provided some some of what those insights are around the populations that we know that aren't accessing bowel and cervical screening. And we want to take this information moving forward in terms of proactively working as a system, as part of our new prevention and screening agenda, to really understand the barriers that these communities face, but also understand how we can work with them in order to improve their understanding about the importance of screening. And I'll pause there. I'll pause there. I'll pause there. I'll pause there. I'll pause there. I'll pause there. I'll pause there. I'll pause there. Sophie? Yes. I mean, indeed. I'll pause there. I mean, indeed. all of the screening programs so I know that for breast screening in particular our colleagues at St George's screening services are proactively engaging with learning disability patients with learning disabilities and their carers about how they can access breast screening it's something that the GP cancer lead here Maria who talks to our PCN and GP colleagues around cervical screening is is keen to stress that actually that's learning patients with learning disabilities do have as are able to access cervical screening as much as any other patient I think there is a misconception that patients that have a learning disability aren't having sex and actually you know the fact that they're not having sex doesn't mean that they're not still at risk or if they're not you know that they're not still at risk so there's a greater awareness amongst the GP community around cervical screening per se in terms of bowel screening again our health promotion specialists at St George's are working in those communities and are wanting to stress the importance of how it's important how it's important for patients that have learned disabilities to access bowel screening and I know that our health promotion specialists have been working with a lot of organisations that support learning disability patients to to take up the offer so it's something that we are definitely aware of and that we that we want to improve on I was just going to add that I mean all patients with learning disabilities should be having an annual health check at their general practice so I've been really trying to enforce that every contact matters and that screening history really should be kind of questioned when patients are seen and if they haven't taken up the screening offer really encouraged to do so thank you thank you I feel I should know the answer to this as the director of public health but I don't I just wondered from your perspective it's slightly unusual for Wandsworth to be near the bottom in terms of any indicators when compared to the rest of southwest London but obviously that is the case for bowel cancer screening and I wondered whether you had any potential insights as to the reason that might be does that really relate to any differences in our population or or any other factors that you're aware of so so what so the target for bowel screening is is 60 percent so although Wandsworth is um um towards the the bottom end of performance in southwest London you are actually exceeding the targets for um um that that NHSC has has put in place for this area um I think you know and I don't think the report and all the population dashboard demonstrates what what communities or or what specific groups we most we most want to target um and again it's it's almost like a similar position across all other boroughs um so yeah I'm I'm not sure I'm not sure how quite to answer your question if I'm you know if I'm being completely honest but I think it's it's it's more emphasis that are that that's needed in relation to those specific cohorts that our population dashboard provides us with insight on as to who is not participating in bowel screening so so much more focus on those groups that is something that we that we're keen to do we mentioned kind of learning disability patients but also SMI patients patients with uh severe mental illnesses um so I'm trying to engage with the mental health workers that are in general practices at the moment um because they're often having more contact than the GPs are just really again promote screening in this population yeah thanks thanks a lot a lot I mean looking at the statistics and um clearly one would need to delve into them in greater depth but it does look uh as if those boroughs which do have significant levels of deprivation somewhere in their borough are at the lower end of the lower end of the list but fortunately they're all above the 60 percent but clearly yet again um there is a lot more to do um I am aware I think we have uh at least one possibly two representatives of you see me uh which is um a charity and organization which is very much at the forefront of um of um promoting uh approaches to cancer obviously including uh cancer screening um i'm always pleased to see people this isn't a formal delegation but i'm always pleased to see people from uh the public i just wondered if you have any comments of your own you may wish to make um yes um good afternoon my name is michael samuel i am here um from the can you see me project project funded by mac millen and which is hosted within the croydon bme forum now um good to see the information that has been published here um which is all very good now some of the things that i have picked up locally which i would like to see is when it comes from the information coming out about the demographics and where the people are i think i've got it here in my notes yeah um stephen hickey pointed this out it'll be good for me to know where the areas where the immunizations are taking place because that will enable me to plan and target where i should be going to and where i should be raising that future awareness also to understand in which areas of the pcns they sit into now i know earlier on it was mentioned and i've left it on my other piece of paper there by sophie where sophie ruiz regarding the work that rm partners may have that detailed information so it'll be good for me to actually get access into rm partners and actually speak to them how that's being done and how we can work together and then also more importantly how the community groups that are all working together because i work with a lot of community groups and we're all doing our own different thing but i really want to bring that all together so we can all help and help the people within the community and it's good to see that in the report it has mentioned the can you see me project in this i know chair that you were able to be our main speaker at the start of that event so thank you very much for that well thank thank you michael and uh particularly for sort of giving impromptu um uh comment etc but uh those points are very well taken and certainly um i thought the conference um was very well organized and clearly focused on a whole range of issues clearly engaged with a very wide range of different organizations all committed to doing that up to try to prevent cancer and also provide responses to it um but can i just ask are there any immediate uh reactions to michael's comments at all from members of the board george can i just ask i'm interested can you tell us the sort of things that you do just just give us a couple of ideas about the sort of things you do to to to address the sort of things that you're aiming at those i know what you're aiming at you're aiming at health inequalities particularly so for bma commitment but if you just give us an example a couple of things that you do to to promote that yeah so some of the key things that we do is trying to break down those barriers so i have got some very good links with um royal milestone hospital directly in sutton but i've also got some great links with st george's speaks ahead of nursing now and what we are doing working together is working out where i go and speak to the communities i am having um workshops with them where they can come in and drop in and see me at certain places so i've got a place in battersea another place in roehampton where i pick up the information from the communities what are their barriers what is not working for them and then i'm able to feed that back into the health community and make sure that we're working together i think one of these things that we got in the community now there's a bit of push and pull is that there there are some things in the community where they are maybe reluctant to understand what needs to happen to get their things done but also from the health community and i'm trying to bring those both together and i've got some things i'm working with now with the royal milestone which i can't really talk about in great detail but there are lots of initiatives that we are doing and it's going down to think one of the key things is maybe not fit someone did mention especially from the community which deals with the charitable community is about the funding i'm quite fortunate my funding is there for three years i'm one year into a three-year project but that uncertainty doesn't help the groups that i'm working with they're not always going to know can they continue the work of that doing with me and can that be sustainable in the long term i know how difficult it is but that's one of the key things thanks a lot um again another um very important sort of discussion on a vitally important topic and again um i think it does indicate there is still a lot more uh that we need to do but we will work with health partners and community organizations um to try to improve the rate of cancer screening so if the board members are content thank you very much michael that's much appreciated um so the next item as part of this report is on climate change and um again uh shannon or if officer would like to identify themselves thanks thank you chair i'm andrew hagger i'm head of climate change and sustainability um and i'm here to talk about the climate change step so just a little bit background is that um the work that we do around climate change is really really closely linked to health um there's some really big health risks that come from a changing climate if you think about some of the things we're likely to see in changing climate is things like increased flooding which brings um health repercussions there uh we're looking at extreme weather events um and we're looking at also um overheating and drought and things like that which will obviously have severe health consequences for populations especially vulnerable populations there's also wider system things that we can see in the changing climate around um food instability and other knock-on impacts as well so a lot of the work that we do um really closely ties in with health so for example if you think about air quality and health and carbon emissions air quality um pollution and sources of carbon emissions are very closely linked and i saw that um my colleague jason andrews is on the call and he can talk a lot more than i can about that sort of stuff he's very knowledgeable about it if you think about retrofit and energy efficiency of homes that's really needed to drive down carbon emissions that come from um from come from homes but also you get warmer healthy homes as a result of that which definitely improves health outcomes as well um there's also active travel which is part of reducing carbon emissions but also has wide health benefits and then if you think about green spaces nature and biodiversity there's lots of uh links between that uh improving those and access to those and increased physical and mental health as well um so one of the things i wanted to highlight um a few things i wanted to highlight here um that set out in the update you've got is the um seth westland icb green plan um and that has been refreshed to go through until 2027 so wandsworth has been involved from a council perspective so i go along to meetings there to contribute public health obviously um go along as well and also nhs providers locally are involved so for example st george's go along to that and contribute to to that plan and that brings together the whole health system together um in terms of what we're doing as a council um there's the ones with climate action plan and that is reported on annually it went a couple weeks back to uh the environment committee where we provide an overview of what we've delivered there's been some significant progress on lots of different actions generally around climate change but um two particular areas um are on retrofit and we've developed a retrofit strategy for the borough and again this really kind of drives forward uh the strong links between energy efficient homes and health if you think about addressing cold homes and the knock-on impacts from that uh damp and mold and things like that can be reduced through improving properties and then also reducing carbon emissions from that and tackling climate change another one that's got a really strong link is adaptation and resilience so we've created an adaptation and resilience strategy and that sets out um the strategic approach that we're going to take as uh as a council to improving the resilience of the borough um it also uses um climate risk mapping which factors in health so we've worked very closely with public health colleagues on creating the climate risk mapping it brings together the different risk factors around flooding overheating access to green space alongside socio economic factors such as indices and multiple deprivation and then also things like um health as well to really identify which communities are the most at risk and then base our actions to uh to increase resilience and put in adaptation infrastructure that's data-led and it's risk-led as well and um within the update you've got a great example of some of the work that we do as a team uh which is the warm home packs uh so this links together cost of living with health and well-being with energy efficiency for reduced um carbon emissions um and so that's funded via cost of living funding but delivers on multiple different things which is one of the things that we are trying to do with the climate change approach is it's not just about reducing carbon emissions it's about the co-benefits that come and can really help take off multiple priorities that we've got as an organization and also um the wider health system as well thank you thank you and thank you andrew any so comments shannon thank you and thank you and thank you andrew one of the things that we have discussed around uh our climate change step in the strategy is to look at some of the work that was done by the uk health security agency a couple of years ago where they looked at potential indicators and metrics that we can measure in order to track the progress in terms of climate adaptation and mitigation so we know we've got several indicators whether that's around infectious disease or whether that's around impact of heat waves on social care services during the summer and those kinds of things so we have had a conversation offline with andrew to start thinking about whether we can look at some of those metrics and perhaps find a small sample of key metrics that we can start to incorporate into our reporting so we can track the the change and the impacts yeah just to add on that um that's one of the um actions that's been identified in the adaptation and resilient strategy is to so we've made sure that's included there um to try to look at how how can we pull together a set of indicators um so we can track this a bit better thanks any further questions steven um thank you thank you very much and the this recognition of the significance of um good good housing good homes um from a health perspective i was going to raise this actually in the later paper on mental health but it actually is good wider than mental health i just wonder how it whether there is a system at the sort of individual level if i'm which i'm not a doctor dealing whether it's with mental health or a physical health case and i am concerned about you know an individual patient um and in particular about their the housing the quality of the housing whether they've got warmth and so on and so forth have we is there other mechanisms for the health at that level to deal with to reach people like you or whoever it is i don't quite know who it is because at aggregate level it all makes sense but actually to the individual level i just don't know whether there are mechanisms in place um where this is a real concern to a to a clinician andrew do you want to comment on that i mean i could say a few things as a counselor but um uh you're obviously much more played into the overall strategy um so i think in terms of a health practitioner um especially say a gp i'm not entirely sure i've got to be honest um but there's definitely sort of work that we do so for example the warm homes packs there's information that goes out around that i think that maybe we can improve getting information out to um health services perhaps um to make sure that they are aware that there is that service there um we do have eligibility criteria but they're not like massively strict it's kind of like if you present an RA needs then you can get some help and there's opportunity to access um access advice as well as the actually getting a warm home pack and what we're doing this year is adding in sort of deeper interventions such as sort of you know dehumidifiers and things like that other sorts of things um lagging boilers doing a bit more um support around draft proofing and and stuff like that so those sorts of levels of support are available via the warm home packs um approach um so i think that maybe linking in a bit more and getting more information out there um is something that we can do yes yeah um certainly from the council perspective i mean clearly um can depend upon the nationals or nature of the accommodation so um some people who are council tenants um certainly have uh or should have a very sort of direct um means of contacting the housing department and the area housing teams to actually rectify uh those particular matters i mean i think you're quite right um steven in raising housing it is a critical issue which impacts upon all aspects of health and we certainly recognize that um in relation to private rented accommodation it can be uh a bit more tricky um obviously in extreme cases um the e-regulatory services could get involved but we obviously have sort of less control over the the private rented sector um we certainly are aware of a number of problems do do exist um i think what we can do is to ask housing rather than me sort of talking on behalf of um a department i'm not the cabinet member for i'm aware of a whole range of things which um they do actually engage in but i'm quite happy to ask housing to give a more comprehensive report um mark and i suppose steven just in terms of i think within primary care if housing is identified as an issue there are many referrals and support that the gps provide to that person i think the other thing to mention is that uh southwest london icb and southeast london icb are working together with housing um organizations about how we improve the link between health and housing and actually onesworth housing uh department are part of that conversation so there is a a strategic piece of work about how health and housing might work even closer yes indeed um i think kate kate um you have a question or comment yeah it's more a comment really because obviously environmental sustainability but obviously running one of the biggest organizations in that sits within onesworth we take this really seriously as an organization as well the broader piece around environmental sustainability and what we as a big organization that can contribute negatively to that can do positively to support um we feed into obviously the southwest london ics group on this which is really active and proactive so it'd be good to be able to sort of feed some of that into the reports as well um because i think as a borough i think we do pretty well but obviously there's lots more that we could be doing so and i'm very conscious that as a as an organization we sit firmly in wandsworth borough thanks thanks thank you very much um i'm really grateful to you for including data on air quality i thought i found that really illuminating i just wondered if i can trouble you for a definition on the world health organization guideline and also the definition of the world health organization interim target i just wanted to get a sense of what that means and then after that i just wondered if i can get your narrative on our performance of air quality over the years and any projected future uh gains in performance actually back out i think that's the next topic that um jason's talking to but at least you have pre-warned jason's thought you you will be asking so i'm sure he'll appreciate that um yeah i appreciate obviously climate change and air quality are um very closely linked um but any more comments specifically on climate change if not i mean i think the importance of this topic is to actually demonstrate as i think stephen was um certainly suggesting the importance of a very joined-up approach across a whole range of different departments uh for clearly all these things ultimately come down to the economic and social determinants of health and it is widely important that we as health are being board aren't just simply focused upon shall we say clinical approaches but looking much more widely in terms of the societal impact upon health and obviously working together cooperatively to address that and clearly climate change and we're going to hear about air quality in a minute but clearly those are very important determinants of health so thank you thank you andrew for coming along and talking about climate change um moving swiftly swiftly on um air quality jason jason andrews is from our regulatory um department um but i'm sure you can introduce yourself jason thanks um um thank you chair my name is jason andrews i work for the regulatory services partnership and i manage air quality and contaminated land um we are one year into our new air quality action plan that was built on the recommendations of the citizens assembly we were one of the first boroughs in london to formally adopt the interim world health organization targets and i councillor will answer your question on that towards the end when we built the plan we made sure that there was the clear links to health and climate and we think that the plan actually is covering those three areas really well the air quality action plan has some 60 measures everything from our regulatory function to transport and it's really difficult for me to condense that into a few slides every year we produce what's called an annual status report that basically reflects on the actions that we've taken over the past year also looks at the measurement in depth around locations in the borough so it's really difficult for me to to sort of put all that information into a few slides but what i have done is i've given some information on the nitrogen dioxide over the past few years and the direction it's heading in and i'm happy to to talk to that further this isn't all of our monitoring sites this is only a few locations and we do challenge ourselves in the borough so these are locations that are quite polluted so these are main roads we don't select back streets to monitor and say everything is fine um so a couple of highlights from me um with secured funding to update our love clean air website which should be able to give information and maps on local air pollution that are a little bit more live than we do at the moment so people should be able to see what their area looks like we do have some training and this probably touches on the councillor's point earlier we do have some training sessions lined up for health care professionals and home visitors looking at internal air pollution including mold so they can identify that if there's any problems in their clients homes and give advice we do a number of engagement functions i think we've done about 50 events this year aimed at different parts of the community we've also installed our new air quality monitoring stations which is great news for the borough it was a good capital investment and now we're starting to pick up pm 2.5s one piece of work that we're doing at the moment that's gaining traction is working with the south west london icb and seeing if we can link in internal air pollution to asthma care plans because we do have monitoring and we do actually actively investigate complaints of internal air pollution and the more you dig down into that the the more alarming it becomes so there are some homes that are actually quite polluted so i'm going to stop there but i will answer the question about the world health organization guidelines um the world health organization recommends um let's say for nitrogen dioxide a level of 10 micrograms per cubic meter the uk current objectives that haven't changed for about 20 years uh recommend 40 and there are interim steps uh in the world health organization guidance simply because to go from 40 to 10 immediately would be almost impossible so we have to have an incremental step uh change um pollution in the borough is getting better um this doesn't include the 2024 data we're working on that at the moment we've got to put all that information together because we love our data uh and we are we i'm predicting that we are going to see uh improvements in the borough so i'll stop there and see if there's any questions thanks thanks i'll work at you um content with the reply i think it's work in work in progress in lowering the threshold shannon uh thank you very much jason i just wanted to follow up on um the update you gave in relation to indoor air pollution and asthma care plans just to try and understand a little bit more whether that's the result of um sources which are internal into the accommodation or their external sources that are affecting people with their indoor day-to-day living indoor air pollution is made up from outside air pollution when you open your windows and from inside however there are activities commonplace activities in the home such as cooking using candles burning incense using wood burners that actually cause um excessive levels of indoor air pollution so it's not necessarily the case you can have a house in a nice quiet back street with nice external air pollution but if you start monitoring inside there are activities in some properties that are causing their own pollution so it's just trying to educate and make people aware that certain activities if you are going to do them and that's absolutely fine as healthy adults it's you know it's probably not going to impact but if you do have people that are vulnerable then those activities could impact so what we wanted to do was do a study around looking at the link between asthma um incidents and internal air pollution but it's not always the occupier's fault but it's a mixture of both but the more we look into it the more interesting it becomes thank you thank you any further yeah steven am i just excuse me i just wanted if you could say anything about how onceworth compares with other um borrowers either some low is it central london that's particularly vulnerable or uh you know where where where one was a fit in in london terms um are we talking about external pollution um if that's the case we are basically similar to many boroughs in london although we do we we do challenge ourselves and we do monitor in in some of the most polluted locations but we have seen reductions and i think last year we saw putney high street start to become compliant which is um quite a great step um but we there's lots to do i think i i don't like to compare one borough to another because you're looking at their monitoring networks and not monitoring networks can differ between boroughs um but we are i think we're doing well and the picture in london is improving because we have things like the eulers and clean vehicles and electric vehicles so we are about the same as most boroughs i'd say thank you um i think we've had a really good discussion a whole range of issues under the live well agenda i think it reflects um the very considerable amount of work that very many people across a whole range of agencies have actually been engaged in so i would certainly like to thank them for that and also the uh very cooperative working which they are working to try to address some of these issues um i think we've heard there's quite a lot of work in progress clearly we can improve we need to improve the whole range of different areas uh but it is at least good to see uh there are so many different agencies that are working collaboratively towards that given end so if uh the board are content um after all that discussion um the action is simply for the board um to agree the recommendation to note the delivery outputs as set out in the report um can we agree that please thank you excellent okay well it's quite sort of good timing uh moving on to the southwest london mental health strategy which is paper number 25 to 75 pages 37 to 48 because um dr tom coffee who's the ones with clinical need for mental health children and um also so uh other matters etc um is only actually available uh until half past two from two to half past so welcome tom i gather you have joined us um are you sort of leading off i am yes so i'm the uh sole person here i think the mental health trust i've got yeah a very busy day today so i'm uh really talking to this strategy it's just very much to give an update uh excellent please yeah yeah carry on so first of all thank you for allowing me to join you and uh being flexible about the timing because of my clinical work so i do appreciate that it's very much to talk about the strategy which is a very much a five to ten year strategy but uh focusing on four themes and what i want to do is talk about four themes but also try to give you a ones worth flavor of what we're doing in those four themes and also take questions from you because you'll be probably much closer than i am to concerns from the community about where things are going well and where things are not going so well so the four key themes around prevention and early support by a so-called social model inequalities and then timely access so there are four themes and so i think you've got a presentation which um i'm going to kind of like use as the as the basis of my um kind of presentation um and in essence you know this started a couple of years ago when the reason these four areas were chosen was because of the feedback from the community and they were areas where people thought we were a bit challenged with so what i'm going to talk about first is the area of prevention and early support and talk about it from a wandsworth perspective also very and we work closely with three or four main partners the mental health trust but also the voluntary sector which in wandsworth are a big provider of services also st george's as an acute trust you know has a lot of patients coming through their any department with significant mental health needs and they uh really do offer quite a big part of the service to our patients uh and then uh of course as a fellow commissioner is the local authority and your your public health team led by shannon and um graham mark roll as a public health consultant and carol mcdonald from your um commissioner team are key partners with us how we can commission and collaborate together to provide services so on prevention and early support what i don't talk about i suppose is what's called the transformation model the ones of now are in year one and on prevention and early support what we've really developed is an increasing number of peer support workers these are workers who are based in a community funded by a ring defense budget uh the money goes to the trust the trust has commissioned a local voluntary sector like sound mines the carer center etc to employ these peer support workers to support people essentially with severe mental illness in the community so when people are now referred into the trust and they feel the trust's assessment center feels they can you know benefit from supporting the community they're referred to one of these organizations and we've got about six people peer support workers in onesworth and they are new in the last 12 months also um what we have uh is very much uh the carer center if you look about the carers are a key part of our community and they provide yeah many more services than us as clinicians do so the carer center now has worked really well with the local authority to have what's called carer centers clinics so rather than randomly referring people for a carer's check via the social services the social work lead comes to the carer center every month and the list is a clinic whereby the carer center will book in a number of uh people who get their carers uh annual check and review from the designated social worker and that goes really really well in the prevention and early support area as well you know i have to mention mhip our ethnicity mental health intervention project we now have two hubs one working with the afro-caribbean community in north tooting and that's so far south tooting working with our south asian community mainly women in that area those two hubs very much they have peer support workers they have uh primary care plus workers they also have a new welfare uh support service because what we recognize is many patients with mental health needs have additional uh welfare and social needs as well and so the welfare worker is based in these two hubs and takes referrals to try to address the many needs of people with a significant mental illness we do we also have other you know excellent um early intervention services in wandsworth we've got our talk wandsworth service we've got our mental health primary care network workers in general practice along with the primary care plus workers and this allows the trust to discharge patients to the gp surgery because now the gps have got two types of workers who are designated just to work with our mental health patients on the biosocial model what we've recognized is that uh the increased mortality and morbidity in this patient group isn't always about their mental illness it's about their physical illness these patients are much more likely to get diabetes heart disease strokes obesity arthritis and fall over so we've got two or three things that we try to do in this area the first is what's called the active well-being project and a partner for us is enable which is part of the local authority making sure all patients with an smi are able to access a personal trainer to improve their physical well-being secondly we have a service whereby all the smi patients get an annual review by their gp and that's doing quite well in wandsworth thirdly um the well center which is a service we've uh joined from lambeth make sure that they offer holistic services to children and young people both their physical health and mental health so therefore the services based around a counselor and also a gp looking after those patients on inequalities the key thing for us is um the issue regarding uh our mhip services and but also making sure that we try to embed services where the need is greatest and a good example of that i feel is that we've got the talk wandsworth services now based within our food banks and what happens there is that um when the patients come with when the uh when the uh uh clients come in if they've got a mental health need rather than have to send them away or diverting them to the gp the um called wandsworth service is now actually providing services in our food banks um and the welfare advice i've mentioned before is in conjunction with the trust has on site a welfare advice service which uh we work together with i have to say access is probably our area of biggest challenge when you talk about access yeah although we try to increase access by increasing capacity in the liaison mental health service in the urgent uh services run by the trust in the urgent services run by the single point of access and similarly for children young people it really isn't enough and the biggest complaint i get from patients carers gp social workers is that they struggle to get urgent access for their clients and they also often struggle to understand the urgent access system a new system on the block is uh the 111 hash 2 line so 111 now if you uh bring up and i've got a mental health uh concern there is a dedicated phone line via 111 this is in conjunction obviously with the uh the emergency line that we have for the trust but you can see how people get confused which one should they ring or should they uh that they go to say george's for the liaison psychiatry service or do they ring the spa who's got an urgent service so it's it's a slightly confused picture the reason the confusion has arisen is because everyone's always trying to build capacity but by building capacity often you bring you build complexity if i were to talk to my social work colleagues who do the mental health act assessments what they would say is we find it really hard to arrange a mental health assessment and when it's done to find a bed for that patient and so i think that is although access we have tried to do so much more it's still an area of concern um the children young people equally you know as well as adults the capacity that we've tried to increase in schools at the moment is we've got a fourth uh trailblazer site in schools covering tooting and balum so this has happened in the last kind of a few months to improve the capacity so we've got early intervention and increased timely access i have to say no matter how hard we work there still is a mismatch between um capacity and demand by the transformation approach the single point of access has given gp direct phone contacts to the on-call consultants so we can do that and uh ringing rather than throwing patients in equally there's a new advice and guidance service for the trust to give timely access so a lot of work is happening in this place but probably is still insufficient this strategy is a five-year strategy and i wouldn't expect us to have nailed everything now at this point so what i'll try to show you today are the four main themes try to show you where we've made successes but also where there's ongoing challenges and also very clear this is a partnership approach with uh the mental health trust also saint george's as an acute trust the volunteer sector the local authority patients carers and users thank you very much councillor thanks tom for that comprehensive report um you should have received uh the attachments etc i think in the original papers that came out because of formatting some words may have been chopped off uh but i think laura has um produced uh some where you can actually read the entire report which is good uh focus is upon um focus areas for 24 25 etc also sets out the intended outcomes uh by 20 32 33 um any comments on anything in the report or anything that tom has said please kate slow make thank you um and thanks tom i think it's a great strategy i really support it um i just had a question and not necessarily answer for now but thinking about how we measure success over time clearly it's too early to do that i appreciate that but have you got some thoughts about what good looks like um and how you'd know that this is making a difference yeah so um when we try to measure our success we do it in uh access experience and outcomes and so they're the three main aims of three areas that we we look at so the access um yeah there are obviously um clear kpis which are in the um you know the the guidance very much around people seen within uh 24 hours for emergency seven days for urgent 28 days for non-urgent the other one is a key one is patients who are in their first episode of psychosis but they get assessment within uh 14 days further with the iap talk ones of services again it's very much around you know how often how quickly people are seen for the first assessment but also as an outcome what is their recovery the target really is to get 50 of people going into recovery and often you get that real dynamic whereby as you increase access you often reduce recovery because people are just going to through too quickly you're trying to make a match or capacity to your demand and not giving people sufficient numbers of appointments so it's always a balancing time all the areas that we look at you know either our nhip program our truly young people's program all have that evaluation of those those similar areas we are doing an evaluation of some of the programs especially our transformation program and we're trying to get an evaluation partner and also the program about how we address some of the changes within the trust the two key areas are a culturally capable workforce and reducing control and restraint in the trust they are kind of being evaluated as we as we move so each project has got evaluation is usually in those three you know themes you know experience access and outcomes thanks any other questions comments um happy thanks um and yeah just to say there was a lot of very positive feeling about the strategy yesterday talking to charitable organizations which is really good one of my questions is that it seems that kind of inequalities or health inequalities of a major theme running through it and as you've just said around inequality of access outcomes all sorts of things we know negatively negatively impact some people's experience and mental health services went to others how does that sit alongside the fact that health inequalities funding is being reduced or ceased should i say um elsewhere it seems that those two strategic things are in contradiction to each other yeah so um so yes so what's happened a bit is that we were getting an inequalities fund which although very useful was difficult to use because it was a non-recurrent basis so what happened was that we would get a certain amount of money each year in southwest london and we'd have to find non-recurrent projects where in fact as you'll probably well know most of the work we do involves staff being recruited which require ongoing funding or services developed for patients which require continuity starting a service which lasts for 12 months no matter how good it is is a disaster so what we've done instead in southwest london is trying to look at how we get our funding and if you look at the three priorities we've set out in southwest london for the use of our growth money the m his money in 25 26 is regarding children young people access and inequalities so to ensure inequality is not lost as a priority just because that ring fence non-recurrent funding has lost we've put it as one of our top three priorities for the m his money overall which as you know is the percentage growth given in the overall budget applied to mental health services and the baseline for 24 25 so that way i'm reasonably confident that the focus the inequalities will remain and also will remain and receive recurring recurring funding project fundings yeah thanks thanks tom that's um extremely important jeremy yes um so um thank you it's a really um comprehensive update um i've got two points and one of them um you highlighted really positive um work around carers and with the carer center so i suppose the question would be is um what more can we do to support our carers um of people with mental um mental with mental illness um and the second point was really just to highlight some really positive work um that's supporting the work around people with complex needs that's taking place in social care um and that's um a successful pilot around mental health reablement um which is funded by the better care fund and that's had some really positive outcomes in terms of helping supporting people um and in a way prevent helping to prevent and reduce ongoing care needs so um i know that some some of the work on that is continuing and so just wanted to highlight that but the question is about carers thank you yeah yeah so thanks for that so when i speak to the leads of the carer's center and wanted care alliance the key thing they say they want to make sure that every opportunity is used to first of all make sure when people are admitted or under care that the carer is uh identified and wherever possible the carer is involved in in the the the planning thereafter what often happens is a patient is admitted and then there isn't a and there is an insufficient active approach to identifying their carer and involvement their carer so therefore when we have our partnership meeting between the trust and ourselves the local authority and the icb and commissioners we really push that can they make sure every single uh assessment that they ask first of all do you have a carer and can we can you please give us consent to um approach and use the carer thirdly once the care is identified to make sure all the pathway reviews that carer is involved because what we all know is 99.9 of the time the patient is in the the hands of the carer not the health services so we push that the second thing that doesn't cost any money that is just an approach second thing is about you know capacity and funding the carer center is very much dependent on funding from ourselves as an icb and yourselves as a local authority to maintain and keep that funding going because the carer center obviously does you know caring for young carers for carers with physical illness but probably their biggest work is a mental uh illness um and and and uh and i think making sure that funding is there one thing that the public health team at ones of do is commission a mental health first aid this whenever it's offered out there might be say 30 courses it's like glastonbury tickets they go in a few minutes so um it really is to make sure that we have as many mental health first aid courses as possible offered in onesworth and secondly rather than a first come first service perhaps we target them to certain groups which we know need that kind of support um so that would be really useful as well so there are three things i would mention frank steven thanks very much tom um very very good stuff i wanted your what's your view about um the capacity access in terms of mental health beds acute beds um obviously we've got the new hospital at springfield and i know in tolworth they're about to um start developing there um but we obviously do get um concerns that actually there's been a reduction number of beds and this is leaving leading to continuing problems what's your what's your assessment about the need for acute beds in this uh world um uh um um so first of all it's kind of it's quite hard initially to quantify the needs you know how many beds do we need um because sometimes the beds you've got are not used very efficiently because let's say you've got patients in there who could be discharged whose length of stay is too long um uh perhaps kind of thing uh has have got an ongoing non-mental health need which needs to be addressed before they can discharged so you might have let's say a hundred beds and of those beds 20 people are occupying those beds where they could possibly be elsewhere however making the assumption that we are where we are that the barometer that i use is how many patients are waiting at any time in any at george's or kingston let's say requiring a mental health bed and there isn't a bed available secondly how many patients who have had a mental health health assessment and are unable for that access to be deployed because there's no bed and thirdly how many patients are in non-nhs beds because there is inadequate beds in the system if those three areas are significant it means we've got inadequate beds now what we can always try and do is reduce length of stay make sure patients are moved more efficiently through the system we've said that for 30 years and the reality is that um you know no matter how hard we try there is always issues where it's much more difficult than we imagine so i would say probably at the present situation there are an inadequate number of beds all right thank you indeed kate stop um thanks very much um from my perspective really um welcome the report tom thank you very much and really the focus on improving mental health for children and young people and really welcome what you've been able to add today about um adding capacity into our schools with the fourth um trailblazer area and tooting and balham i noticed kind of in the year to date you've highlighted that we've been able to public publish uh cams uh waiting lists and i think that's helpful improving kind of carers and parents understanding of how long they're going to help have to wait and that can focus on on waiting well but i noted what you said about the mismatch between capacity and demand so i was just interested in a bit of an update to know what the direction of travel currently is on our our waiting lists and kind of linked to that i know our ambition in totality for the strategy is really to increase the overall proportion of funding directed towards children and young people's mental health specifically and kind of how how we were going to um change that proportion of funding directed towards young people yeah so um uh because i don't work for the trust i don't have at my fingertips the waiting times or the various services so just to kind of uh expand a bit so therefore we have a single point of access but by patients are referred initially and there the majority do get contact within 48 hours and the majority and i mean 90 percent get seen within uh 14 days uh then what would happen is they are either discharged referred on to the family consultancy service which is run by the mental health trust and that is only been a few weeks the areas whereby they get perhaps a significant uh waiting time is when they're referred to tier three and that can be a number of months when they're referred on to their neurodiversity assessment but by that and uh to be quite a long time and uh also although for eating disorders the waiting time has reduced and but the reason that we are focusing on children young people is because we know there is inadequate capacity the funding in 24 25 which went to children young people went to the tier three service in wandsworth so they have got extra funding this year but the our ambition is to make it is really to hit the 18-week target to make sure for all services be the eating disorders uh general tier three neurodiversity no one waits more than 18 weeks but we're not there yet yeah thank you mark i suppose it's it's linked to previous conversations as well just in terms of um particularly diagnosis for autism and i mean the good news is is that we secured almost half a million pounds to address the the diagnostic waiting list now george's and and kate who's on the lane are currently working up that service and recruiting into it so i think um uh without getting into complexity there are a number there are different different funding streams and it goes to abby's point as well um uh uh kind of at play here okay thank you um again this is uh an ongoing issue uh in which uh i think all parties across all agencies the voluntary sector etc etc are working uh very hard to address um this is simply an update uh on the uh mental health strategy as tom uh said it is a five-year program but um can we accept the report please thank you very much indeed thanks and thank you tom for coming coming i think we kept you about five minutes over time okay thanks lot cheers bye i'll get my glastonary tickets now bye bye well i mean on the same theme of the next item culturally mindful um paper number 2576 pages 49 to 56 and it does sort of bring together in some mental health issues and the glastonary factor of culture and arts and other similar type of things so i think uh sarah o'donnell um sarah excellent yeah thank you um yeah thanks thanks thank you uh thank you and sorry i couldn't be there in person today um but my colleagues lelia and tamilia are hopefully in the room with you um so yes so thank you very much for inviting us uh back to report on um the work we've been doing so when we were developing the bid uh to be london borough of culture uh we came to this board to tell you about some of the projects we were exploring and we were delighted when the board then welcomed and endorsed the approach that we were um proposing to take and that helped us win the bid uh to be london borough of culture so at its core um our year as london borough of culture is focused on using the power of arts culture and heritage to transform people's lives in terms of health happiness and ensuring equal access to opportunity and the cultural mindful program that this paper focuses on is our main project and has been designed to address the issues identified um in the enough is enough report as well as to build on the learnings from the cultural prescribing pilots that we funded over 2022 to 2024 so at its core um culturally mindful is about addressing health inequality by embedding culturally relevant creative health interventions where they can be most impactful so in secondary settings and at the heart of communities we know that underserved communities in particular from global majority backgrounds often face significant barriers in accessing traditional health services and our artists are we hope will be uh play an essential role in bridging this gap by offering a breadth of culturally relevant activities and by gaining participants trust through commonalities in lived experiences embedding embedding embedding these programs within grassroots organization and through a co-creation process with the with the targeted communities in um who have that lived experience so the program will support 10 professional global majority artists who will be paired with with host organizations including secondary care settings so st george's hospital queen mary's springfield and the royal hospital of neurodisability and within community charities where they will co-design and deliver creative health programs tailored to the needs of vulnerable groups as part of their paid residencies each artist together with their paired counterpart within their host organization will undergo structured training shadowing and action learning to enhance their practice within creative health through these artist residences we are ensuring that creative health support is delivered in ways that are culturally competent engaging and accessible and these artists will bring lived experience artistic expertise and cultural knowledge to create a space where people feel seen heard and supported ultimately if we want this work to be focused on empowerment in giving artists professional development opportunities while enabling communities to access creative health activities that resonate and are relevant to them it will also ensure that each of the partners the community organizations will be equipped to deliver a legacy creative health program as one global majority staff member within each of those organizations will have been trained alongside the artist we we believe that this model will not only improve the well-being outcome but also lay the foundations for long-term change in how culture and health intersect within wandsworth and we hope that should this program be successful and we've been having very positive conversations with our surrounding boroughs but that this can be rolled out and explored across the rest of the boroughs within the south west london icb uh so yeah lelia jamilia and i um look forward to discussing this further with you today and um any questions happy to take any questions thank you you stole my line but yeah any questions thank you very much for the report sorry thank you very much um for just adding at the end there a little bit about legacy because i was i don't think that was in the report and i was interested just to understand a little bit more about that great that we've got the the program now during the um years of the borough's year of culture but um yeah just a little bit more on the the legacy i'd be interested to hear uh can i ask if lelia's in the room because lelia's been leading on those conversations and it's been leading within the team on creative health for the last uh two and a half three years you want to pick that up thank you very much sarah so in terms of the legacy i would say there are um kind of for us four avenues for legacies um sorry about this one is the fact that um 10 artists from um the global majority based in onceworth will have um been provided with this training which will include mental health first aid create training um supervision and um trauma-informed practice so those local artists will be then available to work across the borough and across the region um the second aspect of uh the sustainable legacy is the fact that within those 10 host organizations one member one permanent member of staff will have undergone the whole training together with the artist which will hopefully have created some opportunities for for skill sharing so that even without much funding this creative health work can continue and focus on um addressing health inequities amongst uh targeted groups um especially focusing around prevention and early early intervention um the third aspect of legacy is that um the we're hoping that um we have um we have ring fenced um as part of the budget correct me if i'm wrong sarah there um a hundred thousand pounds to uh allow for 10 legacy um 10 legacy residencies a creative health residencies to happen although i have to put the caveat there that it's um dependent upon match fundraising from um throughout um london borough of culture but the idea is that there will be some legacy um commissioning taking place to continue the work that we've been doing ever since 2022 and um the fourth um aspect is that we've been having um conversations for the past two years now with mary adieu um at the integrated care board and we and with the gla great london um authority and we're hoping as sarah said that we might be able to um come together to uh fund to roll out this pilot this once was based pilot to the whole of southwest london um so that the the the funding can be shared and the practice can be shared because artists and residents you know are are mobile um and obviously initially we were we were looking at the health inequalities funding for this and i understand that this has not been continued however um as we've been reassured that health inequalities will continue to be one of the top three priorities and the the the at the moment we're working with the gla and the icb to bring together the five boroughs um as part of the southwest london to try and have a joint approach on creative health and see how um this can address prevention and early intervention on mental health but also on the other um priorities of the southwest london health and care plan um we're hoping that we'll we'll we'll find a sustainable model to keep on training people and diverse the idea is to diversify the offer so that it's more relevant to um the people who need it most and to diversify the workforce so that we kind of save time on the establishment of trust because as we all know change and social change in particular happens at the speed of trust or rather the speed of relationship which themselves happen at the speed of trust so developing a culturally diverse workforce we believe could um go far in terms of um encouraging people who would not normally access NHS services to kind of um have a personalized approach to their care through social prescribing that would be cultural relevant and provided by people who have commonalities in their lived experience um thanks very comprehensive sarah i just wanted to come in and add to that to say that uh we've been speaking to uh croydon kingston merton and the richmond culture team who are all really keen to explore this and uh and they have um started initiated conversations with their public health team um to see um how this could be uh something that they could get involved with uh depending on funding going forward but yeah so far it's been uh really positive uh feedback indeed yeah hi you sure i think that's very after you after you so so english of us um thank you for the um report and um i was very excited to get an email from you the other day about calling out the call the call out question is really around how does that work for the voluntary sector like is it a case that it will be kind of open to all and people will kind of know to apply or is it that you are kind of targeting specific groups or specific providers should i say so open it is really hi everyone and my name is jamelia i'm the newly appointed creative health officer um we are having a two from the approach so it will go out um as a open call on the website and it will go into the marketing strategy but we're also having conversations with organizations we feel would be um well placed to deliver the residencies um so that they know it's happening as well and are being encouraged to apply so yeah both will be happening if i may come in just um to add things is that we we are aware that the the demand will outweigh um the the number of residencies because we have 10 residencies in total four in secondary care settings only six in uh grassroot organizations across the borough so we will have to be mindful of having a good geographical spread but also target the most vulnerable communities and there will be kind of a natural selection in the fact that because we want to upskill the grassroots organizations they will need to be able to um to um to delegate a full member of their staff to attend the training together with the artists and to shadow the artists throughout their residencies so it does take um i suppose um for the grassroots organization to be large enough to be able to support this um however we're very keen for all the organizations who are interested to apply because it will also help us demonstrate the appetite on the need for this type of work which hopefully will help us um continue fundraising for it bearing in mind that the gla and the arts council of england and several other organizations are also supportive of of of this concept vena hi uh divina smear senior community safety consultant for richmond wandsworth i'm covering i'm kieran flagpole for stronger and safer um just again is that better yeah okay sorry i won't repeat my title again sorry if you've got that in the minutes um just yeah echoing the same as earlier by abby like it's really good to see this report and um my question was more around the contingency because i've seen potentially in other boroughs where um they've been you know very optimistic with the kind of delivery and obviously the sign up has been maybe very fruitful but potentially as the project kind of delivers and rolls out sometimes there's jobs drop off changes in staff i just wondered how you'd thought about that in terms of managing managing the project through its life cycle in terms of the initial sign up of those 10 artists in residency and potentially if there is some form of dropout how can others maybe be weaved into a program or some kind of buddying system you might have already thought of it i'm just making some suggestions sarah do you want to take this or shall i take it uh i think you're probably better placed than me lelia okay so thank you very much for this question about contingency it's a it's a question that um we we try and address in all our london borough of culture programs because um obviously the each project is carried by one member of the team however we tend to work and we're very experienced in working in partnerships so we have some very strong partnerships on board um so saint george's hospital um trust and saint george's charity are on board and they have um experience of organizing artist residencies in both saint george and saint and queen mary's hospital um and the springfield is also on board and they're going to support us with um not only by hosting one residency but also by offering some first aid mental health training we're working very closely with um the gla and the integrated care board and the social prescribing um steering group um so that they're all uh very involved and obviously we've just uh recruited uh jamelia who is uh very experienced um she's the director of one of our creative health partners of health partners organizations in the borough and she also works for london arts and health who are one of our partners on organize a similar program called artist recovery represents recovery network and jamelia coordinates this program also um and we also in conversation to with batsy arts center who are going to be um some of our place-based delivery partners in um in the once worse i'm sure i've forgotten some some partners there i think in in relation to your question about contingency of staff and commitment to the program and that's going to be part of the questioning as well as in the interview process before selection and having worked on the artists represent recovery network and taking the learning from um their program when they they're on the second cohort the first cohort didn't have any dropouts and currently it's been 100 attended um i think it is about making the right selection and being very open about what the commitment is um so on the website and when the call out goes out the dates will be listed so that people have a sense of when and where it's going to happen um and i think conversations with the organizations that are interested and us having webinars for people to drop in and talk to us about what it would cost them to be part of the program will help them to know whether they can sustain um commitment to being involved um i think it would be quite difficult to if a partner drops out to then have a partner come in like midway because they would lose out and but it might be possible if a partner drops out for an artist to go to another partner like a bigger organization such as one of the hospitals to continue their residency um so yeah we're we're being very mindful about risk and being very open and transparent about what people will need to commit to thank you thank you sorry can i just add uh just on on the artist side uh we've talked about sort of the organization and and in fact ourselves but within the artist part of the the the reasoning for why these are paid training posts and paid residencies is in order to ensure that those artists um are being recognized and that you know that will hopefully ensure that you know they can continue throughout the duration of the program thanks thanks thanks sorry i mean this is quite clearly an important topic and uh yesterday we had a very very successful launch of the uh london bar of culture which attracted a considerable amount of uh publicity and certainly in the last week i attended um extremely interesting webinar organized between the local government association arts council around the topic of creative health and uh we do of course have a health world being board a seminar on the 4th of march uh and certainly it is my intention to actually raise that there as a future priority that we should actually look into or certainly to ensure that our overall strategy ties in with that so i think there's certainly plenty of further opportunity to talk about creative health um i think it does have a major role to play so can i thank um um um and also sarah for presenting to the board um and uh the decision is we agree um with the recommendations to note and comment on the culturally mindful program which is part of onsworth uh london bar of culture 25 26 can we agree that please excellent thanks right um um well on the one hand i'm being a very poor chair because we've still got a few things to get through on the agenda um i'm in your hands actually i mean i think we have some really rich conversations here and um you know for as long as we're actually talking about positive issues uh i'm more than happy to continue um so but the next issue you know potentially chunky pieces of work uh the nhs 10 health plan consultation um paper number 2577 pages 5768 uh this is the response to the consultation and again mr shannon over to you thank you chair i'll try and help with the agenda by being very brief uh this paper is uh highlighting the health and well-being board's joint response to the council's um to the government's uh consultation on the 10-year health plan for england and the submission um that um that was drawn from health and well-being board members um and then summarized into a single submission in december of last year i'll take the submission as read and just move very quickly to highlight the timeline since the submission um according to the government's change nhs uk website in january of this year they would have been updating the website and contacting people who've registered so far with the activities i don't believe we have received a response as a health and well-being board so that's probably something we could follow up on um and the idea in february was that they'd be launching more workshops with staff taking place all across the country with organizations and local health systems and running workshops to get some final insights um by the 14th of february so again i think that suggests that they may be running behind a bit with that because we've not had any further information the intention according to the website is to hold a national summit in the spring with the selection of public and workforce people drawn from the regional events to help to finalize the plan so that's all the detail that we have to date thank you okay thank you any comments at all i must be getting there to three o'clock steven it's um i mean everything one reads about the the 10-year plan is all excellent stuff i don't see anything which one could disagree with putting it crudely my worry this is between me is sort of the elephant in the room which came up actually when we talked to tom coffee just now which is about acute hospitals um i mean i obviously trying to get people out of acute hospitals as far as possible is highly desirable for all sorts of reasons including clinical reasons leading the size finance but the as tom actually indicated when we just talk just now people have been talking about this and trying seriously to address this for many many years and curiously enough the challenges are still there and we see it you know not just here and we see it all there's a national issue clearly um and with corridor care and and you know all that stuff ambulance services and it does worry me that the the 10-year the the 10-year strategy doesn't sort of seem to really address that because i deep in my bones i have this awful gut feeling that despite all the efforts to sort of get people moving through hospital faster and all the rest of the community and all excellent stuff nonetheless the need for you know more capacity crudely at the acute sector whether it's mental health or physical health actually is a real challenge and in some ways um and we see it obviously with intelia recently um it's going backwards rather than forwards so i have no answer to this i recognize you know if i was the government i wouldn't have an answer to it either it's it's a it's a very but but it does worry me that the major 10-year strategy i don't i i think we should keep an eye on it as a minimum that we don't lose sight of the need for acute good good quality acute care as well as all the rest yes i mean i do know ministers are focused upon that stephen kinnick in in particular who's a sort of care care minister and the importance of um as we discussed trying to free up beds in um acute settings um it is obviously a challenge i think the purpose of the 10-year strategy is to try to look at these longer-term issues and to eventually address them some of the issues clearly around sort of discharge of payment of patients um are to some extent sort of covered in the next item of the better care fund but yeah i take your point in entirely you know steven it's it's very challenging agenda which is why i i think the government um developed um the consultation on the 10-year strategy and it is important we get societal sort of buy-in um from every quarter uh mark i suppose it's it's the strategy's not out yet is it the strategy we're expecting it kind of at the end of april i think that's the uh around that time um and steven i take your point and i take um tom's point but um i suppose there is a counter to that is that we mustn't stop trying to make that shift um because we know actually that people do stay in hospitals longer than they need to do they stay in the mental health acute wards longer than they need to and what we need to do as a system is that we need to be working together so that actually it's a seamless kind of transition from acute to community or acute to uh to social care um and we are working very hard on that we haven't got it right yet by any means but that's that's i think that's the thing is that we can't lose track of we also know it's better for people to be at home they have better health outcomes when they're at home so i just wanted to kind of put that caveat i don't think it is just about extra beds i think it is about us working as a system more efficiently yeah thanks thanks love clearly this is also a work in progress and i'm sure we will maybe to actually get a uh final response from the government uh we can have a further discussion about it but yeah there's um a lot of work to be done etc um um so uh having said that um can we uh let me see uh what we're doing here and we agree the recommendations to note the submission of the mhs 10-year health plan consultation response submitted on behalf of the health marketing board since it's already been submitted i don't think you've got much of a choice frankly but you know nonetheless can we at least agree that uh uh you know without any sort of fundamental disagreements as to the content okay thank you very much moving swiftly on the better care fund lynn oh shannon no i think i'm being pointed out yet um so i like my colleague shannon i will i will presume the paper has been read and i will then just highlight a few things if that's okay um there was an ask um from the health and well-being board about impact and some of the better care fund metrics actually demonstrate some of the impact now so if i just if i point you towards point nine um with a lovely blue blue and yellow table so um so there is a piece of work within the better care fund that looks at um that looks at intermediate care demand and capacity and as part of this so in this isn't a a metric as we will understand a bcf metric but there is a average response time to um from referral to discharge which actually we can see um has reduced from from the baseline which was set at 23 24 yes 23 24 it's reduced by by a day and a half on average across you know almost 2 000 people so actually what what we have seen is actually um an efficiency gain via the better care fund in terms of hospital discharge of and this is across all wandsworth residents um adult residents regardless of which hospital when obviously st george is about two-thirds of that and the other the other thing i think it's probably worth noticing as well is on that same table below urgent community response there's about a 30 increase in people being supported and kept at home regardless so so so and this is you know these are these are reasonably big amounts of people being supported by the urgent community response service um but we're still not achieving the avoidable emissions metric so so regardless that we're actually supporting a lot more people actually there's still work to do in terms of supporting those people although some of those people are are managed for our same-day emergency care so actually their their stay in hospital is actually very very short um and and finally um there is so and jeremy mentioned um um the uh sort of mental health discharge and rearmament pilot which has actually seen an impact of over a day just to add to that um so there is there's a southwest dundon scheme supporting step down from mental health and um and and that's seen a lot of people being supported across southwest london or across the five southwest london george's facing boroughs um being supported to to either as part of the crisis pathway or to or to actually get them out of acute secondary mental health beds and we'll pull that report in the next time that's happening um in just very very finally at the moment we are planning for the 25 26 better care fund round there's been quite a lot of changes i suspect in line with what will be coming out in the 10-year plan um and partners are absolutely working on that as hard as they can to meet the regional and national deadlines the regional deadline is monday and the national deadline is the 31st of march uh thanks brian comments uh just uh firstly to to name and and and uh shout out for brian in particular so i think brian has been doing work across wandsworth and richmond particularly on the data um and actually this morning we called uh it was a brianism we talked about brianizing all the data across all the bcfs in in across southwest london so um i just wanted to really call them out because actually this the level of data that we're now reporting on um is a step change i think the other thing to say is though is that we do also have to reconcile with that that with our data sources around um whether it be our acute colleagues etc i'm sure kate will agree um because actually we need one version of the truth and we need the whole pathway kind of measured and so it's just uh fantastic work um but i think we've still got a way to go as brian said yes agreed entirely um any in fact sorry any further comments from anyone um well thank you thank you very much uh brian for sitting in and presenting the report um i think you know it does go some way to answering some of the points that steven raised but clearly again you know we do face challenges and but it is important the work that we're actually sort of doing in this this area so um thank you very much for that um a lot of these things of course are overlapping interchangeable etc so hopefully you found the rest of the meeting helpful and useful good okay so the recommendations on this particular paper so we note uh the bcf spend and outputs activity for those schemes reported on for the period april to september 2024 as appendix one and also to note the outcomes and impacts of the bcf on hospital discharge as demonstrated by the intermediate care demand and capacity reporting can we agree that please thanks a lot excellent good uh moving specifically on the health and well-being board work program um then i'll go right this time this is me and um really i'm going to take it as read it's fairly obvious um the big thing i want to highlight is as um councillor henderson already said is our seminar on the fourth of march which is really about shaping the board so that it we all understand why we come here every quarter and that um we get the most that we can out of this really important strategic partnership and it will be run by the lga it will be here um in in person so please do come um and then finally to say as i always do if you have papers which are relevant to the work of this board please let us you know and we can put it on to the forward plan and to encourage partners to share um information here that's it excellent thank you uh brevity um much appreciated any comments at all on the work program excellent good so can we um let me see what we're doing on this one we're noting item is information does the board note the word program so thank you right that so moves us on up to the date of the next meeting which we held on the 26th of june uh of this year um but just to say to emphasize that we are holding this very important seminar next week on the 4th of march um starting i think at 10 o'clock etc it'd be great to see as many of you there as possible because as lynn said it really is uh an opportunity for forward looking to determine where we want to focus our attentions etc as well as you know creating an understanding not that i think actually we necessarily need a great deal of additional understanding as to why we're here and what we're actually trying to achieve but hopefully it will be um you know a very collegiate uh opportunity for us to come together and to talk about things our priorities interests etc um in a fairly sort of open way so i look forward to seeing as many of the board members and one or two invitees um to um that meeting on the 4th of march um i've been for or hasn't been notified of any other business um i would say if anyone does have any other business that hopefully it should be a fairly important issue i can't see anything and presumably no one behind me is indicating so um that concludes the meeting apologies it has sort of on uh you know there were some really meaty items there and as usual um um you know we've had some really rich conversations and a range of issues a lot of very pertinent questions which we will certainly take into account and uh develop responses to etc uh but i think it is a measure of setting the challenge we face across a whole range of areas but the willingness of all partners to come together to actually meet those challenges so can i thank on behalf of um onceworth council to thank absolutely everyone in the room and everyone uh who couldn't actually make it for our very positive and significant contributions to try to improve the health and well-being of the population this borough thank you