Transcript

Good evening. I'm a councillor. I'm councillor Jelani Choudhury and I am chairing tonight's meeting. Please note that we are not expecting a fire alarm test this evening. So if the alarm is sounded, please follow my instruction and evacuate the building. This meeting is being webcated to allow those who cannot attend in person to follow the proceedings. Please could I ask you to turn on your microphone when invited to speak and to remember to turn off your microphone when you have finished speaking. Please could committee members and officers introduce themselves starting on my right. And other officers will introduce themselves before they present their items. And we also have Sarah from Whittington who has joined us online. Thank you. Apology for absence. Apology were received from Councillor Croft, Councillor Gilligan. There are no substitute members for this meeting. Is there any other apology? Thank you. Thank you. Are there any declarations of interest? No. Minutes of the previous meeting. Can you all agree the minutes of the previous meeting of the health, wellbeing and adult social care scrutiny committee health on 20th of March 2025? Thank you. Thank you. Chair report, thank you to all the members that attended the witness evidence meeting with Clarion Housing Group last Thursday. Councillor Clark, could you provide some feedback on how the meeting went and any key point to be noted? Certainly Chair, it was a very good meeting. There was two Clarion officers there and they were very, very keen to hear our questions and answer our questions and they provided contact details so we can send further any cases to them that we're having trouble sorting out. I did raise the fact that I find the communication between Clarion and Islington Council, it could be improved in that I've got cases where Clarion are not actually responding to Islington when they're trying to sort things out and so it was really good to be able to talk to them face to face and get them to take that on board and I think they have and I've sent that particular case to them. I haven't heard back yet from them. So, yeah, I'm happy with that meeting. Thank you, thank you. Thank you for attending the meeting. It was really nice and it helped us to write our recommendation. Public question. I'm aware that we have a member of public present here today who has, I'm sorry, I'm sorry, will consider any question from the public after each agenda item. Please, can you keep your presentation to a minimum presenting key point only? Whoever is presenting any item, please make it minimum. We believe that everyone read the report and please just focus on the main point. Yeah, yeah, then we'll ask the question. Thank you. Now, B1 Wheattington Hospital performance report, Sarah, willing to present. She's online. Please, Sarah, you can go ahead. Oh, thank you very much, Chair, for the opportunity to present. So, colleagues will have seen. I've included key highlights of the quality count and this is the look of... Just, just, just, just, just, just, just, just, just, just, just, just, just, just pause it, please. ...counts and the priorities looking forward. Um, I suppose, I just wanted to, to note our relationship with the CQC and our regular meetings with the CQC around that, and specifically... Just, can you, just pause it there, please. Now, now, now, if you start again, sorry. No problem. Can you hear me okay? Yeah, would you like me to start at the beginning, Chair? Excuse me. So, so, so, so I think the key things are, so this is the, the quality account, the look back of 2023, 2024, and we're in the midst of, of developing our key priorities, looking forward for the next year, working in partnership with our key stakeholders on that. Um, we have a, you know, consistently, um, robust relationship with the CQC through our engagement meetings, um, which this year are very much focused on our work. Just, just, just, can you pause here, because it's very difficult for members to understand, because echoing everything. Just pause there, we'll see, we can do something. We did do a test, but I don't know what happened. Can you just try again, please, so we can see you? Yes, of course. How's that working? Is that left-hand for you, your end? Excellent. Shall I continue, Chair? Yes. Um, okay. So, our ongoing relationship with the CQC, so this year is very much focused on, um, Barnet 0-19 services, which has come into the Whittington family, so that, we're now providers of 0-19 services across the three boroughs, Haringate, Haringate, Islington, and Barnet, and some, um, working across those, uh, and your meetings around medicine management, um, and patient safety, so we have a good ongoing dialogue with the CQC on areas of focus. The key priorities for last year was hospital acquired deconditioning, um, access, and again, I think colleagues will remember that's a particular area of focus, particularly around attendance for appointments, and also health inequalities in our local population. If I pull out sort of salient points that I just wanted to, to, to, to, to go through, so pressure area care, um, across the organisation in hospital and community services. We've done a lot of work around pressure damage and prevention and work, but it remains, um, very challenging. We didn't meet our target for last year, despite a lot of education support and work with, um, colleagues around that. I think some of the key drivers, um, there's different drivers in the hospital compared to our community services, um, so in the hospital sector, the long waits in ED has definitely contributed to some of our pressure ulcer damage, although we relentlessly focus on making sure patients are moved through the organisation and discharged as quickly as possible. Um, community services remains very complex in terms of our real partnership working with social care, um, but also looking at, um, we, we're seeing issues around families not being able to afford to, um, use the mattresses and turning the pressure relieving mattresses off, um, and, you know, some concordance and some work very specifically with NRS, our equipment provider, um, which has been challenging. Um, which has been challenging over the last 18 months, but we have some improvements in, um, um, discharging patients with the correct equipment and responding, but that still remains an area of challenge. I would say this will remain a key area of focus and, um, we've very much been working with our safeguards in Leeds as well around looking at some of the challenges around pressure ulcer care. Um, um, hospital acquired, um, deconditioning, um, so you will know our work around virtual ward, um, I think the things I would really, an urgent response and rapid, um, access, but the things I would pull out is medically optimised patients. Um, it remains a challenge across the organisation at any one time we can have between 40 up to 60, um, patients that actually should be cared for in community services. So lots of great ongoing work with social care, but through our winter months, we did open up additional capacity and also, um, got additional support by an external company, Ahmed, which helped us expedite some patients to have care in, in their home, um, to bridge care through that time. Um, I think around virtual ward, one of the things that we're looking forward for the next year is looking at, um, making it more sustainable model in terms of consultant cover. So we've got medical consultant cover. So we've got medical consultant cover. We now want to develop advanced nursing, um, pathways and career options there, which I think is a really positive step forward. Um, around nutrition, we focus very much on our most vulnerable patients around supporting those and we've made some headway, um, regarding that. And we've also very much worked with our estates and facilities team on making sure we've got food out of our oven and they've got access to food. So we've got attendance for appointments. Attendance for appointments. Um, again, some great work around this, around the use of Zesty for, for patients and being able to see their outpatient appointments through that time. And a large pod project on patient letters, um, which has been a real key driver. We had enormous amount of letters that, you know, didn't have the correct information and confusion for patients. So really worked in partnership with our patients to improve that. We know, um, the hospital site can sometimes be, um, quite hard to find your way around. We've done some work around wayfinding, but also increasing our volunteers. So supporting patients when they're going to different parts of the organisation. We've massively increased their use of volunteers and, and see that's a really positive element. Um, colleagues will know about our work in CDC and happy to take questions around that. Um, I think as well, really focusing on our most vulnerable patients around learning disabilities and patients with autism. So again, we've very much worked with patients, um, that have lived experience of learning disabilities, developed videos around what it feels like to be a patient at the Whittington. Um, and those are accessible for patients with autism as well, but we do have, I think, further work to do, particularly through the emergency department on patients that have sensory, um, issues. And I think, again, this is an area that we will focus on. Uh, focus around transport. So we have seen some complaints reduced in our partnership work with DHL. But again, I think an area of focus, um, and we have performance meetings on a regular basis with them to, to look at some of the issues that we have. And some of those have been about, um, taking equipment with patients on discharge. And again, sort of working in partnership for improvement. You will know, um, our sickle cell patients is a really important part of our organisation and getting the care right for those patients remains a relentless focus for us. We've seen some really good improvements around, um, access to pain relief through the emergency department. A real focus on that through our ambulatory pathways. We've now identified a ward, um, for adult patients with sickle cell, which we very much want to work with our patient group on, you know, supporting and training, um, staff more in that area. We did have a peer review of, um, sickle cell, um, over the last year, which showed some really good practice and really dedicated clinicians and really great patient feedback. But we still have work to do, um, around that. So again, an area of focus. Um, we continue with our Oliver McGowan training, which, which you'd expect around autism. Um, and then I focus on prostate cancer. So I think a really good initiative around the C factor. So this is, um, very much an eight week course supporting through storytelling, supporting the pathway for patients, um, that have prostate cancer in the organisation. That is very well supported. You will see over the last year, we've done huge, um, improvements on our patient experience, particularly in cancer care and really pleased to be working with UCLH on that sort of real partnership work. And so making sure patients get timely access, um, to treatment, but also how they feel and nurture through that pathway has been absolutely essential. We've got an active patient group actually in prostate cancer, which has continued to develop on looking at improvements. So I think our looking forward, um, you know, so our key priorities, you'll see them in the presentation, but the one I really wanted to call out that we will absolutely focus on next year is environmental issues that affect patient experience. We've got an aging, um, estate, which we are looking at ways that we can do things like the floor, the fabric and make it, um, as light as possible in a financially capital constraint environment and also a very busy organisation. We've recently just done that one of our wards, um, care of the elderly ward, which, um, the actual fabrics was really challenging and challenging from an infection control point of view. So again, our real sort of focus on that and how that, that improves patient experience. Happy to take any questions. Yeah, I hope that was timely enough. Thank you. Thank you. Although it's very difficult for us to digest everything, it's echoing everything, but it's okay now. And, but I would be grateful in the future meeting, if you can come from Huntington for face to face, it is easy for us to listen, also other members. Thank you. Thank you. Thank you. Thank you. Thank you, Chair. Thank you for the, for the, the written report was really excellent. It is very good. And, um, sorry, we couldn't hear you that well. Um, just now, but, um, I'd like to just say, well, that I've actually been under the Wittington, I had a fracture, and I've been there today, actually, and it was extremely busy. And what I noticed, the culture is very friendly. There's a, the, the, you know, people, patients are treated with great care and patients, and I really, I did really notice that today. Uh, you know, staff are working really hard to, to create that culture. And, um, I'd like, well done with that, really. The thing that I picked up from the report was about the digital, you've got this new digital. I can't remember the name of your system, but, uh, the thing that I did, that affected me, was when I wanted to change my appointment, it was quite, I had to be very, you know, patient, really, to change it. I had to keep phoning up, because everyone's so busy there, it's hard to get through on the phone, and I left a few messages, and eventually I did get through, and, and managed to change the appointment, because, of course, you don't want people not showing up for appointments, you know. So, uh, that, that'll be good when you have actually sorted that out, that part of your digital system out, that'll be great to improve that. And I'd just like to ask you about delirium discharge pathway. What, uh, what actually is the delirium discharge pathway? It's mentioned on page 13, um, but generally, a very good report, you know, great improvements. Thank you so much, Councillor Clarke. I really appreciate the feedback, and I'll make sure, um, colleagues in the organisation hear that you did come on, and particularly today has been exceptionally busy. We were on April 4, and, and I will make sure that the team are aware of your positive feedback. And I'll also pick up around the necessity, around the changing of appointments, and perhaps come back, um, through the committee to, to give some more feedback and assurance on that. The delirium pathway, so this is, um, supporting patients that do have altered cognition to, again, get patients back into their own home as quickly as possible. We absolutely know patients do better in their own environment with support and infrastructure through our consultants, nurses, and that multidisciplinary team. And, um, we've had some really great feedback around how, how much better patients do when they're supported in their own home. Um, I think, again, being able to offer that to more patients is absolutely vital. Um, so, again, an area of absolute focus. And I think with extending our advanced practice roles with nurses and AHPs, it's something we can absolutely build on a good platform. Thank you. Thank you. Great. Thank you. Um, just a couple of questions from me, uh, and thank you again for the report. Um, first of all, I'm very conscious that we're kind of dealing with the, the sad news that the raw free paternity ward has been closed. Um, so I'd, I'd be interested just to know how the Whittington Hospital is, is grappling with the fact that it will be dealing with and supporting mothers from a wider geographical area. And, um, how we can look forward to see kind of maternity services, uh, hopefully adapting and thriving. Yeah, absolutely. Thank you. Thank you. And also acknowledging in this situation that, you know, obviously we're very delighted at the Whittington, um, that, um, Starkwell supported the Whittington stay in the haven, but also recognise that's very difficult for colleagues at the Royal Free. So I suppose, firstly, I just want to acknowledge that. Um, secondly, um, we're standing up to some working groups as there has been through the whole of that process. Um, it's been very much led through the ICB with absolute collaboration across, um, partners across North Central London. There's been several work streams around that looking at workforce would be a really good example. Finance would be another. Um, at the moment we're working through what does that mean in this, in this period of transition. There's a meeting tomorrow, which I think will give more clarity on the sort of work plan going forward. Having said that for Whittington, we absolutely acknowledge once you have an announcement like this, um, women and families will vote with their feet. And we absolutely expect to see an increase before the maternity unit closes at the Royal Free. Um, but also, you know, very much again work with our partners at UCLH as well, because I, I think it is likely that patients will be, um, across. I think in terms of the wider geographical, um, elements, so this is really about working with our, um, maternity neonatal voices partnerships. We've got brilliant, um, support through those. Um, and I think it's actually we're talking about that today, working with them and our local people, local population, um, and co-designing pathways that, that, that work. So we, so we've got a lot of, I think, one, we've got a lot of experience. Two, we're really excited. And three, we've got a journey to go, um, on that. So, um, we will absolutely do that as, as the way we always do in complete collaboration across the system. Great. Thank you. That's really helpful. And just a final question for me, and it's helpful that you meant, uh, mentioned integrated care boards. Um, I'm very conscious that ICBs have been asked to make quite dramatic cuts to their resourcing at the same time while major changes are proposed at NHS England. Um, it'd be good to understand how the Whittington is kind of navigating those changes and, um, yeah, what, um, what, what, what we can expect in terms of, uh, changes to service delivery. Yeah, thanks very much. I mean, I think firstly, again, just to acknowledge how, what a challenging environment, um, colleagues are working in at this moment in time. And I suppose for us, we're waiting on clarity on, on what that might mean, but there are elements of absolute certainty that we absolutely know across the system and how that translates at the Whittington, the Whittington board and the whole of the organisation. So key things are real focus on temporary staff. So focusing on reduction on agency, on bank, and really putting them some, some, you know, support to make sure that we reduce from that point of view. That is a really key part from our point of view. Um, I think there are opportunities in this really tricky time though. Um, and what I would say on that is I think we will, we are seeing that staff are not, are not moving as much. Um, and therefore, you know, I think there is an opportunity to support and develop the workforce, um, in this uncertain time, actually. So, um, in terms of service provision, we've not cut any service provision, but I, what I would say is that, you know, we're working really strongly in collaboration with UCLH around some fragile services and some pathways around how we can strengthen our relationships for the benefit of patients and also staff. So myself and the chief nurse at UCLH are looking at what's, what's, what's the art of the opportunity to develop nursing midwives and AHP across our two organisations of what things can we do together that makes sense around training, around rotation, that really develop the workforce for the future as well as patients. So I think being nimble in this time and being really sort of thoughtful around, um, some of the challenges as well as the financial constraints. From a safety and quality point of view, they're very much thinking about my professional hat from that point of view. making sure when any service provision is proposed has changed that we do a quality impact assessment and that we re myself in partnership with the medical director particularly scrutinise that and advise the board if there's any risks associated with that that we can mitigate. So we're really working on that and, um, yeah, but it, but, but, but, you know, it is challenging for everybody. Thank you. Anything? Okay. Thank you. Thank you, Chair. Thank you, Sarah. Can I ask what the statistics are for A&D waiting times at the moment? Yes, um, let me just pull up our performance report if that's okay. Um, so we had seen quite a lot of improvements, um, on our A&D performance, but we have also now seen a bit of a dip and particularly, and again, yesterday across the whole sector, there was a real challenge around, um, well, ambulance diver, let me pull up the, if I can find the exact time, uh, the response time for you. Um, so I think importantly, one of the things I would like to frame though is at ambulance handover times we work really hard at the Whittington to make sure patients are moved into the organisation and not waiting in ambulances and I think, you know, our time, uh, um, patient times on that is, is really important. We do have 12 hour waits, um, which has increased, um, over the last month and, and some of that we, we are definitely seeing an influx in mental health patients and that's adults and children and waiting for onward placement. And that, that becomes very challenging, um, you know, because it's such a hyper stimulated environment. So again, very much myself and the medical director and the coup trying to work with North London mental health partners around, um, you know, timely discharge, but for patients that are in hours. Um, so, so the March performance for, for the, the standard was 72%. So that is an improvement. Um, but February's performance was 66.8. So, um, and you know, there's been a whole range of, of things that we've, we've done to try and improve those sort of weights, um, around that point. Thank you. Thank you. Thank you. Is there any question? Oh, yeah. I just want to say that, um, the chair, Councillor Chowdhury and I were members of the joint health overview scrutiny committee for the last couple of years and been dealing with the ICB on the closure of the Royal Free and on the, you know, choosing, um, between the Royal Free and the Whittington. Very, very, very difficult, very hard, but it's a great relief that we have the maternity service at the Whittington because it serves such a huge geographical area and the, and it was much better used than the Royal Free. And, of course, we don't want to see the closure of any maternity services, but we were told that there'd be investment in the Royal Free, in other services. And so, the, you know, as I said, we really welcome the, the, the maternity unit at the Whittington is going to be improved. Thank you. Thank you. Thank you. Thank you. Thank you. Is there any question from the public? Yes. On a, on a, on a, on a further point of information, I asked earlier on if a transcript of the report would be made available, which I, I understand that what amounts to an undertaking is being given by the committee that it will be, presumably, when the minutes are published. None of the questions and answered, except you, madam and you, sir, were very clear, but the answers couldn't be heard. This amounts, I think, to a democratic deficit. It's not possible to understand what is going on in these proceedings unless the reverberation, which is all too clear. I'm not sure if you, ladies and gentlemen, have got an automatic transcript appearing, but someone in this room is linked in and they have not put it on to mute. So could I also ask, as a second point of information, it would be good if it was confirmed, that a transcript of the questions and answers was also made available with the minutes of the meeting? Yes. All the answer I was given today is, will be available next meeting. Yeah. It will be made verbatim? Yes. Sorry? Verbatim. As it was spoken. No. It will be verbatim. Not in summary form. No. No. It will be verbatim. No. Not in summary form. Thank you. Thank you. Please. Could we mute the report? Thank you, sir for coming here. Many thanks. Please, could we mute the report? Thank you, sir, for coming here. Many thanks. Thank you very much. The opportunity... I'm looking forward to when you come next time to Face2Face. Of course. No problem. Thank you, Chair. Bye-bye. Thank you. B2 UCLH annual performance update. Someone like to present this? And you also have David Preva, who's the Chief Executive. David. Go ahead. Are you going to display the presentation on the screen? Or should I just assume that it's... If people have it... Because on the main point, yeah, then we can make a question. Yeah, sure. Thank you. Okay, so as we've done in previous years, we'll just do a quick look through all the key areas of our performance over the last year. And we start off in the first couple of pages looking at things like our infection rate. So you will see from the papers that we've maintained kind of a good, low level of infections in areas like MRSA and Clostridium difficile. This was in the face of kind of increasingly stringent targets. And we've been pleased in particular on the C. diff that we've been able to keep within those targets broadly. The next page looks at our performance on pressure ulcers, where you'll see, again, we've kept a very kind of low level of pressure ulcers. It's quite difficult to find benchmarking on this within the NHS, but most of the intelligence that we can find is that we've got a good, low level of pressure ulcers. And there's some information there about how we go about keeping on top of the number that our patients have. In terms of waiting times, this is referral to treatment waiting times. So this is how long it takes for us to move a patient from referral through to giving the patient the treatment that they need. The focus of the NHS has been very much on the longest waiters since the pandemic. So trying to bring down the very long wait that the NHS has seen for patients. And for the last year, the aim was to get down to a maximum waiting time of 65 weeks. So just over a year from referral to treatment. We got down to 20, at the end of March, 26 patients waiting longer than 65 weeks. So we were disappointed that we weren't able to deliver that kind of standard for all of our patients. Just two or three services where we had particular challenges. But we are confident that we'll be able to get down to that standard over the next month. Instead, the focus shifts now to a bit more about returning to the old constitutional standards, which is the percentage of patients waiting more than 18 weeks. And there we've got to get up to 65% of patients rather than we're about 60% at the moment. So that's going to be quite a challenge for the coming year. And if you do invite us back again next year, we'll tell you how we're doing against that. Diagnostic waiting times, you'll see that we've done quite well there. We are very close to getting back to the standard of 95% of patients being tested within six weeks of the request for the test. That, and also with the RTT performance, we're performing relatively well against the rest of the NHS. So we're kind of pleased with that performance there as well. In terms of cancer rates, we've done really well against the standard that we need to give a diagnosis to a patient within 28 days of them being referred to us. And there we've kind of been exceeding the national targets and then also exceeding the national targets in terms of making sure that 96% of patients are treated within 31 days of us saying we're going to treat you for something. So we're pleased with how things have been going with cancer. AD performance. We're kind of around the London average in terms of the four-hour standard, four hours from the time that a patient comes to the ED to the time that we either discharge them or admit them. Doing well against some of the safety metrics as well, which we're pleased with. So the colleague from Whistington referring to ambulance handover times, we're really pleased with our performance there. We've got one of the best performances in London on that, and that means that patients aren't waiting inappropriately in an ambulance and we're looking after them in a much better place. Just move on to the inpatient survey, where you will see that from these results, which I think are the 2023 ones, we are performing really well compared to London in terms of the overall experience, the patient's report through the inpatient survey. And then in terms of our workforce, which is something which you asked about last year, our vacancy rate has improved across the year. So we've got a really low vacancy rate at the moment, which is paradoxically also driving an increased kind of headcount, which is one of the focuses in the coming year in terms of the financial challenges for the NHS. Yes. And just one thing that we should perhaps put into the slides, which was our performance on the staff survey, where we think we're the best acute trust in the NHS in terms of staff engagement and performed really well across a whole range of measures. So we're very proud of UCLH as a place to work. So those are the kind of key things I was going to give well out. Thank you. Thank you. Yes, Councillor Clark, please. Yes, thank you very much for coming. And really, I just noticed on the inpatient report, you talk about the peer, the peer, comparison of peers. And I just noticed that a lot of those hospitals are like South London hospitals, aren't they? And I just wondered about the Whittington and why that isn't mentioned as a peer. And that leads on to my question about the working together with the Whittington and UCLH. How's that going? And could you just fill us in a little bit about that, please? Thank you. We can certainly include some of the more local trusts as well for future years. I don't know off the top of my head how the Whittington they're doing, but yeah, we should have included the Whittington there. I think it's roughly peers based on bed number size, looking at the type of hospitals. So roughly hospitals that have a kind of thousand beds would be our peers and teaching hospitals. Chelsea, West and Menstead maybe being the exception, but we can include the Whittington. Just in terms of the collaboration with the Whittington, if it's okay, I'll give you a brief update. So the collaboration is going very, very well. It's been in place now. We've been running a committee in common for around 12 months. As colleagues will know, we have one joint chair in Baroness, Neuberger, who chairs both organisations. And what we've set about to do is not focus on function, form or governance, but to focus on getting good clinical teams together and operational teams to see whether we can deliver better care for our population together rather than two individual organisations. I should just point out, yesterday we had a presentation from our colleagues in nuclear medicine. So a very complex, difficult area where UCLH and the Whittington now run one service for the population of Islington. And the speed of access now for local residents has improved dramatically. The expertise has improved dramatically. And the same is true particularly for cancer services provided from the Whittington, where we now generally jointly appoint between UCLH and the Whittington, which has one benefit in terms of the type of individuals that might apply. But very importantly, people are coming to work and be connected with UCL. So you're getting fantastic academic leaders coming into both UCLH and the Whittington as well, the collaboration. So all is going very well and positively. And the mood music on the ground amongst staff is very positive. Thank you. Thank you. Great. Thank you. At the risk of repeating myself, I'm very conscious of the upheaval in ICBs and the changes to NHS England. And I'd be really keen to understand how you're navigating that space right now and whether or not you're seeing any impacts. Yeah, I should admit or confess that from Tuesday next week, I also become the deputy chief executive of the NHS. So I'm going to have a bit of a role in this as well as my UCLH role. As Sarah said, this is an incredibly difficult time for our colleagues in the ICB who do the most tremendous job. And we're very fortunate in North Central London to have such fantastic leaders. So we're working with them to work out what we can do as organisations and acute providers to support the good work that they've been doing. There are a number of areas. I won't go over the type of things that Sarah was talking about, but there is definitely room and opportunity for more collaboration. The reduction of potentially nearly 50% of the workforce is sizeable. So we need to understand what we can do both at provider level and at regional office at London. And we're working through that now, I think, with the aim of having things at least confirmed towards the autumn for the staff. But it's a very difficult and challenging time. A bit like Sarah, at this stage, we see no particular impact on clinical services that we intend to offer to the population. Thank you. Yes. And just one more from me. I'm very conscious as well that the pay review bodies have made announcements that sadly are under union recommendations and that the spectrum of strikes in the next 12 months has grown. I wondered whether there's any kind of planning or preparation for the likelihood of a strike and what that might mean for services. Yeah, I think many of us had hoped we were going to face a year with no further industrial action. We still hope that is the case. But we are just beginning now to think about the possibility, particularly in first instance with nursing colleagues and in second instance with our resident doctors or doctors in training. So we will go through the process of starting to plan at least at tabletop level at this stage. Many hospitals in London, UCLH included, I think, handled the period of strike very well from a safety perspective. No patients came to harm as a result of the strike. However, many patients had their care disrupted and that isn't acceptable. So we have to work out how we can try and minimise the risk of that happening as we move forward. So just starting to plan now. Thank you. Thank you, Chair. Thank you for the presentation and congratulations on your... Or is it commiserations, is it? Right, okay. Next year when I come back, I'll tell you. Okay. Can I ask about cancer performance? The stats are really quite good for UCLH. But then one reads that England does worse in cancer treatment than many other of our statistical neighbour countries. So do you know how you compare with other European countries? I can give a bit of detail, but Simon's always the brains behind the data. So I'll give you a little overview. So particularly when you look at UK performance against colleagues, firstly it's very difficult because we don't generally measure apples for apples. So it is sometimes hard to look at the comparison, the way people collect data. But very generally the UK does poorly, particularly against Nordic countries and particularly against other European countries. And we believe, the theory is, and I think it's probably true, that it's access to early diagnostic care that is one of the single biggest challenges. So UCLH is part of obviously the British NHS. There are a number of areas where we would fall into that position of having patients arrive at us late in their pathway. And therefore we would probably rank fairly similarly to other NHS hospitals. However, there are a number of areas, and blood cancer, haematology being one, where the latest data that we collect on our transplant survival rates, so the amount of patients we transplant, and we're the biggest centre now in Europe, compared to amongst everybody in the world, almost ranked first, second, or third in any given year. So whilst there are areas we need to improve on, there are certain areas where we specialise, where we're very proud of how we've managed to do. But generally, it's access down the pathway to early staging of treatment. One thing I may just comment on, if I may, because we should be very proud here in this part of London, is what's known as the Summit Study, led by Dr Sam Jaynes at UCLH. He has been working hard for a number of years to get MRI access and scanning X-ray access out to the population, for everybody who's smoked and is over 60. He's put those machines in car parks, Sainsbury's, everywhere, all over this part of London and into East London. The results of his work has been published recently, and will be further published, and he showed that by doing that, we've managed to move a stage earlier, the cancer journey of diagnosis. Now that's the type of initiative we need to focus on in prostate cancer and more broadly. So there's some wonderful work going on, right on our doorstep, but we've got a lot more to do as a country. Thank you very much. Thank you, Chair. Thank you. Okay. Just one question, if any, no, just one question regarding your appointment system. Now you did a digitalization appointment system, yeah. For me, sometimes I find it very difficult, especially, and also just your booking sometimes received, from my personal experience, someone called me and they say, your appointment is day after tomorrow for us. I find it very strange, like this kind of appointment, like, or about the working, or they need to manage their time and everything. Are you aware of this kind of thing? And also people, like older people and other people, they find it very difficult to use digitalization. What kind of support is available for them also? Thank you. Thank you, and I apologize for your experience. The first thing to acknowledge to colleagues is that we absolutely accept that the service quality we offer in terms of booking an appointment is not always at the optimum level, which we want it to be. I think where we find ourselves at UCNH, and we're not particularly different to a number of other hospitals, is somewhere between the modern technology of the app and the traditional technology of the telephone and the paper. And we are slowly moving to a position where more people are going towards the app, and we have a very sophisticated system which we're working on to allow patients to change their own appointments through the app, whilst at the same time recognizing that for some people, that's a system people will never wish to use, and we will never force people to singly use that one system. But that does mean we're having to keep infrastructures on both sides. So at the moment, it isn't at the level we want it to be. The first thing we've been focusing on the last two months is our telephony system and access for patients more direct, as well as through the app, and you should be able to see the results of that relatively soon. But secondly, we're looking at centralizing and changing our admin function so that we can better support appointments and booking. No patient should be being phoned up with 24-hour notice for an appointment, unless they've been asked to be put on the last-minute list, but I'm sure that wasn't the case in your position. So I can only apologize, and when we come back next year, I hope we've made good progress. Thank you. I have a few questions that I would like to ask on behalf of other counsellors. My first question is, can UCLH confirm whether receiving and responding to Conor's court order requesting witness best able to assist in identifying the cause of the death is regular and accepted practice? Thank you very much indeed. And thank you, colleagues, for giving us the opportunity to see that question in advance from Councillor McHugh. So just to very briefly summarize the process, when somebody has deceased in our hospital and the coroner contacts us regarding that, the coroner will ask us to review the case, and our legal team will look through that case and review all of the incidents that have happened along it and contact the people involved in that person's care. Sometimes the coroner will ask us intentionally to provide witness statements or evidence from particular individuals, but more often than not, they won't. In that case, our inquest manager will go through the entire pathway of care, the medical records, and ask for those colleagues involved to provide written evidence as to what's occurred in the case, and all of that will be submitted back to the coroner. The coroner will then sometimes come back and ask specifically that certain individuals then attend the rest of the hearing as it goes forward, or, as has happened in a number of occasions, they will leave that to us to make a judgment on who we think can give the best overview of the care as it's presented. So, this is very much determined by the coroner. This isn't determined by us. And when we are given an opportunity to determine it ourselves, then we try and do so providing the best people that we can put forward with the best evidence available. The next question is, can UCLH further give details about how such determinations are made and scrutinised internally? Yes, so hopefully I've managed to answer that just now, but we will determine that through our inquest manager, through our clinical governance team, to make sure we have the right people providing the right statements and attending the right coroner's inquiry, as we determine best or as the coroner has requested. Thank you. And finally, the task wrote to Councillor McCorkle on 18th of February, 2025, advising that it is recognised that cognitive error contributes to most diagnostic error in emergency healthcare. Can the task please confirm its initial statistics for how often such diagnostic errors occur and how often the task mitigates procedures and mitigated the impact of cognitive basis? Vice? So, in terms of that type of error, we don't record it to that level of detail in both of our recording and incident systems, but we've looked back over the course of the past year, or from spring last year up until about April 25, and within our emergency department, there were five errors that were determined in diagnostic pathways by humans, human errors. How we mitigate them is something I think we are quite proud of at UCLH. We encourage learning amongst our consultant body. We add things to our resident doctor trainings. We expand our library on everything we learn, and we talk very openly both at board committee and at all the subcommittees with those involved to try and understand how these human errors occur and how we mitigate them occurring moving forward. And we've seen some very positive results in a number of areas where we have mitigated errors reoccurring on a number of occasions. It is unfortunately part and parcel of healthcare, but our job is to recognise it, to be transparent, and to mitigate those risks as much as possible. And I think, on the whole, we do a good job of doing that. Thank you. Thank you. Here's the Councillor of Greg. Oh, yeah, thanks. So, this report is very positive, is showing great improvement, and, you know, the stats do. But there's just one area that is always really concerning, and it shows an increase. And as you mentioned in the report, there's a national increase in the case of C. diff. And, you know, to me, this is very important. You know, when you go into hospital, you want to be safe, as you know. But could you give us some ideas of how you're going to... You say here some of the ways you're going to improve the situation. Could you elaborate on how you're going to improve that situation? Often, the focus is on our antibiotics prescribing. That's one of the key things. And I think there's so much research that we're doing now into how we can provide better information, better protocols, and really get on top of our prescribing to reduce the risk down further. A lot of these cases are in our cancer population, so patients with cancer who are kind of much more susceptible to that particular infection. So that's where the bulk of our kind of response is. It's very difficult with such a large, particularly hematology, population. There will always be degrees of levels of C. diffus in particular. But I think on the whole, when you compare bed numbers and levels of outcome, we're very, very low. But one case is one case too many. So I know our chief nurse and infection prevention control team are really focused on this moving forward. Thank you. Is there any question from the public? As in that, you have any question regarding this agenda? Is it related to this topic? Okay. Introduce yourself and ask the question from there. Yeah? Thanks very much. Just before you start, if a question regarding the agenda, if you have any question regarding your personal, anything, yeah, you can write to us, we can reply back to you. Because they are here regarding the agenda, whatever the agenda is, and they discuss. Do you have any question with that? Absolutely. I completely understand that. It's just by way of quite a few of yourselves sharing personal experiences. So I'm kind of obviously preambling with that. So our experience from a sort of inpatient patient perspective of the discharge process has been a little bit lacking, I would say. My mother in 2022 was discharged and transferred to Royal Free Hospital. It was a late night transfer and she was sent without a nurse and obviously suffered cardiac arrest and passed away subsequently. You spoke about looking at debts and so I still have not had an adequate response to my complaint with regards to that. So that's, you know, one thing. And I'm kind of talking about this as a general point of discharge because that was in 2022. 2023 and 2024, my father has been an inpatient on T10, elderly medicine ward. And the discharge matron, and we can go into this offline, obviously, because it is personal, but there have been quite a number of unsafe discharges and it is blatant. So it is obviously quite good to celebrate success, of course. However, I'm not sure that these instances of where things are not going right are being looked at and then something being done about it because we're in 2025 now and this still continues to be the case. Thank you. Just take on that because this is more personal and if you feel that you're going to write personally to them you can do it so you don't need to answer as a personal question but generalise, you can answer to us. But personalise anything when you do it so you can reach and answer to us you can give it to them or whatever it is. Thank you very much. Will, it would be very wrong on me to respond in any detail but what I did want to say was to firstly pass on my condolences for your loss and secondly to apologise if we haven't communicated back to you properly and to assure you Mrs Roy that we will look into that. Thank you. Thank you very much for coming. Many thanks. Thank you for coming and a very good report. Thank you. Well, on a point of information will what has just been said by Mr Prober to understand now is going on to greater things at least for a year also be a verbatim transcript within or attached to the minutes of this meeting. Thank you. And now B3 quality assurance and home care. Anna, may please come here to present your report. Would you like me to begin? Please. So, thank you for inviting me here today. So, this is just to discuss the process that we undertake within the council to quality assure our providers in particular home care. So, my name is Anna Makepeace. I'm the assistant director of quality contracts and brokerage and within the health and social care directorate. So, I guess just to reassure colleagues today that we actually have really robust processes that we undertake in order to support our providers and to ensure that the people and residents of Islington have high quality, effective and safe care. We do this through a number of approaches including collaborative approach. We work really closely with our colleagues in care quality commission, with our health partners, with our colleagues in operations at safeguarding and across, most importantly, our feedback from our residents in order to ensure that any learning or anything that we're taking we can take forward. So, I guess lots of reassurance around that. We also work really closely with our voluntary sector. So, we do commission two services within the voluntary sector to work specifically with people with learning disabilities to get feedback in order to make sure that we can factor that into all of our processes. In terms of just a couple of key points, so the approach that we take is via a quality assurance framework. So, the quality assurance framework was rewritten last year and launched in September 2024 and in that it really shows the importance of putting the residents and feedback at the heart of everything that we do. As part of that process we undertake three kind of main activities. So, first one is quality audits. We undertake an annual quality audit of every provider that we have a contract with which is around 80 contracts and we look to do that every year. Currently, in the first six months we undertook 37 and I think 34 of them were good or outstanding which is really good practice. We also undertake contract review meetings so that's where we look at how their performance is on our key performance indicators and actually we undertake that quarterly or six monthly depending on how the contract is going but we make sure that we have that honest robust conversations covering things such as equalities, how they're working with their staff, how they are managing any challenges so really trying to understand them. And then the third thing that we do is we do something called an annual quality audit, annual quality statement and that is to make sure that we get a framework to understand that providers have got the right policies in place to make sure that they are following what we want so things like they've got the training for the staff which we kind of follow up in the quality audit. So we have a really robust process. All of this is overseen by something called the Integrated Provider Quality Oversight Board which is chaired by our Director of Strategic Commissioning and Investment and reports it up to the Safeguarding Adults Board. That's a monthly meeting that brings together any concerns or any worries we have about providers and the report goes up to the Safeguarding Adults Board each quarter just reflecting on that. That's a really useful meeting and it's about working in collaboration going forward. I guess the final thing that we do to give assurances is we're not the only provider or the only organisation that works with providers. The Care Quality Commission is a really key partner for ourselves. They have statutory responsibility for ensuring they oversee regulated care so for example with home care or care homes we have really close working relationships with CQC and we monitor their activity and also their rating so you'll see in the presentation that we delivered that a number of our providers are rated good or outstanding where providers have not yet been assessed we work with them closely to start that assessment process and we share intelligence as much as possible. What we're trying to do and we continue to do is take learning from what we're doing so just because we've launched a framework doesn't mean that we're going to stand still. What we're looking to do this year is continue to work with our colleagues about making sure that we really really celebrate the voice of the resident and use their feedback to support us and making sure we get our processes right. Continue to be that supportive and collaborative approach with our providers that's so important and actually when things go wrong it's about supporting them to make things better not necessarily just telling them off and also continue to work at how we can look at data so actually how we can use IT and digital to ensure that we are using the best use of our resources but also supporting that provider to use the best use of their resources so they can focus on what is most important which is delivering the care for our residents and I'm happy to answer any questions that people have. Thank you. And when to start? Yeah, thank you. I thought this was a very reassuring report actually because something needed to improve around quality assurance and we've had you know events that have been quite tragic and so this is I'm really glad to read this and the good I just wanted to I mean there's 92 contracts you know and so that's going to take quite a lot of monitoring and you do go you go into great detail about how you're monitoring them and there's a bit a few discrepancies though because you'll say like contract monitoring on page 53 you say contract monitoring every three months for other contracts meetings at a regular period and it doesn't really you know so it's very specific for home care and but then it gets very vague for other contracts which is at a regular period and then there's another bit of discrepancy with page 54 and page 55 with a reassuring list of activities that maintain quality and provide assurance and the quality assurance happens every two years for home care but then it goes to annual you know the quality assurance happens every two years for home care and it just you know it seems a bit not good enough really yeah so I don't have quite the pages here but if I explain and apologies for any confusion so the approach that we take is a risk rated approach so we monitor within our team care homes home care all the way through to voluntary services that don't necessarily deliver personal care but they deliver services in the public I guess so one of the things that we try to do is as she said we have a number of contracts is we've regulated them based on the level of risk that risk is reviewed really regularly so actually if you are a provider that perhaps delivers personal care such as care homes or home care you get kind of more enhanced monitoring so for example you have a contract meeting every quarter you have our annual provider visit we meet with you regularly we have those engagements if for example you are quite a small contract so we have some contracts where it's about engagement with the public and actually we believe that you're doing well what we're trying to do is reduce our level of monitoring because actually we know for them it's stressful it takes also there's not always a good use of our resource so we'll actually meet them annually so we tend to do that in terms of home care that is a high risk area for us and what we're doing is meeting them quarterly and then annual visit provide visits so I'm sorry if there's confusion in any of the reports great great thank you I was listening interestingly about the different ways that we measure quality assurance one of the things that I'd like to hear a little bit more though is about the role of workers and unions and making sure that like we are hearing that services are of good quality yeah so in terms of in terms of the unions in terms of from our staff within our organisation or just a bit more clarity so unions that represent some of the care workers that are in there yes that's a really good point so we haven't that's something we haven't explored and I'm happy to take away and look at that further what we have done as part of the quality assurance framework is we now talk to staff so actually before we probably talked to them but it was a more informal process now we have a set space within that audit where the contract officers that's the people that do the audit they talk to staff on a one-on-one basis we have confidential conversations as much as possible and we ask them a range of conversations so they can be honest with us I think that's really important one of the things that my team do check is things like that the staff member understands the whistleblowing policy as well so actually it's about some of that wider staff we haven't engaged the unions like I haven't said and we can take that away but actually at the moment it feels the work we're doing with the staff feels new to us and needs developing but feels like it's really really positive and giving us some really good assurances or on the other hand giving us some areas of feedback that we need to kind of check on so for example if a manager tells us that they're getting training but the staff member contradicts that that's something that we will explore and have senior conversations with great it'd be great to kind of follow that up on unions and perhaps share an update of potential plans on that because I think that'll be very welcome just one more question for me I wonder whether there's any role in quality assurance for looking at ownership and ethical ownership I'm very conscious that sadly we're seeing an influx of private equity and worse flooding care homes and home care spaces and what the ramifications for all that means for care it'd be interesting to know whether there's any kind of measures or practices that the council looks at in terms of the businesses it partners with their practices and corporate social responsibility yeah so I think that probably is best I'm asking my colleagues who lead on the commissioning of the block contract so I work once it's been procured it comes through to my team I guess when it does come through to my team we are really aware of the work that is happening around some of the market and I guess we have a care act duty to ensure that we have a sustainable market we do a lot of work within the department looking at social value and how we support it and enhance it the things that we do are aware of is that we will check providers and make sure that they are financially sustainable and actually where we think that there are financial issues we will take them through kind of our serious concerns process and we'll walk with them we have sadly had cases not with organisations based in this borough but outside where we had a few packages with them where staff weren't being paid and we managed that working with those local councils so we are trying to manage the market I guess just to say the market as you reflected is in a very difficult position and actually working with our colleagues in north central London and with ADAS I think it's how we need to support it across the country not just the care homes but the whole social care sector and we'll continue to do that and advocate for that in the various forms that we all attend Thank you that's really interesting complaints and inquiries received around home care so in the past year there have been four complaints from residents now I know that people who are receiving care don't like to complain fairly so that's not a very good measure on the other hand can you tell me if that is an improvement with the new providers before the new contracts were issued so I would need to check that what I can say and I will come back to you in response on that point I'll get the complaints team to run that what I can say is that it feels like when we're talking to residents they're happier and we are feeling the positive feedback we're getting is much more positive that's from the conversations and social care reviews that we're getting obviously some of the pre-existing providers moved us onto the new framework but I do think in general the feeling is better I get less informal complaints to myself I would say but I would need to check the complaint process obviously we've gone from I think it was around 20 to 30 spot providers to a much smaller number which actually makes this process a lot easier for us as well a lot less providers to work with and easier to build those really strong relationships which are so important for the activities that we do thank you just to carry on from my previous question more clarification about the quality assurance visits which I didn't quite get across there because these visits are happening in your report you say you've had 37 of them and 92 contracts so I just want to know you say the emphasis is put on the home care and the care home contract that's the visits are done regularly are the other contracts getting quality assurance visits as well and how often are they happening because there's only 37 out of 92 so far it would be good to know that they're getting the same sort of focus yeah so the 37 is because we launched it in September 2024 we only had six months to do the focus so the priority we gave was the 37 contracts that perhaps we had maybe concerns about or we didn't there were new contracts or for example we thought a couple were outstanding and we wanted to kind of look at best practice so that's where the 37 came from the intention for this financial year is that we do 100% and my team monitor that and we report that to a senior leadership team each quarter but we should be and hopefully we'll get there 100% of all of our contracts will be reviewed and audited this year and we'll monitor that and if not we can update but that's my intention I think every provider should have a visit I think that's important for safety reasons but also it's important that we get the feedback from staff and residents and that we're managing that but like I said because it was six months through the year we only managed to do 37 we did try and do more but just other activities such as care quality commission visits the inspection and just actually my team needing to learn that process and it's amazing making such a cultural change you know talking to residents making sure that we've got the right language being used we needed to adapt some of that so we went a bit slower than perhaps you might have expected so we were learning as we went through none have been rated inadequate which is good it's really good but what I'm not quite sure what would be the process for that if that happens someone is rated inadequate what would you do? So we would put them through our serious concerns process so basically if anyone's rated requires improvement or inadequate we review that so that would come through to myself and we would look at the reasons it was rated requires improvement or inadequate I would imagine anyone inadequate would be immediately put onto what is called our serious concerns process and we have two stages for that so we have something called the quality improvement process or the provider concerns process and level depends on whether we think that they can still take people so we might embargo them and we might decide you know and it's about working with them so we don't immediately stop and remove people unless it's a very extreme case we would try and work with them to understand what has happened and try and take that approach when we put somebody or ask somebody to go through our kind of serious concerns process they get a lot of intense support that's monthly meetings a lot more oversight and we've had people through that process as you can see in the report and actually it is to be supportive but inevitably that doesn't always work and we have to make a very very difficult decision that sometimes we do choose to move people from the provider that's not an easy decision and we do that with a lot of thought and careful thinking because of the impact on that resident and we would hope that we would move people out so for example I think we've got two people coming in the quality improvement process in the council at the moment and I'm really pleased to say that having met with one of them this week the intention is that we will move one person out of the quality improvement process tomorrow so we'll just have one provider left which is a really fantastic place compared to where it will be over the last few weeks and months thank you just have some question first of all I was thank you for the to make north central and south dividing it is helpful for the care to provide service yeah this is a good thing we did it but I've got a question you have lost so many care provider how many of them is linked on base I don't know that but I can find that information out as part of I can find that information out I wouldn't want to guess right now I don't think that's appropriate so I'll come back to that information when I've asked my colleague next week tomorrow sorry tomorrow we are strongly believe that we will promote organization to get a promote and help them to get a contact and everything yeah another thing is a lot of question is coming monitoring process and you said yearly six months you do the monitoring but my concern is we used to have a yearly or six month assessment by the social worker when social worker did the assessment days to do monitoring everything how services provided and everything this is a gap now in the area we don't do regular assessment sometimes how you can confirm us that resident because the older people especially older people they are scared to make a complaint because they find if their service is going to be withdrawn everything and it's really easy how you can give us assurance that service delivery is going to be educated and you may know there was a case that one services was passed because of that light was on or something yeah and how you can give us assurance that you will do continuous service that care are not lacking their duty and everything yeah so I guess in terms of the social work process and the annual reviews we do have a process within the council and within our team that actually we work really close about operations and safeguarding colleagues we have a process called the service issue process so if any during any reviews or any conversations with family members social workers or anyone occupational service are worried about a provider's quality they can fill out a quick form it comes through to the team and we will proactively pick that up so we do really really support the feedback in terms of kind of how the operations team within social workers that is outside of my remit and Victoria Nesta who usually comes to this meeting unfortunately isn't here today that's probably a better question for her to respond to in terms of how the reviews are happening and how they're kind of doing that ongoing work within her team in terms of the social workers so I can certainly take that back and feed that back to her because it's from my experience lots of vulnerable graduate with the older people I know that lots of people haven't got any evening next of kin that people neighbor or someone to take that and lots of people don't know that what the service is getting here I think in the future this kind of yeah I think it should be better someone from this side who can give us the answer would come with you then give us answer next time would be best thank you if anyone has any other question thank you many thanks be for quarter three part performance report I think councilor for Williamson right right so I'm presenting the Q3 performance report for adult social care so obviously we're looking a little bit behind I'm going to be really brief on this push because I'm sure the committee have very thoroughly read everything and already have their questions lined up but basically this is broadly a pretty good news story we are on target for pretty much all of our KPIs they are broad they are all all all bar one is better than last year so again we're seeing that kind of improvement that we're seeing and I think again this is a lot of these KPIs around supporting people to stay as independent as possible for as long as possible which as the committee will know our broad vision is around supporting people's independence and so a lot of these indicators are indicating that work is having some impact in a positive direction for residents in Islington if you've got any questions I'm happy to ask them or share them with John Everson thank you do you have any questions right now great thank you so it's positive to see the performance of the re-ablement service but last week I met with who were deeply concerned about the proposed privatisation of the service it would be good to understand where we are in that process and how perhaps unions concerns have been responded to so obviously we meet unions regularly they've met meetings I've met with them so we are regularly in contact with the unions that's a saving that you were at the budget meeting and I noticed the Greens didn't put in an amendment on that budget item so I'd be interested to follow up with you around what amendment you'd put in the future that million pound saving and what your proposal would be for something else out of that budget but we can take that forward later with regard to that saving it's not coming in place for nearly three years this is a really long process we really appreciate the work that the staff are doing that there is a million pound saving to be had in terms of services the council does offer we are a bit of a rarity we've kept in house our day services which are all good we've got some residential services all in house as well so we have prioritised where we can keep them in house now for the re-ainment service it's a six week service so in terms of having different carers to the actual residents they're not going to see any particular difference because it's only a short term service and it's quite niche and it's quite flexible so in terms of the economies of scale that you get on it it's quite difficult to run it and get more efficiencies now the team have been working for the last two to three years to really try and make it much more cost effective because the cost per hour is significantly high and that is one of the reasons why that saving came forward but again I'll be interested to see what the Greens put forward their budget next year because they didn't put anything forward this year so thank you thank you just a couple of more questions because again from legalisation last week one of the things that they asked about was whether the extra capacity of the service have been looked at in terms of using for other services like home visits or welfare checks has the council looked at other ways that that capacity that isn't used right now could be applied I'll probably hand this to John but yes is the answer but it's a specialist service it's not a transfer a completely transferable skill so you can't let everyone work on doing this and then moving on to something else is the reality of it but I don't know if John's got anything else you want to add to that well just to say the unit cost is obviously very high so we need to make sure that we're using that skill and that high level of cost appropriately obviously we're looking at the performance of the current service so if there's an item where we're going to be looking at savings but to go through a different process just one final question for me I know the trade union rep couldn't make it today so I'm just really keeping that there are questions there so for service at this meeting so I do understand that one of the other options might be looking at some of that extra capacity for other councils in London it'd be good to understand how much of a conversation has been had with workers about their interest and whether these services could be shared with other councils around the borough and giving them the option to contribute to whether that's something they'd be interested in or support It's something we have looked at thoroughly as you appreciate we have looked at every option including the other members of this committee on it but the reality is the cost is extremely high there is in reality and there is and the last two years there's the cost has come down a lot by the work of council staff but the reality is there is no council that's going to buy in that service and there's no way that we believe that cost can come down further in its plant format if we did we would absolutely be keeping it in house but we absolutely do not think there's a way to bring it down further now if you've got a plan or an idea then I'm more than willing to hear it because obviously our preference will always be in house we are a leading council in this around bringing things in house where we can but we do have a financial duty to secure the finances of this council and our really good adult social care services so those good in house day services we have which so many councils have outsourced that we've kept in house and they are supporting this every single day in the way that's probably most meaningful most impactful for having a change on their lives and keeping them as independent as possible thank you anyone else oh yeah it's good there's another three years of the reablement service and it would be good to because this report actually does comment on the improvement performance alongside the change in the models this report does suggest that reablement supports residents experience positive outcomes so that is a very positive statement to make about the ablement and it's great we've got three more years with it and you know maybe in three more years we'll be able to look again at the situation it might look a bit different I mean I think the reality is around money but yes we're obviously always monitoring the situation it's about getting that unit cost down to ensure that we you know it's as cost effective as possible okay I've got some question and observation regarding the in-house yes we are part as our politics and everything we believe in-house is the best possible and also we had a recommendation domicile care in-house and everything I know this is a very difficult situation to take it back in-house funding is really but as a Flora you know UNMI and our politics as possible we can do it can you just give us assurance that if possible you can look everything or whatever to that I know this time is not possible because of the funding but if funding available then your policy and your work towards getting in-house domicile care and also you can keep if what is a piece of like and all that if the three years is funding and everything going to come you're not going to go other route I can't give a specific I can't reassure different bits definitely going to give that sort of reassurance but what I can give is every contract where there's things coming up I have personally given this to officers that I want to see my preference is always going to be in-house as it is of this entire council as it is of the policy and so therefore in-house is always going to be our preference but it's got to be cost effective and it's got to be good quality for the residents so that's the ultimate thing at the end of the day is like are our residents getting the best quality care that they could be getting or the best quality service and occasionally we know we may not be the right people for various different reasons and so it's not it's always going to be a little bit nuanced but the preference is always going to be in-house and last question from me Flora and John both just I was asking so many times because now the digitalization system and everything people quarry to the adult social care even safeguarding to other quarry here people put the information they don't get any reply from the council the system there is some lacking the system I did raise so many times this thing please go and this because when people raise anything they should get some kind of email you will get within two weeks this answer yeah follow up this is not my question just observation please join yourself to look at this one I know you raised that in the past and we need specific examples as far as we're aware that shouldn't be happening so if it is happening we need to know very clear specifics so we can look into it okay I will show you if you go to the council or there is a I forgot the line if you put the social service inquiry here some kind of site then you can do it then he's going to go then you supposed to get some kind of reply yeah if you can share that with us that would be useful because it's hard to see an entire process okay there is a question from the recipient hi Sanchita again you said about specific examples I'm more than happy to share several numerous actually over the last two years again John will know this as well because I have asked for many meetings with yourself that I've not had a response to my father he's almost a hundred years just one thing like on that your query was answered by the officer yes I received that answer thank you very much but the answer unfortunately is glossy and it's just a lot of platitudes it doesn't really meaningfully answer anything and the fact is that my father who has been assessed to need 24 hour care is still only getting four hours a day of direct contact care he's being left alone unsafe for over 20 hours a day and night and this has been the case for the last two years he's got lots of chronic health conditions not to mention is palliative and almost dying he was admitted into A&E twice over the weekend for various reasons heart failure kidney failure and it's quite tragic actually that someone who is so vulnerable is being left to fend for themselves it shouldn't be the case and while I hear about all of this we're doing well and we don't want we need to safeguard etc etc the reality is that that is not happening and people in the room know a deliberate oversight in my view okay thank you thank you for your question John and your team can write to because this is a specific question and because this serious question she raised about the issue please answer this one you don't need to say because this is a personal idea please answer because her father needs support from us yeah look the case properly and give the answer to her is it okay I was going to ask sorry I think I have previously answered you and I have actually gone through your father's case in quite a lot of detail but I'm more than happy to me if you want that further information but it's definitely not being forgotten and if there's additional bits of information that you want more than happy to follow on that but if you can just send that to me thank very much because it's been two years and he's now dying he's literally last days and he has not had the care that he receives he's become deconditioned because of all of this and I have recently received an email from a social worker who's not even called him let alone gone to visit him saying that they're not going to pull the feeding time that he has as a human being at the very least he needs nutrition and it's not great I'm happy to pick it up outside this meeting thank you I believe our great counsellor will take this one and she listen and take a further action because this is your personal and they will take that thank you thank you now just we have a B5 scrutiny review draft recommendation do you have anyone has any question anything about that yeah great thank you just thank you for the work that's gone into it I know we've been working on the scrutiny for a number of months and I know a lot of thought has been put into it I really appreciated the addition of recommendation to looking at the planning process I do wonder in between the draft recommendations and final recommendations whether or not it's worth checking the recommendation with the planning committee as well from the other end because I this one report I don't know if it's helpful I shared it with councillor Brad Bradford earlier today he said the planning one specifically that he was happy and he was aware that officers had seen that particular one thank you I know you are great thank you that means we now take this recommendation is it okay everyone accepted this recommendation okay now we're going to write the report and put it to the next meeting to finalize yeah thank you now B6 work program can we note the work program note that work plan for next year will be provided the next scrutiny meeting yeah I would like to inform the committee that this will be my last scrutiny meeting as the chair for this committee as the chair I always focus on the needs of the community and I hope I have helped the council in the decision making process towards this one of the biggest achievement for council at Clark and I sitting in Joss and influence maternity ward and Huntington hospital and this is a great achievement for everyone we did and also we did so all the scrutiny review and everything focus on our need and everything this year one because of the problem was the older people accommodation this great thing we did I would like to also say a very big thank you to all the members that have supported and contributed towards this committee as well as all the officers who have also supported me through this process there being no further business I declare this meeting is closed there is further business yes yes yes yeah I just want to record my thanks for your work and your passion about adult social care and how that has really helped to transform adult social care in this thing and thanks for being the chair for so long thank you thank you so much your passion for this subject shines through so thank you for the work that you have done the past few years thank you also you did really fantastic job especially sitting in the jobs and you are the executive member of this and it is a very adult social care is very difficult John and also officers they are finding also very difficult because the demand is going up and there is no money it is really really difficult and John and other team they are doing very thank you thank you for everyone contribution many thanks thank you