The Waltham Forest Health and Wellbeing Board and Health and Care Partnership Board were scheduled to hold an integrated meeting on 20 October 2025. Items for discussion included updates on promoting wellbeing, the Better Care Fund, and the Special Educational Needs and Disabilities (SEND) Improvement Plan. A series of linked papers on obesity were also scheduled to be discussed.

SEND Improvement Plan

The boards were scheduled to receive an update on the delivery of the Waltham Forest Special Educational Needs and Disabilities (SEND) Improvement Plan. The plan was created to address challenges within the national SEND system, such as increased demand for Education, Health and Care Plans (EHCPs), and workforce availability.

The report outlined progress made, identified key achievements and challenges, and highlighted next steps in strengthening outcomes for children and young people with SEND.

The boards were asked to note the progress made in implementing the SEND Improvement Plan and the areas of sustained improvement, and endorse the continued focus on:

• Improving timeliness and quality of Education, Health and Care Plans (EHCPs).
• Strengthened partnership work to improve Year 9 annual reviews, co-production, and communication with families.
• Improve data quality and system performance.
• Continued monitoring and risk management on community equipment.

The report noted that a SEND Local Area Improvement Plan was published in April 2025, integrating actions from the SEND Strategy and responses to inspection reports. The plan has six action areas:

• All children in Waltham Forest with SEND have their needs identified early and receive timely intervention, in a child-focused way.
• Strong communication and co-production with children, young people, and their families.
• All children have a high-quality outcome-focused education, health and care plans.
• All children attend a setting which improves education and life outcomes.
• All transitions prepare children and young people with SEND for their next life stages, including adulthood.
• All children with SEND in Waltham Forest have timely access to health services.

The report noted that the local authority has continued to invest in SEND services to support fundamental improvement, and that NHS SEND investment monies have also been secured to support the recruitment of key clinical therapy staff in North East London NHS Foundation Trust (NELFT) and support an integrated early-years and SENDIASS offer with the council.

The report also highlighted positive progress made, including:

• The historic backlog for EHCPs has been cleared through investment into SEND case officers with a dedicated backlog.
• SEND Sufficiency Plan has been approved at SEND Strategic Board. Improvements in Commissioning mean that only five children have had to be placed out of Borough this year (compares with 28 last year).
• Moving towards full recruitment The proportion of permanent staff in the establishment is currently 70%.
• Health Visiting Services high performance on mandated development checks for under 5's now higher than the London average - July 93% of 2-year-olds received their review by 2.5.
• Waiting times for SLT are improving. They remain approximately one year for OT due in part to staff time being deployed to support the move to another community equipment provider. Recruitment for therapies is going well despite national challenges.
• There has been engagement at commissioner level with equipment providers for both wheelchairs and other community equipment which will result in improvements to the service.
• Waiting times for neurodiversity assessment remain a year once on pathway but have come down slightly. Referrals to CAMHS overall, however, have increased and are characterised by anxiety and resulting challenges with school attendance which need a multi-agency approach to resolve. The rising demand is reflected by increasing numbers on the Dynamic Support Register (DSR) register.
• A multi-agency working party led by health is well underway to strengthen the offer of support for children and families following diagnosis and is facilitated by learning from the Partnership for inclusion of neurodiversity in schools (PINS) project.
• Returns of health reports to contribute to EHC needs assessment within 6 weeks are within acceptable ranges to support the EHC process (65-90%).
• The continence pathway is under review with a changed approach to facilitate wider knowledge and understanding of how to approach young people's bladder and bowel issues. Key staff in education and health are being trained, numbers on the pathway are starting to reduce with long waiters booked to be seen.

The report also noted improvement areas, including:

• Managing EHCP timeliness. 28% of EHCP assessments were completed within 20 weeks as of August 2025 due to the delay in Education Psychologist assessments being completed, which is a result of vacancies in the system that are difficult to recruit to. A recovery plan is in place with additional staffing to address backlogs by end of 2025.
• Year 9 annual reviews remain a concern with 156 reviews overdue, however, this is a slight improvement from the previous reporting period where there were 202 reviews overdue. However, Annual Review templates have been revised and focus will be placed on upskilling SENDCO's.
• Improving data and systems quality remains a priority. It is anticipated that performance data may be providing a worst-case scenario as data analytics from our Capita system is inaccurate. This needs to be addressed to provide accurate forecasting and analytics.
• Community Equipment Services An emergency direct-awarded community equipment contract was made to Enabled Living Healthcare after the previous provider signalled significant financial viability issues which culminated in declaring insolvency on 31st July 2025. The new contract and provider arrangements are being kept under constant review through contract and other partnership meetings. NELFT are also monitoring the ordering and delivery of children's special orders routinely to mitigate risks and are also represented and report back to the WF tactical response group.

The report included a summary of the Area SEND inspection of Waltham Forest Local Area Partnership, which took place in February 2025. The inspection found that:

The local area partnership's arrangements lead to inconsistent experiences and outcomes for children and young people with special educational needs and/or disabilities (SEND). The local area partnership must work jointly to make improvements.

The inspection team noted that there was a shared ambition to improve service provision and delivery across education, health and social care in Waltham Forest, and that many children and young people attend inclusive education settings. However, the inspection team also found that there were variable waits to access specialist intervention on mental health pathways, in occupational therapy and speech and language therapy services, and that some children and young people wait six months or more for a wheelchair, others receive equipment that is faulty, the wrong size or unsuitable to meet their needs.

The inspection report recommended that leaders across the partnership should improve communication with parents, strengthen how well children and young people are effectively prepared for adulthood, ensure that a multi-agency quality assurance framework is in place for EHC plans and annual reviews, and that health leaders should implement at pace their plans to improve waiting times for children and young people with SEND to access specialist health services.

Promoting Wellbeing Update

The boards were scheduled to receive an update on the Promoting Wellbeing workstream, which aims to advance a preventative approach and reduce health inequalities, bringing together partners from the local authority, the NHS, and the voluntary and community sector.

The report included a status report with updates from the five priority areas within the workstream, detailing progress to date, and associated risks and mitigations.

The boards were asked to note the latest updates and progress of the priority areas of the workstream, and to review and address a critical risk concerning the Safe Surgeries Initiative, under the Borough of Sanctuary workstream.

The five priority areas were:

• Strengthening the partnership with the voluntary and community sector and faith groups, to promote health
• Borough of Sanctuary
• Employment and Health
• Housing and Health
• Mental Health Promotion

The report noted that the Voluntary and Community Sector (VCS) Leadership Group has accelerated delivery across several priority areas, including the launch of the Long-Term Conditions small grants programme, and that Locality Hub development has advanced through resident focus groups and targeted engagement.

The report also noted that progress on the core Safe Surgeries Initiative has stalled and remains a key risk for escalation, with a second mystery shopper exercise revealing a worsening trend in GP practice compliance, with a significant majority of surgeries still requesting ID or proof of address despite national guidance.

Better Care Fund Update

The boards were scheduled to receive an update on 2025/26 Better Care Fund (BCF) activities. The BCF is a programme designed to support local areas to integrate health and social care services.

The report provided an update on 2025/26 Better Care Fund (BCF) activities, including formal approval of the Q1 report by the Health and Wellbeing Board (HWB) and timelines for the upcoming Q2 submission. It outlined proposed updates to the Section 75 agreement schedules to reflect changes for 2025/26 and seeks delegated authority to progress a new agreement from April 2026. Strategic developments were also noted, including a NEL-wide review of BCF usage, changes to the Disabled Facilities Grant allocation methodology from 2026/27, and planned BCF reform aligned with the 10-Year Health Plan, embedding it within Neighbourhood Health Plans.

The boards were asked to:

• Formally sign off the Q1 BCF 2025/26 report submitted to NHSE on the 15 August 2025 by delegated authority of responsible SRO officers.
• Delegate authority to the designated SRO officers to sign off the Q2 Better Care Fund 2025/26 submission, which is due for return to NHSE by 11 November 2025.
• Delegate authority to the designated SRO officers to vary the Section 75 Better Care Fund agreement for 2025/26, reflecting updated expenditure in line with the BCF 2025/26 plan, and incorporating updates to non-BCF schemes included within the Section 75 agreement between LBWF and ICB.
• Delegate authority to the designated SRO officers to progress a new S75 agreement through ICB and LBWF governance, effective from 1 April 2026. The proposal is for the new S75 agreement to be open-ended, with a termination clause that can be exercised by either party if required.
• Approve plans to develop 2026/27 strategic priorities via a workshop or at the next HWBB.

The report also noted strategic updates, including:

• A NEL-wide working group has been set up to review how the Better Care Fund (BCF) is used across the system. It aims to compare local approaches, assess outcomes, identify best practices, and support consistent and sustainable planning. The findings of the working group are due to be presented at the NEL ICB Commissioning Board on the 13th October 2025.
• The proposed changes to the Disabled Facilities Grant (DFG) allocation aim to replace the current outdated allocation with a more equitable, needs-based approach. The new methodology will use updated data to better reflect local demand, regional costs, and demographic shifts, supporting fairer distribution across local authorities.
• The Better Care Fund (BCF) is set to undergo significant reform from 2026/27, aligning with the 10-Year Health Plan to support more integrated, community-based care. The reformed BCF will be embedded within Neighbourhood Health Plans, jointly developed by the NHS, local authorities, and partners, focusing on services like discharge, rehabilitation, and reablement.

Obesity

The boards were scheduled to discuss a series of linked papers related to the prevention and management of obesity in Waltham Forest:

• Waltham Forest Healthy Weight Strategy Progress Report
• Specialist Weight Management Services and Weight Loss Medication Access
• The Cost of Obesity as a Driver of Multimorbidity

The Waltham Forest Healthy Weight Strategy 2023-27 sets out a vision to create a borough where healthy choices are easier and people living with obesity are treated with empathy and understanding. It adopts a whole systems approach, recognising that individual behaviours are shaped by wider environmental, social and economic factors. It aims to reduce obesity prevalence, while also improving health outcomes for those continuing to live with the condition, and foster a more supportive, inclusive environment for all residents.

The boards were asked to note progress with the Healthy Weight Strategy, including the focus on creating healthy environments alongside efforts to reduce stigma and establish effective treatment pathways, to note and comment on the current priority areas and agree whether these should remain in place for the final 2.5-year period of the healthy weight strategy, and to support the delivery of the weight stigma campaign to front line staff in their organisations.

The report on Specialist Weight Management Services and Weight Loss Medication Access related to work on Weight Management and Obesity by NHS NEL ICB, across the seven NEL Places. At present work is underway to commission and mobilise new weight management services, and to enable access to weight loss medication as part of those services. The boards were asked to note the report.

The report on the cost of obesity as a driver of Multimorbidity presented initial thinking on the impact of obesity on Long-Term Conditions (LTC) and Multiple Long-Term Conditions (MLTC), and associated costs to both the health and social care system and is intended to shape strategic thinking on a way forward.

The boards were recommended to:

• Continue to develop of a borough-wide whole systems approach to obesity prevention and management, with clear pathways for patients with Class 3 obesity and MLTC.
• Undertake a detailed cost-analysis of obesity and multimorbidity in Waltham Forest at Neighbourhood level to quantify the cost burden of obesity on both health and social care. The new data systems like Snowflake and Pathfinder that link both health, and social data will allow data linkage in ways we couldn't previously.
• This new analysis could be taken forward through the newly formed Population Health Data Board (chaired by Joe McDonnel) and the Neighbourhood Executive Board and framed as a priority question for the system partnership supporting our ambition to use data more effectively.
• Ensure equity focus, aligning interventions with areas of highest deprivation and need.