The Health Overview and Scrutiny Committee met to discuss performance updates from St George's University Hospitals NHS Foundation Trust, review findings on Violence Against Women and Girls (VAWG), and examine the Adult Social Care Outcomes Framework (ASCOF) performance report. Key decisions included the approval of recommendations from the VAWG Task and Finish Group.

St George's University Hospitals NHS Foundation Trust Performance Update

The committee received an update on the performance of St George's University Hospitals NHS Foundation Trust. Kate Slemeck, Managing Director, and James Blythe, Interim Group Chief Executive, presented the report, highlighting that while the Emergency Department continues to meet the four-hour standard, there are ongoing challenges with Emergency Department (ED) flow. Significant progress has been made in reducing waiting times, with the Trust having eliminated 65-week waiters and now focusing on reducing 52-week waits. Diagnostic performance remains strong, with cancer diagnosis standards also within or above the upper quartile.

Financially, the Trust is forecasting to break even for the current financial year, despite a challenging efficiency target. However, for the next financial year, a significant deficit is projected, requiring substantial savings plans and ongoing work with NHS England and commissioners to address a £18.2 million gap. The report also touched upon industrial action by junior doctors and healthcare assistants, noting that the Trust managed to sustain a high percentage of planned activity.

Regarding CQC inspections, the Trust's maternity services have improved from inadequate to requires improvement, and surgery services have dropped from good to requires improvement. Urgent and emergency care remains rated as requires improvement. The leadership inspection also resulted in a requires improvement rating, with areas for development including vision and culture, governance, and freedom to speak up.

A significant concern raised was the issue of stranded beds, with approximately 300 patients across the St George's, Epsom, and St Helier (GESH) group awaiting discharge. While the trend is downwards, reasons for delays include waiting for care packages, nursing home placements, and family agreement. The committee discussed the interface with Wandsworth Council and potential improvements, with the Trust highlighting good relationships and ongoing work to refine transfer of care processes.

Councillor George Crivelli questioned the realism of meeting government targets for 18-week waiting times, with the Trust aiming for 65% by March 2026. Councillor Crivelli also sought assurances that the significant savings targets of £90.6 million would not impact patient care, with the Trust outlining rigorous quality impact assessments for all cost improvement programmes. Concerns were also raised about reassurance for pregnant women using St George's maternity services, with the Trust highlighting improvements and a move to requires improvement from inadequate by the CQC.

Councillor Jessica Lee raised the issue of freedom to speak up, following CQC feedback that more staff had contacted the CQC anonymously. The Trust detailed its leadership and management development programme and increased oversight of concerns raised by staff. Stephen Hickey, Chair of Healthwatch, inquired about corridor care and mental health cases in the ED. While corridor care remains an issue during peak pressure, the Trust has implemented safeguards and is working towards zero corridor care. The frailty same-day emergency care service has shown success in turning around patients, preventing admissions. Work is also underway to improve urgent mental health support.

Violence Against Women and Girls (VAWG) Task and Finish Group Report

The committee reviewed the findings and recommendations of the VAWG Task and Finish Group. The report, which drew on feedback from over 350 individuals including survivors, young people, parents, and professionals, highlighted five recurring themes: the inconsistency of conversations around VAWG with young people, the isolating nature of online spaces, the importance of a sense of belonging through community activities, the lack of visibility and connection between existing prevention services, and the unequal experience of prevention due to intersecting vulnerabilities.

The Task and Finish Group proposed three recommendations for Cabinet approval:

1. To enhance the reach and visibility of Wandsworth's existing VAWG prevention offer in schools, exploring co-produced interventions with young people.
2. To ensure a robust systems approach across agencies for VAWG prevention and early identification by increasing visibility and sharing best practice.
3. To maintain ongoing engagement with survivors, including seldom-heard communities, to inform service improvement.

Councillor Caroline de La Soujeole and Stephen Hickey raised questions regarding the involvement of mental health services in VAWG prevention and support. Gabrielle Aron, Vulnerabilities Manager, and other officers detailed existing partnerships with mental health services, including risk management panels, signposting at one-stop shops, and the IRIS-i programme. The committee approved the recommendations, which will be submitted to Cabinet.

Adult Social Care Outcomes Framework (ASCOF) Indicators Annual Performance Report

The committee received an update on Wandsworth's performance against the 2024/25 Adult Social Care Outcomes Framework (ASCOF) indicators. Carl Fenty, Adult Performance Manager, presented the report, noting that 70% of indicators performed in the top two quartiles in London and nationally.

Key highlights from the Adult Social Care Survey included Wandsworth ranking top in London for residents having as much social contact as they would like and second in London for the social care-related quality of life outcome score. However, the adjusted quality of life indicator has moved to the third quartile in London and the lowest quartile nationally, despite a slight improvement, due to stronger improvements elsewhere. Overall satisfaction with care and support reduced slightly but remains in the second quartile in London.

In terms of performance indicators, Wandsworth is joint top nationally for care users receiving support via a personal budget and for residential care providers being rated good or outstanding by the CQC. The borough also ranks highly for safeguarding enquiries where risk was reduced or removed and for the proportion of older people receiving reablement services after hospital discharge.

Two new indicators showed areas for improvement. The proportion of older people discharged from hospital into reablement who remained in the community after 12 weeks was in the lowest quartile in London. This complex indicator reflects the increasing complexity of residents' needs and cannot always determine if readmissions are directly linked to reablement support. The proportion of older people receiving long-term support who live at home or with family also fell into the lowest quartile in London, though the Council continues to place fewer people in care homes.

Councillor Crivelli and Councillor Norman Marshall sought clarification on the ASCOF indicators, particularly concerning hospital readmissions and the connection to stranded beds. It was clarified that readmissions can be for unrelated medical conditions, and the indicator reflects the complexity of residents' needs rather than solely the success of reablement. The committee noted the report for information.