The Health in Hackney Scrutiny Commission met on Monday 2 March 2026 to discuss patient experiences of sickle cell care, the Care Quality Commission's assessment of Hackney Adult Social Care, and updates on the Transforming Outcomes Programme. The Commission was requested to agree the minutes of the previous meeting and note the action tracker, and to note the updated Work Programme for 2025-26.

Patient Voice: Sickle Cell Care in Hackney - What Has Changed 10 Years On?

The Commission reviewed a Healthwatch Hackney report that followed up on its 2015 findings regarding sickle cell care at Homerton Hospital. The report highlighted that patient experience of sickle cell care continues to be a postcode lottery, varying significantly depending on where care is accessed. While the Medical Day Unit (MDU) at Homerton Hospital was praised for its excellent, safe, and responsive care, with patients being believed immediately and treated within 30 minutes, other settings, such as A&E and GP surgeries, were found to be lacking.

Patients reported being disbelieved about their pain in A&E, facing long waits for pain relief (exceeding the 30-minute NICE standard), and being labelled as drug-seeking. GPs were criticised for their lack of knowledge about sickle cell disease, with some refusing to prescribe pain medication despite hospital documentation. This led to patients stockpiling medication, a practice acknowledged as unsafe.

Lloyd Ward, an inpatient ward, showed improvements since 2015, with staff described as more professional. However, care remained inconsistent, depending on which staff were on duty. Communication, particularly around discharge, was identified as an area needing improvement. The report also highlighted significant issues with the transition from paediatric to adult sickle cell care, which was described as poorly managed and leading to a lasting distrust of healthcare providers. Racism and stigma were identified as underlying factors contributing to these failures.

Homerton Healthcare NHS Foundation Trust provided a response outlining actions to address the recommendations. These included reviewing and strengthening standards for A&E care, improving awareness of care plans, and introducing reflective learning sessions to address racism, stigma, and bias. The Trust also committed to protecting and sharing learning from the MDU model and addressing space and privacy constraints within the MDU. For Lloyd Ward, improvements in communication and deeper reflective work on stigma were planned. Recommendations were also made to the North-East London Integrated Care Board (NEL ICB) to improve GPs' understanding of sickle cell disease, reduce reliance on A&E, and improve the transition from paediatric to adult care.

CQC Assessment of Hackney Adult Social Care

The Commission received a briefing on the Care Quality Commission's (CQC) assessment of Hackney Adult Social Care, which rated the service as Requires Improvement, just one point below a Good rating. The assessment covered nine quality statements across four themes: Working with People, Providing Support, Ensuring Safety, and Leadership.

Hackney Council's strengths were identified as its strengths-based and person-centred practice, support for independence, an anti-racist culture, transparent leadership, and a focus on continuous improvement. However, areas for development included delays in assessments and reviews, particularly for carers, and gaps in reablement provision. The CQC noted that while the council's website was being improved for accessibility, it was not yet fully compliant with AA Web Content Accessibility Guidelines. Direct payment uptake was low, and there were concerns about the consistency of co-production in commissioning activities.

The report highlighted that while there were sufficient care and support services available, not all were located within the borough, leading to out-of-borough placements. Quality assurance processes were in place, but oversight of out-of-borough placements was less comprehensive due to delayed care reviews. Safeguarding systems and practices were identified as needing improvement, with some delays in responding to concerns and a lack of clarity in operational guidance for certain teams.

The council acknowledged that many of the CQC's findings were already identified in their own three-year plan and transformation programme. Actions were underway to address waiting lists, improve the website, enhance support for carers, develop direct payments, and improve market and contract management. An improvement board was to be established to oversee actions from the inspection and the ongoing transformation programme.

Transforming Outcomes Programme in Adult Social Care: Spotlight on Reablement

An update was provided on the Transforming Outcomes Programme (TOP) in Adult Social Care, with a specific focus on reablement. The programme aims to promote independence and ensure the sustainability of adult social care services. The first phase of TOP ran from November 2023 to March 2025, and the second phase, which began in June 2025, includes workstreams on increasing direct payment uptake, digitising adult social care, home adaptations, reablement, preparing for adulthood, carer support, and care charging.

The reablement workstream aims to implement a social model of reablement to support more people with a wider range of needs, promoting independence and reducing the need for ongoing care. The vision is to expand reablement capacity, ensure high-quality, strength-based support, and broaden inclusion criteria to support individuals with higher and more complex needs. Case studies were presented demonstrating successful reablement outcomes, where individuals regained significant independence, leading to a reduction in care hours. Financial benefit projections indicated significant savings from avoided care costs.

TOP in Adult Social Care: Update on Disabled Facilities Grant Adaptations

The Commission received an update on the Disabled Facilities Grant (DFG) adaptations pathway, which was redesigned as part of the TOP. The project, which concluded in December 2025, resulted in the establishment of a new DFG Home Adaptations Service within Adult Social Care. Changes included streamlining referral processes, increasing the means test threshold, approving a Dynamic Purchasing System for contractors, and developing a new Home Adaptations and Repair policy.

A performance dashboard has been developed to monitor key data points, including caseload visibility, waiting times, and satisfaction scores. While initial data is still being gathered due to the phased implementation of the new case management system, early indications suggest progress. The report highlighted that 173 DFG-funded adaptations had been completed in 2025/26.

Minutes of the Previous Meeting and Action Tracker

The Commission was requested to agree the draft minutes of the previous meeting held on 2 March 2026 as a correct record and to note the updated Action Tracker.

Health in Hackney Scrutiny Commission Work Programme

The Commission was requested to note the updated Work Programme for 2025-26.