The Scrutiny Health & Social Care Sub-Committee met to review progress on the Executive Mayor's Business Plan, discuss updates from Croydon Health Services NHS Trust and South London and Maudsley NHS Foundation Trust, and consider the Adults Living Independently Transformation Programme. Key discussions included ambulance handover delays, mental health service transformation, and strategies for promoting independence and wellbeing for residents.

Ambulance Handover Delays and Corridor Care

Representatives from Croydon Health Services NHS Trust provided an update on ambulance handover delays, corridor care, workforce pressures, and patient experience within the Emergency Department. The Sub-Committee sought further details on the number of patients experiencing delays exceeding 30 minutes and the circumstances under which corridor care is utilised. It was explained that delays exceeding 45 minutes are the key performance measure for the London Ambulance Service (LAS), with approximately five patients per day experiencing such delays. Corridor care is used as an escalation measure when no suitable alternatives exist, with strict criteria in place to exclude vulnerable patients. While safeguards are in place, it was acknowledged that patient privacy and dignity are inevitably affected. Concerns were raised about the impact of prolonged stays on patient wellbeing, including risks of bed sores and deconditioning. The Trust confirmed that skin assessments are completed within four hours of admission and that patients requiring specialist mattresses are transferred to appropriate beds as soon as possible. Regarding staffing, vacancy levels within the Emergency Department were reported as low, with reliance on internal bank staffing rather than agency workers during periods of high demand. Staff have experienced sustained pressure due to rising attendances and an increasing number of patients presenting with mental health needs. The Sub-Committee was assured that daily staffing reviews, visible senior leadership, and close partnerships with mental health and social care services support operational resilience. The Trust acknowledged challenges in fully preserving confidentiality and dignity within corridor care settings, despite efforts to mitigate impacts through screening and alternative arrangements. The Sub-Committee welcomed the Trust's acknowledgement of these challenges and its commitment to improvement. The Trust agreed to provide a progress update on improvements arising from emergency care and maternity inspections.

Transformation of Mental Health Services

Jonathan Northfield and Ajoy Thachil from South London and Maudsley NHS Foundation Trust (SLAM) presented an update on the Community Transformation Programme and the future development of neighbourhood-based mental health services. The programme aims to integrate mental health services more effectively with local communities and partner agencies, forming part of a wider NHS shift towards neighbourhood-based care. Existing services will continue throughout the implementation period, with clear transition arrangements to maintain continuity of care. The Sub-Committee inquired about the September freeze period, contingencies for those awaiting assessment or in crisis, and how continuity of care would be managed. It was clarified that the freeze refers to a programme implementation period for development work, not service delivery, and that services would operate as normal until the changeover date. Transition arrangements have been co-designed with an overlap period to ensure continuity. Members sought assurance on the assessment of the impact on unpaid carers and additional support for families. Carers and service users have been involved throughout the design process, with strong representation on steering groups. Plans include commissioning additional voluntary and community sector support. The concept of easy in, easy out access to services was discussed, with work underway to provide earlier intervention and support to prevent relapse. SLAM advised that support extends beyond signposting to include practical assistance, advocacy, and help with housing-related discussions. Additional Better Care Fund resources have been secured to strengthen links between mental health services, housing, and hospital discharge arrangements, including a dedicated housing liaison role. The Sub-Committee found some aspects of the report difficult to understand due to the language and acronyms used. Assertive outreach was explained as a proactive approach to engagement within communities. SLAM will provide ongoing support to commissioned partners through lived-experience practitioners and regular oversight. Commissioning specifications require partner organisations to demonstrate appropriate training and workforce development. The model's response to serious mental health deterioration was discussed, with community partners not expected to provide clinical interventions for acute crises. Escalation routes include urgent community mental health services, home treatment teams, and emergency care services. The NHS 111 Press 2 service offers mental health advice and support. The rationale for five mental health neighbourhood teams, despite six localities for wider health and care arrangements, was based on detailed assessments of population need, demand, and resources. Integration of mental health services within new medical centres, such as the one being developed in Coulsdon, is a long-term intention. The possibility of a patient-initiated follow-up pathway was welcomed, with scope within the proposed model to consider innovative approaches to support ongoing engagement. While estate arrangements currently limit walk-in services, service users can contact their care coordinator or duty officer for urgent appointments. The development of a model similar to that piloted in Lewisham, allowing greater flexibility for users to initiate follow-up support, is a long-term ambition subject to future funding. The Sub-Committee concluded that the presentation was informative, encouraged continued efforts to develop neighbourhood-based mental health hubs, and supported exploring patient-initiated follow-up models and greater integration.

Adults Living Independently Transformation Programme

The Sub-Committee reviewed the progress of the Adults Living Independently (ALI) Transformation Programme, a key component of Adult Social Care's transformation agenda, aimed at improving resident outcomes, supporting independence, modernising service delivery, and contributing to the Council's Medium-Term Financial Strategy. The programme is in its implementation and delivery stage. Discussions focused on how the programme delivers financial savings while ensuring appropriate care. The programme's design and governance have received external assurance, with decisions guided by the Care Act and individual assessments of need. The focus is on ensuring support reflects residents' needs and independence levels, leading to increases in some care packages and reductions in others. Real-time performance dashboards are used to monitor demand, activity, and expenditure, enabling the identification of emerging pressures and review of individual cases. Progress is assessed through care plan reviews, quality assurance processes, performance dashboards, and resident feedback, with a particular emphasis on reablement services. Reablement pathways have been extended beyond hospital discharge to be accessible directly from the community. Assurance was sought on maintaining service quality and momentum during a major Directorate redesign, which reflects wider changes in health and social care and aims to strengthen professional practice. Delivery of the ALI Programme is considered essential for improving outcomes and financial sustainability, with risks associated with organisational change being managed through communication and engagement. The success of digital changes is measured against defined business cases, baseline measures, and expected benefits, with professional judgement remaining central to decision-making. Transcription technology is being used to reduce administrative burdens, allowing practitioners more time with residents. Resident consent is required for recordings, with safeguards in place for appropriate and ethical use. The programme's impact on residents' outcomes, independence, and quality of life is assessed through various mechanisms, including quality assurance reviews, practitioner supervision, resident case studies, and feedback from people with lived experience. The programme operates on a 'test and learn' basis. Direct payment uptake stands at approximately 17.5%, below the aspiration of 25%, with work underway to simplify processes and improve support. The vision for five years from now includes more residents living independently, a stronger focus on prevention, and a shift away from reliance on high-cost, long-term care. Prevention, including falls prevention and reducing social isolation, plays a central role. The Sub-Committee sought clarification on the rating of Disabilities Workstream Key Performance Indicators (KPIs), with an explanation that an amber rating for one KPI did not reflect overall underperformance but a specific measure, while the workstream as a whole was performing strongly. The Community Care Action Plan's emphasis on prevention and community capacity was discussed, with progress monitored through regular governance and outcome measures. Accommodation and housing pressures affecting older people and those with mental health needs were highlighted, with ongoing joint working between Adult Social Care and Housing Services. Performance relating to older people's residential placements and domiciliary care remained under pressure, with detailed analysis underway. A further independent programme health check will be undertaken. The Sub-Committee noted that residential care starts and new domiciliary care hours for older people remained significantly above target, with detailed analysis showing demand arising from both hospital discharge pathways and direct community-based services. Mitigation measures include reviews of practice, service manager oversight, and increased use of reablement services. Partnership working within the Mental Health Workstream, particularly regarding accommodation and independent living, was discussed, with ongoing collaborative work to improve pathways. The impact of post-COVID mental health challenges on schools and partner organisations was addressed, with services focused on building resilience and promoting emotional wellbeing. A 'reablement first' approach is adopted, with assessments to determine suitability for reablement. Reablement is not suitable for everyone, and decisions are based on individual assessments and professional judgement. The community reablement pathway, introduced in April, has made reablement a more accessible option. There has been an increase in successful reablement completions and a reduction in subsequent need for long-term care. Adult Social Care works closely with the Homelessness Service to support residents in private accommodation whose health has deteriorated, considering various solutions including reablement, extra care housing, and supported accommodation. Healthwatch Croydon's involvement in the programme through representation on the Adult Social Care and Health Improvement Board has informed the design and delivery of the ALI Programme. The Sub-Committee noted that Croydon remained below the national average for direct payment uptake, with engagement undertaken to understand barriers. A recommissioned direct payment support service, simplified processes, and the development of community micro-enterprises are expected to improve choice and flexibility. The Council has set a target of increasing direct payment uptake to 25%. Workforce issues and future succession planning were discussed, with efforts to support newly qualified social workers and apprenticeships. The Sub-Committee was thanked for the informative report and welcomed additional learning opportunities. They also welcomed reported improvements in long-term support outcomes for adults aged 18-64 and expressed interest in seeing future reports include forecasts on the Transformation Programme's influence on performance. Actions proposed included introducing a balanced outcomes dashboard, providing a deep-dive report on the Older People workstream, and arranging in-person training and service visits for Sub-Committee Members.

Update from Healthwatch Croydon

Healthwatch Croydon provided an update on their service, including findings from their Community Pharmacy Project. The project gathered feedback from 211 residents, who generally expressed high satisfaction with the accessibility, convenience, and quality of support from community pharmacies. However, concerns were raised regarding medicine shortages, awareness of available services, and communication about waiting times. Awareness of the Pharmacy First service remained relatively low, despite generally positive perceptions among users. Healthwatch recommended clearer communication and public awareness campaigns to support wider use of Pharmacy First as an alternative to GP appointments. The Sub-Committee highlighted the importance of understanding the experiences of disabled residents, particularly regarding accessibility issues such as pharmacy labels obscuring Braille packaging. Healthwatch was encouraged to consider accessibility in future engagement and research. The Sub-Committee noted that an update on the Pharmacy First programme in six months would be beneficial to assess its impact.

Scrutiny Work Programme 2026-2027

The Sub-Committee noted the Work Programme for 2026-2027 and was asked to consider items for inclusion in the next year's programme. The draft work programme for 2025-26 was presented, with the understanding that the final decision on any changes rests with the Chairs & Vice-Chairs Group. Members were invited to suggest additional scrutiny topics and to consider which individuals or organisations they wished to invite to future meetings. The Sub-Committee also noted that the item Prevention of Future Death Notices had been identified as an area for scrutiny but had not yet been scheduled.