Health & Adults Scrutiny Sub-Committee - Thursday 4 September 2025, 6:30pm

Health & Adults Scrutiny Sub-Committee
Thursday, 4th September 2025 at 6:30pm

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Good evening and welcome everyone.

My name is Councillor Gulam Kibriya Choudhury and this evening I will be chairing this meeting,

Health and Adult Subcommittee meeting.

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After taking advice from officers.

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Thank you.

Jack Pinter, do you receive any apologies?

I have received none.

I don't receive any apologies.

Councillor Amy Lee just apologised for being late. She's on her way. She's just caught up in public transport.

Thank you.

Before we move

onto the main order of business,

I would like to formally welcome

Leo

on our new health watch

Leo, if you wish to say anything

or happy for us to move

on the main order of business,

it is up to you.

It is up to you.

If you want to say something.

Hello.

My name is Leo Condra De Souza.

I'm happy to be here to make any contribution of value,

which I feel will help the Scrutiny Committee to march forward

and make a difference to the community at large.

That's all for me, sir.

Thank you.

Thank you for having me.

Thank you.

You are most welcome.

Now, declarations of

disclosable

pecuniary interest.

Can committee members

introduce yourself

and declare

if you have any

DPIs

and indicate

which aspect

of the interest relates,

state whether

the interest is

personal or

prejudicial

nature,

I will ask the chair to give an explanation of each declaration, please.

Thank you, chair. My name is council Ahmad Al -Kabir. I don't have any DPI.

Thank you.

Chair, good evening. I'm a councillor from Gombe north, nothing to declare.

Thank you, chair. So I have no declarations of pecuniary interest but in the interest of transparency.

I've been notified that I might have a personal interest in items relating to the award of the home care contract.

Nothing to declare, huge apologies for being late.

Allia always doing Crusader's house

grow spree,

talk just now about growth when ozone

Thank you.

The minutes from the last meeting, 29 July, have been sent to everyone.

Can the committee members confirm this as a true and accurate record?

We have received responses from officers on information requests which is included in

the action log.

Do members have any brief comment or can we move on to the next item?

If you have any question or any clarity, it's up to you.

Thank you very much, Chair, and thank you to officers and the team for providing the

information.

So I wanted to ask in relation to the home care contract and the discussion that we had

last time, two things.

So first of them is we've received a copy of a letter that was sent in August, towards

the end of August, in fact just before the agenda was published, which was I guess a

kind of a reminder to the 400 or so service users of one of the agencies that the intention

is no longer to use that agency about what to do or what will happen and what they need

to do. So what we didn't get was the earlier letter and any earlier correspondence that

might have been sent than that that might have been sent to those residents as well

so it would just for the record be useful to have that. As I said there were around

400 service users so really significant number of people affected by this change

in the as a result of the procurement process and yeah I think that's

something that needs that needs that we as a committee should should look at and

think about and maybe even see if we could proactively or the officers could

give us some proactively give us some response and update about what's happened with those

people. Are people requesting that their existing carers be retained or are they happy with

the change. So the other thing I want to mention just in relation to them, this is in relation

to the contract discussion that we had about home care was that it's repeatedly stated

that home care is free and it's subsequently been drawn to our attention

that home care is not free, that there are some aspects of home care which

continue to be charged and so I just wondered if we could get a note formally

setting out what's being charged for still and what has actually become free.

I think we knew already daycare wasn't going to be free but there are some

aspects of home care itself that are not so it would be helpful to get that. Thank you.

Thank you, chair. Thank you, Mark, for your questions. Like yourselves and the rest of

the committee and the rest of the residents of this borough, we know 400 residents and

care users will be kind of affected and we are in mind of that. Sorry, the initial letter,

You say you didn't get it but we could certainly send around.

So the initial letter was to all users of home care stating what the arrangements would be following the failure of the procurement process.

So that's the initial letter, it wasn't just to users of APISAN, it was to all home care users.

And that's the letter referred to in the second letter.

We can get you a copy of that, definitely, and we will send that.

But that was a more general letter to home care residents who use home care in this borough

to say your care will continue, basically, whilst we look at the framework arrangements

that we'll make.

But we can definitely get you a copy of that.

Yeah, and I just wanted to add the whole transition process.

Obviously there are a lot of big concerns and we are aware of that.

So that's why there will be that slow procedure.

But we haven't actually started, we don't know exactly when it will be,

but the initial kind of talks are there, discussions are there.

A lot of the care workers are saying are they going to have the same hours,

or are they going to be with the same care users that they've been supporting.

With that in mind, we said mostly that we'll be looked into, but it won't be 100 % where you've had the same clients that you have again.

But mostly, we'll try to fit in how whatever user that they've been caring us a point for will continue, because we know some of the residents are very vulnerable and they don't like change.

So there will be that transition process where slowly discussions with both the care worker and the service user,

there will be discussions way in advance of that. But we don't know exact dates of when exactly that transition or that takeover will happen.

And I think another question was about the care home.

So remember daycare isn't free, it's the home care that is free.

But yeah, listen to some of the residents, they've come across some residents like,

look, we're getting home care free now, which is great, absolutely.

But at the same time, sometimes my mum is taking for a walk and that's been charged.

So I've been getting some cases like that so maybe perhaps we need to be clear exactly

what is meant by free home care.

I was just going to add that it would be helpful to get your, from what you've heard, what

aspects of home care are not seen to be free and will take it back to Georgia and the team.

I'm happy to look for individual case but their responses that have come back from the

directorate itself.

So I think for example things that have fallen under the bracket of domestic assistance might

not be and obviously that was part of the home care that was provided free previously.

So just in relation to the letters, sorry that wasn't, I misunderstood that from last

time and from the correspondence that we've seen, that it was a generic letter.

Like it's good to know that a more bespoke letter has been sent to the service users

with the agency concerned, but that was a month after we raised that in this committee.

So yeah, let's have the copy of the initial one that was sent to everyone

and we can see that and and I guess just on the point that the

lead members making about I like really appreciate the assurance that she's giving and

Genuinely understand the difficulties that will be and obviously some carers might not want to change their agency at all

But I think it would be useful to put some metrics on that who is

is who's seen a change of carer of their kind of normal carer of those 400 people since?

I appreciate that can't be done quickly.

Thank you, thank you Chet, just quickly but yeah I appreciate what you say about people

maybe needing more information because we have had this where people are concerned that

I think they thought they were getting a completely free package and it doesn't seem to be the case.

So I appreciate what you say.

I'm just, in terms of this discussion we're having, you have already said in this, there's the FAQ document,

you've already said that you're going to write to residents again shortly.

I think given that we're looking to see these letters just to know what information residents are receiving,

I think if we could receive, if that letter's already been written or if it's about to be written,

I think we would appreciate seeing that as soon as possible, just so we're all on the same page.

and you've also said, as you mentioned, that there may be visits by social workers or support workers

to discuss ongoing care and the transition arrangements, which I think is very positive, I think that's a good thing,

but if you've already sort of got these arrangements not quite done and dusted, you're shaking your head,

so I'd be interested, where are we in this process? If we're already thinking that people need to have a visit

to discuss this is that everybody is that certain residents who are quite

extremely vulnerable and what level of support is going to be provided during

this transition. I think this is a very good start for sure having home visits

but I'd just be interested to hear a bit more about the transition period.

So as Councillor Spina said before we haven't established what the timeline is

around that transition so people are continuing to have their care provided

by their carers and the agency that that was providing it. The intention is to write to

them when we are very clear around that transition timeline because we don't want people to get

concerned and then wait months for that to actually happen. So the negotiations around

that transition period are ongoing. We will probably visit the vast majority of those

people because unless they've had a Care Act review very recently and that's not necessary,

and it's not necessary we don't want to do an additional review very quickly, it is an

opportunity for us to cheque that their needs haven't changed and that we will, once they

transfer to a different provider, their care plan is accurate. So it's difficult to say

We will give you the numbers when we get them, when we get the data.

But it would be, I think, the majority of those would be visited.

Yeah, I just wanted to share, like, with every resident, every service user, the care plan is different.

So it's kind of like we need to meet them and have that journey with them, especially with some of the changes that they may not be wanting to do.

Also we've met with many care workers, so individually from different organisations we've met, not myself but the officers have met,

with care workers, kind of reassuring them that their jobs will be in safe hands and we're trying to provide them with some of the providers that we have.

So there was a lot of fear in the community, a lot of in the media as well, so we tried to meet as many as we are doing, kind of ongoing every week.

I would just say in this FAQ the exact words are, we will write you again shortly. That usually means in the near future, so people are probably waiting to hear.

I appreciate you might not have the timeline ironed out, but shortly means soon.

So you know where I'm coming from.

Thank you, Sabina.

Now our performance of dashboard.

We have received the performance dashboard in agenda.

Do members want to raise any points, any clarity?

We have about five minutes for any question.

If not, I am happy for us to move to Romania in this evening.

So that's the action of itself, isn't it?

Sorry, Chair, I'm just going to get it, because it's on the online version.

Councillor, it's just after the winter planning thing.

The A &E item.

Okay, I'm really sorry I can't actually find it.

It's after the A &E hospital waiting times.

Right.

So I just want to say first of all, Chair, thank you very much for supporting.

in getting this information,

getting it in advance at our last meeting,

also getting it published for this one.

Thank you also to the lead member

and the team for getting this.

So I think this performance data

actually reflects really well on the directorate.

I think that there's signs of strong performance here

across these performance indicators.

So I think as I said at the last meeting when we were talking about the work plan

it would be useful for us to have a formal session on this aspect in

particular about the targets that have been chosen and to talk through some of

those which are not quite, there's only a couple but some of those that are not

quite at the level that the team that were hoping that they would be for

For example, proportion of people using social care who receive direct payments is an example.

Now I wouldn't necessarily choose that or choose such a high level of performance, but

you know that's what's been chosen and that's what's been kind of scored against I guess.

So yeah, so I don't think we can go through this in detail now, but I do think it would

be useful to have a more kind of bespoke session on it.

Agree.

and that transition are handled with compassion and clarity.

I think if you read like this,

we shall work with all our care providers

to make sure that your care is not interrupted

and that you are given clear information about any changes.

And it is not just that what we want to be clear,

we also don't want to shoot like a council,

we want to sound like a member of a family.

Thank you.

Now we move on our main agenda, is A &E waiting time.

This is our first item on this meeting.

Accident and emergency services are the front line of urgent healthcare and their role is

critical to manage life -threatening emergencies.

They offer 24 -7 access and is really safety net.

In principle, one that coordinates

quick diagnostics and treatment.

We know from media resources that many hospitals

face overwhelming demand, and there are some that

have been failed to declare critical incidents,

and in some cases, leaving patients

unawared of delays or risks.

We also are aware that long waits, sometimes exceeding 12 hours, have been linked to many

excess deaths.

We know there are pressures, particularly for hospitals such as Royal London Hospital,

as it's not just a local hospital, but it's also a south -east hub for services which is

a treatment to the good work it delivers,

but also creates capacity challenges.

And we know the Resources A and E department

across the country are often stretched beyond capacity.

With this mind, can I now welcome

Dan Norton -Jung, Deputy CEO,

Bartsch NHS Trust, Royal London and Milan Hospital.

We will have up to 10 minutes to give us an overview.

Please take the papers as read and perhaps highlight

the most pertinent issues that this committee

needs to be aware of.

Then we will move to members questions.

You may start now, thank you.

Thank you very much, Chen.

I think you've given a really good overview

of why emergency care is really important to residents,

but also particularly why our hospital is important both to local residents but also

to patients across London as part of a network of major trauma centres.

So for the sickest patients coming to our emergency department, we are one of four centres

in London that will deal with those trauma cases.

So Chad, you've set out really, really clearly some of the challenges that we face.

I wanted to talk a little bit about the performance data that we've included in the pack, but

also some of the transformation work that we're doing to address the challenges that

you've identified very clearly. So I'll start with our performance in A &E where we were

really pleased in July, as you'll see just on the right of the graph, to see a 6 % increase

in the number of patients who were seen within four hours in the main emergency department.

That was quite a significant jump as you'll see after a period of sort of flatlining a

little bit and we're really, really pleased to see that.

We've made a number of changes inside the emergency department that have helped with

that, particularly making sure our initial assessment and early senior assessment within

the department, so this is a very senior decision maker, reviewing patients as quickly as possible,

ideally within 15 minutes of them arriving.

We've changed a little bit the way that we do that and that's enabled us to send more

patients to the right setting of care for them, which might be the Urgent Treatment

centre, it might be our same day emergency care and for the very sickest

patients to get them into the emergency department as quickly as possible. So

we're really really pleased with the performance that's given us and we're

hoping that will sustain and set us up well going into the winter which is

obviously the busiest time for the emergency department. I should also say

on the third slide we've provided as well as the the kind of performance

figures and waiting times it's really really important to us that we are

listening to the voice of our patients and the way that the NHS nationally does

this is through the friends and family test so every patient is asked would you

recommend this service to your friends and family and we were really delighted

that we've had an increase in our performance to 75 % in July answering yes

to that question based on our in our main department so there's always more

to do but we're pleased with that performance and hoping to see it rise

We've also included some of the qualitative feedback that we've had from that and just

some examples of that on the slide.

I should also say I presented one of our staff awards to an emergency department nurse, a

really very, very moving dedication about how a nurse working under a huge amount of

pressure in the emergency department still managed to provide really compassionate, generous,

kind care alongside really outstanding clinically excellent care as well. So that

source of data is really really important for us if we're listening to the

voice of our patients as well as looking at the performance of the department. The

second slide talks about our urgent treatment centre so that's just round

the back on Stepney Way. This is a GP led service and again we've been able to see

a slight uptick in performance in July by about 4 % which again we were very

very pleased to see. So again that's a service that we run in partnership with

primary care and a large number of patients who come to the main emergency department

were actually able to see them more effectively in that urgent treatment centre setting so

that patients who are a little bit sicker can stay in the emergency department and everybody

can be seen more quickly in a setting that's right for them. And again we were really pleased

with the 60 % performance there. The wait's a little bit longer there so we've got a little

bit further to go in improving that but again I think we're on an upward trajectory and

we've got a bit more to do there but we're moving on up. I just want to talk about two

things that we're doing at this time of year to try and get ourselves into a better position

going into the winter when obviously the department will be busiest. We currently have what we

call a reset week which is when we have a number of interventions that we run

both across the hospital and in every ward to try and make it easier for

patients to get home from hospital as quickly as possible. That then obviously

means that patients who are needing a bed in the emergency department so the

sicker patients generally who need to be admitted that they're able to be moved

to that bed more quickly and again I think we've seen saw in July an

improvement in that 12 -hour wait on a trolley we took a percentage off that

the number of, so a 1 % fall in the number of patients waiting for more than 12 hours

on a trolley in July. So we were really pleased to see that and we think the interventions

that we're doing through reset week will help us to do that even further.

Finally I just wanted to talk about another transformation initiative we've got which

is through REACH, our community emergency medicine service. This is delivered in partnership

with London Ambulance. It embeds emergency department nurses and doctors alongside London

ambulance service so that when an ambulance has gone to somebody's home

and is planning to take that patient to hospital, the ambulance crew

are able to call in advance to cheque with a team of emergency department clinicians

whether actually that patient does need to come to hospital or whether there's

another way of providing the care that that patient needs and we're really

pleased that that's saving more than 500 patients every month needing to come to

hospital which again means those ambulances can be released to see other

patients, it means those patients could get quicker access to what they need without needing

to go to hospital and it means that the emergency department is able to care for the patients

that can only be treated in the emergency department.

We're now expanding that along with London Ambulance Service, we're very excited to be

doing that through Single Point of Access where that after patients call for an ambulance

to be able to again do another cheque, does an ambulance need to go to this patient?

So again it's about making best use of the resources that we've got and making sure all

of our patients, whatever their level of needs, are able to get that as quickly as we possibly can.

I'm very happy to take questions, Chair, but I hope that's reasonable as an introduction.

Thank you, Dan, for your overview. Do members have any questions on what you have heard so far?

I will take two questions at a time and then ask to respond.

If we have time after the first round, I will allow one more. Thank you.

Thank you, Chair, for giving me a chance.

Thank you, Dan, for your presentation and good evening.

On your presentation, you just mentioned the,

refer to the improvement in this number

of the patient living A &E within four hour.

But the largest figure July shows A &E.

And it's only achieving 62 % which is below the national

average 78%.

Let alone the standard 95 % on set target 2010.

and what are you doing to improve performance under this four hour target?

This is my first question.

And the second one, what are the criteria for sending patients from the Royal London Hospital ANE to the UTR, UTC sorry, urgent treatment centre?

Thank you, this is the two questions.

Thank you very much Councillor for your question.

The national data with a 78 % target includes both the main A &E, so our type 1 performance,

but also the type 3 performance that we see below.

So the first two slides are what go into our overall performance and I'm pleased to say

that our performance in July was 77%.

So when you add together the A &E but also our urgent treatment centre, we were very

close to hitting the target.

clearly we want to do better and hit it and exceed it to get back up to the soaring heights

of 2010 exactly as you say. But the 62 is in the main department but we had a much higher

performance of 91 % in our urgent treatment centre and with the volumes weighted by that

the overall performance in July was 77%. So we're nearly hitting the national ambition.

And again that 77 was a big increase, we were I think 71 % in June. So we had quite a significant

improvement in July which we were pleased with but clearly still more to do. In terms

of working out which patients need to go and are best seen in the urgent treatment centre,

that's done in the very first stage of patients. So patients will arrive at reception, sit

in the waiting room for a few minutes and then be seen by a very senior decision maker

and right at the front of the pathway in the emergency department. That's essentially

an extended form of triage senior assessment that will then work out if that patient does

need to stay in the department or actually whether a GP led service might be provided

just over the road, just 100 metres away, two minute walk away, whether that's better

able to suit them and we think that's the best way we found to make sure that all of

the patients, whatever their level of need, are able to get what they need as quickly

as possible.

I have a question here. Thank you for giving me the opportunity to ask two questions.

But I'll take one at a time. The first question, sir, you mentioned listen to voice of patient.

Now, listening to the voice of the patient and working on it like how many patients you get with the same voice.

How do you matrix it? In other words, how you measure and monitor?

And then how do you prioritise that yes, this is like a pain point and I need to give more attention to it.

And the last one sir is how many times your committee meets in a month to look at this entire listen to voice feedback.

could be constructive, not constructive.

And then, you know, make a list, prioritise,

and this we need to attend, this.

And then, end of the day, how many have we listened to?

And how much difference it has made.

Sorry for this long, you know.

Over to you.

Thank you for your question.

I think we have lots of ways that we listen to patients.

I've presented in the paper here the friends and family test, which is one aspect, but

it's only one aspect and it is a nationally mandated thing that we do along with everyone

else in the NHS.

But there are some really important other mechanisms that we have as well.

A number of our services within the hospital have patient groups within the service, so

that might be the respiratory team or the gastroenterology team, where they have groups

of patients who are involved in shaping that service, perhaps coming to meetings, co -designing

alongside our clinical teams key service changes.

We have across the hospital a patient experience committee,

which meets I think monthly and reports

into our quality committee.

So a really important part of how

we assess quality of our services

includes safety, includes the patient experience,

includes our outcomes, our complaints.

And we triangulate that all together

in our patient experience committee with the reports

to Quality Committee which is the formal board of our hospital where this is all reviewed.

We have a committee that looks at it in detail, it then reports into our Quality Committee.

The third thing I think is really important is patient voice in shaping our work. So our

maternity and neonatal committee for example starts every meeting with a storey of a patient

we had in the last meeting two weeks ago, an incredibly moving storey of a woman giving

who'd had a really unhappy time and we hadn't done as well as we should have done for her.

And actually bringing her, giving her the opportunity to speak at the meeting with support from some of our teams

who work on patient experience within their roles was I think a positive experience for her at feeling listened to,

having not been listened to at the time when it mattered the most.

And it's also really important for us as a hospital to be hearing and centring the voices of patients

as we try to think about how those services are performing.

So I'm sorry if my presentation was a bit too narrow on the friends and family test,

we have lots of other means of doing that.

And I should finally say Healthwatch are a really important partner as well,

we had an extremely good report from Healthwatch at our last quality committee actually,

so I know the Patient Experience Committee looked very closely at the work that Healthwatch have done,

including a very good report that we've reviewed recently.

So a few different answers to that,

and I'm sorry if my answer was a little bit too narrow

previously.

Thank you very much.

You put it well.

My second question, I know that there are huge challenges.

And one of the biggest challenges

that I've seen when I have done my research

on the entire community is that there is an increasing

population in this area.

The question that begets me is how do you manage it with the limited resources

that you have and is there a way like you get it's correlated like increase in

budget for you with the increase in population that keeps on coming in?

Yes we do but there is sometimes a little bit of a delay in that money

coming through so obviously people are moving in all the time and then the

formulas are updated nationally and it takes a little bit of time. The other

thing to say is the money may increase but actually the space in the

hospital doesn't. We have the same amount of space in the hospital so even if

we're able to have a bit more money to particularly employ staff that the

hospital itself doesn't get any bigger and so we're working within some tight

physical constraints. The response to that ultimately has to be to try and be

more efficient and so the kind of interventions I talked about in the

department but also across our inpatient care, what we do jointly around discharging patients

as quickly as we possibly can. It's really, really important to improving the productivity

of the services that we provide so that we're able to provide a really high standard of

care to, as you say, exactly as you say, quite a rapidly growing population. This part of

London and actually our wider catchment in North East London is among the fastest growing

populations in the country. So it does pose some particular challenges in our locality.

Thank you, sir. I rest my case.

Thank you. Thanks very much, Chair. Just very briefly, I think there's a very good point that was made that

you've got data on poor, or very poor experiences, I think it's a question of how much you actually dig into that

and look in the patterns, so I think that's a very, very good point.

But my question is about the, again, about the urgent treatment centre.

So you said that 45 to 50 % of the patients who attend A &E

attend, then subsequently attend the urgent treatment centre,

which I think is obviously a very big number,

and I imagine that this is what is driving a better performance in A &E,

that you're able to have this opportunity to send people

where they're to be perhaps more appropriately treated.

But my question is about when it might not be the right choice to do that.

So how many of these people that are sent from A &E to the UTC come back to A &E?

Either the same day, the same week, the same month, because they haven't quite been able to address their problem there.

Because it perhaps is an emergency issue that wasn't appreciated at the time.

And also, I, taking us back slightly, members might remember, I think it was last year,

and it was this meeting, because I remember the headline actually,

there was a point made about how the Elizabeth line

and the closeness of the Elizabeth line to the hospital

had caused the numbers to surge, which is of course, as you just said,

money might increase, facilities don't.

What impact has that continued to have, and how many,

I know you can't say that, how many of those people go from

into the UTC or the A &E, but what impact is that having in general,

because I do remember that being raised and thought it was an excellent point and I'd just be interested to hear an update on that.

Thanks very much. It's difficult for us to know precisely the impacts of the Elizabeth line opening but we are seeing a steady increase in the number of tendencies.

Part of that will affect a growing population, some of that will affect a sicker population

as the population ages in an increasingly multi -morbid.

Some of it may affect, exactly as you say, the fact that our emergency department is

perhaps more accessible than some others.

It's difficult to quantify the three of those factors precisely, but we think they all play

a role.

In terms of patients from the Urgent Treatment Centre who return to the emergency department,

I don't have that figure to hand, but I'm very happy to write to the committee and to

provide it.

I think it's very, very small numbers, but I'm happy to confirm that in writing if that

would help.

Thank you, Chair.

Thanks for your presentation on this.

I've got a brief question, two questions, if I may, that I have to ask.

One of them is how many patients are going to A &E because they cannot get a GP appointment?

How many of them will get an emergency treatment or be sent back to GP under the same day access?

Can I get some figures on this, please?

So that's for the benchmark.

Also, my second question, brief one is, why do 33 % of the patients rate urgent care sent to the poor?

and what are we doing about it on the report. Thank you.

Thank you very much. I don't know if, college, do you want to comment on the GP appointment

on the same day access point? Is that something you have figures on or the ICP have figures on?

How do you provide figures?

We can provide figures outside of this course in order to give you an accurate figure if

that's what you'd like. Just so that I'm clear you want to know how much 33 % of people use

in same day access appointments slots. Is that the question?

I'm very happy to take that one, but in terms of patients coming to the emergency department

who can't get access to a GP, I'm not sure we have figures on that, but I wonder if ICB

colleagues might have on that. Certainly it is a factor but I do think

we have really, for the most part, really very good primary care in Tower

Hamlets and we work very closely with our partners in primary care so it

certainly is a factor and if there are localised examples where things

have not worked and we're always very happy to pick that up. In terms of

the 33 % who had a 32 % who had a have had a poor experience of the urgent treatment

centre that is certainly higher than we would want and again in the major in the

main emergency department that figure is significantly lower that's 16 % so it's

about twice the rate it is in the in the main emergency department I think I know

the providers of the UTC GP care group are constantly trying to work on that

they've have sometimes have had a couple of challenges including this week that

have disrupted their service a little bit which has meant is patients have

sometimes waited a little bit longer there than perhaps they than anybody

would have liked so there are occasionally also some staffing

challenges in that service as well but I think there's a recognition that that

that that level of dissatisfaction is is not good and not where we want it to be

again I think we're working closely with GP care group on on trying to improve

that to address some particular issues.

Did you want to add anything?

I just wanted to add that with regard to the same day access

appointments, the key thing for us

is that we are very much aware that activity in the UTC

or even going through the front door into the ED department

is increasing substantially.

At this point last year, we've seen an increase of 2 ,200

people going into the hospital and then

either landing within ED or within the UTC.

What the thing that we're trying to achieve here is about how patients use our services,

are they using the right services at the right time.

Most of the people presenting at the UTC tend to have a primary care need.

And in order to try and change people's behaviours, we're getting them back into an appointment,

into a same -day access appointment.

A figure that I have only from yesterday is that one of our same -day,

we have about 30 same -day access appointment slots per day.

GP Care Group redirected 25 people to that same -day access appointment slot.

Only one person was a DNA. They did not attend.

So there's work to be done about how people use our services.

How we best communicate that is something that we struggle with.

We've used Health Watch in the past.

Healthwatch undertook a survey on our behalf, excuse me, Healthwatch undertook a survey

and the people were quite clear that they would go to the same day access appointment

if it was available to them. So there's something that needs to be said about how people use

services that we provide but using them appropriately. Excuse my throat. Thank you.

Thank you for your answers.

But there was no concrete answer to it.

So can we be able to follow up on the figures in other three months' time or six months' time to see what we are from now on?

Can you make a note on that, please?

Just for our references to see if an improvement happens.

We can talk about it here.

by electricity improvement plan and we should be stuck in five months time down the line

to give us some indication on this. Thank you.

Thank you. Before I go to Mark Francis there. Alia, do you have any question or anything?

I have got one question. It's very simple. Like all my colleagues were talking about the increase

on increasing of the population in Hamlets, I understand it's increasing but then hospitals

or care services are not getting any bigger but we have enough staff like working staff to give

them health care, provide services as a patient like you said like we're giving people

for patient -centred care, which is very important for people.

But how are we coping with these many people, giving them the support?

Are we coping good enough or do we need more staff?

Because I've been hearing a lot of things that there is not enough staff, that there

are a lot of people, populations and things like this.

I just want to be clarified this, like these are the questions really bugs me sometimes.

how would we cope with this? Thank you.

Yeah I think it's really good and I think one aspect I think is really

important is that when services are under pressure the impact it actually

has on staff and I know that staff across the council will also face this

when you're faced with you know significant increase in demand it can

it can compromise people's sort of professional integrity sometimes and

we're very mindful of that within our hospital. The hospital has, for nurse staffing, a series

of nationally mandated ratios to ensure that we always have enough staff to look after

the needs of patients there and that's a really important safety benchmark for us that the

NHS has introduced over the last 10 or 15 years, particularly following the mid staff's

of inquiry and the France inquiry that came out of that. So we work to nationally mandated

staffing ratios. What's really important to us is that we, as well as having enough staff

in each of our clinical areas, that we're providing the right support to staff so that

they are able to give the best that they possibly can to patients as to what they all want to

do. But when things are stretched as they sometimes are, that can be a little bit harder

for people. So giving people the support they can through good line management, through

appropriate support for their wellbeing, tackling things that make it really difficult. Violence

and aggression sometimes is a challenge for our staff, that's true for many people working

in service jobs. Again we've put in body cams in some of our areas, it's a shame that we've

had to do that unfortunately but it's really right that we've taken that measure in others

to protect our staff from violence and aggression.

So there are lots of different aspects of this,

the national staffing ratios, but also, crucially,

the support that we give to staff when they come to work

every day so that they feel valued and supported

and able to give the best that they can to their patients.

Thank you, Mark.

Thank you.

Sorry, do you have any supplementary question, please?

I understand that, what you're saying.

You know like like if you have a like it's been like 10 to 15 years you seen that there is a

measurement of staff but how do you look after you know that you have to look after your staff as

well like nurses and doctors and the service workers you if you have like I understand there's

enough key workers but how do you look after yourself in terms of looking after and understanding

look after patient at the same time you have to look after the doctors as well you see but it's

good enough, like are we, because we need to look at the both side as well. So how are we coping with

the doctors now? You know like the shortage of staff and things like that. Sorted of staff I

mean like doctors and nurses. I understand they said there is enough, the government has their

policies, that there are staff there that keep workers enough workers but

think is every day people are increasing like growing in the global population are we coping

well with the mentally and physically? Am I clear? I think it's a really astute question

one of the things one of the delights of working in a hospital is that it's a very multi professional

multi -specialty workforce. We have doctors, nurses, healthcare assistants, porters, cleaners,

therapists, pharmacists, a whole range of people doing it. It's a real team sport and I think what

we really aspire for for our staff is to feel that they're part of a multi -disciplinary team

of different people all working together in the interests of patients but also really importantly

to look after each other. And so the sense of team is really, really important for us.

The best support for staff comes generally from their colleagues and their manager, and

so we try really hard to instil that sense of teamwork, solidarity, working together

to address difficult challenges that people face on a multi -professional basis, not just

nurses, not just doctors, not just therapists, not just pharmacists, not just cleaners, everybody

together as part of a single team all working together so that multi

professional dimension and the teamwork is really really important to us and we

do a lot to try and promote that.

Thank you, thanks for the presentation and to your team for the work that's

happening so thankfully I haven't had spent any time in A &E in Royal London

this year and but I think like many of us have and many of our constituents

have experiences of difficult experiences in the past.

And so it's really encouraging to see this uptick

in performance.

I know it's only like a start of an uptick, hopefully,

but it's clear, and it's also really clear to see the focus

on the kind of, I guess the kind of procedural

and operational side of things that's helping to deliver that.

So I think I've been complimentary about the work

that the Directorate within the Council is doing,

and should certainly be complementary to the staff

at the Bartson NHS Trust as well for this performance.

I think this is all about whether this can be sustained.

This is the sort of thing that you can chuck some resources

at, chuck some new management at,

and deliver some short -term wins.

But obviously, this isn't about achieving that target

within a short space or for a short period.

it's about sustaining it over the long term.

So I really agree with what colleagues have said

about the need for this committee

to have kind of eyes on this on a fairly regular basis.

But yeah, I'm really happy to see this

and to see that perhaps our constituency experiences

have been better in the last few months.

I just say thank you, Councillor, I just really appreciate it.

There's a lot of hard work goes in

from a lot of people to do this.

And ultimately that uptick on our line is people getting better care more quickly and that's what we aspire to.

It's great that we've managed to deliver that in July.

You're absolutely right that sustaining this, particularly as we go into winter, when was we know,

that's the time when seasonally the emergency department is busiest, I think is going to be a challenge for us.

But we're up for a challenge. I think we've done ambitious things like this before, but you're absolutely right.

and we look forward to coming back to the committee in future to hopefully present a continually improving position.

But thanks for the recognition, it will be really appreciated and welcomed by our staff, so we'll pass that on. Thank you.

Thank you. This last one is from me. Thank you.

In your view, what makes Royal London Hospital's clinical prioritisation the most effective in London?

and what happens to the patient after the prioritisation exercise?

I missed the last bit of your question, I'm very sorry, what happens to the patient after?

Yes, okay, so clinical prioritisation is a really, really important part of actually

almost everything that the hospital does requires a degree of clinical prioritisation

and that's about making sure that we see the sickest patients soonest so that we can help

them to get better. But also that we make sure we see absolutely everybody as long as

we can, as quickly as we can. We know that we do have some patients who may not have

super urgent conditions but it's really important to us that they don't wait too long even though

they have conditions that are not perhaps life threatening or super urgent.

We've had a significant improvement over the last 12 and 18 months in particularly the

patients waiting a very long time for planned procedures.

So significant improvement in our referral to treatment performance which includes a

number of patients who are not the sickest patients that we see.

But we've seen just in July a 7 % reduction in the number of patients waiting more than 52 weeks for planned care.

Again 52 weeks is far too long for anybody to be waiting.

But unfortunately with the COVID backlog that we've done across the NHS has emerged as a result of the pandemic.

We've been steadily making progress in doing that and again I'm really pleased to say that in July we did take that number down by 7%.

the number waiting more than a year for treatment. So those generally will not be patients who

are, who've been assessed to be really needing an urgent intervention, but it's really important

that we see them as quickly as we can, even though their condition may not be life threatening,

it may be impacting their family life, their ability to work, you know, they may be waiting

in pain. And so it's really important as well as treating the sickest patients soonest,

that we treat everybody as quickly as we can, and I think we are making some progress on

and those long waiting patients as well.

Thank you.

A &E is not just a hospital wing,

it's how we as a society will urgent care

with human dignity at the core.

Public scrutiny is important on this issue

as it shines a light on systematic challenges

such as understanding corridor care

and normalisation of delayed admission

that not just inefficient but also dangerous.

As a committee we should continue to have a watching

brief on this issue and I appreciate

it's not overnight fixed.

We as a member should work with our partners

to get message out there.

With this I conclude this item.

Dan, you are free to go.

Thank you for your nice presentation.

Thank you for having answered different questions.

Thank you.

Please, Yussa, I'll do your part.

Chair, can we maybe have an action point to ask for the data again by the end of the year,

to see where things stand by the end of the year, so that it can…

Is that all right?

Thank you.

Our next item for this evening is the winter pressure and planning.

As we will be approaching the cold season, seasonal pressure can often put vulnerable

residents and patients at risk.

Our focus is to consider the education of current winter preparation plan, consider

any systematic risks and ensure that strategic coordination and resourcing are in place so

as to manage safety and equity in service delivery.

With this mind, can I now welcome Councillor Sabina Ahtar, Cabinet Lead for Health, Wellbeing

and Social Care and Suman as well, Public Health Director.

You will have Julie Dublin.

Thank you.

Senior Programme Manager on Planned Care and Ageing Well Integrated Commissioning Division.

You will have up to 10 minutes to give us an overview and please, like previous agenda,

take the papers as read and perhaps highlight the most relevant issues that this committee

needs to be aware of.

Then we will move to members' question.

We may start now.

Thank you.

We all know how important it is for our residents, the vulnerable residents, to be well prepared

for winter and that's why it's so important.

But I must say I'm really kind of disappointed in the quality of information that the North

of East London Integrated Care Board has decided to share with us today.

The whole purpose of these meetings is to give us elected members to represent our community

and the opportunity to question the delivery of health services and give recommendations

on how the needs of these constituents can be met better.

So while these reports may be easily interpreted for someone inside the ICB, within the ICB,

but it kind of leaves the crucial details that my colleagues and I would perhaps want

to know more properly about the support our residents will get through the winter months.

Do you want to carry on?

Thank you.

I am

Paul Swindles, I am one of the service heads in adult social care.

I am here representing Judy Davidson today.

Okay, so I'll take you through the document that's in front of you, but first of all I

just want to acknowledge there's a couple of errors in the document in terms of some

of the dates, but I'll point those errors out. But from the top it's also that this

is a work in progress because the ICB is currently going through its winter planning process

as well and what we do locally is going to feed into delivering the priorities and ambitions

that have been set at a national level.

So the first couple of pages, what we've done is it clearly states some of the key ambitions

that the health need to achieve over the winter period.

We heard from our Barts colleagues about the 78 % of patients, so there's a 78 % of patients

seen within four hours.

And then fewer than 10 % of patients

waiting over 12 hours in A &E. And the average 30 minute

category two ambulance response time demand

is quite important that we actually

lay out those ambitions at the top,

because that's what we're doing locally around winter,

is going to address that situation during the period.

I just want to also mention that there is no additional funding

for winter. What I will be talking about is physical capacity funding that we've received

this year and those are the schemes that are listed in the document as well. So going forward,

in slide four, the one that says UEC plan for 25 -26, they've indicated what success

looks like. And so, staff vaccinations, eliminating corridor care, these are all things, just

some of the examples that they've identified that would help support them deliver the three

priorities. The next document I want to go on to really talks about the key actions for

winter. So this is what the ICB is doing for the system and then how that feeds down to

the place -based levels and the timeline

within which they've got to deliver this work in.

I don't want to label the point too much on this.

A key thing though on slide six,

you'll see the diagram that says what do we need to do.

It looks a bit like the River Thames,

but what it's doing, it's actually showing

what input patients can expect when they touch our system

and what practises are going to be put in place to actually drive people through and out of the system.

It's all about trying to make care as close to the resident as possible

so that patients are seen in the right place at the right time

and also that they get a minimal delay in their treatment

and also improve safety, flow and performance,

which is only for patients and not just for patients but also for staff.

The next slide identifies the winter priority cohorts.

Actually, you can see in the diagram that says older people,

vaccines, primary care, BCYP, those are the areas

that we're trying to focus on over winter.

So we look at frailty, care homes, care homes in conjunction

with London Ambulance Service, you know,

and there's also the emphasis on increasing vaccinations.

So whilst this, and then also in another section,

it talks about boosting and increasing vaccinations amongst our population.

So the next slide, and the next slide, slide eight. This is just a diagram, I know it's

unreadable, and this is really just a matrix that we all had to complete across North East London,

just to demonstrate what we're doing over winter, and to rag rate it to see how, you know,

are we going to achieve, are the schemes going to achieve what's under those headings.

But I do appreciate that that document is not readable as it is.

More than happy to get that document and share that so that people can see what the components

are.

So from slide 10, this goes into our winter schemes.

And what we're trying to show here is that there are schemes that exist.

We already commissioned them.

So social prescribing, for instance, community pharmacy.

We have some step -down provision and other provision in terms of community health services,

mental health crisis.

These services are already commissioned and they continue to be commissioned as we go

forward.

And then the next couple of slides, what we've got here, are the schemes that have been proposed

through our physical capacity funding.

I'm going to spend a little bit of time on this particular section because these particular

schemes are the ones that are going to improve, that have been identified as being able to

improve patient flow.

So from a hospital perspective, the provision to facilitate discharge, bed and breakfast

provision, so this is aimed really at homeless people, so the hospital has about 30 homeless

patients at a time in the hospital and getting them discharged out of hospital is an imperative.

But not just if discharged onto the street, it's also just about trying to find alternative

accommodation for them so that they can be picked up by services.

And so as you can see, the impact of that is to reduce discharge delays and reduce length

of stay.

Most of these schemes are actually to achieve that.

There's care navigator in A &E, we were talking about same day access appointment slots.

The care navigator in this particular instance is to ensure that patients actually get to

an appointment elsewhere so they will find them an appointment and we've commissioned

this additional capacity.

So this is already on top of what primary care are providing.

Then there's the mental health discharge to assess.

that scheme in itself is focused around mental health patients,

supporting them into independent living once they're ready or clinically fit for discharge.

And also they've already got accommodation sourced through a provider to support these patients.

And I just want to make a comment that scheme one has learnt from scheme three

and that's why the bed and breakfast temporary accommodation scheme has been put forward.

Moving on, we've got schemes from a community nursing around identifying frail patients in the community.

So this is before they actually land in A &E.

It's working with primary care to do that early identification for patients who are at risk of falls

and working, going out, reaching out to them,

working with Link Age Plus and the consultant geriatrician

to keep them safe and develop a plan to reduce risk of force

and support them to build their resilience.

Then the next one is really around securing additional

primary care capacity.

This is really to address the problem that we have

with increased capacity at the front door.

we recognise and based on the data that we get,

that we get a lot of people turning up

that only need to see a GP.

Yesterday we had a situation in the urgent treatment centre

where there was no water,

so the service was compromised for about four hours.

And on the announcement that the service

is going to be compromised and they were going to be delayed

about 50 people left the building straight away.

So they self -discharge, which kind of begs the question, why?

So we've got skilled clinicians here

who are able to identify patients who

are suitable for primary care.

And we try to make the effort to ensure

that the capacity exists in primary care to support them.

We've also set aside a really small budget

for winter communications.

This is to ensure that it's localised for tower hamlets,

because when you see in the last few slides at the end of this document,

there is a communications plan that's been drafted by North East London,

which is so that the messaging is consistent across North East London,

but what we are quite keen to ensure is that we have local messaging for our population,

and that local messaging will be run through our urgent care working group,

which is a multidisciplinary team that supports our population.

So on the next, on slides 13 and 14, I do have to apologise here that those dates should say 2026.

They actually say 2025, so that's slides 13 and 14, the schemes that are shown here

are schemes that we commission through Better Care Fund that are here to also support the winter schemes.

So when we talk about step -down beds for Sue Starkey House,

or 11 general and acute beds, those

are schemes that are funded through the Better Care Fund

and Physical Capacity Fund that they are running up

until 2026.

So these are ongoing.

So I mentioned the communication strategy.

And you can see that the communication is,

they want to deal with winter preparedness, wellness,

as finding the right care and right start in life to protect potential.

So that is definitely aimed at children and young people and vulnerable people.

When we say vulnerable in this instance I'm talking about pregnant women, frail adults

who will need vaccinations, etc.

So this is what the ICB has developed for us to circulate across North East London.

You can see the timeline within which they're going to be running the campaign.

in this as well.

And then the next slide, slide 20,

we go through the governance arrangements.

So everything that we do runs through the urgent care working

group, the urgent care working group feeds into the town

hammers to get the partnership board,

and then obviously into the internal structures

that we have on that page.

Now there are a number of risk and issues

that we've identified.

I'm not going to read them all, but one of the key issues that we identified is around

certainly funding.

We don't seem to have enough funding to support the scheme, so there are some things that

we would have liked to do that we can't do, given the cap on our funding.

Some of the inability to discharge patients into the community as well, because there

are real challenges with that.

And I think one of the things that we didn't include in here, and I do apologise for that,

is the equipment, the community equipment, or the NRS situation where the NRS has gone into insolvency,

which has meant there are real problems securing equipment so that we can get patients discharged.

But the way that's been mitigated is that the local authority have got three options to secure equipment,

So we're just keeping a very close eye on that.

So as I said, this document,

which I should have put on the front of it,

that this is a draught, because it's a work in progress,

we haven't quite completed it,

because this is just talking about what the NHS is doing.

It doesn't address what everybody else is doing,

i .e. what the hospital is doing,

or what the local authority is doing.

So there's something that needs to be done

about bringing the whole thing together.

I appreciate we are over time, but it would be helpful maybe Paul to talk about the local

authority perspective on winter planning.

Thank you.

Yeah, thank you.

So I mean ultimately the governance around this plan has been through the urgent care

working group where we do have representation on that.

When there are any specific local authority schemes on the physical capacity fund for

this winter but we have we have secured for the full year through the Adjunct Social Care

Discharge Fund over £400 ,000 to support from a local authority perspective the discharge

pathway and that's funding some additional posts across our hospital based team in A &E

through our re -abornment service and through our initial assessment discharge cluster team

as well. So we've already got those in place. They're well established and that's certainly

supporting the system from an adult social care perspective.

Thank you for your presentation Julie. Thank you. Now members, you have opportunity. I

will take two questions at a time. And if we have time, then we will go second down.

Thank you.

I'm really interested to hear why you might not be so impressed with this report, because

I was about to dive in and say that, one, I'm really grateful that we have this report

now because I've been on this committee since the term started and every single year we've

expressed a desire to have this report earlier in the year.

I feel like it's always come a little bit later and it feels like we're scrutinising

something that's already been a done deal, whereas you've just said that this is a draught

document, I feel like this is more meaningful. And also what I was going to say was that

this is the most information I've ever seen in a document about winter planning, so I'm

really genuinely interested to hear what's missing on your part. I think that would be

really helpful for us to understand what you need that you're not getting at this, because

my main question is about our role in this, about the Council's role, about how we can

support this work because there is a lot of work that we can do as a council and it's

good to hear, but that was my main question, so I'm sort of saying what are we going to

do, but what information are you missing perhaps that you need to be able to do more?

Thanks, Councillor. So like you said, there is a lot of information, but perhaps more

of a breakdown of the financial kind of the dedicated funding will be used for the winter.

So we can actually scrutinise it more and we can improve or prepare beforehand. But

yes, there is a lot of information, but perhaps in terms of the dedicated funding, so we can

be more kind of how the effectiveness of those using it will be evaluated, that's all.

So more of a detailed delivery plan.

Just anything about how we're going to support this work, the winter preparedness?

There's a little bit in here about sort of comms and using our structures and that,

but I'd just be interested to hear a little bit more if anybody can answer that.

I think in terms of where the support comes from, this is part of the town's together

partnership and as Judy was describing, the winter planning group feeds into a number

of other operational groups so that where there are issues, it's connected across the

and the health and care systems.

Yeah, so in terms of the support itself,

as Shomin has just articulated,

we have a monthly meeting,

which is the OSU Care Working Group.

What we'll be using that meeting for

is to actually monitor the impact of the schemes,

because obviously we want to know

that we're going to get a return on our investments,

because some of these schemes, most of these schemes are new.

There are schemes that we brought to this meeting last

year that are not on here.

So for instance, we had some step -down provision,

which we funded for two years.

And unfortunately, the utilisation of those services

wasn't as effective, or it didn't have the impact

or outputs that we had expected because of the patients

that were going into the services,

and they actually stayed in those services.

Whereas we wanted to turn around, that didn't happen.

But what we will do is, through the urgent care working group,

we will monitor them.

We have got metrics that they will need to report against,

so that we can, and those schemes will be evaluated.

Because going forward, we would want to think,

So, if this does work, then we will take it forward.

So, one example is the bed and breakfast provision

to facilitate discharge, which is against homelessness.

There is a Northeast London Homelessness Strategy,

which was signed off this year.

And under pillar one, they're looking at one of the schemes

that we've got here.

We have got to align with that pillar

and inform them as to how effective this scheme is.

So, this is effectively gonna be like a lessons learned.

So I hope I've answered your question. If I haven't, I apologise.

But I do hope I've answered the question for you.

Thank you chair. Thank you all everyone for your lovely presentation.

Can you tell me about a bit of, I don't understand as much as you just explained about the step down provision.

firstly, as far as my understanding, there's the full unit of step -down provision.

Is there all passion to be welcomed for that, or how do you run this?

The step -down provision.

So, are you going to answer that Paul?

Yeah, sorry I couldn't answer that if you like.

I mean the paper highlights what the range of step -down offers are across the region.

So most of the step -down offers are more regional for North East London.

So some examples there of some rehab units like Ainslie Ward.

We've got some historic step -down at East Ham Care Centre over in Newham.

But also we've got some local, very much Tower Hamlet centric step -down as well.

So we run full step -down units at Sue Starkey House, which is one of our extra care sheltered

units, we've run that for a number of years as well.

So it's a bit of a range of offers really.

I suppose one of the challenges around the more regional offer is it's regional, so we

are almost competing for the same capacity across the region and that creates some challenges

certainly.

But certainly from a more local perspective as well, I know my hospital services, we look

more bespoke step -down offers in residential and nursing accommodation as well.

They're often temporary, they're done on a spot purchase arrangement as well,

and there's generally capacity in the system to allow that to happen.

You know, as you mentioned, the step -down units, what is the Tower Hamlets Local one?

Where is the Tower Hamlet's local one and is that welcome for us to visit this step -down provision?

So we don't know about the service you provide but we can educate our residents. It's better for them.

Yes, so the very obvious one we've got is over at Sue Starkey House which is near Arbour Square.

That's one of our Exocare sheltered schemes.

As Julie's already mentioned, it's funded through our BCF scheme, so that's linked to

the Adult Social Care Hospital Services.

We lead on that with the provider, who's creative support, who's got the contract generally

for extra care sheltered, and we've got four dedicated units there, so absolutely, if people

want to find out more about that and what the offer there is, we can arrange for that

to happen.

As part of the offer there, apart from the fact that that's 24 hours kind of sheltered

scheme, we also provide wraparound support through our commissioned home care providers

as well.

So it's a bit of a mixed model there.

Thank you.

Welcome Mr. Swindles to the committee and I want to say put on record thank you for

all of your help over several, many years in fact for individual cases, individual constituents.

So as Mr. Swindells knows, one of the concerns that I've raised on behalf of constituents

previously is about the packages of support that are put in place at the point of their

discharge from hospital, which is an NHS thing and then there's this transition across to

the council's own services.

So like Councillor Lee, I was really impressed,

actually, to see this, to see the detail in this.

I'm not a healthcare professional, so I can't judge it,

but it seems really thorough and comprehensive to me.

And if there's extra things that need to be added,

then it seems that there's good time

to be able to try to make that happen.

So that's all good.

How do we avoid, though,

in the context of these winter pressures,

our constituents being discharged

from the Royal London Hospital or Whips Cross or other hospitals ahead of when they might

otherwise be able, the NHS might otherwise deem them able to live independently again,

how do we ensure that there's not pressure on individuals who might be vulnerable themselves

and their family members to free up bed space within the Royal London Hospital?

And I have a separate question as well which I'll come back to at this time.

I'm pausing before I answer the question because that is a tough one.

The hospital ensures that people before they're discharged they have an expected discharge

date and they work towards that date, so making sure that the patient is fit and able to be

discharged, even if they will also need support for their families, because some people that

is the case. I sit on discharge calls on a daily, I've sat on discharge calls on a daily

basis and people are on a medically optimised, they call it the medically optimised list,

So apologies for the language, but this is what it's called.

They're medically optimised list,

so that means they're ready to be discharged.

But sometimes they need, they're awaiting a doctor

to say, yes, this person can definitely go.

So they don't necessarily,

sometimes they're under list to go today,

and the hospital makes a decision themselves

not to discharge because they feel

that just one more day in hospital is suitable for them.

There are other patients in hospital,

they have what they call an advanced discharge planning schedule.

So they identify them days beforehand

because they're very familiar with some of the conditions

and some of how these conditions show up.

So they start working on some of their social factors

like their housing, if they've got housing needs,

or if their housing needs cleansing or the packages of care,

they start working on those much sooner than they would do.

So the patient is still sick, so that by the time the patient is well, they're able to be discharged safely.

Obviously, sometimes, you know, everything's not 100%, so sometimes people will go back into hospital,

but the hospital does, you know, they're not in the business of clearing the beds because they need the beds,

even though they are under pressure. I know it might sound like that's what it looks like,

but having sat on some of those calls from my experience,

that is not necessarily the case.

Come back on that for a second.

Yeah.

So I appreciate that, and it's not to question

the kind of the integrity of staff within the NHS.

Nevertheless, there are competing pressures.

Obviously some patients, you know,

they wanna get out of hospital

before they've even kind of sat down,

but there are other patients that I would understand

might be reluctant to leave, might lack confidence to leave,

or their family members might feel that they're not ready.

I'm just trying to understand whether there's anything

that Tahamet's Council does at that stage,

or whether this is all then about a negotiation between

the individual, the family and the NHS with the support of

patient advice liaison.

So we have where it's needed there are social workers that support the NHS to support them

to get patients discharged from hospital and that support comes in the form of, so if there

are meetings that need to be organised to have that negotiation with the family, the

patient, because sometimes the patient wants to go, the family don't want them to go as

you've just mentioned, and so the adult social care,

that's Paul's team involved in arranging those conversations,

because we want to do things that's best for the patients.

Obviously, if the patient's got mental capacity

and they want to go, then they will

work with adult social care to support that discharge.

Thank you very much.

Thank you, Chair.

First and foremost, I must say, you are Georgie Achebani, madam.

I am Julie Dublin.

Sorry?

Julie Dublin.

Oh, okay, because it is not on yours.

First and foremost, I must say, Julie, amazing presentation,

and the way it was crafted and put forward,

you know, I was trying and searched for questions.

I like the way it is, I like the vigils.

I could see, I could feel, you know, and

I have one question for you, two questions actually.

Number one, the first one is,

I could see the pain in body language when you were presenting.

So what I would like to know is what is the biggest challenge you face in your job

and the pain points you go through and then depending on your answer, I'll go to the second one.

Oh, that's such a nice question. Thank you, Leo.

You can be my friend. I'll take you out for coffee.

I didn't get that. Anyway.

So, I think one of the real challenges that we face, obviously, is, I mean, we've got a lot of pressure on the system.

I mean, you hear that unplanned care, emergency care, is constantly in the limelight.

So, that is, you know, those are some of the challenges.

I mean, I work with some excellent colleagues, you know, adult social care, in particular,

given that most of our patients, particularly on discharge,

need adult social care support,

and we are very good in Tower Hamlets

at looking after our patients in Tower Hamlets.

The real challenge we have is around people

that come from outside of the borough,

who are, there's about, I think it's 54%,

if I remember the stats,

54 % of the people in the hospital

are from outside of Tower Hamlets.

54 % of the people that are inside our A &E department and UTC are from outside of Tower Hamlets.

And so the real challenge for us is trying to support the hospital, because it's a group effort this is,

in trying to ensure that we're meeting the goals that we've been set.

And certainly around the Urgent Treatment Centre, that has been just trying to make sure that they hit 95 %

has been a real challenge.

So some of these schemes that you've seen in the document may not address all of that,

but it's certainly the thing, it doesn't keep me up at night, but it's certainly the thing

that I do what I am concerned about.

Thank you very much.

Now my second question.

If you had the power with all the challenges that you faced through, and you don't have

to go through anybody, your superiors will say,

you know what, Julie?

Do what you want.

You know, here it is.

What is that one thing, if you had the power to change,

you would change?

The one thing I would change is the way the speaker, thank you,

I think the way we work together.

I think what's important is this is not a single person's

effort, it's a team effort.

So it will be all of us, not just the professionals sitting here speaking to our councillors and to our community members, it's a combined effort.

And if I had all the money in the world, this is one thing that I would try and endeavour to do, to get us all around the table, to deliver the kind of transformation that we need.

because we work in silos a lot and working in silos doesn't help anybody.

I've worked in Tower Hamlets for a long time, so I know Tower Hamlets very well.

So working together is the key thing for me.

Thank you very much. I feel what you feel. Thank you.

Thank you, Chair, finally. Thanks for your presentation.

It's lovely, easy to get through and see through this.

One of the slides on page 59 or maybe page 17 is about the publicity on this.

I'm particularly concerned about the secondary school flu vaccination.

A large number of population, over a third, maybe half of the school students are Thai

are Muslim population and in the past we know the vaccine, they contain some pork product.

Therefore a lot of parents decide not to give their children the vaccination.

How we address this and is the new product coming in this summer, does it contain the

product or not? What are we standing on this at the moment? Thank you.

I think the question, there's something that needs to be done around comms just to

give people assurances about what the ingredients are in the vaccinations. I mean we have a

identify, or not just identify, but just to explain what's inside the vaccine, any vaccine that we give our population.

And given that in Tower Hamlets we are very familiar with the demographics of Tower Hamlets, I would query if, I would use the word, I would question if there was pork in the, pork byproducts in any of the vaccinations.

I myself don't eat pork because it's unclean.

And so we could work with our medicines management team

just to establish what's in those vaccinations

and then make sure that the comms campaign actually addresses that as well,

because I think that that's the only other way that we could achieve that.

And just to follow on from that, I think this is where one area where the NHS and the local

authority work together quite a lot because the responsibility for immunisation is with

the NHS, but we, between public health and the schools, we work together ensuring that

the right information is going to parents.

But it is an issue because we have low uptake.

That's not just that vaccine, but across the board,

Tower Hamlets typically has lower uptake of vaccinations generally.

There are opportunities for the council cons and the council media.

We've worked a lot with actually the mayor's office to disseminate messages

But it is a struggle in this borough to get really good uptake of vaccinations.

But part of that is getting the right information, but part of it is working with communities, community leaders and peers.

That approach is really important.

I just have a question. Thank you for hiding that.

The reason I was asking that, because the previous year, there was a myth as well going

around, so therefore it outweighs the health, what children get.

So if we get it comes out sooner than later, then it cut all the myth and what it is, what

So that way we will have a maybe a better chance of being better

Uptake on this because the end of the day is saving children children lives and so on. So thank you on this. Thank you

Thank You councillor, sorry, I'll have a gun. Do you have any questions, please?

Are you okay

Thank you, it's good enough for today. Thank you

Quick question. So Mr Dublin mentioned about the community equipment service. So Councillor

Actar will remember that we had a lot of discussions in the scrutiny committee under the previous

administration about the outsourcing of the community equipment service. And I understand

that it went from MedEquip to Nottingham Rehab Services which is now folded. And so we have

Obviously that is, as was identified, a potential risk to winter pressures, but a risk more generally as well.

Just wondered if there's anything that the team can say about that this evening, about what's been done so far to put an alternative in place in conjunction with a consortium.

but also if you're not able to answer that, if we can just get a note just explaining

what's going to be done to fill the gap or get someone else in to cover that area of work.

So this is actually an area of my responsibility that I've been working on in the last 8 to 12 weeks.

So in response to a very sudden collapse in NRS, we have seen a really, really strong response

from ourselves, the NHS and our partners as we stood up a business continuity emergency

service.

So we're partly doing a kind of smaller service from the PDC in Tower Hamlets which is staffed

by, it's a whole council response actually, so it's staffed by people from resources and

from communities who have been redeployed in an emergency capacity plus our own occupational

therapists and commissioning team. We've got actually equipment there, so there's some

quite interesting photos I can share with beds and stuff that's there and there was

an organisational memory around providing an in -house store which fortunately was there.

So in terms of where we are in performance it's not as good as a

business as usual but actually on the sit reps we haven't delayed very many

discharges at all. We also have a number of other options which are short -term

contractual options with providers and things like that so it because it

literally folded on the 1st of August and we were there on the 1st of August

because we've done a bit of planning around it.

And I think it is a real, shows a real strength of the council

plus our partnership with the NHS that we were able to do that.

And I haven't had the figures in but I think of the 21 boroughs in London,

our performance is pretty much to the top of that.

So we are now out of contract, any contractual arrangements with NRS that has all gone.

Our longer term solution to it will go through a full governance stage because there are

options, there is an insourcing option, there's some community providers, there's other big

equipment providers.

So we will need to set out an options appraisal around that through commissioning and procurement

process and that will come kind of autumn or October, November time that will start

a full governance so it will probably it will end up before this committee at some point I would imagine.

And yes we will consult with all the stakeholders on what the options are that are available and what the options that we can do.

But I would just state and anybody's kind of welcome to visit the PD see if they want.

It has, it's a real, it showed to be a real coming together in a time of crisis thing that we did.

Yeah, I just wanted to add to that. So this issue, so it's more of a, what's happening nationally as well,

so other boroughs are actually having the same kind of issues and we're working really closely with other boroughs.

But I just wanted to add about the financial challenge as well. So obviously whatever place we go for or whatever options,

there's an added financial and it could be quite high compared to...

It could be, we all see to be a tremendous reduction.

So there will be a lot of financial challenge or whatever option we do offer,

but yes we're at it, officers are working really hard with all the neighbouring virus as well

and having a proper pre -planned session.

Thank you, that's really helpful and that's encouraging to know and to understand the work that's already underway.

So this is effectively a de facto in -house service right now?

It's so blind with this service.

We've got the equipment there.

We've got some. Community equipment is a range of things.

We will set out what the options are and the costs are for any alternative provision but

we will have to run this blended service for probably another 12 weeks I would have thought

at least.

So chair I don't want to add to the team's work but I think it would be helpful within

the next month say to have an update, a formal written update for this committee and maybe

from ONS as well, in fact maybe for all members because we all come across constituents who

use this service.

I'm just saying what's being done in the interim and that gives us some assurance,

I'm satisfied with what I've heard tonight, but I think going forward into a process of commissioning,

which can lead in all sorts of different directions, is a different matter.

So just to know more clearly what's happening now would be useful, I think.

That would be good to get feedback.

Thank you. Finally from me.

Can you outline how the amount 631 ,829 out of hospital allocation be monitored for impact

and value for money?

Sorry, can you repeat the question again, please?

Yes. You need to outline how the amount 631 ,829 out of hospital allocation be monitored for

a loop for money and impact.

So at the end of March, we have asked our providers to provide us with an evaluation

of those schemes.

So they will be reporting against a number of metrics and also what we will end up doing

is assessing those evaluations to see if it's something that we will use going forward.

So in terms of value for money, that's something that I'd have to go away and discuss with

colleagues as to how we would be able to assess that.

The second one is what is being done to ensure sufficient vaccine stock and clear public

messaging for the full programme flu programme and second one is what is the

expected impact of the mental health discharge to assess D to A scheme on ED

congestion and patient outcomes?

Sorry I did catch that. So with the flu the vaccination B campaign that

the North East London has developed is a campaign that will actually just constantly reiterate

the messaging around the need to have vaccinations. We locally in Tower Hamlets we have got some

funding that we can amplify that messaging using different media if we need to, for instance

posting on bus stops or on sites of busses, but that's a conversation that we would need

to have with colleagues to assess what else do we need to do on top of what is being done

at a North East London level. I mean because obviously our funding is for Tower Hamlets,

the population of Tower Hamlets, and that's then that's who we need to get our message

out to. And also we'd have to capture the point that one of the councillors made around

ingredients in some of the medication, doing some myth busting at the same time, so there's

If you can repeat the second question for me, please.

So the impact for the mental health D2A scheme is to ensure that those patients who are put under discharge

to assess pathway are discharged as soon as possible so that in terms of reducing the amount of time they actually stay in a hospital bed.

Ensure that they are discharged into a safe and secure service or place where they get that wrap around service which will support them,

and provide them with rehab and enable them to live independently in a secure space before

they move on to more longer term accommodation.

Thank you.

In the coming winter it's clear to anticipate and have a collaborative planning between

our council and health partners to manage the critical seasonal pressures.

We must ensure our vulnerable residents are supported, frontline staffs are resilient

and lessons from previous winters are embedded into the approach.

This committee will continue to scrutinise and support efforts that protect public health

and uphold the quality of care during the most challenging months of the year.

With this, I can conclude this item.

Now you are free to go.

Thank you for your nice presentation and answering a lot of questions.

Thank you.

will visit the Council during the week beginning 13 October.

They will interview a number of officers and members, including the lead member and myself.

We thank officers for all their hard work in preparing for the inspection and wish them

all the best.

The final sign off will be at OSC, this month, sorry, the challenge session on postnatal.

So we have looked at the draught of this programme last month and with the exception of CQC inspection

response and challenges session on postnatal care, do members have any comments or can

we in principle agree the work programme for this subcommittee?

Sorry Chet, could you just clarify what you said there because what I was going to ask

was that with the CQC inspection obviously there's nothing in the work programme at the

moment, I know we've discussed this but there's obviously nothing in there at the moment.

I'm aware that it's a long process and it's months and it will take us into for the actual thing to be completed

it will take as well into next year, but

We've waited this long. How many years?

Very long time like it's the most important thing we could be talking about

So I just want assurance that we are going to have the time and space to discuss this

But I don't know if you were saying that I think I didn't hear quite what you're saying

So if you just Clara every just expand on that

I think the CQC inspection is the first time happening in the council, isn't it?

Am I right?

Or has it been happening before?

More than 14 years.

Sorry, are we talking about the adult social care CQC inspection?

Yes.

This is the first time that this has happened.

A very long time, so we can't really even compare.

I just want assurance that we're going to have time to discuss this as a committee,

because as I say it's one of the most important things that will happen and it's not currently

in there, so I just want assurances that the time will be made to discuss that later in

the year.

Sorry, Councillor, the caveat is as soon as we get confirmed dates, then we'll add it

too, because that is a priority.

Of course, because it's our priority.

I just wanted to clarify, obviously the site visit is in October and I think what we're

asking is once we have the findings of the CQC inspection it will come here for discussion.

So I just wanted to clarify.

No, of course, and that's why I say I know that this takes a long time and there's several

stages to it. I'm not saying we're going to need an update once a week because it's just not humanly possible,

but I think when we have the findings it's really important that they come here as a priority.

So just to say, I really do think that it would be useful to schedule like just 20 minutes

or something to look at the performance data and to get a short presentation from the team

on the performance indicators.

That would be my view.

Chair, with your permission, can I ask a question or later?

Thank you.

Just very quickly.

I just remember last year when we had the issue where the NHS could make it but the stakeholders couldn't

and it was unfortunate, nobody's fault, but it meant that the process was sort of disjointed.

I think if we're going to be looking for stakeholders, and I'm sure this is already on your mind,

but I think if we could do that as soon as possible just to make sure that we can get both groups in the room at the same time

because it was a bit of a missed opportunity last year, which again, it was through no one's fault.

I ask now Councillor Mannane to speak to his children and education subcommittee

given that we do have a number of younger parents in the borough

and I ask colleagues at Overview and Scootoony to see if members there might be interested in attending.

It's okay.

Okay.

First of all, thank you for, we know the, the subcommittee, I will carry out last year

a fiscal meet survey.

Recommendation went well.

Ten recommendations is adopted by the cabinet.

So that's good news.

This year programme already I'm outlining the programme for next eight months.

One of the programmes that I would like to do with my subcommittee for children's education

is to figure out the school bullying, which is simply high across the inner cities, and

that tends to a lot of mental health.

If that is possible, I'd like to take that as an outreach work, similar to what we do

as well.

So that's my update on this as well.

If we can get the timeline and agree with the officers and the scrutiny members,

then I will invite others to come and join in as well.

But this is still a primary stage. Thank you for giving the opportunity.

Thank you, Councillor, because I know it's very important this is bullying in secondary school or primary school,

but we have to think about is it related to our agenda or anything.

If we have, we will have this opportunity.

So this is a plan what we do is crucial in this outreach work

that what we did on the last years on the preschool meal.

So this is additional to what we're going to do on this.

Thank you.

Thank you for your noted here.

Now can our democratic services officers noting note that the health and adult social care work

programme has been agreed by the subcommittee subject to additions such as the sequence

findings and responses from the council.

Our agenda items

of the 11 November

will be to consider the draught

learning disability strategy

and the introduction

of the neighbourhood

health team.

Do members have any particular focus

or scope

on these specific items

they wish to share

If not, can I ask members to consider this and let me and Philip, our officers, know

by next Thursday, please.

Can I ask you...

Yeah, please.

So my memory is that there was actually a presentation previously, maybe four years

ago, on this previously, or an investigation on it.

Do you remember? Maybe it went to main overview and scrutiny.

Yeah, so maybe we should just, I'll cheque that myself and I'll come back to you if there's anything on it.

Councillors, I've sent an outline paper that went to THT board recently in July.

Just for background information ahead of this, so it might be helpful just to review that.

That will give you a bit more details about the neighbourhood and then I can flesh that out.

Thank you.

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Health & Adults Scrutiny Sub-Committee - Thursday 4 September 2025, 6:30pm - Tower Hamlets Council webcasts

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Health & Adults Scrutiny Sub-Committee
Thursday, 4th September 2025 at 6:30pm