Health & Adults Scrutiny Sub-Committee - Tuesday 11 November 2025, 6:30pm - Tower Hamlets Council webcasts

Health & Adults Scrutiny Sub-Committee
Tuesday, 11th November 2025 at 6:30pm 

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Good evening everyone. My name is Councillor Gulan Kibriet Choudhury and this EMANEX meeting I will be chairing.
This meeting is being recorded for the Council's website or public viewing.
If there are any technical issues arise, we will decide if how the meeting should continue.
Members should only speak on my direction and ensure to speak clearly into the microphones.
Please have your mobile on silent.
Those joining online, can you keep microphones on mute, except when speaking.
Those of you online who wish to speak, please raise the hand function.
Now, Justina, do you receive any apologies?
No, Chair, no apologies have been received.
Thank you.
Good evening, everyone.
I am a Councillor from Bromley North, no DPA to clear the notice.
Councillor Mark Francis from Bow East Ward, no declarations.
Good evening, everyone.
My name is Councillor Ahudil Kabir.
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Thank you.
The minutes from the last meeting on 4 September 2025 have not been circulated.
Just now please explain the reason.
Thank you.
Thank you, Chair.
Due to resource issues, the minutes for the 4 September were not being circulated.
not circulating time. Those minutes and these minutes from this meeting will be presented
at the meeting held for the 20th of January. My apologies on behalf of my team.
Now it's Action Log 2025 to 2026. We have received responses from officers on information
request which is included in the action log.
Do members have any brief comment or can you move into the next item?
Thank you very much, Chad.
So first of all, thank you to the team for the really comprehensive responses that we've
had to the queries that were raised and that are reflected in this action log.
Unfortunately, whenever you provide more information, it does prompt additional questions as well.
So I wanted to ask a question in two areas.
First of all, in relation to the letters that have been sent to users of one of the home
care providers that wasn't due to be taken forward in the new contract or the interim
contract, I wondered if you could say a little bit more beyond the letter that's here, the
latest update letter to those service users, about what the response has been from the
service users and how Town Hamlets Council is managing that process. I understand the
contractors discussions are subject to legal action and I'm not expecting comments around
that but just in terms of impact and response of service users who have been proactively
contacted. And then the second thing is about the community equipment service which as Councillor
Actare will remember we raised at the last meeting and also some of us raised previously
concerns about this contract being outsourced in the first place so this
points towards a timeline of it being regularised I guess in the new year and
so since our last meeting I've actually had several constituents talking to me
about delays in the delivery of stuff coincidentally a couple of those have
been resolved relatively quickly after I've raised it but nevertheless it does
point to the ongoing problems with the, I guess, trying to stabilise that service.
So I just wondered if the team could say a little bit more about what's being done on
that.
Thank you.
Or if not tonight, then if we could get a further note following this meeting.
Sorry, I'm trying to, okay, so there's two things, isn't there, Councillor Francis?
so there's community equipment, and then the other was about the letter in relation to the home care provider.
So as you know from the copies of the letter that you've seen, we wrote to residents and notified them of impending changes.
We set up an email address and a phone number so they had one point of contact.
There were a number of inquiries, but we were certainly not inundated with...
So the inquiries we got, people were understandably concerned in terms of wanting to know what next.
And we are still at the position that is still stated in the letter in terms of care continues to be provided at the moment.
There's been no changes in terms of the care.
And once a transition plan has been agreed and formulated, we will be in touch with people to start to work through that
so that there's continuity of care.
So that is still where we are.
We did have a couple of initial inquiries
soon after sending the letter,
but as I say, we were certainly not inundated.
There were, of course, some concerns,
but people have any number of ways
in which they can express their concerns.
Some people rang in, some people emailed,
some people, when they saw a social worker
or occupational therapist,
or whoever they may be working with,
might have had a conversation.
So there's been a number of forums
by which people can get information.
Yeah.
Shall I move on to the next one?
I was not sure if you wanted to come back.
And then in terms of community equipment service, we are still in what I would still describe
as business continuity.
So what we have at the moment is we are actually quite proud in terms of our response as tower
handlers because this affected another 21 London boroughs.
So we were one of 22 that were affected by the liquidation of NRS.
And we were one of the first to actually stand up a response.
At the moment we're in business continuity,
our response is at the moment we have a very small in -house service
where we are able with support from colleagues,
from communities are able to go around with vans, pick up equipment,
deliver equipment as is appropriate.
It is still quite small and that service is being used for what we describe as priority one
Where people ready in terms of priority one in terms of requirements for equipment?
We also have a handy person service. I think it might be through one of our voluntary organisations
That's providing more simple equipment. So if somebody needed for instance a grab rail and so forth
They already have a contract that provides something similar
So we've just asked them to provide a bit more to support that and we're also working at the moment with
Enabled living which is part of Newham Council who have their own in -house
equipment service and they are also providing so between the three that's part of what our
Business continuity process is but we are at the at the moment
Recognising that we've been in business continuity in essence since this started which was about I think July time and what we now want
and doing actually as we speak is trying to agree more medium to long -term solutions because
clearly we can't continue to work in the way in which we're working.
We've had really good support corporately from other directorates in terms of support
to ensure that we've got the right staff, particularly staff who when we used to have
an internal community equipment service who are still around, who've been able to lend
their skills.
So that's part of the package that has been incredibly helpful.
But now we are and we're quite happy to bring something in the next maybe in a couple of months or so
In terms of where we've got to in terms of the more medium to long term. I don't know if you want to add anything
Thank you for those really helpful response so there are two key
components I guess of adult social care and
And it's really good that despite the challenges that the authorities face in that there's
been so much good work to be able to kind of stabilise and
or minimise the impact directly on service users.
So my understanding was that there has been a change though in terms of that
home care provider no longer providing
care, home care for town hamlets.
I thought that was the case but from what you were saying that provider is continuing
to provide.
So sorry, so because...
I'm sorry, Councillor Francis, I'm just getting a bit confused because are we talking about
home care or equipment, community equipment?
Home care.
Working with the service users in the borough, but going forward, like we said in the cabinet
meeting and we've come back before in the Scrutiniers' Bowl, we will not be continuing
in terms of new business, but in terms of now, yes, they are receiving money from the
council to have whatever service users they have at the moment, but they're not getting
new kind of business from the council at the moment and like you said there are no
trials that are going on so we can't talk into extreme details but in later
future there will be and there should be a statement up soon as well from the
council kind of explain further. Okay perhaps that's my mistake because I'm
sure that I saw people standing outside the town hall saying that they were
unable to continue to care for people that they've been caring for but I'll
I'll go and cheque that to understand.
And in relation to the community equipment service,
so I think it is really noteworthy
that there are still former employees of that service
working within the council who were redeployed
after it was outsourced,
and that they've been able to lend their expertise.
I guess the kind of contingency arrangements
that you've got in place there,
perhaps point to the
The council rightly focusing on the more acute extent of need but I have had people
Talking to me about delays in the delivery of hospital style beds and things like that
Which I do think we would be responsible for so I think last time when we've talked about this
said like if it's possible to get a note, but I do think if you're moving towards a decision on
I have a reprecurement
in combination with others or doing it as something in house ourselves, it would be helpful to maybe to get that report that the corporate director mentioned for the next meeting.
Yeah, we're happy to come back, for example, like what Georgia said, the long term. So initially it was getting on, you know, business continuity and having a rapid response, which we believe we have.
Like Georgia said, it is 21 of our barriers.
Going forward, that would be the mid -term, long -term plan.
We can come back and give you guys a better update.
Thank you, Chair.
About the community equipment, I know the company collapsed
and we have to step in immediately to provide service to the community.
The equipment we are buying and giving out to the vulnerable people, how are we monitoring
those equipment?
Are they proper system logs or are we just temporarily just manually recording those
stuff?
I'm sorry, Councillor, I don't understand the question.
Monitoring what?
I'm looking at the community equipment service that when we said we were watering some of
the equipment and then recording on consortium lead commission on the coming monthly report,
how this has been recorded and how we on transparency in the way energy system is no longer available.
So when we PCB response had to be inputted manually
Can we know are we putting on everything on manually importantly or can we are we putting on any electronic systems? That's what I'm asking
At the moment our system is manual
Because we are in business continuity the electronic system that we used to use belonged to the company that went into into liquidation
So at the moment we're using a manual system, but the manual system is working quite well. It's obviously time -consuming
the
community, but it is working well.
Thank you.
Thank you.
Now our next agenda is we have received the performance
dashboard in the agenda pack. Do members want to raise any
points?
We have about five to seven minutes for any questions. If
there are not any questions, I am happy to answer them.
I am happy for us to move to our main
agenda this evening.
Regarding dashboard 1, please.
Thank you, Chair.
On the page 3, there was two
set of figures relating to these
people bringing discharge from the
hospital.
In September, 861
people were discharged from the hospital. 52 people had their discharge delayed
because of the issue relating to the social worker and 176 people had
their discharge delays because of the issue related their care package and
227 people delayed out of 861. Just over the quarter of the people that have
in the delay leaving hospital, why this and what can we do about that?
I think there are a number of complexities to this and generally speaking,
Taoham is performing extremely well on hospital discharge.
We're very proud of our working relationship with our health partners
and how we plan for discharge.
I think there are a number of issues that we need to look at,
the volume of people being discharged from hospital, how we ensure that people's needs
are understood, how we're ensuring that when we're ready, when they're ready for discharge,
how we support them.
And I think there's some further analysis on how long is that delay manifesting itself.
So I'm happy to provide some further analysis that perhaps dives into that question further.
We have clearly had some challenges over the summer period
with ensuring that we have the right equipment available
to ensure that people are discharged from hospital in a timely way
and it may be that some of that has contributed.
So some further work and analysis, but in general terms
our hospital discharge record is very positive.
Is there any future plan to resolve these kind of issues?
I think the challenge on discharging people from hospital and our ensuring that people
have that smooth transition out of hospital is part of our ongoing work and always something
that features in our continued partnership working with health to ensure that we are
notified early, that people are likely and anticipated to be ready from discharge. If
information isn't shared with us in a timely way from
health, that can sometimes be something that
contributes to that delay.
So I think we are proud of our
working relationship with our health partners,
but again, something that needs to
continue to evolve and develop.
Thank you, Councillor.
Please, before
asking a question, just indicate me one
thing.
Julie, could you explain,
introduce yourself for the
record of the paper, please.
Of course I'm Julie Davidson, I'm the Interim Director of Adult Social Care.
First of all again, thank you for this performance data. This is really invaluable and I'm genuinely grateful to the team for their transparency and their willingness to put this there.
So my two questions are relating to those that are red here.
Percentage of safeguarding concerns completed within five working days,
which is showing as red compared to the minimum target.
And also the similar target in adult safeguarding inquiries
completed within 20 working days.
So those targets for the two are they show a sort of I guess a fairly stable trajectory
and fairly comparable to previous years as well.
But what they all show, seem to show is that we're quite a long way short of the target
timeframes that we've set ourselves.
So the first thing I would say about that is that I'm really pleased that the council is setting itself an ambitious target
I don't know whether there's any statutory guidance around that but it you know took for 90 %
Within five days and the inquiries themselves within 20 days 90 % again
Obviously hugely challenging target. Nevertheless. We're just above halfway towards that
So I just wondered if the team want to say a little bit specifically on those two
Thank you. Thank you, Councillor. And it's a really important question and clearly a
focus in terms of our most vulnerable citizens who are subject to safeguarding concerns.
And part of our CQC inspection preparedness has been really about focusing on timeliness
of both dealing with concerns and inquiries. And what we have done is implement the Pan
procedures and the timeframes which is the focus of these five days and 20 days
And since my arrival in December of last year whilst we're not quite there with that
We've narrowed the time frame in terms of improving that level of performance
So although we're still falling without so we're much closer to achieving that and it
It continues to be an area of focus and progress as we work with staff in adhering to those
Pan London timeframes, but important that we set that expectation of adherence to delivering
on Pan London procedures, so we're working towards what is a guidance expectation and
part of how we work in London.
Just come back, thank you.
it's helpful to understand that that is something that's more than just a kind of an aspiration,
that it's a benchmark for others as well. And I really do understand the challenges.
I mean, I guess, you know, there can always be a drop off in August. It's always a real
life possibility for anyone in any organisation around school holidays and Christmas as well.
I guess it would be helpful perhaps at some stage again in the next meeting to understand a little bit more about how the team expects that the interventions that are being made now are going to drive that performance much closer to those two 90 % targets that are there now.
I should just say, I raised a safeguarding concern on behalf of a resident that I met
relatively recently and I was massively impressed with the response that I got back from the
team, both in terms of the promptness and the thoroughness of the response and the fact
that that individual was clearly well known to the team and the service.
So that in itself gives me a lot of confidence about how these kind of things are dealt with.
But yeah, and so I appreciate that.
But yeah, I think overall, obviously, if there are delays,
then there is risk attached to those delays.
And so it would be helpful to have that,
the more detail on the interventions that are being made.
Thank you, Chet.
Thank you.
In relation to the neighbourhood health teams,
agenda, I am somewhat disappointed with our health
partners on the short notice for requesting to withdraw the
spotlight on neighbourhood health team's items.
We have provided our health scrutiny forward plan,
which has been agreed by the overview and scrutiny committee,
and also shared the forward plan in many iterations.
I understood from our health partners who are leading on this
item that more work needs to be done to bring it alignment
across the partners and therefore they have requested if we can bring this back later
in the year next.
Removal of agenda items as short notice also has an impact on our city schedule and we
should have received notice much earlier.
This is an important focus area.
I hope that it does not become a pattern and something this committee will monitor carefully.
Thank you.
Do members have any comment and abuse regarding this?
Thank you.
We were just discussing on the pre -meeting, as you said, they have given the explanation.
My question is, Chair, this is a very important item that has been cancelled and therefore
So we would like to see this financial or this year the item back on the agenda somehow.
So I know we got a package ended up with it throughout the year, but somehow we need to
have the agenda back on the agenda.
So discuss it.
Thank you.
Now, tonight we move on our next agenda, is learning disability strategy.
This is an opportunity for subcommittee to fit into strategy.
I am hoping it will provide us evidence of the approach, outline the improving health
outcomes, access to the service and support for individuals with learning disabilities
across our local system.
I am accurately aware that over the past few years we are seeing more cases of neurodivergent
challenges and I would be interested in how this is being tackled in the strategy.
With this mind can I welcome back Councillor Sabina Hatta, cabinet lead member for health
wellbeing and social care, Georgi A. Simbani, corporate director for health, adult and social
care and Lorraine Kraut, interim director for commissioning.
I want also to welcome Kerry Kilpatrick, Deputy Director Mental Health, Easy Health.
Thank you.
And Joint Commissioning who will be presenting and talking to this item.
He will have 10 minutes and just highlights the main point and take it.
We have read it.
And after your presentation we will open up for our questions.
Thank you.
I am the deputy director of joint commissioning in Tower Hamlets where I work across health
and social care.
My role is for adults rather than children.
What is in front of you, and hopefully you will have read, is an outline paper that presents
the work that we've done over the last year.
last few years on a learning disability strategy and our intentions for the next five year
strategy. It brings together a number of data sources, so I think this group has previously
looked at the needs assessment, so you've got within the paper the high level areas
of needs that we have identified through the work that we've undertaken with our public
health team, you have some of the main feedback that we've received from people with a learning
disability that live within the borough and that is the people that will draw on care
and support but also the broader population that live in the borough that don't draw on
care and support through our social care.
And through the work that we've done there, looking at the data, looking at feedback from
people who live in the borough and people that care for people that live in the borough
with a learning disability and some of the key data needs that we've identified.
We've put together four core areas that matter most to people with a learning disability.
So the areas that people have told us we need to focus on are outlined within the pack on
my page 89. There are four key areas which we've tried to group. As you would imagine,
people are complex and they have lots of things that they want us to focus on, but we try
to group the areas according to those four key headings.
So achieving the things that matter most to people, really thinking about the choices
that people have, how people can access employment, training and education, and how we can address
some of the social isolation that people feel and some of the sense of not always fitting
within communities and some of the barriers that people experience in those areas that prevent or
put barriers in place to those areas. We've looked at one of the key other areas is ensuring that
there's clear and easy to access information that people that address people's barriers to
inclusivity. There's a key area around improving and managing physical health so we know that
There are a number of health inequalities that people with a learning disability face.
Some of those are outlined within the paper.
This is really about access to health, primary and secondary health services, ensuring that
people have the information that they need to address what is a high prevalence of long -term
conditions and in particular some support around weight management.
Also looking at how we support people to have a good experience of care.
So that's really thinking about the services that people will generally draw on through
adult social care, so accommodation services, residential care, thinking about how we support
people meaningfully through transitions and how services are designed to ensure that they
meet the cultural needs of individuals.
Within this you'll see some key, we tried to add in some, the voices of people that
we've spoken to, some of the key things that they've said are important to them, some of
the key barriers that they face. And then in the last couple of pages are the outline
areas that we think we need to focus on in order to begin to address some of these. There
has been a lot of improvement in some of these areas over the course of the first strategy,
and the last five years since that strategy came to a conclusion.
But there's always more work to be done here
and these are the areas that we want to focus on.
This is a very high level initial list,
so we're really coming to you to get a sense of your feedback
on whether or not that looks like the right list.
And over the coming weeks,
we'll be working with the Learning Disability Partnership Ward
that's made up of key stakeholders and people that access services
and draw on care and support, so our Empowering Voices team are very represented there, hopefully
you know who they are, they're made up of people that use our create service and our
services across the borough, and we really want to refine that list and draw from that
list some key priority areas of transformation that we know that we want to focus on.
There should be no surprises in here, these are things that we have seen before and things
that we know are important to people, as I've said earlier.
I won't run through them all in detail,
but I'm happy to take any questions
if there are some specific areas that you want to draw out.
Is there anything?
Okay, so just to say that this is a collaborative piece
of work, so Naveed and myself,
Naveed has worked on our strategy and performance team,
so he will be helping pull that,
enabling us to pull that together into a document
that everybody's happy with and then it will go through the process when we're all happy with it
and the next stage will be I think to take it through into cabinet at some point in the future.
The other thing I guess we need to just recognise, I think you mentioned in your introduction that neurodiversity,
this is really a strategy that focuses very much on people with a learning disability
but there is obvious overlap and synergy with people that are neurodiverse and also people
that have a mental health issue. So there are, as we develop this, we will be looking
at those synergies and how that all fits together.
Thank you, Georgia. Do we have anything? Or a lead member, please?
No, nothing from me, Councillor Chaudry. I think Kerry described it very well. Thank
you.
Thank you for the opportunity, Chair.
Could you find out the current provider for people with learning difficulties, how we
on a kind of housing which they need, are we providing any sort of special provision
for the housing, anything like that, on a plan for people's difficulties?
Sorry, bit out of practise. So, as you would expect, people with a learning disability
you need access to a full range of housing.
And so within this plan, we'd expect
there to be a focus on how we can
ensure that those housing opportunities are
available for people.
You'll see in the first couple of pages
that we are supporting more people through adult social care
services than we were five years ago.
We've seen many more people with access to supported housing,
residential care.
some people will have access to nursing and many people will want access to care within a general needs housing offer
with support coming into their homes. So we would expect there to be a broad range of housing options available to people
because we know we've got more adults with a learning disability coming through our services,
we need to make sure that what we're able to offer keeps pace with that.
But that will be fully documented within the report, within the strategy.
Thank you, Abi. The reason I ask on this is four nights ago on my ward, I have given a key to the family purpose built house for autism kids in Bromley North.
That was the first ever house built for the autism children, people with disability.
And that's a prime example of how we should be helping disability people.
So my question was, as you said, are we doing similar sort of thing on the plan that for
future building for especially built for the purpose of the disability kids and those house
were built for people in mind of autism, so I gave the key out to those
families two weeks ago.
There's a question, do we have similar offers for people that are autistic within the borough?
For basic disability, yeah. So we do have a housing with care strategy as well,
that sits alongside that, this strategy.
Yes is the answer.
I was just looking at the data.
So we do have in the region of about 90 people
within supported living services within the borough
and outside of the borough, some of those people
will have a learning disability.
Some of those people will have a learning disability
and be autistic.
and we have a range of different services available for people.
Thank you for giving me the chance. I've got two questions to ask.
First thing, what are your challenges to provide facilities for people with learning disabilities?
Your challenges that you face to provide facilities.
And next question is, I'm aware of good adults, right?
Like one of them,
Councillor just mentioned about the housing.
I know that in Hamlet, people are waiting.
A lot of people are waiting for housing and things like that.
But how are you actually, like you go for five years
to 10 years, your statistics, how are you actually planning
to limiting those barriers that you have.
I'm trying to say that, say that you have barriers
to actually giving people homes
and people already actually go home.
How are you providing the facilities for those people
according to their needs or do you look at the families
or do you look at individuals that helps do they need?
What support do they give them at the moment?
Because the adults, some adults,
they have more challenges than others.
Some has to live with their families, right?
So for example, somebody who is learning to kind of socialise,
especially like 25 plus over, and they don't go out,
things like that.
But they have to stay with the home, with the family member,
or something like that.
The duty though, we have lack of housing and things like that.
How do you support them?
And what other challenges do you face to provide home for them?
So there's a number of things. Our position in Tower Hamlets is we always want to maintain people at home where possible and where their needs are appropriate.
If for whatever reason, whether it's issues to do with the family or their needs are complex
and they require a different environment, that's the point at which we might look at something else.
And the something else you generally would provide would usually be supported living,
or in some cases it might be residential care.
But home would be the first point at which we would try to provide that.
We obviously have to work closely with our colleagues in the housing department.
we do not provide housing. The housing that we describe in terms of people who have learning disability
or autism are people who have got care needs and therefore require specialist accommodation
under the Care Act to be able to support them. But if it's general needs housing, that's not something that we would provide.
Sorry, I'm not saying that you provide, I said how would you support these people?
What is your job is to provide them?
How do you support these people?
I know you don't provide home for them.
How do you help them out?
Thank you, Alia.
Before I ask the question to the others, please take my hand.
The needs that we provide are on a needs basis.
We look at every person as an individual.
It is difficult for me to describe.
We look at the individual, we undertake an assessment and depending on what that person needs based on their circumstances, we will try to provide that support.
Thank you chair. How would you assist a person with learning disability and to manage direct payment?
I have a resident who is a care worker
and she said she found it difficult
to direct payment
because the people
who get direct payment
want to give
the care worker less money
and
trying to
give them less.
So how would you
solve this problem
like direct payment?
If somebody has a learning
disability,
it does not necessarily mean
that they cannot
manage a direct payment.
So I don't recognise what you're describing
because a direct payment means we give money to the resident
and then they take that money and they go
and they buy their own care rather than having
that care arranged through the council.
So they then make, they come to an arrangement
with whoever they want to support them to provide that care
and that arrangement is between the resident
and that person who's going to be providing the care.
So that's a transaction that's between the two of them.
We obviously provide some support in terms of things that might be like, you know,
setting up a bank account, cheques that they may need to undertake to ensure that the person
who's providing the care has, for instance, a DBS and so forth.
So there's a lot of support that we'll provide in relation to that.
But at the end of the day, it is a transaction that is between two people
based on what the residents want to be provided and what the person needs to provide.
Is there anything you want to add to that?
I just want to say, so I think the counsellor, if for example they have severe disabilities for example,
I know there is an arrangement with the direct payments, but sometimes the family are involved,
like if they might have a special carer involved, do you think that they will realise with the direct payment?
So if there's any suggestion that the resident who has a direct payment does not have the capacity to be able to manage the direct payment,
then what we would do is there's a process by which we would look to see how that can be managed.
Sometimes as a local authority we can manage it on somebody's behalf.
Sometimes you might just decide, well actually you can't manage a direct payment.
sometimes it's just a question of we cannot give you a direct payment because part of
the direct payment is somebody having the ability to make choices and be able to manage
independently.
If they are unable to do that, then we would ask ourselves questions as to whether it's
an appropriate form of delivery of service for them.
Please, on your mark.
Sorry.
Chair, the question I have is on page 79, you mentioned about your previous strategy
and coming to the new strategy, you mentioned that there is a group which faces significant
barriers and inequality.
Now, there is a gap, you know, and how are you thinking or proposing to narrow the gap
on health cheques, employment and transition, especially from youth to adulthood?
You want me to repeat it again?
Question is, the challenge I feel here is to narrow the gap, you know, from the previous
where you mentioned that you are facing significant barriers, inequality.
How do you propose or what is the strategy or the plan you're going to implement, you
the pathway to narrow the gap where health cheques, employment and transitions, especially
from youth to adulthood is concerned.
There are major issues of learning disabilities with youth.
They are going to be adults one day.
Am I clear?
You are clear, yes.
Thank you.
I think it's a question in two parts.
So there is something about our work with young people transitioning into adults,
which Julie may want to say some more about.
But I think for me, just having a strategy where we're able to put the needs of people
that have a learning disability front and centre and recognise that this is a group
that we need to prioritise and we need to advocate for strongly,
that's the purpose of the strategy.
So by identifying that there are inequalities, really identifying where some of those inequalities exist,
particularly around the health experience and the communication barriers,
we will have some very tangible areas that we want to achieve
and we will want to make sure that we're very clear that those are outcome based.
So some of this is a longer term, you know, when we're talking about health inequality,
We're really talking about the fact that people with a learning disability will often live longer than...
live for far shorter the mortality gap, they'll live less longer lives than people that don't have a learning disability.
So it is a long -term kind of goal, but there are key things we can do to deliver that by making sure that
we look at the number of people that are taking up their annual health cheque, we want to see improvements on that,
We want to see improvements on the number of people that register themselves with their
GP, is having a learning disability because you need to register in order to get those
longer appointments, to get access to those appointments.
And we really have some work, some exciting work we're trying to do to improve people's
take up and experience of key offers like cancer screening.
So the cancer screening rates for people with a disability are lower than we would want
them to be.
So there are some real tangible outcomes that will be in the strategy.
I think there is some specific work that is also being led on improving the transitions
experience and the planning for younger people.
I know that we've just re -established the transitions board.
I don't know, Julie, if you want to say more about that.
You're absolutely right.
The importance of young people transitioning into support is critical and I'm pleased to
say that we are working in partnership with our colleagues in children's services and
with our health partners on thinking about how we manage that process and step change
for young people and their families differently.
So we have delivered two working groups and now have a board established.
We had our third meeting yesterday really looking at how we both work together differently
but how we improve those services in that earlier intervention from adult social care,
recognising that for many families they feel that they're approaching a cliff edge as they
transition from children's services, which is defined by one set of law and governance,
into adult services, which is a different legal framework and a different requirement
on the local authority to provide support, as well as the transition from health services,
which again in the provision to children's is different to the provision in adults.
So we're absolutely working in partnership with both internal council resources and with our partners
to smooth out that transition process, start earlier and help people understand what the offer will look like
into adulthood for young people, both those with learning disability and those who have the appearance
of a care act eligible needs, so that whole spectrum of young people transferring into
adulthood.
And I just wanted to add in terms of some of the challenge that you've given in terms
of how will we resolve some of those challenges, I think Carrie's described very well in terms
of looking at setting ourselves in terms of targets, looking at performance data, but
the most important thing is also working with people with lived experience, so people who
actually have learning disability, and I think Carrie described at the beginning of the presentation
in terms of working with our residents who go to create,
empowering voices, they are the best people
to actually say what works for them
and making sure that they're involved
so that co -production is very important.
Thank you, Chair.
Just a follow -up question to that answer.
You have covered up most of my other questions,
but something which is pending, I thought of.
Now, you mentioned it'll going to be internal,
but what about resident -led input?
Like, for example, I know places there are some,
like learning, disability, citizen group.
You're not, I mean, some other places, like, you know,
I mean, like which is used in collaboration,
in partnership, you know, because you cannot do it alone, I feel, without the residence
input and what are their pain points or touch points working together.
So I would like to know if you have something in place on that part and, yeah, that's the
only question.
That's what I've just described.
So that example I gave of Empowering Voices, it is an established group and I believe on
the Learning Disability Partnership Board, they are also people with lived experience.
So we do already have a number of different groups that are involved or are led by people
with lived experience. So that is already in place.
Thanks for this presentation. So I guess my first, I've got a couple of questions. The
The first of them is that this says that the previous strategy ended in 2020.
I've just had a quick look at the previous strategy.
It would be helpful to understand, obviously there's been the pandemic,
which would have disrupted presumably the creation of a new strategy.
But it would be helpful to understand what has the team been working against
in delivering for people with learning disabilities over the last five years?
So broadly speaking, the team, or broader teams that have been working in this area
have been working against those key priority areas that are listed on page 79.
So really looking at reducing the health
inequality
and the length of the hospital, looking at
the opportunities to live locally,
community inclusion, working,
choice and feeling respected.
So those are the areas that have governed the
work that we have been doing.
Although we haven't had a strategy, we have
still had an agreed set of priorities that we
have been working on.
And in the immediate years after
COVID -19 in 2021,
2022,
the health school district has been
at the time did a deep dive inquiry into the experience of people with a learning disability
that following Covid and we know that people with learning disability fared less well during the
Covid years for lots of different reasons, health inequality, some of the social exclusion and
particularly in Ta 'akamalat some of the impact of on people that had some of those long -term
conditions that we know didn't do so well through those Covid years. So there was a very detailed
plan that was put together as a result of our inquiry council that we then, we were
then acting on for, I'd need to cheque the dates, but it was a couple of years after,
between 2021 I think, to 2023. So there has been a lot of work to do in this area and
it continues to be a lot of work, but that's generally what's guided our work in that time.
Just follow up, so I was actually on the health scrutiny committee at the, in 2019 -20, and
I really distinctly remember the presentation of some of the people with learning disability
who came to the MOBri place and talked about their experiences, talked about how they had
been involved in the discussions around what might follow the 17 to 20 strategy. That seemed
to be really quite positive, progressive, ambitious.
And I think that that did inform the recommendations
that were made.
So that inquiry was really disrupted by the pandemic.
Like that session was literally, I think,
just a few weeks before the first lockdown.
But I can see that eventually the committee,
after I left, put together quite a strong package
of recommendations about what needed to be included within that strategy.
And so is it those that you're saying that there's been an action plan which has incorporated
some of the kind of the thinking around those that the team's been working against?
Yeah, so that plan I think and there has also been a strong focus within the NHS agenda
over the last five years to address some of the post -COVID experience, to look at some of the
other areas that people with a learning disability have less of a positive experience, so hospital
admission, health cheques, inequalities around access to cancer screening and alike. So that
The programme has continued, although albeit not being developed into a formal strategy, if you like, but yeah that's broadly where we've been.
So I think this is an opportunity for us to feed in, is that right?
And to try to help shape it so that this is not an area of my expertise by any stretch.
and that's why it was so interesting to hear from some of the people service users themselves
for that session. So that prompted 20 recommendations ultimately I think there was a
session before the pandemic and a session towards the end of the lockdowns and so it would be useful
I think for the committee and maybe the mayor and his team to understand which of those have been
kind of incorporated and taken forward, which of those have not been?
And there might be entirely justifiable reasons for those not being taken forward.
It's very easy for us to sit in a scrutiny committee and say, oh, do this, do that, and
do the other thing, without any kind of conception of the resources and the capacity and the
intellectual capacity of the organisation to be able to implement those things.
But I think, I don't think that we should just be looking at this again as if we didn't have all of that information.
So it would be useful just to know what's going forward.
I'd like to focus on one area which is around work and volunteering, which was a key part of the 2017, or an element of the 17 to 20 strategy.
So entirely coincidentally I bumped into somebody, the daughter of a constituent who sadly is no longer with us,
who is making her own way in the world with her learning disability and clearly struggling.
And she was previously employed by Renploy and that was perhaps just a moment in time that can't be replicated again,
or maybe shouldn't be replicated again, that sort of set up.
but there's a very strong emphasis on what we were told
I think at that session in early 2020
and is reflected in the Scrutiny Challenge Session report
which is about be more ambitious for us
as people with learning disabilities in terms of helping us find employment,
helping us find training opportunities
and even potentially creating employment opportunities within this authority
and presumably the NHS as well.
So I would, I guess I would, my feedback would be that that would be one area
that I would really encourage you to stretch the council a bit more on
because I think this speaks well but I don't know really what this is likely to lead to
in terms of outcomes that is different than what was achieved in post 2017.
You make a really good challenge, Councillor Francis.
So if I could make a suggestion.
So what we've got in front of us is this is in a sense our start.
So we've said we've done a needs assessment.
This is what we know so far.
However, there's still a huge amount of work that needs to happen
before we have a formulated strategy.
And I think some of what we've described is very much working with people
with lived experience to be able to shape this and form this.
And actually my suggestion is we undertake that work with people with lived experience,
see what they recommend, and then also look back at the recommendations that you've mentioned.
Because you're absolutely right, the world has moved on, some things will have moved
on, but actually some things may still be quite relevant in terms of might still be
the same.
So we can then do that as part of that exercise to say this is possibly maybe as part of some
I think we have to be very careful
as we are working with people with lived
experience.
What are your needs at the moment?
What do you think is important to you at the
moment?
And so forth.
And of course it is always helpful to look
back to say what has worked well and what
hasn't and for what reasons.
I think you do make a good challenge.
Thank you for that.
Thank you.
Thank you.
Just we are developing a draught for learning disability
strategy based on our survey sample and focus group.
My question is how representative is this sample
and what step you have taken to reach the hard to reach groups?
So in terms of the work we've done so far, you'll see from the presentation that there
have been two, three broad ways in which we've reached out to people.
So the public health team when they pulled together the needs assessment did some work
to send out surveys and to hold focus groups. I think it was three separate focus groups
that they held which people came to. That was exceptionally representative. We tend
to have a broad range of people from different backgrounds, from ages and a good representation
from people's families as well.
We also undertook some sessions with the carer's centre
in that initial needs assessment work.
Following that, people in Naveed's team developed a survey
that went out to 114 people responded.
That's a very good response rate, actually, generally speaking,
for people with a learning disability.
those people were supported often by the carers that worked with them.
Again, that was very representative.
We had good feedback from some of our culturally specific services
who worked with people to complete the form
and we had good representation of ages in that.
You can see a broad breakdown of that on one of the pages in the document, 87.
And then of course we have the empowering voices group.
They have a core group of people but they also go out to one of the day services that are in the borough.
So they will do your say, your day events which they invite people in and they get good representation there as well.
So I think we're happy that it's representative of course.
Some of the people that we struggle more to engage with
are the people that are not so able to express themselves verbally
but in those situations we do try to meet with families as well
and carers of people.
Just follow up my question, first one.
is what are your plans to address the gap between diagnosed and estimated prevalence?
How will you improve identification?
May I repeat it for again?
Yes please.
What are your plans to address the gap between diagnosed and estimated prevalence?
How will you improve identification?
OK, so I think that's a very specific question about the people with a learning disability
that are on GP registers.
So that data comes from the NHS data and if you go to your GP and you have a learning
disability they should identify you and give you a code on your register so that when you
come in they can put the necessary adaptations in place, it might be a longer appointment,
They will also reach out to you once a year to offer you that enhanced health cheque to make sure that your needs are being met.
That's been a core priority of the NHS for the last five years.
So in Tower Hamlets we've seen significant increase in the number of people that are registered with a GP.
It's gone up to in the region of 1400.
You've identified that there is a gap between the people that we have registered and those
that the public health notional data tells us we should have in our BOA.
We have done work, we've done a lot of detailed work over the last couple of years to screen
that data in a lot of detail.
we have put people in post to work between our Community Learning Disability team and our GP Registers.
So everybody, we know that everybody who's registered with our Community Learning Disability service is on the GP Registers.
We've also done some bespoke work with GPs.
Some of that gap exists because those rates go down to 14, so it's the 14 to 17 year olds,
and so we're also doing some work from the transitions group.
That's our plan really.
We know that there will be a gap because we know that in a borough like Tower Hamlets
not everybody lives in the borough, some people live outside the borough as well, but we continue
to keep a focus on that.
Thank you, Chair.
referring to page 81 in my agenda, which refers to the national context NHS, point number
two, which is a great cause for concern, the plans with people with learning disabilities
on average die 20 years younger and 39 % of deaths were considered avoidable, you know,
compared to the 22 % general population.
The question here is, what are your plans in place,
strategies to narrow this gap?
And number two, to reduce premature deaths
and preventable hospital admissions?
Can I, can I, you want me to repeat it, madam?
No, that's OK.
Another one to the question of yours,
so if it is OK with you.
A follow up.
The end is a little bit of a learning,
because the village is fine.
So the plan, what is our plan to address the premature deaths
and the preventable hospital admissions?
So that will need to be a key feature of the strategy,
for sure.
It is focused on, there's a lot of national evidence that tells us why people with a learning
disability will die prematurely and some of those things I've mentioned earlier.
So some of that is about health, access to health services, some of that's about the
increased prevalence of long -term conditions. So people with a learning disability might
have more particular long -term conditions that are often life limiting.
We also know that there are issues around communication and diagnostic overshadowing,
so people maybe not be taken seriously or not listened to because they have a learning
disability, so that communication barrier might exist between them and whoever they're
in a healthcare setting, whether or not that's a GP,
or an ambulance service, or a hospital service.
And what the NHS has put together
is a programme called the Letter.
So it's a learning from deaths review.
And so every single person that dies prematurely
with a learning disability,
there is something that looks a bit like
a safeguarding adults review,
and then there's a detailed report that comes from that
and detailed recommendations.
Those will, for Tower Hamlets,
will be looked at in a lot of detail
and will report in to our Safeguarding Adults Board.
There is also a broader set of recommendations
that comes out of that that we would need
to be implementing locally.
And some of that we've covered today,
so some of that is about making sure people
have health cheques, making sure people have
the reasonable adaptations in place when they go into GPs, that GPs and primary care services
are trained in understanding how to communicate with people with a learning disability that
they understand what a learning disability is.
So there is a quite comprehensive programme to address that.
There are other things that we're doing, so obesity is a key factor for people with a
opportunities to
To
For sports and
Gyms and things like that. So we have some programmes locally
We have a programme at the moment that we are running with our leisure centres and one of our voluntary sector
organisations that is going into
leisure centres and providing bespoke sessions and training to the leisure services to
increase access and increase
reduce some of those barriers.
It's difficult for anyone to walk into a gym,
it's difficult for people,
even more difficult if you have a learning disability.
So we know that there is a lot of work to do in this area
and we're trialling particular methods of doing that.
But certainly the opportunities presented by the Leisure Centre
and changes to the Leisure Centre
we're keen to capitalise on those.
Thank you, Chair. I'll make sure this is my last closing question.
Now, that's a brilliant plan that you have in place.
I must commend you for that.
Now, no plan is brilliant till we have the metrics,
we monitor and measure it and see how we are doing on the outcomes expected
and the real outcomes that take place.
Now, do you have a plan in place for every quarterly review involving the stakeholders,
user groups, health watchtowers, councils, anybody, you know, do you have a plan, quarterly,
coming up so that it can be measured and monitored going forward?
Okay, so I think as we develop the strategy, what will need to be agreed will be the reporting
mechanism for that strategy.
We have re -established a learning disability partnership board.
It's been set up for now for just over a year, and that would be the primary governing meeting
where we're held to account, but the value of having a strategy of course is that you will then also help to account for delivering it.
And we will need to agree what that looks like.
And I'm sure that there will be some reporting within health and adult social care and health, sorry,
but then also within the council more broadly will need to be set up around that.
But yes, quality monitoring, outcomes monitoring, deliverability is key.
We have one question in relation to health
inequalities,
we have occasion
as there is an issue
, you have takenassi
issues.
Cancer screening take up and obesity.
Yeah.
So these are national regional issues.
The entire Hamlets, there are two things that we have, we are trialling at the moment to
begin to address those as well as the strategy.
For cancer screening, we have set up a small group and working with the cancer screening
service to and working with people that access our services or draw on care and support.
So a co -produced group to support people and support them to access services with more
support really. So really reaching out to people that are meant to go to cancer screening,
working with them to get them along to appointments, accompanying them where
they need support, providing information, education, adapted information for them
to be able to access. That's the work that we are doing locally. That group has
just been set up so it's very much in its early stages. With regard to the
obesity, again our Community Learning Disability Service have a Shape Up
programme that they're running with public health.
So this is going out to work with families,
with our community provider partners,
and with people that use our drawn care and support
services to educate them around healthy diet, healthy living,
and providing some of the support to people around what
eating well looks like.
We're also doing some work, as I said,
with the leisure centres to try and open those doors to more access to sports and leisure
facilities whilst at the same time training all of our day services and offering some
of those services as well. Those are the main things that we're doing. They're not the only
things we need to do but those are the key areas of focus at the moment.
Thanks. So I don't really have a question. I guess this is more a suggestion for us as
a committee. So I don't feel like I'm an expert in this to be able to feed back to the team
about the direction that they should be taking or how far it's realistic to be able to push
our expectations of a local authority service in this area. But I do think that there are
organisations out there that might have a view and might help us.
So, Barts itself now covers Waltham Forest and Newer.
And so, it presumably is having some involvement in shaping these kind of services,
or services to these clients in those authorities as well.
But there are also a number of charities that specialise in this area.
There's at least one locally, I think, Tower Project, and there are other national ones as well.
I just wondered if we're going to be asked as a committee to give more of a view about a firmed up strategy,
or a draught strategy at some point down the line, whether we ought to inform ourselves,
or ask them to help inform us about what we should be looking for, what we should be asking for.
I think the other thing that I would say,
and it doesn't have to be the next meeting,
but I just think it doesn't even have to be
a kind of a formal scheduled meeting.
I just think it's important for us to have
a kind of external input.
And on that note, I also, one of the things,
as I said at the start, that really impressed me,
was the way that people with learning disability themselves
were at the forefront of talking about the change,
how they would want to see that strategy evolve
five years ago and I think that when we come to have the next conversation it
would be really good to have people talking about their experience for good
as well as if there's been some issues that would help inform what we're able
to say for future.
Thank you.
I hope that committee's contribution has been very helpful and this reflects the needs of
our community and to take this proposal forward.
I look forward to seeing this strategy progress and deliver a meaningful impact.
and tonight I want to mention one thing.
Justine, she is leaving us.
So she is staying not with us.
And we wish good luck for her new role and thank you
for your help and support.
Thank you.
Thank you.
Thank you.
And finally, if there is any other business to discuss, do you have any of your anything
tonight?
Thank you.
So with no other business to discuss, I call this meeting to a close.
Thank you, Scootony members, again, for your attendance and participation tonight.
Good evening, everyone.
Thank you.