Members are reminded to consider the categories of interest in the Code of Conduct for Members to determine whether they have an interest in any agenda item and any action they should take. For further details, please see the attached note from the Monitoring Officer.

Members are reminded to declare the nature of the interest and the agenda item it relates to. Please note that ultimately it’s the Members’ responsibility to declare any interests and to update their register of interest form as required by the Code.

If in doubt as to the nature of your interest, you are advised to seek advice prior to the meeting by contacting the Monitoring Officer or Democratic Services

contact: Linda Walker, Interim Director of Legal and Monitoring Officer, Tel: 0207 364 4348

There were no declarations of disclosable pecuniary interest.

To confirm as a correct record the minutes of the meeting of the Health and Adults Scrutiny Sub-Committee Meeting held on 05 November 2024.

The minutes of the Sub-committee meeting held on 05 November 2024 were approved and signed by the Chair as a correct record of proceedings.

Councillor Marc Francis reiterated his request made at the September meeting, for further details on the key performance measures that will be included in the Strategic Plan. Members requested this be forwarded to the sub-committee for review, prior to the next meeting scheduled for 08 April 2025.

The Health and Adults Sub-Committee RESOLVED;

1.     That further details on the key performance measures that will be included in the Strategic Plan, be circulated to the sub-committee for review prior to the next meeting scheduled for 08 April 2025.

2.     That the Action Log be noted.

Jonathan Weaver, Senior Project Manager, Primary Care, provided the sub-committee with an overview of the programme, which will enable patients to access the same day urgent unplanned treatment and will improve the integrated service across primary and secondary care.

Members were informed that details of the programme have been submitted to the Tower Hamlets Together Board and is a joint effort between primary and secondary care. The Royal London Hospital, who deal  with the Accident and Emergency department (A&E) and the GP Care Group, related to the Urgent Treatment Centre (UTC), have collaborated on designing the patient pathway to ensure early redirection from A&E to the primary care same day access service, to reduce the demand on the UTC.

Mr Weaver noted that the both the UTC and NHS 111 contracts are due to expire on the 31 March 2026. This means that any pathway changes that are introduced require completion over the next few months, to ensure the procurement and appointment process for new providers is ready.

It was noted that the current pathway is not suitable for patients and does not provide value for money. Patients could be redirected within the same day access care program and primary care is approximately a third of the cost. The service will have access to patients' medical records, to enable quicker access to care, make referrals, and ensure patients do not return with other health issues shortly after.

Members were informed that a review was undertaken on patients attending UTC and findings showed that a large number could have been seen earlier if same day access care was provided. A Healthwatch survey was conducted with patients at A&E and 66% were willing to be redirected to a primary care service, if feasible.

Mr Wever provided details of the patient's requirements for same day access care, the choice for patient’s to decide if they want to be redirected and the locations in the borough where the service is available. The aim over the next 12 months is to redirect approximately 90 people to the programme a day, rather than the 30 people per day currently.

Details of the locations throughout the borough were given and the funding risks and business case outlined, to enable the programme to effectively transfer from acute care to primary community care.

Further to questions from the sub-committee, Jonathan Weaver;

•         Confirmed that a walk-in service at St Andrews Hospital site was in operation, however the new programme is by appointment only and  will enable more residents throughout the borough to benefit from same day access care, referable by a clinician, A&E or by NHS 111.

•         Clarified that pilot sites for same day access care services will be available at Cable Street, the Barkentine Practice, Newbie Place, Spitalfields and Wellington Way. This will ensure more capacity of patients and will include  monitoring the number of redirections from NHS 111. Each practice will also monitor the numbers to give a fuller understanding of the programme  ...  view the full minutes text for item 3.1

Julie Dublin, Senior Transformation Manager, gave an update on the hospital discharge process and outlined the Tower Hamlets Together Board’s key priorities for municipal year 2024-25. Ms Dublin noted that hospital discharge varies depending on the individual's condition upon entering the hospital, how they are when departing the hospital and where they will be going.

Ms Dublin noted that the report only deals with adult discharges, then outlined the 4 discharge pathways a patient goes through when approaching their final day in hospital:

?        Pathway 0 refers to a patient discharged to home or a usual place and who does not have any a patient discharged to a home or a usual place who does have new or additional health or care needs.

?        Pathway 2 refers to a patient discharged to a community bed-based setting who has dedicated support for new or additional health or care needs, in the short term to aid in recovery and/or live independently. This also relates to someone who may require longer term care.

?        Pathway 3 refers to a patient discharged to a new residential or nursing home setting who may also require long term residential or nursing home care.

Members were informed that Pathways 2 and 3 require more complex care packages, equipment and support or may also require a residential bed. Details of the discharge framework were noted. This framework, compiled  by stakeholders including Tower Hamlets Council, the Royal London NHS Trust, the East London Foundation Trust (ELFT) and the ICB, sets out six key priorities the discharge service adheres to:

1.     Address risk- adverse decision-making and over provision of homecare in pathway 1.

2.     Improve knowledge of discharge to assess (D2A) process for patient, families and carers.

3.     Improve engagement with families/carers.

4.     Address complex discharge issues earlier in the planning process.

5.     Streamline and accelerate the process for reviewing high-cost packages of care.

6.     Encourage better use of the reablement service, reducing inappropriate referrals, promote goal-focused therapeutic input in reablement.

Members were informed of the multidisciplinary team approach to discharging patients and collaboration required by brokerage staff, the acute hospital and community health services, alongside the reablement and rehabilitation services and the adult social care teams.

The ‘Transfer of Care Hub’, formerly known as the Integrated Discharge Hub, supports people about to be discharged from hospital to the most appropriate place, is not without challenges. Most notably the lack of suitable places within the borough.  This has meant that some patients are housed outside Tower Hamlets, which can cause concern for family members. Members were informed that a lack of equipment has also caused challenges.

Accessible equipment available in more swiftly greatly has improved the  discharging process. There have been instances where a patient refuses discharge due to housing issues and the choice policy has been implemented to facilitate a patient's discharge.

Ms Dublin then outlined the current activities being undertaken in line with the key priorities for a more streamlined service. This included the implementation of the optimal-handed care  ...  view the full minutes text for item 3.2

The Chair informed Members that a second scrutiny review of the Maternity service and support for New Mothers, will take place on 10th February 2025 and will include representatives of Southwark Maternity Commission and Family Hub.

The Chair also updated Members on the final scrutiny session scheduled for 25th February 2025 on gestational diabetes, which has impacted Bangladeshi and Somali women. Members were urged to attend both sessions.