The Health and Social Care Scrutiny Commission met on Monday 5 February 2024 to discuss changes to health scrutiny arrangements, the work of the Southwark Safeguarding Adults Board (SSAB), and the issue of access to public toilets. The Commission requested further breakdown of safeguarding concerns and enquiries and made proposals for amendments to the headline report on the Access to Loos scrutiny review.

Health Scrutiny and New Reconfiguration Arrangements

Sarah Feasey, Deputy Head of Law, provided an overview of the new regulations concerning health scrutiny and service reconfigurations, referencing a guide produced by the Centre for Governance and Scrutiny (CfGS)¹. A member questioned the change in the former power of health scrutiny to refer matters to the Secretary of State for review. Ms. Feasey explained that this change may allow ministers to instigate reviews and that while the role in triggering reviews is reduced, health scrutiny still retains a role.

Interview with the Independent Chair of the Southwark Safeguarding Adults Board (SSAB)

Anna Berry, Independent Chair of the SSAB, and Pauline O’Hare, Director of Adult Social Care, presented on the board's work. Discussions covered the impact of the COVID-19 pandemic on the workforce, with Ms. O’Hare noting that while some experienced staff retired early, a rolling recruitment programme is in place. Regarding safeguarding statistics, Ms. Berry stated that Southwark's figures are broadly in line with national trends, and the board is seeking enhanced data from partners. Ms. O’Hare mentioned innovations to the front door of older people's services, including a more digitally friendly telephone system.

A significant point of discussion was the progress in replicating the Persons In a Position of Trust (PIPOT) framework from children's services to adult services. The SSAB is considering adopting this framework to manage allegations and integrate safeguarding processes with HR disciplinary procedures. The board is addressing the logistical challenges, including data governance and training requirements. Examples were provided of how the PIPOT framework could be applied, such as in cases where a care home worker is accused of abuse or where social media is used to contact a vulnerable client inappropriately. Members also raised questions about protections against vexatious complaints and how lived experience informs social worker training. The Commission resolved to request a breakdown of concerns and enquiries by the type of individual or organisation being investigated (care homes, home care agencies, family members) and the categories of abuse (financial, physical, emotional, neglect).

Hourglass

Kyra Gonzales, Community Response Officer and Independent Domestic Violence Advisor (IDVA) for Hourglass, presented on the organisation's mission to end the harm, abuse, and exploitation of older people. Discussions highlighted that cases often involve individuals with dementia and that Hourglass facilitates information sharing across professional disciplines. A member raised the distinction between safeguarding issues and quality of care issues, with Ms. Gonzales acknowledging a fine line and occasional lack of consensus. The presentation also touched upon the challenges of accurately reflecting where abuse occurs, noting that referrals are often from friends and family, potentially underrepresenting abuse within institutions. The need for increased support within institutions to encourage referrals was emphasised. Ms. Gonzales confirmed instances of insufficient action in abuse cases, citing an example where a woman whose carer was her son with mental health problems was not deemed vulnerable enough for intervention. Recommendations for reducing abuse in care homes included increasing training, fostering open communication, and enhancing multi-agency working.

Scrutiny Review: Access to Loos - Headline Report

Julie Timbrell, Scrutiny Project Manager, presented the headline report on the Access to Loos scrutiny review. Members proposed amendments, including a recommendation for the provision of hard copy maps of public toilets, similar to those provided by Lewisham Council. There was a discussion about leadership for this initiative, with Councillor Evelyn Akoto (Public Health) and Councillor James McAsh (Environment) being considered. The report will incorporate more concrete examples of how anti-social behaviour has been mitigated and suggestions to contact Age UK London for good practice examples. The ongoing importance of toilet provision was highlighted in relation to the consultation for the former GLA City Hall building. The toilet serving East Street Market was cited as a positive example due to the presence of an attendant. The report will also highlight poor toilet provision as an environmental health issue impacting community health and wellbeing, noting instances of public urination and defecation due to a lack of facilities. The Commission resolved that the final report would reflect these comments.