The Health and Wellbeing Board of Redbridge Council met on Monday 2 December 2019 to discuss a range of important issues affecting the borough. Key decisions included noting progress on tackling child criminal exploitation, endorsing the Redbridge Disability Charter, and agreeing to continue supporting the work of the Redbridge Safeguarding Adults Board.

Gangs and Youth Violence

The Board received an overview of how children's Social Care in Redbridge is responding to children exploited by gangs and experiencing youth violence. The report defined Child Criminal Exploitation (CCE) as occurring when an individual or group exploits an imbalance of power to coerce, control, manipulate, or deceive a child under 18, noting that this can happen even if the activity appears consensual and can involve technology. Children in Redbridge are being identified and supported, with an increase in the number of children involved. The Family Intervention Team has developed an innovative approach to working with at-risk children, and various commissioned and externally funded services are collaborating with the Council. Multi-agency strategic responses to CCE are being managed alongside efforts for Child Sexual Exploitation and Missing Children. Initiatives like Box Up Crime have engaged over 200 young people, and £700,000 has been awarded for family functional therapy for 10-14 year olds, with an additional £145,000 for mentoring in three schools. Discussions highlighted the importance of timely mentoring, addressing young people being brought into the borough via transport services for grooming, tackling illegal gambling activities like the 3-coin trick on Ilford High Street, and the need for information sharing with families. The Board resolved to note the progress made and ongoing developments in response to criminal exploitation.

NHS Winter Pressure Plan

A report presented by Sharon Morrow of Barking, Havering and Redbridge University Trust (BHRUT) summarised expected pressures on the health service over winter and the preparations being made. The presentation focused on BHRUT, but also included Whipps Cross Hospital as part of Barts Health NHS Trust. The Barking, Havering and Redbridge Clinical Commissioning Group (CCG) works closely with Waltham Forest CCG, and an increase in demand throughout the year, not just in winter, has been observed. Risks and challenges identified included workforce sustainability, patient discharge to ongoing care, capacity in mental health services, physical space at Queens Hospital in Urgent Treatment Centres (UTC) and Accident & Emergency (A&E) departments, and demand exceeding provision. The Four-Hour Performance of BHRUT hospitals and Whipps Cross Hospital was reviewed, with Whipps Cross performing better overall. Transformation work at BHRUT to manage ambulance conveyances through appropriate care pathways has shown some success. The winter action plan and system-wide initiatives were reviewed, noting an increase in respiratory tract infections and flu cases in children. Discussions raised questions about the effectiveness of winter actions given ongoing workforce issues, potential improvements in patient outcomes from a focus on discharge management, the use of low-tech communication methods like leaflet drops, and the difference between Primary Care Networks (PCNs) and GP Hubs. The Board resolved to note the report on Winter Pressures and Planning.

BHR Integration Update - Mental Health Programme

The Board received an update on the mental health transformation programme, a key initiative of the Integrated Care Partnership. Plans for 2019/20 focused on delivering the Five Year Forward View commitments while preparing for the Long-Term Plan. Dr Raj Kumar highlighted that the programme aims for a fundamental shift from treating mental health issues to prevention and promoting emotional, mental, and physical health across all ages. The Director of Public Health, Gladys Xavier, reported on a suicide prevention audit that has resulted in a plan specifically targeting young people. Issues raised included the importance of training for school staff on suicide prevention, concerns raised by the Care Quality Commission (CQC) about unsafe practices at North East London Foundation Trust (NELFT) and actions being taken, work to prevent mild mental illness from progressing, the Council's involvement in the transformation initiative, waiting times for mental health care, and the need for patient engagement to reduce drop-out rates from Improving Access to Psychological Therapies (IAPT) services. Healthwatch expressed interest in collaborating with BHRUT on patient engagement for IAPT and improving the quality of learning disability health checks. The Board resolved to note the update from the BHR Mental Health Transformation Board and agreed that a further update would be presented in six months.

Haven House Hospice and Saint Francis Hospice - Joint Presentation

Dr Corinna Midgley of Saint Francis Hospice and Mike Palfreman of Haven House Children's Hospice presented a joint update on Palliative Care and End of Life Care. Saint Francis Hospice provides adult palliative care services, including District Nurse Services, GP support, inpatient beds, and Day Therapy Services. Their strategy aims to provide excellent person-centred care for anyone affected by a life-limiting illness. Statistics showed an increase and diversification of services. The Redbridge Macmillan palliative care team's workload is increasing, and access to palliative care is widening, though it is needs-based. A shared venture, the Young Adult Group, is reaching out to young adults effectively. Haven House Children's Hospice supports children and young people from birth to 19 with life-limiting and life-threatening conditions across North and East London, West Essex, and East Hertfordshire, offering services such as end-of-life care, respite, therapies, and bereavement support. Redbridge has the highest number of children and young people with such conditions compared to neighbouring boroughs. Discussions covered the availability of staff to prescribe medicines for palliative care, efforts to enhance community palliative services, challenges in reaching communities, and the expansion of Marie Curie services. The Board noted the joint update and thanked the presenters.

Redbridge Adult Safeguarding Board Annual Report 2018-19

The Board reviewed the Annual Report of the Redbridge Safeguarding Adults Board (RSAB), which summarised safeguarding arrangements and developments from partner agencies during 2018-19. John Goldup, Chair of the RSAB, highlighted that the Board is less well-resourced than children's safeguarding arrangements and that safeguarding vulnerable adults has a lower profile. Concerns were raised about a lack of communication with the voluntary sector regarding actions taken based on their feedback, the increasing profile of self-neglect as a safeguarding issue (accounting for approximately 15% of concerns), and the need to continue work addressing the number of homeless deaths in Redbridge. Discussions noted that the Redbridge SAB receives no funding from the CCG, unlike other Safeguarding Adults Boards in Barking, Havering and Redbridge (BHR). Redbridge takes a higher percentage of concerns into formal safeguarding procedures than the London and national average, and further work is needed to understand this discrepancy. Integrating safeguarding procedures with the People Matter model is a key future challenge, as are problems with the collection of adult safeguarding data. The Board resolved to note the report, continue to support the RSAB's work, and receive the Annual Report for 2019-20.

LSCB Annual Report 2018-19 & Business Plan 2019-20

This report presented the Local Safeguarding Children's Board (LSCB) Annual Report for 2018-2019. It was noted that this would be the final report from the LSCB, which was superseded by new local safeguarding arrangements under the Children and Social Work Act 2017, leading to the Redbridge Safeguarding Children Partnership (RSCP) in late September 2019. John Goldup described the report as presenting a positive picture of multi-agency safeguarding in Redbridge, with a high level of initiative and innovation. Key points included accelerated demand driven by family poverty, with more families receiving support to avoid drastic state intervention; criminal exploitation and gang affiliation as major issues; and acknowledgement of the changes resulting from the LSCB becoming a statutory body, replaced by a BHR-wide partnership, which presents both advantages and challenges, including accountability. Discussions covered how these changes would affect service flexibility and responsiveness, and how demographic shifts would impact safeguarding work. The Board resolved to note and endorse the LSCB Annual Report 2018-19 and agreed to accept an Annual Report for 2019-2020 from the RSCB.

Redbridge Disability Charter

The Board reviewed the Redbridge Disability Charter, developed as a key action from the Redbridge Fairness Commission's recommendations to support vulnerable residents and ensure opportunity for all. The Charter sets out principles to inform commissioning processes across the Council and was developed through consultation. It is proposed that the Charter be implemented through co-production, service specifications, and contract monitoring, with an annual report presented to the Health and Wellbeing Board (HWB) on progress. Caroline Martindale explained a three-stage approach to ensure full implementation. While it was suggested that the Charter might initially affect a small percentage of people with disabilities, officers clarified that policy and guidance services exist across the Council, and work is underway with other organisations. Any organisation can adopt the Charter, and significant work is being done on accessibility, particularly within Customer Services. The Board resolved to note the Charter's contents, endorse its adoption by Cabinet and the CCG Governing Body, and agreed for an annual joint health and care progress report on the Charter to be presented to the Board.

Other Business

The Board noted and agreed the work programme for future meetings. They also noted the date of the next meeting as 2 March 2020. There were no urgent items raised.