The Health and Wellbeing Board of Redbridge Council met on Monday 22 April 2024 to discuss various health and social care system updates, with a significant focus on the experiences and support needs of carers. The Board also reviewed the response to a coroner's report concerning Child and Adolescent Mental Health Services (CAMHS) investment.

Social Care and Health Systems Updates

The Board received updates on several key areas of health and social care within Redbridge.

Public Health

Gladys Xavier, Director of Public Health, reported a decrease in COVID-19 cases, with a spring vaccination campaign targeting those over 75 and the immunosuppressed. Flu and other virus activity were noted as low, though some under-5s were experiencing illness. An initiative to eliminate Hepatitis C will target individuals with substance abuse issues and the homeless through liver scanning and treatment. Travel health advice is being promoted, with the UK Health Security Agency's online tool, travel.prohealth, highlighted for checking country-specific health advice. Confirmed cases of measles, primarily among under-10s, were also discussed, with ongoing work with primary care and communities to increase vaccination uptake.

Adult Social Care and Community Health

Sanjiv Luckhea, Integrated Care Director for NELFT, presented an update on Adult Social Care, noting positive progress in key appointments for Strategic Lead and Safeguarding Managers, with ongoing recruitment for social workers. A pilot for assistive technology across adult social care and community health teams is underway. Children's services are facing staffing pressures, leading to a review of the staffing structure to implement a multidisciplinary team approach. The CAMHS service is experiencing high demand, with 40% of routine referrals waiting over 18 weeks, and work is being done with the Integrated Care Board (ICB) to address this backlog. The Community Children Nursing Team is a fragile service, and efforts are focused on finding a sustainable model. Recruitment to the district nursing service has improved due to an overseas recruitment campaign. The BHR respiratory transformation, including a successful virtual ward model, received an award for outstanding service. To address physical health inequalities for those with serious mental health issues, physical health checks have been introduced, with 75% completion to date.

Barking, Havering and Redbridge University Trust (BHRUT) & Whipps Cross Hospitals

Louise Dark, Managing Director of King George Hospital (KGH), reported that BHRUT met its urgent emergency care target of 76% by the end of March, with KGH achieving 78.5%. A new same-day emergency care unit at KGH has opened, aiming to reduce admissions and improve patient length of stay. Two new elective theatres have opened, with an official opening planned for 17 May, expected to increase the capacity for elective procedures. The faster diagnostic standard for cancer was met in March at 75%, and the 62-day cancer treatment target also saw significant improvement. A Redbridge Place Based Lead for BHRUT is expected to be announced in May.

Redbridge Borough Partnership

Adrian Loades, Corporate Director of People, shared that a diagnostic exercise on mental health, disability, and autism spending across North East London (NEL) revealed that NEL, and Redbridge specifically, have lower spending in these areas. There is a commitment to address this funding disparity. The partnership also considered a proposal for a mental health offer for domestic abuse victims, agreeing to form a task and finish group. A review of a difficult discharge case involving a young person from KGH highlighted the need for bespoke discharge and escalation arrangements for young people. An update on Health Inequality funding indicated positive benefits, with a measured approach to assessing its use.

Response to Regulation 28 Prevention of Future Death Around CAMHS Investment

Portia Kumalo from the ICB presented the ICB's response to a Regulation 28 notice issued by His Majesty's Coroner for East London following the inquest of a 12-year-old who died by suicide. The notice highlighted failings in care within an under-resourced Emotional Wellbeing Mental Health Service (EWMHS). The ICB established a multi-agency Task and Finish Group to review service provision and develop a business case. Discussions included the impact of a revised Neglect Tool Kit, Redbridge's Pathfinder Status for child protection arrangements, and the need for increased investment in community-based Tier 2 services and voluntary sector organisations. The potential for replicating a pilot involving Clinical Psychologists at Primary Care Network (PCN) level was also considered. Assurance was sought on the sufficiency of new services, with the Start Well Steering Group to oversee the process. The Board resolved to receive subsequent updates on the ICB's actions.

Carers and Mental Health

A themed session focused on the experiences and support needs of carers and their mental health. Individual carers highlighted issues such as insufficient promotion of Redbridge services for carers, a need for better information sharing between services, and the importance of continued support for young people transitioning to adulthood. Concerns were raised about the availability and accessibility of respite care, particularly for working carers, and the need for activities to prevent carers' mental health from impacting those in their care. The unacceptable waiting times for CAMHS communication and the decommissioning of Barnardo's were also mentioned.

Organisations also presented their work:

• Redbridge Carers Support Service (RCSS) noted complexities in accessing services and the need for clearer navigation systems and more efficient processing of applications for emergency alert cards.
• One Place East provides mental health services to individuals with disabilities and their carers, offering emotional and practical support through volunteers, trauma recovery groups, and peer-led reminiscence groups. Key messages from service users included the importance of safe spaces, a holistic approach linking physical and mental health, and the difficulty in obtaining timely support.
• NELFT – Redbridge Community Mental Health Team discussed their adult mental health services, including support packages for carers of those experiencing psychosis and older adults. They highlighted a gap in support for carers of individuals with early dementia and noted the availability of specialist psychological services, including a monthly carers support group and a primary psychology talking therapies programme. Collaborative care plans and tailored services like Open Dialogue sessions were also mentioned.
• Primary Care representatives acknowledged that more could be done, with GP practices required by the CQC to implement a framework of commitments for carers. The introduction of PCNs offers opportunities to utilise link workers, appoint clinical psychologists, and provide GP practices with directories of services, including a carers' register.

The Board acknowledged the importance of the carers' feedback, noting consistent themes of accessibility and information sharing. The need to address gaps in service provision and improve pathways and feedback mechanisms was highlighted. The Chair thanked participants and stated that next steps would focus on translating insights into action.

Forward Plan

The Board noted the Forward Plan for future meetings.

Dates of Future Meetings

The dates for future Health and Wellbeing Board meetings for the Municipal Year 2024-25 were confirmed as 24 June 2024, 16 September 2024, 18 November 2024, 24 February 2025, and 28 April 2025.