The Health Overview and Scrutiny Committee of Wandsworth Council met on Monday 01 December 2025. The meeting included an update on St George's Trust's performance and key issues, a report on key mental health areas delivered by South West London & St George's Mental Health Trust, and a report on integrated care developments in Wandsworth by the NHS South West London Integrated Care Board. The committee also discussed the CCTV Strategy for Wandsworth (2024-2029), the Wandsworth Sexual and Reproductive Health Strategy 2025-30, and received a verbal update on the CQC's Local Authority Assessment of Adult Social Care. Additionally, the committee reviewed the 2023-24 Adult Social Care Outcomes Framework Annual Report and the 2024/25 Q3 Budget Monitoring and 2025/26 Budget.

St George's Trust: Performance and Key Issues

Representatives from St George's University Hospitals NHS Foundation Trust provided an update on their performance and key issues. They reported meeting the national 4-hour A&E target in December 2024, with 79.7% of patients admitted or discharged within this timeframe, despite a nearly 3% increase in attendances compared to the previous year. The Trust is working closely with local councils, including Wandsworth, to ensure patients are cared for in the most appropriate setting, particularly during winter pressures. The Transfer of Care (TOC) hub at St George's Hospital is actively working with Wandsworth Social Care and Reablement Teams to facilitate timely patient discharge.

Consultant-led elective treatment waiting times remain a priority, with a focus on eliminating 52-week waits by March 2025. As of November 2024, 31 patients were waiting 65 weeks or longer, placing the Trust in the second quartile nationally and performing better than its peer average. While 858 patients were waiting 52 weeks or longer, detailed plans are in place to mitigate waiting time growth. Diagnostic services are performing strongly, with nearly 93% of patients receiving tests within six weeks of referral, against a national ambition of 95%, with recovery projected for early 2025. Cancer standards performance is also meeting trajectories, with 62-day referral for treatment at 77% and Faster Diagnosis at 84.5% in November 2024.

Financially, the Trust is navigating a challenging environment and is focused on delivering its financial plan. Deloitte has reviewed the Trust's financial position, validating planned actions and identifying further improvement opportunities. The Trust reported a year-to-date deficit of £14.3 million.

In maternity services, St George's delivered 3,965 babies in 2024. Significant improvements have been made following a 2023 CQC inspection, with 16 out of 21 actions complete and the remaining 5 in progress, projecting full completion by March 2025. Patient satisfaction levels are high, with the Trust scoring 9.0/10 for kindness and compassion and 8.5/10 for trust in staff in the NHS Maternity Survey. Changes in midwifery leadership have occurred, with interim appointments in place until permanent directors commence in March 2025.

Regarding workforce, the Trust aims to be among the top five trusts in London for staff engagement by 2028. Their People Strategy 2024-2026 focuses on key areas including basic staff needs, future workforce development, inclusive culture, learning opportunities, wellbeing, and integrated working. The Trust held its first group-wide awards in December to celebrate staff achievements. Recruitment efforts have seen the vacancy rate reduce from 18.8% to 12%, with a focus on critical hard-to-recruit posts. Retention initiatives are also in place, leading to a reduction in turnover rates by approximately 24%.

Children's cancer services are set to move from St George's to the Evelina London from October 2026 onwards, following a decision by NHS England. Discussions are ongoing with partners about managing this transition effectively for patients and staff.

South West London & St George's Mental Health Trust: Key Mental Health Areas

Philip Murray and Priya Samuel from South West London & St George's Mental Health NHS Trust presented an overview of their key mental health service delivery and community programmes. The Trust serves over 1.2 million people across six boroughs, with a workforce of over 2,700 staff. They provide services across acute and urgent care, community services, Child and Adolescent Mental Health Services (CAMHS), and specialist services.

The Trust's strategic ambitions include increasing quality years, reducing inequalities, making the Trust a great place to work, and ensuring sustainability. Their key priorities are improving the adult patient journey and creating a valued and stable workforce, underpinned by efforts to tackle health inequalities and become an actively anti-racist organisation.

The Adult Patient Journey programme aims to reduce long lengths of stay, avoid crisis care, and enable community well-being. Initiatives include enhanced crisis support through the Coral Mental Health Crisis Hub, a family placement scheme focusing on culturally appropriate support for Black, Asian, and Minority Ethnic communities, and new protocols for patients with complex emotional needs. They are also enhancing community support and have introduced interface worker roles to tackle delayed discharges. Specialist teams have been enhanced, including an Adult Eating Disorders enhanced treatment team and a new Perinatal Trauma and Loss Team.

The Trust is committed to becoming an actively anti-racist organisation, working to dismantle racial prejudice and address disparities in mental health services. The Ethnicity and Mental Health Improvement Project (EMHIP) is a key initiative in Wandsworth, aiming to reduce inequalities in access, experience, and outcomes for Black, Asian, and Minority Ethnic and marginalised communities. This involves establishing community hubs, reducing restrictive practices, enhancing inpatient care, and ensuring a culturally capable workforce.

The Trust is also transforming its digital strategy, focusing on digitally enabled employees and patients, and interoperable systems. As an anchor institution, SWLSTG is investing in its estate, with projects like Springfield Village aiming to create modern mental health facilities and community spaces.

Councillor Gray raised concerns about the lack of interaction with liaison and diversion teams at courts, to which Philip Murray explained the Trust runs a liaison and diversion service as part of its forensic division, working collaboratively with other trusts and having recently submitted a joint proposal to expand these services.

Councillor Worrall questioned the challenges in taking forward anti-racist agendas and strengthening equality work. Priya Samuel highlighted the complexity of inequalities, including reduced life expectancy for those with severe mental illness, and detailed initiatives like the MHIP project aimed at understanding and addressing specific inequalities faced by different communities.

Councillor Kassain noted a deterioration in occupied bed days and an increase in the average length of stay. Priya Samuel explained this was due to factors such as patients being clinically fit for discharge but awaiting placement, the increasing complexity of patient needs, and the impact of introducing day surgery. They are working to address these issues through the Adult Patient Journey programme.

The committee also received an update on CAMHS, with responses to Councillor Davies' questions to be shared later.

SWL ICB: Integrated Care Developments in Wandsworth

Mark Creelman, Executive Director of Place for Merton and Wandsworth at NHS South West London Integrated Care Board (ICB), provided an update on integrated care developments in Wandsworth. He explained the ICB works at two levels: South West London ICB and PLACE (Wandsworth), which includes primary care, community services, and delegated authority for pharmacy, optometry, and dentistry. The ICB's focus is on integrated working, reducing A&E and ambulance response times, improving planned care waiting times, enhancing access to primary care and dentistry, and improving patient flow and care for mental health and learning disabilities.

The ICB is committed to shifting focus from treatment to prevention, analogue to digital, and moving services from acute settings into the community. Katie Jennings, from the ICB, highlighted that Wandsworth is ahead of the curve in developing integrated neighbourhood working, aligning with new NHS operational guidance.

The first phase of Integrated Neighbourhoods is set to launch on 1st April 2025, focusing on Battersea, Roehampton, and Tooting. These neighbourhoods will aim to provide local system leadership for planning and delivering health and care services for populations of 30-50,000, prioritising prevention to improve care outcomes and reduce health inequalities. James Walker, also from the ICB, elaborated on the practical implementation, emphasising the importance of building a good working culture and trust between providers, with the patient and citizen interest at the heart of their work.

Councillor Davies inquired about the balance of resource distribution between different sectors and enriching collaboration. Mark Creelman committed to providing exact figures and highlighted the ICB's commitment to shifting funding towards primary and community services. Katie Jennings expanded on partnership working, noting that while partnership working is not new, the new approach will bring together a wider group of people, including the voluntary sector, to look after communities on a larger geographical footprint.

Councillor Averil Farage asked about the geographical scope of the integrated neighbourhoods, noting that Battersea and Tooting are large constituencies. James Walker explained that the initial neighbourhoods were selected based on data and level of need, working on a 30,000 to 50,000 population level for primary care networks, but acknowledged that other services work to different footprints. The aim is to provide coverage across the north, west, and south of the borough, with a long-term vision to develop comprehensive services.

Councillor Crivelli questioned the financial stability of the ICB and its ability to commission services at the Wandsworth level given new guidance from central government. Mark Creelman acknowledged the challenging financial environment and the potential for hard decisions, but stressed transparency and quality impact assessments. He confirmed that decommissioning plans would go through the place committee, attended by officers and councillors, to minimise impact on direct patient care.

Stephen Hickey asked about the breadth of the multidisciplinary group and how it would be operationalised. Katie Jennings explained that the steering group includes GP practices, community services, social care, the voluntary sector, St George's, and South West London & St George's Mental Health Trust. Social prescribers and health and social care coordinators will play a key role in linking to the wider voluntary sector and coordinating delivery. They are also exploring IT solutions to support multidisciplinary working.

CCTV Strategy for Wandsworth (2024-2029)

Tom Crawley, Assistant Director of Resident and Estate Services, presented the Wandsworth CCTV Strategy for 2024-2029. The strategy aims to create safer neighbourhoods by ensuring the CCTV network is effective, sustainable, and used appropriately. It is guided by three themes: effectiveness, growth and sustainability, and lawful and justifiable usage.

Wandsworth has over 1,200 cameras, with an upgrade programme nearing completion. The strategy outlines plans for the next five years, including an intelligence-led deployment approach, infrastructure maintenance, and impact evaluation. A CCTV monitoring pilot, introduced in October 2023, has placed monitoring officers within the Joint Control Centre (JCC) to monitor CCTV at peak times, working with police officers to prevent and detect crime and locate vulnerable people. This pilot will be proposed to become permanent.

The strategy also addresses the growth and sustainability of the network, prioritising resources for maximum impact and exploring income generation opportunities, such as increased charges to insurance companies and offering services to other housing providers and retailers. New technology, such as pattern recognition software, is being considered. Lawful and justifiable usage is paramount, ensuring compliance with legislation through regular audits and a dedicated CCTV Steering Group with representatives from council departments and external partners like the police.

Councillor Adela Sasshoor questioned the clarity of the strategy and the definition of success with measurable KPIs. Tom Crawley explained that while direct KPIs are difficult due to CCTV being one part of a wider crime prevention strategy, the aim is to ensure communities feel safer and to support police efforts in reducing crime and antisocial behaviour. He noted that the strategy is the council's first CCTV strategy and sets out existing practices while planning for effective use of the network.

Councillor Davies asked about the potential number of cameras within five years. Tom Crawley stated there is no specific target number, as the focus is on effectiveness and flexibility, with the possibility of decommissioning cameras if they are not justified by their contribution to public safety. He also mentioned the increase in deployable cameras for flexible deployment.

Councillor Ghossain raised concerns about democratic accountability, noting the lack of elected representatives on the steering group and the absence of formal review processes for councillors or the public. Tom Crawley assured that significant policy changes, such as facial recognition (which is not planned), would be brought back to a committee for approval. He explained the steering group's role in overseeing strategy implementation and regulatory compliance. Kieran, from the Community Safety team, added that the Community Safety Partnership Board is a statutory board, and the steering group will feed into it. She also highlighted the requirement for clear signage and a point of contact for public concerns.

Councillor Marshall inquired about the use of facial recognition and AI beyond that, such as pattern recognition and predictive analysis. Tom Crawley confirmed no plans for facial recognition but mentioned the ongoing consideration of pattern recognition software. Kieran elaborated on the police piloting facial recognition in the borough, but not by the council. She also discussed the precision crime-fighting forum and the intelligence-led nature of surveillance operations.

Councillor Crivelli questioned the correlation between crime data and CCTV effectiveness, asking for breakdowns of data to evaluate CCTV's impact. Kieran explained that the crime data table shows relevant crimes potentially impacted by CCTV, and while direct correlation is difficult, case studies demonstrate real-time activity and successful apprehensions. She confirmed that data on outcomes is being captured and will be shared with the committee as judicial processes complete.

Councillor Crivelli also asked about the cost of cameras and deployment, seeking a breakdown for cost-effectiveness. Matt from the council provided the capital cost of a deployable camera (£2,500) and committed to providing indicative costs for deployment.

Councillor Dobres, Cabinet Member for Community Safety, addressed concerns about democratic accountability, stating that the strategy is being brought to a scrutiny committee, which represents democratic accountability. Annual reports will be submitted to the committee, and the Cabinet Member takes ultimate responsibility. He also mentioned guidance for councillors on requesting CCTV coverage.

The committee agreed to support the recommendations in paragraph 2, with amendments including presenting an annual CCTV report to the full council or appropriate committee, considering the inclusion of elected councillors on the CCTV steering group, publishing key decisions of the steering group, maintaining public accessibility to a list of active CCTV locations, introducing a formal process for residents and councillors to challenge CCTV use, and commissioning independent audits.

Wandsworth Sexual and Reproductive Health Strategy 2025-30

Dr. Ramya Rabindrain, Consultant in Public Health, and Kate Jennings, from Adult Social Care and Public Health, introduced the Wandsworth Sexual and Reproductive Health Strategy 2025-30. This collaborative strategy, developed with health, volunteering, and community sector partners, is based on the findings of the Wandsworth Sexual and Reproductive Health Needs Assessment undertaken in 2024.

The strategy adopts a life course approach, considering needs from young adults to older people, and aligns with existing local, London-wide, and national strategies, including the Violence Against Women and Girls Strategy, the Youth Strategy, the HIV Action Plan for England, and the Women's Health Strategy.

The strategy is structured around the WHO Framework for Sexual and Reproductive Health, covering eight key intervention areas from education and prevention to treatment, antenatal, intrapartum, and postnatal care, and psychosexual counselling. Each section details data, community feedback, current provision, gaps, priorities, and next steps. A significant focus is placed on reducing health inequalities and fostering a collaborative approach between the council, health, volunteer, and community sectors. The implementation will be overseen by a multi-agency partnership group, the Sexual Health Implementation Group, with evaluation over the five-year period.

Councillor Worrall commended the comprehensive nature of the strategy and the extensive consultation and research involved, highlighting the importance of sexual health, which is often marginalised but has a major impact on population health. He recommended the strategy and praised its layout, linking actions with priorities and developing a measurable matrix.

Councillor Crivelli sought clarification on how data gaps, particularly concerning marginalised communities like sex workers, would be filled. Dr. Rabindrain explained that during the needs assessment and strategy development, they worked with partner organisations representing these groups, including a sex worker who spoke to the implementation group. Going forward, they will continue to use qualitative data, explore London-level data, and combine years of data to address small numbers. They will also focus on intersectionality where individuals belong to multiple marginalised groups. Kate Jennings added that contractual levers with GPs and pharmacies could be used to incentivise data collection.

Councillor Crivelli also asked about the evidence on STI diagnosis and testing rates in Wandsworth, noting that while diagnosis rates appear higher than the London average, testing rates are also higher. Dr. Rabindrain clarified that it's a combination of factors, including more testing, Wandsworth's mobile and young population, and a national increase in STIs. She added that comparative analysis with other boroughs helps indicate genuine issues. Councillor Crivelli sought to understand if the demographic composition of Wandsworth makes it inherently more difficult to improve STI rates, to which Dr. Rabindrain responded that while demographics are a contributing factor, the strategy aims to tailor interventions and health promotion to address this, without marginalising other groups.

Stephen Hickey from Healthwatch asked about the collaboration with partners across the health system. Dr. Rabindrain confirmed extensive collaboration during strategy development and ongoing engagement through the Sexual Health Implementation Group, citing examples of working with schools on RSE, commissioning the 0-19 service, and engaging with St George's on midwifery offers.

The committee unanimously supported the recommendations in paragraph 2, adopting the Wandsworth Sexual and Reproductive Health Strategy 2025-30.

Verbal Update on the CQC's Local Authority Assessment of Adult Social Care

Jeremy D'Souza, Executive Director of Adult Social Care and Public Health, provided a verbal update on the council's preparation for its forthcoming assessment by the Care Quality Commission (CQC). The Health and Care Act 2022 introduced a new duty for the CQC to review and assess local authorities' performance in delivering adult social care duties under the Care Act.

The CQC assessment framework covers four themes: working with people (assessment and review processes), providing support (commissioning and partnerships), ensuring safety (safeguarding adults and the council's role as lead agency), and leadership (the council's leadership role in adult social care).

The CQC began its assessment process in 2023, and several London boroughs have already been inspected. Wandsworth Council received notification of its assessment just before Christmas on 9th December, and submitted a comprehensive information return, including its own assessment of performance, on 10th January. The council is now awaiting notification of the on-site visit by the inspection team, anticipated within a few months.

During the on-site inspection, the CQC will speak to a variety of individuals, including senior leaders, frontline staff, people with lived experience, care providers, partners (particularly in the health service and voluntary sector), Healthwatch, and elected members. Specifically, they will be interested in speaking with the Cabinet Member for Health, Councillor Dobres (Chair of the Health Committee), and Councillor Crivelli (Opposition Speaker for Health).

The council is currently focused on being ready for the inspection team, and the committee will be kept updated as the process unfolds. The assessment report is expected to be published and brought to the committee in the autumn, likely for the September meeting.

2023-24 Adult Social Care Outcomes Framework Annual Report

Claire, Assistant Director of Assurance and Innovation, presented the annual report measuring performance against the Adult Social Care Outcomes Framework (ASCOF), benchmarking against other London boroughs. The report is based on a service user survey, a carer's survey, and performance indicators.

Wandsworth demonstrated strong performance, with 17 out of 22 indicators (77%) in the top two quartiles, and no indicators in the bottom quartile. Feedback from service users was positive, with improvements in five out of seven indicators. Wandsworth performs in the top quartile for five indicators, including ease of finding information about support, control over daily life, social contact, social care-related quality of life, and overall satisfaction. The adjusted social care quality of life indicator improved from the third to the second quartile, ranking joint second in London. The proportion of people who use services who feel safe moved from the top to the third quartile, and further analysis is being undertaken.

For carers, all five indicators in the biennial survey are performing in the top two quartiles, above London averages. The proportion of carers finding it easy to find information about support remains in the top quartile. Three indicators moved to second quartile performance: social contact, overall satisfaction with social services, and inclusion/consultation in discussions about the person they care for. The carers quality of life indicator maintained its high performance, ranking in the top five in London.

In performance indicators, six out of ten are in the top two quartiles. Wandsworth ranks in the top five London Councils for five of these, is the best in London for one indicator, and joint top in three. The proportion of older people still at home 91 days after discharge into reablement is the best in London. Wandsworth is joint top for service users and carers receiving support through a personal budget and for carers on a direct payment. The proportion of people receiving short-term services with no ongoing support has improved but remains in the third quartile, reflecting increased complexity of needs. The percentage of people on a Direct Payment has slipped from the second to the third quartile, with efforts underway to address personal assistant workforce shortages. Admissions to care homes for younger adults is third in London, and for older people, it remains in the third quartile but has improved. The indicator for adults with learning disabilities living independently has also improved and maintains third quartile performance.

Councillor Crivelli noted that four indicators have been removed nationally, including those related to safety, employment for adults with learning disabilities and mental health services, and independent living for those with mental health services. Claire confirmed these are national changes and that the council will continue to track similar KPIs internally. Councillor Worrall commended the staff for their efforts in achieving these results. Councillor Crivelli also inquired about the slip in Direct Payment performance, which Claire attributed to national challenges in the personal assistant workforce but assured that the council is working with providers to address this.

The committee noted the report for information.

2024/25 Q3 Budget Monitoring and 2025/26 Budget, including Annual Review of Charges

Sarah Evans presented the Q3 budget monitoring for 2024-25 and the proposed budget for 2025-26. The committee's remit is projecting an overspend of £2.685 million against a revised budget of £102.660 million. This is primarily due to increased demand, more complex care needs, and rising costs of care services across all client groups in Adult Social Care. Mitigating actions are outlined in the report.

For most adult social care services, contributions are based on financial assessments. Proposed charges, not based on financial assessments, are set out in Appendix C, with a proposed 2.2% increase for Adult Social Care Services fees from 1st April 2025. The 2025/26 budget and future years' budgets reflect demand-led pressures and planned efficiencies.

The Adult Social Care and Public Health Directorate is forecasting an overspend of £2.733 million, mainly due to increased demand and complexity of needs, exacerbated by pressures within the NHS leading to quicker hospital discharges of patients with complex needs. Services for Older People and Physical Disability are forecasting an overspend of £0.444 million, and Learning Disability Services £1.537 million, largely due to increased complexity and cost of care packages. Services for Adults with Mental Health Needs are forecasting an overspend of £0.629 million due to increased demand.

Business Resources is forecasting a £0.141 million overspend, primarily due to an increase in public health funerals. Community Safety is forecasting an underspend of £0.047 million.

Mitigating actions are being implemented through the Transforming Social Care Programme, focusing on reablement, care technology, improved referral management, market management, and commissioning reviews.

The annual review of charges proposes a 2.2% increase for self-funders and day services, linked to August CPI, while freezing concession charges. Deputy fees are capped by the Court of Protection and will be confirmed in February 2025.

The committee supported the recommendations in paragraph 2, approving the revised charges and noting the proposed budgets.

Verbal Update on the CQC's Local Authority Assessment of Adult Social Care

Jeremy D'Souza provided a verbal update on the council's preparation for the CQC's assessment of its adult social care services. The council submitted its evidence return in January and is awaiting notification of the on-site inspection, anticipated within a few months. The CQC will speak to a wide range of stakeholders, including elected members. The assessment report is expected to be published in the autumn.

Wandsworth Sexual and Reproductive Health Strategy 2025-30

Dr. Ramya Rabindrain and Kate Jennings presented the Wandsworth Sexual and Reproductive Health Strategy 2025-30. The strategy aims to improve sexual and reproductive health outcomes through a collaborative, life-course approach, focusing on reducing health inequalities and ensuring equitable access to services. It is informed by a needs assessment and extensive consultation. The strategy is structured around eight WHO intervention areas and includes specific actions to address the needs of vulnerable groups. The committee unanimously supported the recommendations.

CCTV Strategy for Wandsworth (2024-2029)

Tom Crawley presented the Wandsworth CCTV Strategy 2024-2029. The strategy aims to enhance community safety through effective, sustainable, and lawful use of surveillance, guided by three themes: effectiveness, growth and sustainability, and lawful usage. The strategy was discussed in detail, with councillors raising questions about KPIs, democratic accountability, the use of AI, and costs. The committee agreed to support the recommendations, with amendments including the presentation of an annual CCTV report, consideration of councillor involvement in the steering group, and improved processes for challenging CCTV deployment.

St George's Trust Report on an Update on the Trust's Performance and Other Key Issues

The committee received an update on St George's Trust's performance, noting progress in A&E waiting times, elective care, and cancer standards, despite financial challenges and pressures on services. The report highlighted improvements in maternity services following CQC inspections and ongoing workforce development initiatives. The committee noted the report for information.

South West London & St George's Mental Health Trust Report on Key Mental Health Areas Delivered by the Trust

The committee received an update on the Trust's key mental health areas, including improvements to the adult patient journey, efforts to make the Trust a great place to work, and initiatives to tackle health inequalities and become actively anti-racist. The report detailed transformation projects, including new mental health facilities and community-based support. The committee noted the report for information.

SWL ICB Report on Integrated Care Developments in Wandsworth

Mark Creelman and Katie Jennings from the NHS South West London Integrated Care Board (ICB) presented on integrated care developments in Wandsworth. The report focused on the progress of Integrated Neighbourhood working, with phase one set to launch in Battersea, Roehampton, and Tooting. The committee noted the report for information.

2023-24 Adult Social Care Outcomes Framework Annual Report

Claire presented the 2023-24 ASCOF annual report, highlighting Wandsworth's strong performance against London benchmarks. The report showed improvements in service user and carer surveys, with many indicators in the top two quartiles. The committee noted the report for information.

2024/25 Q3 Budget Monitoring and 2025/26 Budget, including Annual Review of Charges

Sarah Evans provided an overview of the Q3 budget monitoring, indicating a projected overspend of £2.685 million within the committee's remit, primarily due to increased demand and costs in Adult Social Care. The report also detailed proposed fee increases and future budget considerations. The committee supported the recommendations regarding revised charges and noted the proposed budgets.