The Health, Wellbeing and Adult Social Care Scrutiny Committee met to review performance updates from Whittington Hospital NHS Trust and University College London Hospitals (UCLH) NHS Foundation Trust, and to discuss the council's quality assurance processes for home care and the Q3 performance report for Adult Social Care. Key discussions included hospital performance, patient safety, waiting times, and the effectiveness of care provision.

Whittington Hospital Performance Update

Sarah Wilding, Chief Nurse and Director of Allied Health Professionals at Whittington Health NHS Trust, presented an update on the trust's quality account priorities for 2024-2025. The priorities include ensuring patients are seen by the right person at the right time, improving access and attendance, reducing health inequalities, and enhancing the hospital environment for patient experience.

Key achievements highlighted included the implementation of the Birmingham Symptom Specific Obstetric Triage System (BSOTS) in Maternity Triage, Oliver McGowan training for 75% of staff, and updates to outpatient letters for better wayfinding. The trust has also seen successful utilisation of virtual ward beds and is providing training to staff to support mental health patients.

Councillor Tricia Clarke shared a positive personal experience at the Whittington, noting the friendly culture and the care provided to patients. However, she raised concerns about the digital appointment system, finding it difficult to change appointments by phone due to staff being busy. Clarke also inquired about the delirium discharge pathway, which Sarah Wilding explained as a process to support patients with altered cognition to return home quickly with appropriate support.

Discussions also touched upon the closure of the Royal Free Hospital's maternity ward and its impact on Whittington Hospital. Sarah Wilding confirmed that the trust is working with partners across North Central London, including UCLH, to manage the transition and expects an increase in maternity service users at Whittington.

Regarding Integrated Care Boards (ICBs) and potential resourcing cuts, Wilding acknowledged the challenging environment and stated that the trust is awaiting clarity on the implications. She highlighted a focus on reducing temporary staff costs and exploring opportunities for staff development.

When asked about A&E waiting times, Wilding reported a recent dip, with 12-hour waits increasing, partly due to an influx of mental health patients. The March performance for the four-hour standard was 72%, an improvement from February's 66.8%.

UCLH Annual Performance Update

David Preva, Chief Executive of UCLH NHS Foundation Trust, presented the trust's annual performance update. He reported good performance in infection rates, with low levels of MRSA and Clostridium difficile, although C. diff cases were slightly above target. Pressure ulcer rates remained low, and the trust had made significant progress in reducing the number of patients waiting over 65 weeks for treatment, with only 26 patients remaining at the end of March 2025.

However, Preva noted that the focus is now shifting to returning to the old constitutional standard of 65% of patients waiting no more than 18 weeks for treatment, with UCLH currently at around 60%. Diagnostic waiting times were performing well, with the trust close to achieving the 95% standard for tests within six weeks. Cancer performance was strong, exceeding national targets for diagnosis within 28 days and treatment within 31 days. A&E performance was around the London average for the four-hour standard, and UCLH had one of the best performances in London for ambulance handover times.

The inpatient survey results showed UCLH performing well compared to its peers, with a high overall patient experience. The trust's vacancy rate had improved, and staff engagement was reported as being among the best in the NHS.

Councillor Clarke inquired about the peer comparison in the inpatient survey, noting the absence of Whittington Hospital. David Preva stated that peers are generally selected based on bed numbers and teaching hospital status, and that Whittington could be included in future comparisons. He also provided an update on the collaboration between UCLH and Whittington, highlighting the success of joint services in nuclear medicine and cancer care, and the positive feedback from staff.

Concerns were raised about potential cuts to ICB resourcing and the impact on service delivery. Preva acknowledged the challenging environment and stated that UCLH is working with ICBs to support their work, with a focus on reducing agency and bank staff. He also mentioned exploring opportunities for collaboration with UCLH and Whittington to strengthen services.

Regarding potential industrial action, Preva confirmed that planning is underway, particularly for nursing and junior doctor colleagues, to minimise disruption to patient care.

In response to a question about cancer performance compared to European countries, Preva acknowledged that the UK generally performs less well, attributing this to access to early diagnostic care. However, he highlighted specific areas of excellence at UCLH, such as blood cancer treatment, where the trust is a leading centre in Europe. He also mentioned the Summit Study initiative, which aims to improve early cancer diagnosis through accessible scanning.

Concerns were also raised about the digitalization of the appointment system and support for older people. Preva apologised for any negative experiences and assured that improvements are being made to the telephony system and admin functions.

Councillor McHugh asked about UCLH's process for responding to coroner's court orders for witness statements. The trust explained that this is determined by the coroner, and they provide witness statements or evidence from relevant individuals as requested. They also have internal processes involving their inquest manager and clinical governance team to ensure appropriate individuals provide evidence.

Regarding diagnostic errors, UCLH reported five diagnostic errors in the emergency department in the past year, attributed to human error. They have a robust learning process, including consultant training and open discussions at board committees, to mitigate such errors.

Councillor Greg raised concerns about the increase in C. diff cases. The trust acknowledged this national trend and highlighted a focus on antibiotic prescribing and support for their cancer population, who are more susceptible.

A member of the public, Mrs. Roy, shared a distressing personal experience regarding her mother's discharge and subsequent death, and ongoing concerns about her father's care. The trust expressed condolences and apologised for any communication failures, assuring that her father's case would be reviewed.

Quality Assurance and Home Care

Anna Makepeace, Assistant Director of Quality Contracts and Brokerage, presented the council's approach to quality assuring home care providers. She outlined the robust processes in place, including a Quality Assurance Framework launched in September 2024, which prioritises resident feedback. The framework involves annual quality audits of all 80 contracts, contract review meetings, and annual quality statements.

Makepeace highlighted the collaborative approach with the Care Quality Commission (CQC) and other partners, and the importance of resident feedback. She noted that 37 quality audits had been completed in the first six months, with 34 rated as good or outstanding.

Councillor Janet Burgess MBE expressed reassurance about the report, noting previous tragic events that necessitated improvements in quality assurance. She raised concerns about discrepancies in the frequency of contract monitoring and quality assurance visits for different types of contracts, with some appearing less detailed than others. Makepeace clarified that the approach is risk-rated, with higher-risk areas like home care and care homes receiving more frequent monitoring.

Councillor Benali Hamdache inquired about the role of workers and unions in quality assurance. Makepeace acknowledged this as an area for further exploration and stated that the council now engages directly with staff during audits, ensuring confidential conversations and checking for whistleblowing policy understanding.

Hamdache also raised concerns about the influx of private equity and its potential impact on care homes and home care services, asking about the council's practices regarding ethical ownership and corporate social responsibility. Makepeace explained that the council has a duty to ensure a sustainable market and checks providers for financial sustainability. She acknowledged the difficult market conditions and the need for advocacy across the sector.

Regarding complaints about home care, Makepeace stated that four complaints from residents had been received in the past year, and that all complaints are investigated. She noted that the new framework and reduced number of providers have led to a generally better feeling and less informal complaints.

Concerns were raised about the frequency of quality assurance visits, with only 37 out of 92 contracts having received a visit so far. Makepeace explained that the framework was launched in September 2024, and the intention is to complete 100% of contract reviews within the financial year. She also detailed the process for providers rated Requires Improvement or Inadequate, which involves a serious concerns process with support and oversight.

A member of the public raised concerns about the lack of response from the council regarding inquiries and the inadequate care provided to their father, who requires 24-hour care but is only receiving four hours a day. They highlighted that this has been ongoing for two years, despite their father's deteriorating health. The council officers acknowledged the seriousness of the issue and assured that the case would be investigated thoroughly.

Quarter 3 Performance Report – Adult Social Care

Councillor Flora Williamson, Executive Member for Health & Social Care, presented the Q3 performance report for Adult Social Care. The report indicated that the council is on target for most Key Performance Indicators (KPIs), with improvements seen in supporting people to remain independent.

Key indicators showed that 76% of people were reabled and did not require long-term support after reablement, which is within 5% of the target. New admissions to nursing or residential care homes were 128, meeting the target of no more than 150. The percentage of service users receiving long-term support who had received a review was 44%, exceeding the year-end target. Direct Payments usage was at 30%, an improvement on the previous year and better than London and England averages. Safeguarding performance remained strong, with 95% of service users reporting their desired outcomes were achieved and 92% of safeguarding enquiries resulting in risk reduction or removal.

Councillor Benali Hamdache raised concerns about the proposed privatisation of the reablement service, questioning the response to union concerns and the timeline for savings. Councillor Williamson explained that the savings are not due to be realised for nearly three years and that the council prioritises keeping services in-house where possible. She noted that the reablement service is a short-term, niche service with high unit costs, making it difficult to achieve economies of scale.

Hamdache also inquired about the potential use of the reablement service's extra capacity for other services, such as home visits or welfare checks. It was confirmed that this has been explored, but the service is specialist and not easily transferable. The possibility of sharing the service with other councils was also discussed, but it was deemed unlikely that other councils would purchase the service due to its high cost.

The report highlighted that the reablement service supports residents to experience positive outcomes, and the council has secured three more years of funding for it.

Work Programme 2024/25

The committee noted the work programme for 2024/25. Councillor Jilani Chowdhury, Chair of the committee, announced that this would be his last meeting as chair and reflected on achievements, including influencing the maternity ward at Whittington Hospital. He thanked members and officers for their support.

The meeting concluded with expressions of gratitude for Councillor Chowdhury's work and passion for adult social care.