The Health in Hackney Scrutiny Commission met to discuss quality accounts from Homerton Healthcare NHS Foundation Trust and St Joseph's Hospice, adult social care inspection preparations, and substance misuse support in the borough. The commission agreed to a work programme for the coming year, and noted the results of public engagement on scrutiny topics.

Homerton Healthcare NHS Foundation Trust Quality Account

The Homerton Healthcare NHS Foundation Trust Quality Account 24/25 response was presented by Breeda McManus, chief nurse and director of governance, Dr Stephanie Coughlin, chief partnership and place officer, and Basirat Sadiq, chief executive. The report highlighted successes such as low mortality rates, the launch of 'Call for Concern' in response to Martha's Rule¹, and high performance against the four-hour A&E treat/discharge target.

Councillor Ben Hayhurst, Chair of the Health in Hackney Scrutiny Commission, raised concerns about the impact of savings targets on the place-based partnership², to which Dr Stephanie Coughlin responded that the situation was evolving, but that local focus was on preparing for potential resource reductions by focusing on integrated neighbourhood teams.

Councillor Abebeo asked how patient feedback was used to improve staff behaviour, and Breeda McManus explained the monthly review of violence and aggression incidents, and the use of patient feedback to improve communication and training. Basirat Sadiq added that she and Breeda McManus review over 90% of complaints to identify trends and intervene when necessary.

Councillor Kam Adams asked about staff feeling safe to raise concerns, and Breeda McManus highlighted the increase in staff raising concerns, the role of the freedom to speak up guardian, and the introduction of the Patient Safety Incident Response Framework (PSIRF).

Councillor Ben Lucas commended the quality account but questioned how patient trust was being built during organisational changes. Breeda McManus explained the robust process in place to assess the quality impact of any service changes. Basirat Sadiq added that patient voice was included in redesigning care, and that the voluntary sector was a key part of the conversation.

Councillor Claudia Turbet-Delof raised concerns about the national rollout of the federated data platform led by Palantir, and asked about data protection. Basirat Sadiq responded that the Homerton had strong governance around data leaving the organisation, and that the matter could be brought back for further discussion in the future.

Sally Beaven, Executive Director of Healthwatch Hackney, shared key takeaways from Healthwatch's response to the quality accounts, including overall positive reviews from 64% of patients, improved satisfaction in maternity and A&E, and the importance of patient voice and involvement.

Councillor Ian Rathbone asked about services that had not been reviewed since 2014, and Breeda McManus explained that the Care Quality Commission (CQC) had been prioritising particular services, and that the Homerton had an internal peer review process to ensure CQC readiness.

Councillor Ben Hayhurst asked about designated funding for reducing waiting lists, and about soft services. Basirat Sadiq responded that the Homerton had submitted a plan focused on reducing waiting times and had received funding to do so. She added that the board had made a decision to go out to a proper procurement process for soft facilities management services, and that conversations were ongoing with system partners, including Barts Health and Hackney Council.

Adult Social Care CQC Inspection

Helen Woodland, Group Director - Adults Health and Georgina Diba, Director - Adults Social Care and Operations, provided a briefing on the upcoming CQC inspection of Adult Social Care services. Helen Woodland also gave a verbal update on the Housing with Care CQC inspection from November of last year, stating that the service had been rated as 'Good' across the board.

Helen Woodland explained that this was the first inspection under a new framework, and that the CQC would be assessing the service against four themes: working with people, providing support, ensuring safety, and leadership. She added that the CQC would be giving both a one-word rating and a score.

Georgina Diba summarised the key strengths and areas of focus in the self-assessment, including keeping people safe, promoting independence, tackling inequality, and continually improving. She also highlighted the challenges around systems, supporting unpaid carers, recruitment and retention, and working with the market.

Councillor Ben Lucas asked whether the CQC regulatory framework was fit for purpose, and Helen Woodland responded that it was an evolving process, and that the CQC had made tweaks to the framework over time.

Councillor Anna Lynch commented on the Oliver McGowan training³ and Martha's Law, and emphasised the importance of innovative approaches such as social workers being agile and working in neighbourhoods.

Councillor Ian Rathbone asked about Riverside, and Helen Woodland explained that they provided housing related support to help people maintain their tenancies.

Substance Use Support in Hackney

Simon Young, Substance Misuse Partnership Lead in Public Health, and Andrew Trathen, Consultant in Public Health, provided an update on substance use support in Hackney. Andrew Trathen gave a history of substance misuse support in Hackney since 2020, and Simon Young described the current strategic approach.

Councillor Ian Rathbone asked about the highest number of deaths last year, and why further work needed to be done to define the strategic approach to alcohol-related harms. Andrew Trathen clarified that the 26 deaths from drug poisonings in the past year was the highest recorded, and Simon Young explained that the Combating Drugs Partnership (CDP) had now expanded to take on board alcohol-related harms.

Councillor Ben Hayhurst asked about the different outcomes of different demographic groups, and Andrew Trathen responded that successful treatment exits were lower than compared to other areas, and that there were reasons to believe that people from different ethnicities and cultural backgrounds had different experiences.

Councillor Grace Adebayo asked whether the council was working in partnership with the NHS or local organisations to address the root cause of substance misuse, and Simon Young responded that they worked closely with the NHS and other partners, and had commissioned a new service to support individuals with both mental health and substance use support needs.

Councillor Claudia Turbet-Delof asked about the statistic that 50-75% of opiate users and 82% of crack users in Hackney were not receiving any treatment, and Simon Young responded that they needed to think innovatively about how they worked with communities to make sure that the offer of support was right for them.

Councillor Ben Lucas asked about the Mayor of London's recently commissioned drug report on cannabis use and legislation, and Andrew Trathen responded that they had to partition it off in terms of meeting local needs, and that it had not been a huge strategic influence in their approach.

St Joseph's Hospice Quality Account

Dr Rachel Black, chief executive of St Joseph's Hospice, and Jane Naismith, outgoing deputy CEO, presented the St Joseph's Hospice Quality Account 2024-25. Dr Rachel Black spoke about the hospice's strategy to align with the NHS's 10-year plan, focusing on moving people from hospital to community, moving from analogue to digital, and focusing on prevention rather than treatment. Jane Naismith spoke about the transition from respite to rehabilitative palliative care, and the hospice's goals for the following year.

Councillor Ian Rathbone asked about the achievement of the National Advice Quality Standard Accreditation, and Jane Naismith responded that it had been met in May.

Councillor Grace Adebayo asked about a high number of falls in September, and Jane Naismith responded that it was due to one patient who fell more than once.

Councillor Sharon Patrick asked about assisted dying, and Dr Rachel Black responded that as a Catholic organisation, assisted dying was not a practice that they would be able to support.

Work Programme

Councillor Ben Hayhurst then moved on to the next item on the agenda, which was the work programme for 2025/26. He explained that the commission goes out and asks partners and members of the public for suggestions, and that they then try and group those suggestions into themes and put those that are practical onto the work programme throughout the year.

Councillor Ian Rathbone suggested that the alcohol, unharmed, substance misuse representatives should be invited back, and Councillor Ben Hayhurst responded that it would be better to leave it a year to see where they were on the public position and the cadavx consultation.