The Health in Hackney Scrutiny Commission met in September to discuss adult safeguarding, changes to adult social care, and the closure of a sexual health clinic. The commission reviewed the City and Hackney Safeguarding Adults Board annual report, received an update on the Transforming Outcomes Programme in Adult Social Care, and discussed the consultation on the care charging policy. Members also received a briefing on the planned closure of the Homerton's Leadenhall St Sexual Health Satellite Clinic.

City and Hackney Safeguarding Adults Board Annual Report

The commission reviewed the City and Hackney Safeguarding Adults Board (CHSAB) Annual Report 2024/25, which is required under the Care Act 2014¹. Claire Solley, the new Independent Chair of the CHSAB, presented the report, highlighting key achievements and future priorities. The report noted an increase in safeguarding concerns, but also strong partnership working across City and Hackney. Two Safeguarding Adult Reviews (SARs) were published during the reporting period, one concerning a man named JL who lived in his own property and experienced self-neglect, and another regarding Steve, a homeless man.

Key areas for improvement identified in the report included developing a multi-agency data set and improving community engagement. Councillor Ben Lucas, Vice-Chair of the Health in Hackney Scrutiny Commission, raised concerns about hospital discharge procedures, particularly in light of increasing pressures on hospitals to discharge patients quickly. Georgina Diba, Director of Adult Social Care Operations, clarified that the SARs contained specific learning related to housing and hostel environments, rather than unsafe discharge practices.

Councillor Ben Lucas asked about housing input on the board, and Claire Solley responded that there is now housing representation on the board.

The CHSAB's strategic priorities for 2025/26 include:

• Developing and implementing a community engagement strategy
• Establishing a multi-agency dashboard and conducting regular multi-agency audits
• Ensuring learning from SARs and other reviews is completed and shared in a timely manner
• Implementing the updated London Association of Directors of Adult Social Services (ADASS) Pan-London Adult Safeguarding Policies and Procedure
• Improving outcomes for people experiencing homelessness
• Minimising the risk of self-neglect and financial abuse

Transforming Outcomes Programme in Adult Social Care

The commission received an update on the Transforming Outcomes Programme (TOP) in Adult Social Care, with Helen Woodland, Group Director, Adults Health and Integration, Georgina Diba, Leanne Crook, Assistant Director of Transformation, Adult Social Care Public Realm, and John Holden, Assistant Director of Finance - Sustainability, Special Projects, Finance & Resources Directorate, in attendance. The first phase of the TOP ran from November 2023 to March 2025.

The programme aimed to promote independence for Hackney residents and ensure the sustainability of care services. Phase 1 included eight workstreams and delivered over £330,000 of cost avoidance in 2024/25. The programme expects to deliver £2.392 million in 2025/26 and a further £4.154 million in 2026/27.

Workstream highlights included:

• Hospital Discharge: Avoiding 12,500 home care hours in 2024/25 and on track to reduce formal homecare hours by 63,000 by the end of 2025/26.
• Learning Disabilities: Support packages for people with learning disabilities transitioning from children's services into adult social care have been 51% lower than expected.
• Long Term Care: 42% less new placements in residential care homes than expected and homecare packages have been 14% more independent since April 2024.
• Technology Enabled Living: Increased the range of technology enabled living options available.
• Carers Strategy: Co-produced a new carers strategy and action plan with over 160 carers.

Phase 2 of the Transforming Outcomes Programme includes the following:

• Understanding demand and maximising prevention
• Digitising ASC
• Reablement
• Mental Health Transformation Programme
• ASC Preparing for Adulthood
• Care charging
• Home adaptations
• Mosaic (case mgmt system) Transformation Programme

Consultation on Care Charging Policy

The commission discussed the ongoing public consultation on changes to the council's care charging policy, which closes on 5 October. Georgina Diba and Helen Woodland were present to provide information. The council aims to update the policy to make it more equitable, with those who can afford to contribute more towards their care doing so, allowing the council to continue supporting those who cannot afford to pay.

The consultation covers non-residential care charging practices, including at-home care, day centre attendance, direct payments, supported living services, non-residential respite care, a self-funder arrangement fee, Technology-Enabled Living (TEL) service charges, and a blue badge administration fee.

Closure of Homerton's Leadenhall St Sexual Health Satellite Clinic

The commission received a briefing on the planned closure of the Homerton's Leadenhall St Sexual Health Satellite Clinic, located in the City of London. Chris Lovitt, Deputy Director of Public Health, Froeks Kamminga, Senior Public Health Specialist, and Dr Lizzie Williams, Consultant in Sexual Health and HIV, Homerton Healthcare, were present to provide information.

The clinic is set to close in mid-October due to a review by the Homerton of service usage, cost-effectiveness, and changing patterns of patient access. Since the end of the Covid-19 pandemic, attendance has declined significantly, with current activity levels averaging between 6,000 and 8,500 patients per year, compared to 17,000 to 19,000 patients per year prior to the pandemic.

The Leadenhall site primarily offers sexually transmitted infection (STI) screening and treatment, rather than the full range of complex sexual health services. The site also incurs high operational costs, with the lease and service charges amounting to approximately £350,000 per annum.

Only 4% of those attending the Leadenhall clinic are residents of the City of London. The council intends to work with the Homerton to establish an alternative site at which sexual health services can be provided, and is in discussion with the Neaman Practice regarding the development of a primary care-based service.

Other Business

The commission agreed the minutes from the meetings held on 24 June and 10 July, and noted the action tracker. Members also considered the updated work programme for 2025/26.