The London Borough of Newham's Health and Adult Social Care Scrutiny Commission met to discuss emerging matters in health and social care, hospital pressures, and alcohol misuse inequalities. The commission agreed to note submissions and comments made regarding hospital pressures and confirmed its intention to further examine reablement, step-down, and discharge support at a future meeting. Councillors also agreed to note reports on alcohol misuse and take forward observations and recommendations as part of ongoing scrutiny.

Tributes to Councillor Neill Wilson

The meeting began with tributes to Councillor Neill Wilson, Newham's Cabinet Lead for Health and Adult Social Care, who had recently passed away. Councillor Susan Masters, Scrutiny Commission Chair, noted Councillor Wilson's long service on the commission and his commitment to ensuring scrutiny's opinion was included in the Care Quality Commission's (CQC) deep dive.

Emerging Matters

CQC Inspection

Councillor Rita Charder, the newly appointed Cabinet Lead for Health and Adult Social Care, reported that the council had not yet received feedback from the CQC inspection of adult social care services. Dr. Aidy Cooper from the adult social care team confirmed that the Practice Improvement Board meeting had been cancelled due to the inspection and would be rescheduled. It was anticipated that the draft report would be received soon, with a formal date for publication expected in October.

Closure of Services at Chargeable Lane

Lydia Drummond, assistant director of commissioning in adult social care, provided an update on the closure of older people's services at Chargeable Lane. She reported that of the 37 residents affected:

• Two opted out of formal services.
• One chose a tailored solution with reduced support.
• One resident had passed away.
• 12 residents transferred to the in-house dementia service.
• 21 residents transferred to Subco Trust, which made changes to accommodate them, including supporting those from outside the South Asian community. Reviews were scheduled to ensure a smooth transition.

Supreme Court Ruling on Gender Definitions

Tom Ellis, director of strategy for Newham Hospital, reported that there had been no impact on services following the Supreme Court ruling on gender definitions, with the hospital awaiting national guidance.

NHS 10-Year Plan

The commission discussed the new NHS 10-year plan, with Councillor Rita Charder noting that it pushed for closer working but lacked clarity on funding. Alan Adams, interim corporate director for adults and public health, highlighted the plan's focus on prevention, digital solutions, and community care, emphasising the importance of partnerships and personal relationships between system leaders. Claire Reshek from public health welcomed the shift to prevention, noting its alignment with Newham's 50 Steps strategy. Charlotte Pomery, chief participation and place officer, explained that integrated care boards would focus on strategic commissioning rather than delivery, with services hosted by local neighbourhood health providers.

Councillor Susan Masters requested an organogram detailing changes to the integrated care board structure and the local team, considering funding changes. Councillor Anne Easter raised concerns about the abolition of Healthwatch and the need to replace its independent voice. Charlotte Pomery acknowledged the loss of Healthwatch's independent voice and engagement function, stating that the integrated care board was seeking joint solutions with local authorities and partners.

Bailey Mitchell from East London Foundation Trust (ELFT) noted the 10-year plan was general but aligned with mental health services' existing community and digital engagement. He raised concerns about real-terms funding impacts on mental health and challenges in outreach to high-risk individuals. Tom Ellis discussed the new NHS trust league tables, noting the difficulty in extracting Newham Hospital's performance from Barts Health's overall ranking. Bailey Mitchell added that the metrics used may not reflect community priorities.

Councillor Joy Laguda MBE raised concerns about the inclusion of Barking, Dagenham, and Redbridge into the trust and the potential impact on services. Tom Ellis responded that it was too early to tell if there would be any impact. Councillor Nur Begum raised concerns about long waiting times for neurosurgery at the Royal London Hospital, and Tom Ellis offered to inquire on her behalf. Charlotte Pomery offered to liaise with Tom Ellis on a response regarding access to neurosurgery.

Close to Home: System Pressures and Responsibilities

The commission then moved on to discuss system pressures on acute care, the first part of their Close to Home scrutiny. Councillor Susan Masters explained the aim was to understand how health and care partners are working to keep residents care close to home, minimising hospital stays and improving well-being.

Charlotte Pomery emphasised the importance of care closer to home to relieve pressure on Newham Hospital and enable residents to access care locally. Tom Ellis reported that Newham Hospital sees around 3,000 attendances a week, with 90% of admissions coming through the emergency department. He noted that the emergency department was built for 250-300 attendances a day but often sees 450, with peaks of over 500. He also highlighted that 20-30 medically optimised patients are in hospital each day, awaiting discharge due to care package or housing issues.

Councillor Susan Masters raised concerns about corridor care and the protection of vulnerable patients with long waiting times. Tom Ellis acknowledged long waits, particularly for mental health patients, and assured that clinicians prioritise patient safety.

Councillor Joy Laguda MBE questioned the low number of responses to a Healthwatch survey and the negative feedback regarding hospital services. Charlie from Healthwatch explained that the data was gathered through a community insight system and included comments from various online sources.

Councillor Jane Barbara Lofthouse inquired about the increase in planned admissions and the reasons for unplanned admissions. Tom Ellis explained that planned care is managed through the Gateway Surgical Centre, while unplanned admissions are driven by various factors, including access to primary care, deprivation, and cultural issues. He offered to share anonymised data on the reasons for emergency department attendances.

Councillor Jane Barbara Lofthouse also asked about the remote access coordination hub. Tom Ellis said he would provide figures on its reach and success.

Regarding mental health admissions, Bailey Mitchell noted that admissions were lower due to investment in community and crisis services, increased length of stay, and housing issues. Councillor Joy Laguda MBE questioned the causes of discharge delays, with housing accounting for a significant portion. Bailey Mitchell confirmed housing was a major challenge, particularly emergency accommodation and determining the appropriate housing authority. Councillor Thelma Odoi asked about the impact of staffing ratios on discharge delays and the link between mental and physical health issues. Bailey Mitchell responded that there was no correlation between staffing levels and delays, but comorbid physical health complexities were a factor. He also mentioned a joint post with Barts Health for a diabetes psychiatrist.

Councillor Susan Masters noted that the commission would delve deeper into community support services at the November meeting.

Alcohol Misuse, Inequalities, and Response

The commission then discussed alcohol misuse, inequalities, and the local response. Fiona Hackland, assistant director of commissioning adults and health, highlighted the impacts of alcohol across various levels of drinking, including cancer risks, mental health issues, and community impacts like anti-social behaviour. She also noted the alcohol harm paradox, where deprived areas experience higher harm levels even with similar alcohol consumption.

Councillor Susan Masters questioned the directorate's determination to bring this issue to scrutiny, considering Newham's historical perception as not having a significant issue. Fiona Hackland cited equity issues and data from health checks revealing concerning drinking levels in certain populations. Councillor John Gray inquired about the mechanics of the alcohol harm paradox, and Fiona Hackland explained that the relationship between deprivation and harm was evident, though the exact mechanisms were not fully understood.

Aiden Bowen-Avery discussed the new team at Barts, including a youth worker, to address early onset alcohol and drug misuse. He noted that national data estimates 12-15% of emergency department visits have alcohol as a contributing factor, though it may not be clinically coded.

Councillor Mohammed Gani asked about the overrepresentation of the white community in alcohol-related issues and the unmet needs of non-white communities. Fiona Hackland said that the data did not break down further than that, but that she could try and find out if that's useful. Lauren Mulligan from Newham Rise discussed working with community groups to reach residents who may not access traditional substance misuse services. Fiona Hackland noted the social taboos around drinking in some communities, making it difficult to gather accurate data.

Councillor Jane Barbara Lofthouse raised concerns about street drinking and asked about licensing's efforts to address it. Edward King, assistant director of licensing and regulation, explained that licensing works with premises to prevent serving street drinkers, removes high-strength alcohol from sale, and takes enforcement action when necessary. He also mentioned the use of a public space protection order to seize alcohol in public areas.

Councillor Jane Barbara Lofthouse asked if the successes in reducing street drinking were just shifting the problem elsewhere. Edward King acknowledged the risk and explained that targeted enforcement and data analysis were used to address hotspots. Fiona Hackland noted the success of minimum unit pricing in Scotland and suggested it could be a potential campaign for Newham.

Regarding treatment and prevention services, Mike Ward from Alcohol Change UK discussed the Blue Light project, which focuses on assertive outreach and multi-agency management for complex dependent drinkers. Lauren Mulligan discussed the complexity of cases and the importance of tailored treatment plans and wraparound support. Sarah Curry discussed co-production efforts to ensure services meet community needs.

Councillor Carolyn Corben highlighted the psychosocial reasons for drinking and the need to address underlying stresses. Councillor Mohammed Gani asked about the use of patches for alcohol misuse, and Lauren Mulligan explained that while there are no patches, medication is available to manage withdrawal symptoms and cravings.

Councillor Joy Laguda MBE asked about the effectiveness of public health outreach, and Lauren Mulligan reported a significant increase in the number of people accessing services due to outreach efforts. Councillor Mohammed Gani inquired about support for homeless people with alcohol issues, and it was noted that there is a specific rough sleeping team from CGL that provides outreach and support.