At a meeting of the Health, Wellbeing and Adult Social Care Scrutiny Committee, councillors heard an annual performance update from the London Ambulance Service, discussed a whole council approach to healthy weight, received a performance report on adult social care, and reviewed the transformation of adult social care services. The committee agreed to its work programme for the rest of the year, with the next meeting scheduled for 8 December to discuss smoking, the Safe Tiling Adults Board annual report, and public health performance.

London Ambulance Service (LAS) Annual Performance Update

James Johnson from the London Ambulance Service (LAS) presented the LAS annual performance update, highlighting improvements in response times and collaborative work with the Integrated Care Board¹. He noted that the LAS has improved its Category 2 response times from 45 minutes to 26 minutes, against a target of 32 and a half minutes. Mr Johnson also spoke about the LAS's work in schools and communities to teach CPR and provide defibrillators, and the Mayor of London's investment in defibrillators across London. He noted that the LAS has been working to improve staff engagement through surveys, and is focusing on issues such as safety, sexual safety, and career progression. He also highlighted the LAS winter plan, which aims to maintain service levels despite hospital delays.

In response to questions, Mr Johnson explained that north-central London faces challenges due to road networks and hospital delays, which impact response times. He also detailed measures to protect LAS staff during winter, including ensuring that 85% of staff are fitted with FFP3 masks² and promoting hand hygiene. Councillor Hamdash thanked the ambulance service for their help when her partner had an asthma attack, and asked about the LAS's progress in implementing recommendations from Siobhan Mellier's independent review on the culture in the ambulance service. Mr Johnson responded that the LAS has introduced team-based work, changes to processes for bullying and harassment, and sexual safety briefings for managers and staff.

Councillor Hayes asked about mental health ambulances, and Mr Johnson explained that these ambulances are designed to provide a more humane and appropriate service for mental health patients, and that the LAS hopes to expand their use in the future.

Healthy Weight Scrutiny Review

Fran Bury, Consultant in Public Health, presented evidence to the committee on healthy weight, noting that high body mass index (BMI) is the leading risk factor for time lived in poor health for Islington residents, and the second most important risk factor for early death in the borough, after tobacco. She emphasised that obesity is not an individual issue, but is the result of structural factors and the environments in which people live. She also noted that prevention is better than cure, and that stigma makes it harder for people to lose weight.

Ms Bury noted that childhood obesity trends in Islington are fairly stable and similar to the England average, while adult obesity prevalence is lower than the England average, but still affects nearly half of Islington's adults. She also noted that there are significant inequalities by deprivation and ethnicity.

Ms Bury outlined the council's strengths in this area, including breastfeeding support, enhanced school meals, progressive planning policies, and a well-established food partnership. She also highlighted opportunities to do more, including addressing the commercial food environment, tackling food poverty, and reducing inequalities in physical activity.

Councillor Hamdache asked about school food standards in academies and faith schools, and the success of the council's local plan provisions to prevent junk food outlets near schools. Ms Bury responded that the enhanced school food standards apply to schools that buy into the council's catering contract, and that the local plan policy has been effective in preventing new hot food takeaways, but does not address existing ones.

Councillor Hayes asked about the impact of people working from home post-COVID, and what could be done to improve messaging around walking and the link between community wealth building and weight. Ms Bury responded that Transport for London (TfL) is consulting on a new walking plan, and that putting more money in people's pockets would enable them to make healthier choices.

Councillor Clarke highlighted the free swimming and leisure centre access available in Islington, and asked how to communicate the message that obesity is a killer. Ms Bury responded that her priority is to change the environment to make it easier for people to be healthy, rather than frightening them.

Councillor Bertrand noted the high population turnover in Islington, but highlighted a University of Essex survey that found that free school meals had a dramatic impact on reducing obesity.

Adult Social Care Quarter 1 Performance Report

Councillor Sarah Hyde, Executive Member for Health and Social Care, and Victoria Nester, Deputy Director for Adult Social Care, presented the Adult Social Care Quarter 1 Performance Report. Councillor Hyde highlighted that 81% of residents who received reablement³ needed no further support, and that safeguarding outcomes remain robust, with 98% of section 42 inquiries⁴ resulting in risk reduction or removal. Councillor Clarke raised concerns about a resident's negative experience with the integrated front door⁵ and difficulties in finding a care home place for someone with complex needs. Ms Nester responded that she would take the feedback on board and that the council does have access to accommodation for people with complex needs, but it can take time to find the right place. Councillor Hamdache suggested including additional data points in future reports, such as waiting lists for assessments, deprivation of liberties measures, care provider ratings, and user satisfaction. Councillor Hyde responded that the council collects data on all of those measures, and offered to provide a presentation on the data and how it is used.

Councillor Hayes asked about the increase in safeguarding referrals. Ms Nester responded that the number of referrals has been relatively static, and that the council has been working to ensure that referrals are appropriate and targeted.

Transformation in Adult Social Care Scrutiny Review Update

Councillor Hyde and George Roscoe, Deputy Director for Assurance, Strategy, and Improvement, presented a 12-month update on the scrutiny review of transformation in adult social care. Councillor Hyde drew attention to the Care Quality Commission (CQC) good rating in adult social care, and emphasised the importance of experts by experience in shaping services.

Mr Roscoe highlighted recommendation five, which calls for Islington Council and partner organisations to work together on recruitment campaigns that prioritise the employment of local people.

Councillor Hamdache asked about the underuse of reablement hours. Councillor Hyde responded that the services have changed and that the take home and settle offer has been very successful.

Councillor Hayes asked about ensuring that the spirit of recommendation eight, around using provider summits to encourage partnership working, is captured within a new VCS strategy. Councillor Hyde responded that the new Health and Social Care directorate brings together adult social care, the Communities and Partnerships team, and Public Health, which will foster collaboration.