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Okay, good morning, everybody. [BLANK_AUDIO] Yeah, perfect, excellent, excellent, good morning, everybody on screen. Good morning, everybody in the room. Welcome to the session of the Edinburgh Integration Joinboard. Before we all start the usual kind of announcement, it's that I would like to draw to your attention that this meeting is being filmed for life or subsequent broadcast by the Council's internet side. You should be aware that the IGB is a joint data controller with the city of Edinburgh Council and NHS Law within under the General Data Protection Regulation and Data Protection Act 2018. This meeting will be broadcast to fulfill our public task obligation to enable members of the public to observe the democratic process. Data collected during this webcast will be retained in accordance with the Council's published policy. Members of certain attendees should also be aware that the chat function is visible on the live broadcast. Thank you, everybody. Okay, Andrew. Okay, so the first item is welcome and apologies. We've got apologies submitted from Phillip, Alan B and Elizabeth Gordon. The order of business is set out in the agenda. Version two of the meeting papers were published on the 18th of April and are available to view on the Council's committee portal. They were also circulated to members as a PDF document and just ask members who have joined online if you could please use the raise hand function indicating when you wish to speak so the chair can bring you in order. The next item is declarations of -- Sorry, I don't mean to stop you from getting on to that, but I wanted to ask something under welcome and apologies. It was just because last week I had emailed you about the announcement that came out from Sandyford about the changes that they're making to treatment that's being offered to transgender young people which affects population in Edinburgh and I think that also there was something else that came out from NHS Lothian as well about work and treatment for adult people. So I just wanted to ask because I hadn't heard back yet whether we can formalize that request for briefing because I think it's probably something which we need to know about. Is that okay? Yes, absolutely clear. I think there's probably something else we can erase and any other business but, you know, no, no, that's absolutely fine. Absolutely fine. Thank you for raising us. So I just wanted to comment because I actually forwarded that on to NHS Lothian just to be clear and actually I think in terms of the transgender young people I actually thought it came under the Chandler sexual health services and it doesn't, I think it actually comes under children's services so it's just I've followed that up already in terms of putting that into the system but I can speak to you about it afterwards if that's helpful. Thank you for the update, Mike. Thank you, Claire. Andrew? Okay, so the next item is declarations of interest, the code of conduct requires members to declare any interest they have in the items being considered at today's meeting. These can be financial or non-financial. Thank you, Suki. Can I ask you? Mm-hm. Righty. Evoque is in receipt of health and social care funding as an organization. Mm-hm. Thank you very much. That's a transparency statement rather than a conflict of interest statement. Yeah, okay, that's great. Thank you. Of course, so are there any other conflicts? No? Okay, that's good. Thank you. Okay, so that takes us to deputations. We have one deputation today from Edinburgh Trade Union Council. And we'd like to speak to item 5.1, rolling actions log with the sub-item of system pressures update. Our committee, happy to hear the deputation? Chair, thank you for agreeing to hear the deputation today from Edinburgh Trade Union Council. I wish to make comments on item 5.1 on the intention to hold development session to discuss workplace strategy with members. Having read further papers, I'll also be commenting on risk 3.2 on page 151, which describes the objective of matching future service demand with future workplace supply. I am Deslopterly, section of Edinburgh Trade Union Council and my colleague is Liz Taylor. He's a delegate to Edinburgh, TUC and a social care worker. My first comment is on the issue of the Scottish Living wage, which is now £12 per hour. I read in the papers that are supposed to be paid for the 1st of April, but there seems to be a question of whether it will be paid as the Scottish Government has not given EIGB enough money for the increase. Apparently, 5.3 million of service reductions will be required as the Scottish Living wage is to be paid for the 1st of April. The paper suggests that the EIGB will have to delay the payments of the £12 per hour until the point is reached with the EIGB can pay for it for the rest of the financial year. This point is being stated as being on 22 June 2024. I think it is a bizarre situation, as the papers say, although sufficient funding was provided at a national level, the way it was distributed across local authorities meant that some EIGB received insufficient funding, while others were allocated more than they required. How this can happen, I don't know, why should low paid workers be penalised for bureaucratic blunders by Cozzler and produce the urge of the EIGB to pay the relevant increase to £12 per hour from the 1st of April? The trade unions would support the EIGB in demanding the rectification of the way money was allocated. On a similar thing, trading unions would be lobbying the Scottish Parliament on Thursday this week. We will be supporting a motion by Caron Mock and MSP. The motion is part of the pay care workers' 'The Missing Millions' campaign. The motion reads that the Parliament notes that what it sees is a disproportionate impact of cuts to fair work initiatives or the social care workforce notes that 38 million previously allocates to fair work in social care has been cut from the budget without consultation with trade unions, local authorities or employers, believes that the COVID-19 pandemic exposed a number of injustices in relation to the social care workforce that left the workforce of largely women increasingly underpaid at under-resourced, and so the motion goes on. That lobby is on Thursday and I think that 38 million wouldn't just go to unions, 38 million would be go to organisations like the EIGB to improve things like contractual sick pay, so I think we think it's an interest in the EIGB to actually express its support for this motion and to demand that that money be put back in the budget, as was promised. You read the risk assessments on page 151 and agree with the assessment, although the risk has existed for some time, what we do not understand is what is going to be done about the risk to modify it. We would like to know what exactly is meant by a statement that is like at this risk when materialised in the next 12 months, what action is going to be taken to modify that risk. So I'd now like to hand over to my colleague and thanks for listening to me, I'd be happy to answer any questions. Hello, I'm a union rep in Bontory sector of social care locally where I've worked through over two decades. I would like to ask you about how you intend to address the workforce strategy challenges highlighted in your February report. Back in February, you describe the challenges of social care in Edinburgh in terms of difficulties attracting and retaining staff, its ageing workforce and social care not being seen as an attractive career path. Have these challenges changed since February and what are the EIGB and Council actually doing to address them? I simply can't believe that they can be tackled within the context of slashing services. In terms of the cuts that are occurring or proposed to services supporting vulnerable people, it is important the board recognise the longer term costs that will be incurred. Just as one example, my workplace supports one autistic individual who is learning disabilities who is about to lose his overnight support. On the surface of it, he still retains a significant package of care so he'll be fine one might think. However, that is to ignore the extreme distress that such a change will bring him. This individual expresses distress to physically hitting out and this will inevitably impact workers supporting him, jeopardising the ability to staff his remaining service. Social care is a high stress job at the best of times and turnover is huge, costing the sector and public purse in terms of recruiting, inducting and chaining any new recruits. A person who loses much need of support will also look for their needs to be met by other services which are equally under pressure, such as GP practices for instance, or A&E being another one. Edinburgh TUC has previously highlighted that housing-based support is explicitly assistance to help people maintain their home and well-being, exactly the day-to-day support that stops people falling into crisis and integrator levels of need that are far more expensive to address. I believe some members of the board will share my concerns about the impact of the planned cuts on unpaid caters, largely women, who will have to take the extra strain as their loved ones lose services. Often people who are attracted to social care jobs, very many of my colleagues and myself included, and especially those in the older demographic, are those who have experienced outside of their work as unpaid caters. Something I don't hear discussed enough is that because Canadian support workers are often very same individuals providing unpaid care to elderly or disabled family members, these cuts will actually take more people out of the social care workforce because they will have no other choice but to fill the gaps. If they remain in social care, they will be hammered on both fronts. Our members will tell you that to attract and retain staff to what can be deeply rewarding work, would be a lot less difficult if we could have access to the fair work in decent wages that staff have long been promised, not having to rely on food banks to get through the month like too many of our colleagues, and not seeing adequate training supervision and support as some kind of luxury. This COVID workforce morale is an all time low, experienced people are leaving in droves, and the council can no longer take the resilience of care staff for granted. The pressures on our organisations are worse than anything that I've personally seen in more than 23 years in the job. The scale of these cuts is horrifying to us in the voluntary sector. Thank you again for listening. Des and I are happy to take any questions that you might have. Thank you very much, Des, and Liz, for coming and presenting your first hand, very enriching contribution and talking about the impacts. I will open up to board members in a second for questions, just I think as a point of clarification, Des, I believe, if I recall correctly, the budget that has been passed does foresee the Scottish living wage as applying from the 1st of April. You do have until, I think, the end of June to implement it, but my understanding is so that's just to enable everything to be ruled out. My understanding is it will be retrospective to the 1st of April, so that was one of the decision points that was a major point of discussion from our budget perspective. So I just wanted to make that clear that is my understanding right, Pat. Sorry, can I just come back on that, because when I read the papers, there was this comment on the 22nd of June, and then there's a comment on, It's going to be five-something-million-pounds or ever cuts, will be these finances, and then there seems to be reference to this sort of bureaucratic mistake by a cosler that's wondered what has been done about that. It seems to be an amazing mistake for cosler tonight. It is a confusing situation, Jess, I cannot blame you. There is a lot of connectivity messages, I will bring them where, because she will be able to explain it much more eloquently than I can. So firstly, it wasn't a cosler mistake, and cosler made a decision, they made a decision we might not have agreed with, but it wasn't a mistake per se. You are quite right in terms of what the actual paper said and what the recommendation was, but what happened after the paper was published and before the meeting was held was that we deceived a letter of comfort from the council about additional funding as a result of UK government consequential, and what the board agreed to do was to use that money to plug that gap and therefore to pay contracted providers £12 an hour with a fake from the first of April, and as the chair has said, there are a few months to actually implement that, which we are in the process of doing now, but it will be back dated to the first of April. Thank you very much, Marisa Dez, hopefully that shows that, you know, absolutely whenever that the extra funding became available, the IGP absolutely took a decision to move those funds towards the implementation of this policy. So hopefully, but I absolutely acknowledge it's well done to you for trying to puzzle together all of the kind of different messages in the different papers. It was a very, very quick, fast-moving beast at that stage, so thank you for bearing with us. Thank you, Mara. Right at this stage, I would like to open up for any questions from any members for Dez and Liz. Bridey, please. Good morning and thank you both. I think you know that in the voluntary sector, we have spoken about the impact on care is in a similar way. People who are part-time workers, we do think the female workforce in particular will be incredibly disadvantaged. And sometimes I think what the communication is back to yourselves and to us is that people have strategy responsibilities, so they can't do this other thing that's required, whether that's to address the issues you both raise. I think our argument is the opposite, that actually, strategy responsibilities can't be met because one's not making the right investments and other types of systems thinking, such as loss of staff. And I'm curious about the call that you made in particular, Dez, for the idea of being a time when we could all work together if there's been any progress if you've heard back on that, because that was one of the concepts you wanted was a conference which really looked at the future of health and social care in Edinburgh for both of you. So I think to yourself, Dez, that event, and secondly, just to acknowledge to your colleague as well, the importance of that bringing people together about wider systems thinking. Thank you. Yeah, so we've still got this idea of having a conference to try and look at issues in more detail than just through like deputations and questions. And particularly, we want to try and construct a conference that will look at the sort of cases we've been putting forward about preventative services, I mean, if preventative services are going to be cut, is that wise, or is there going to be cut by how much? And I think we need to be careful, given about the impact of budget issues on preventative services. So we think there needs to be a conference on that, but I think as you can gather, there's lots of interested forces or stakeholders in such a conference, and we're trying to construct in our own minds what would be the best type of conference to organise, say for a day, and who should we invite to speak, and what would be the best fruitful discussions to take place at such a conference, and whether a conference should be a labour movement conference or a conference should be organised in partnership with the third sector, and also what would the role of the AIG officials be in such a conference, and then the big question mark for us is what about the private sector in Edinburgh, what should our relationship be with them in discussing the impact of cuts? So that's still a lot of concern, but I think if it was going to be organised, the earliest it would be organised is in June. But I think we need to consult with lots of people before we lay some definite plans for that. That's great. Thank you, Brady, for the question, and thank you, Des, for the answer. Peter, you'd like to come in? Yeah, thanks again Des, and Brady for raising that issue. I'm just thinking out loud really in regard to such a conference, how careful we need to think about the agenda and the structure of a conference, and I'm sure you're on that one because nobody within this room or within the local community is going to welcome the idea of further cuts in the future. So in order to think something constructive out of a conference like that, which is the hope we can do, is going to take a fair bit of thinking about how to achieve such a thing. But I do wonder whether, and I may be under the wrong track on this one, is that would it be too ambitious also to consider future ideas about supposing that a future government did invest further, particularly in England, and in the consequences for Scotland, what would we want to invest in as well? That might require a different conference, but it's something we need to consider. We've got two issues going on at the same time. One is the reality of the cuts and how to make those palatable and at least damaging and prepare for the future as well through prevention, but also what comes next should the political circumstances change in the future which might be beyond the scope of such a conference. I agree that the aim of the conference has to be rethought through what can be achieved, and I don't know enough about actually about the way the Scottish Government funds things to work out what pressure can be put on the Scottish Government now in 2054 to make them cough up more money. All I do know is that I was involved in the Bedroom Tax campaign and everyone said Scotland had to implement it, but then we found this loophole about discretionary housing payments and local authorities and the trade unions and community groups put pressure on the Scottish Government and they check they increased their money that would go to discretionary housing payments which made the Bedroom Tax a Scotland null and void. So that was a campaign over three or four months, and it produced more money. I think the money it produced was like 20 million which isn't a lot for IJBs in Scotland, but I think how to mitigate the cuts is one thing. I think there is another thing we're interested in and that is how do you get more money out of the Scottish Government and I think we would need experts advice. We need to be a lot of thinking done about whether that's actually possible. Then again, what is possible in a general election year? Because the consequences of general election say in the Orton could mean more money for Scotland, and if there is going to be more money for Scotland by one means or another then how's it going to be used? So I think the issue is about funding aren't just an issue for the long term. I think it's a general election issue and it will be something there too. That gets us into political territory. So if you don't mind, I will probably stop you there. We are running the risk of going slightly off-piste now, slightly going off topic. But absolutely fascinating, fascinating discussion, really always interesting to hear perspectives. Are there any other questions for Dez or Liz? Indeed. No? That's great. Thank you both so much. Obviously, you're very welcome to stay or you're welcome to watch this broadcast or do whatever you wish to do with the rest of your day. I was very good to have you here. Thank you so much. Thank you. Andrew? Okay. So the next item is item 4.1, which is the minute of the Edinburgh Integration Joint Board of the 18th of March 2024 and the Board is asked to approve this as a correct record. Thank you. Are members correct? Approved as a correct record? Yes. I see no objections. Thank you. Okay. So the next item is item 5.1, which is the rolling actions log. We have one action recommended for closure, which is action 2. Chief Social Work Officer, annual report 2122. That's great. Thank you for that. Are members content to agree with the recommendation to close the action in relation to the Chief Social Work Officer report? Yes. And to note the remaining outstanding actions. Are there any questions or points on any of those? No? Perfect. Okay. That was great. Thank you. Yep. Righty. So there's a reference to performance data in this. And what I'd like to do is a follow-through in terms of the request that we made at the previous IGB, which is that we are not -- we're not seeing performance data being used from existing contracts and grants in a way that we think is relevant for planning. So I would like to ask for that to be followed through specifically, both in terms of this report, but also with those both children overseas, children and young people, but also adult data, because all of these things help you know what it is that prevents statutory cases, which is one of our key arguments around why we're having to make very tough decisions as the prevention focus. So I think there's more work needs to be done on data, on analyzing data for the contracts and grants that you issue. There was no reporting at all cumulative reporting for the grants for the adults side of things. Some progress has been made on the children's front. I think it's really important, you know, where to invest. This really relates to a key point that Peter made at the previous IGB, which is about data analysis. I want to see reports here for both children and families, because then you know what happens there that does prevention in terms of then what might land on your and the work of the IGB, which could have been prevented pre-16, and then the adult health and social care specifically, Hamza Yusuf, is interested in winter planning. We're a long way off the winter at the moment. That's an example of where data could be useful. So it's the specific reference to data in here. I think we need to do more work on that together. Thank you. Thank you for that, Brian. Just a little check. Which specific action was that for dis-immigration purposes? Yeah, so I'll just find the point for this. So, 0.16 and 0 on page number, page 4, I think. So, page 16 to 18. We're not seeing data on performance. It feeds into decision-making in this public domain, either for children services or for adult services that are commissioned and grants-based. Okay. Thank you. Sorry. Is that in relation to the rolling actions log? Yeah. So, I think wherever you ask first to comment on this report. Understood. Yeah. Okay. So data. Understood. Okay. Do the officers have got any views on this? So, the grant evaluation report for the grants that are issued by the IGBB of the council is due to the performance and delivery committee, if not the next meeting and the one shortly thereafter. So, that's when that information will be available and will be shared. Okay. Thank you, Maura. Okay. Right, Dave. I think we need to do more with it in the future rather than just be data that comes to a meeting that then doesn't get used in terms of management information about where to invest. Okay. That's fine. Well, it's a valid opinion. Of course, we are talking further down the agenda today about committees and performance, et cetera. So, I think that's probably something that we can pick up as part of that discussion as well because I think that's absolutely right. Okay. Yeah. I see Claire nodding as well. So, it's good. Yeah, Claire very much agrees. That's good. Rose, I saw you did have your hand up earlier. Did you want to come in? It was just a check with Brad. It was just talking about the rolling action report or the Chief Social Work Officer report. Understood. Yes. Yes. I think that was the case. Okay. It don't make more sense now, I think. Yeah. The Chief Social Work Officer report. Yes. Sorry. Sorry. Sorry. You need to turn on your microphone, Brad. You're sorry. Thank you. Yeah. We need to do that work on data. So, I'm bridging it and making sure that I see it's captured in the rolling actions because otherwise what we have are, you know, fantastic ideas that we don't implement. So, it's actually making a bridge between the two things. Thank you. Thank you. Okay. Right. Um, on to the next agenda item, I believe, Andrew. Okay. So, the next item is item 5.2, which is the annual cycle of business and we have Angela Bryton speaking to this report. Thanks, Chair. The main points of the annual cycle of this national reference in paragraph 2 of the report and happy to take any questions. It's great. Thank you very much for that, Angela. Are there any questions on this agenda item? No. So, our members happy to agree the annual cycle of business as attached to Phoenix 1. Yeah. Okay. Perfect. Thank you. Okay. So, as there are no items of strategy, the next item is item 7.1, which is the Chief Social Work Officer Report and we have Rose Howley speaking to this item. Over to you, Rose. Thank you. Hi. Yes, the Chief Social Work Officer Report is for the period 22, 23. It was in a year of two inspections, recovery from a pandemic and with all the wider context as well. So, it is a report that contains information on improvements. Bryton was talking about data and in my report, it mentions improvements that have been made in terms of our performance data across the piece that includes children and includes health and social care partnership so that we can understand demand coming into services and also in terms of the workforce that we have to respond to that. And so, in terms of the service redesign and restructure, that will also have a factor going forward. So, I'm happy to take any questions on the report. Thank you. Thank you very much, Rose. Thank you. Really interesting, obviously, piece of work, a bit of retrospective, a bit of kind of forward-looking as well. I would like to open up to members. I see Vicki, please. Thank you. Following on from the data conversation, improvements to our data, do you think will come with a new system, the new replacement first, Swift? Yeah. So, we are moving to a new operating model with the access group and mosaic. That's procurement has now ended and the contract has been offered. So, having used mosaic before, there is a greater capacity to collect data and we will have a greater understanding in our new operating model. The main work that now needs to take place is in terms of data cleansing and making sure our data is up-to-date within our current operating system and ensuring that we can take data and performance information from that system and where we can, that we do so to ensure that we have information that provides information on demand management and on our workforce, on waiting list assessments and making sure that we have that data so that we can look at that. In terms of our demand, where we look to community provision and look to early intervention, we need to be able to look at that data as well, which Brady was referencing. There is a need to work together on that. Thank you. Thank you for that. Peter, please. Thanks, Rose. What a weighty report. A lot of information within it. Thank you. On the main report, on the one Edinburgh Home Base Care Section, which I think is page 17 of the actual report, you provide some interesting statistics there. I'm not sure if we've seen those before. We may have done, but actually to see them laid out in terms of the review that's been carried out on packages. On that, I'm not expecting an answer now, by the way, but what I think would be useful is a consequence of these figures. I'm looking at 103 people identified that they continue to recover and no longer needed support or home support at this time. As one example, in 164 identified that required less support. My question, I mean, are those likely to be typical of what we will find? In other words, we'll be talking about some of the 8% of people that are currently getting packages are likely to have their packages found to be unnecessary now, rather than when they were first receiving it. But the second point is, how does this translate into ours saved? We're talking about individuals here. Are we talking? I mean, I don't know if you know the answer to this, but are we talking generally that these are people who had a very small package and there's a realization that they're largely independent of the need for care at home now? Or are they people with particularly in 164 who have had a reduced package? Are the people who had a larger package and have been able to reduce the size of those packages? I don't know if you've got that information or whether that's something that perhaps could come a future date in terms of statistics. Thank you. Yes, there would need to be further information provided on that. The information came from the service at the time, and there is work to review care packages, and we are looking at a workforce that needs to respond to demand. And so the principles of home care and home first are obviously there, but we need to continue to make progress in terms of reviewing care packages. Thank you. Rose, Mike, you wanted to come in. Yes, there's probably further analysis, Peter, that we would need to do in terms of the detail that sits behind this, but there's absolutely no doubt that this has all informed our review programme in terms of our savings for this year, in terms of the level of, because it's from a financial perspective, it's a saving, but also in terms of, actually, for the most important part that actually what we're doing is we're actually supporting people to live as independently as possible without a need for care. I think it's worth saying, I was looking to my colleague here as chief HP to make sure that I'm saying the right thing, but we actually believe that it's probably both. There's certainly smaller packages where we are seeing a reduction, and probably there we would see in terms of a reduction to potentially people not requiring care. But I think it's also fair to say that actually from some of the work that we have done recently, we are probably seeing some of the larger or some changes in terms of the larger packages of care being reduced to. So I don't think it's one or the other, but what I wouldn't be able to do is give you the exact percentages for that. But we're happy to do more analysis because we're collecting that data as part of our review program. Thank you. Thank you for that, Mike. Really helpful. Yeah, Tim, you would like to come in. Thank you, Chair. Rose, probably one of the most significant issues that you report on there is around the two inspections that were undertaken during that year, and we all know the improvement plan that we agreed last year and the significant work that's going on around those two, the review and improvement plan. I just want to give them that this is the point when we look back and reflect. If you could give us an update just generally, just in a kind of global sense within your services on how we are responding to those inspections in that report and where that work is at currently. Just give us a kind of general overview of that, please. Yeah, of course. And in terms of adult support and protection, there has been a huge amount of work that's been undertaken within the health and social care partnership. And that hasn't just been social work as us also being the police and health colleagues also, and a huge amount of work. And I feel more assured and able to give you assurance in terms of adult support and protection. In terms of wider improvements, there is continued work. The strengthening the progress is being made and will be made further within redesign of services. And this will have a huge impact in terms of being able to manage demand and make sure that people who access services are offered early intervention and early help within their community, that is the care inspector that said that we were missing opportunities in terms of early help and intervention within local communities, our front door service. And I'm confident that progress is being made, but we're still a way to go on that. I do have caution in terms of assurance regarding the budget and the budget savings. And I am keen to ensure progress, but with being mindful and making sure that we can still provide statutory services, which will be more difficult within the budgets that we have. So in terms of progress, I'm confident that progress is being made and that we will, and that we're in a better place a year down the line, but there is still work to do. Thank you very much for that, Rose. Tim, does it answer your question? Yeah, that's great. Thank you. Thank you. Really helpful. Peter, you would like to come in. I'm sorry to ask two separate questions. Rose, it's such an interesting report. I was finding lots of things in it too. But again, I'm focusing on numbers again, as is my one. But building on the question about adult support and protection really on page 20 of the report, you quote or you highlight the increase in the number of contacts during that year, April 22 to 23, compared with the previous year. And I don't know whether you'll know the answer. I mean, 24% increase is a large increase. And what I was curious, I suppose, but you may not have the figures to hand, was whether that reflects a relatively low number. The previous year, kind of post COVID, I know we're not, we shouldn't use that phrase, but immediately after the COVID impact, were we not picking up issues of adult support and protection to the same extent? Or has there been some other factor that we are now seeing a genuine increase in the need for adult support and protection? I don't know if you know the answer to that, but it's an interesting question, given the change that occurred in one year. Yeah. It's complex. It's fair to say in that, the caring spectra said we're missing opportunities, and that we weren't providing adult support and protection when it was required. However, they also said that there wasn't quality assurance in place, and we went auditing and we hadn't audited for the past two years, and perhaps beyond that. So in terms of quality assurance, we have more of that in place now when we're able to look through our audits and through due diligence of improved manager oversight, we can see that sometimes we have taken people down an adult support and protection route where that might not have necessarily been required. So it was more about getting the thresholds right and making sure that we have the correct thresholds, there's been a lot of work undertaken with the colleagues to ensure that people understand what's required in terms of adult support and protection and the three-point criteria. So I am confident now that we are getting it right in terms of the threat of adult support and protection, but it is fair to say that there has been an increase nationally, and this is reflected in what Edinburgh has experienced. And I think that is wanting to come in as well on that, so. Yes, thank you very much. Rosemary, please. Thank you. I was just going to add to what Rose has said. One particular factor is the revised national code of practice relating to adult support and protection, and that has actually broadened out the kind of lens through which little legislation has remained the same. There's a broader sense of individuals that we should consider through adult support protection and taking a more trauma-informed approach and also in relation to issues of misuse and mental health and homelessness. So this is a very big part of the work we do every single day, and it is growing, and our ability to respond to that is put under more and more pressure as we at the same time try and improve the way that we are doing it. Just to add to that, I think that is OK. I think what the report is doing here is really setting out some of the context which we can expect to see increase over the coming years. We are undertaking a separate piece of work which will project our, the increase in demand associated with starch to duties within, within everybody now in 2020. Some of that will be complementary to what is the projected demographic growth, but just in terms of what everybody experiences, a 25% increase in adult protection nationally, that was 20%, so it's almost in keeping with where we are nationally. In addition to that, we have had a 40% increase, a sustained increase as you add, in compulsory treatment orders here in Edinburgh. So we are, we appear to be heading in the same direction and it's only going off in relation to all of the increased demand associated with our starch to responsibilities. But as I said, we are working on a report in relation to this, and we will come back here when we're ready to present it, right? Thank you. Thank you very much for the question, Peter, and thank you for the answers. Everybody's really, really quite insightful. Eugene, you wanted to come in. Yes, thanks. Thanks Rose for the report. It was very informative. I'm just focusing in on paragraph 17 of the HSP report and the feedback from service users. I'm keen to understand where we are in that process. Is there, is there active involvement in service users' feedback at the moment? And what's the sort of time frames for us to implement a more effective system in this respect? Yeah, in terms of vital support and protection, there has been an increase in services of feedback and ensuring that we have documented people's views within our case recording. There is more work to be done in terms of service user feedback, and we could do more. And it's part of the improvements in terms of quality assurance in that we need to be collecting the information. So we need to be learning from complaints. We need to be learning from our advocacy services, while people contacting and asking for advocates, or when in what occasions do we need an advocate to act on, and gathering all that information is part of our quality assurance framework going forward. And direct asking of people is there anything that we, what went well, and is there anything that we could have done better, is part of our transitions, policy and procedure, and needs to develop within our wider work that we do. Thank you. Right. Thank you very much. Are there any variety please? Just like to bridge these two issues that actually we've got this, you know, this process we're by, we're really needing to bring in lessons learned in previous occasions. And I just want to say thank you. Rose, there's a lot of really fantastic things in there that it's important that we take cognizance of, such as progress on the promise. But I'm curious from your point of view in terms of partnerships, because the relationship between the both children's partnership and the IJB with the community sector, absolutely needs not to be transactional, it needs to be partnership-based. What data can you give us that's actually about the impact of both the children's services, contracts and grants, and also then the performance and development committee. What's the relationship between those two things, so we can know where we can do more with the community sector to prevent the growth of statutory response. So I'm curious where we'll be able to see some of that type of investment. And again, I'm particularly thinking back to the last IJB and some of Peter's points around data and some of our counselor colleagues here. How are we going to see some of the opportunity from both children and families services and then adult services. One of the things that's current at the moment is with the WF funding from the government, you're taking in partnership applications. While the money's not been allocated in that, one of the really fantastic insights from that is how social workers are working so closely with community services to actually prevent statutory outcomes. So that's an example of something that's happening at the moment. This is a past report, but looking forward, how's our reporting going to really capture those exciting opportunities rose from your point of view and what can we do differently here? Yeah, it's absolutely crucial that we look at our whole family while being fund and the funds that are allocated to children and families obviously then has a knock on effect to adults who receive services. And so we need to obviously move all our services to more of a prevention that starts with children and families and also continues with adults. And the ethos of whole family support within communities is that communities can access support that should be non-signatising and that we should be able to get support in whatever form as they get support from a GP or from a health visitor. So it's absolutely crucial that we look at and join up funding going forward, that we have whole family support and early intervention strategies in place so that we target our resources at that early helping prevention and going forward. That needs to be balanced alongside such responsibilities and we obviously, so I'm getting a bit of feedback so then hopefully you can still hear me. But that we work together in terms of the funding. Okay, if we could see a report back here from that specific piece of work that would be really interesting because I think it's learning when the government making that investment wanted it to be very collaborative. So it'd be really good to see that reporting back here but what Rose just described because it actually will help with some of our pressures going forward. Okay, thank you for the suggestion. I think we'll leave it up to the officers to consider whether it's an ad hoc, whether it's including that into the regular reporting. Yeah, again, I'm not too close, I'm not too close to kind of the mechanics behind that to be able to make a recommendation just now but I think your request has been noted. So I'll leave it to the officers to think about what's the best way to respond to this request for more data and transparency in the space. Is that okay? Perfect. Okay, that's good. Right, well, I see no further hands up so thank you everybody. Thank you very much Rose for your report. Absolutely, just to echo what Michael separately said and I think between them they've kind of covered the questions I had. So yeah, really, really useful, very, very useful report, really good discussion. Thank you everybody for the really insightful questions and yeah, thank you Rose for your answers. So thank you. Right, moving on. Okay, so the next item is item 7.2 which is the primary care 2324 summary report and we have David White speaking to this item. Welcome, David. Good morning, good morning. Chair, can I just welcome as well Dr. Christina Morton on the screen. Dr. Morton is the appointee of the local medical committee and GP sub committee who provide the independent oversight of the investments that we've been using from the government on and she provides that on behalf of Edinburgh GPs. So as always, we welcome the annual opportunity just to brief the IGB on progress and concerns in primary care and this slightly fuller report comes forward. At the end of the period of substantial investment from the government started in 1819 and went up until the end of last year. Hopefully, therefore, from previous reports, many of the issues and content are familiar to members and I should mention that this report is slightly amended from the version that we agreed at the leadership and resources group and also was considered by performance and development earlier this month. Chair, I'm not going to go through each of the sections but if I can just briefly emphasise now a couple of points in the report. First of all, the substantial growth of pharmacotherapy now embedded in each practice across the city in making a substantial contribution to both quality and capacity in primary care over a workforce of over 100 now grown from about 12 or so in 2018. Secondly, the overall PCIP, the primary care improvement plan impact is referred to again. I've shared some calculations but members should be in no doubt that if they were to go out and around practices in the city, they would hear a highly varied feedback of what contribution had been made and what the impact was and we understand that variation well. So, the other thing is that IGB members have previously heard on a number of occasions are the concern about our growing population and the mismatch with our primary care premises and indeed with some key funding streams that are required to support primary care. This has been reported now over the last decade and obviously this has been made worse by the pause in government capital funding in the NHS which has brought some of our capital aspirations to a halt. Although, as was mentioned in the report, we're very pleased that Robin and I will be appointing a new medical practice for the Mayberry practice based out at the end of this month. Health inequalities, of course, remain a key area of attention for primary care with much of the excess demand and stress and strain in the system really coming as a fairly direct result of the impact of poverty. This, of course, is a dynamic area and every few years we're throwing up another challenge and it's an opportunity just to mention in particular the work of Eileen McGuire and the Borreloch practice in supporting asylum seekers and refugees coming into the city. I think the Edinburgh response to that we're very pleased with. The vaccination again has been reported on separately, area of strength for Edinburgh arrangements gradually settling and we reported some of the results and also both in terms of efficacy and uptake continuing very strongly in the key over 65 groups and also economically we seem to be able to deliver it under £10 of vaccination which seems to be a benchmark which evades other systems. Finally, just to say the other report does report a lot of very positive process and we strongly believe demonstrates that we use the public resources that are trusted to us well but overall primary care remains under significant strain and as a public service remains quite fragile and more fragile than we would wish it to be. So really in terms of the recommendations chair I suppose the key one is whether the IGB values an annual report directly to the IGB such as such as this. After we anticipate the requirement to do this with the IGB actually may fall at the end of the investment period. Thank you very much. Thank you very much David. Exactly as last year when I first saw the equivalent I was absolutely blown away by the quality of data and kind of just the clarity of the presentation. It's exactly the same this time around as well. Lots of edges, there's lots of colleagues nodding. I will open up to colleagues for questions first and then I've got some points myself to make as well. Claire, Claire please. Thanks very much chair and thank you David for the report and I would say in response to your question I think we do value this while I certainly value the reporting and we'd hope to see that continuing and I think reporting around specific packages of funding and initiatives is one thing but I value the broader reporting on primary care and the broad brush understanding of the challenges and the progress and the changes in the data so I think that broad overview is actually really helpful for us in getting away from PCIP or any sort of specific policies or initiatives and I did have a couple of questions for you. I'm grateful for the correspondence that we had since the papers came out which answered a lot of things that I had itty-bitty questions on but I think one of the kind of broader things I wanted to ask about was you've said in the report and you've included the paper that has been put forward to the Scottish Government fair shares for a growing population and the population question is a great deal of what you've covered in the report. I would like to know what the latest is on what Scottish Government has said in response to that paper and in general in response to that issue of population growth not being met by the funding streams both in terms of demand and just, you know, pure population numbers. Try and choose my words carefully. The response for a long time has not been as we would wish it to have been and has we feel I suppose played down what we think is a problem by simply saying we would prefer to stick with the registrar's population estimates rather than the GMS general medical services list size estimates that we would prefer and which are used for other primary care streams of income. I mean possibly clutching at straws here but by coincidence I was told last week that one of the people in Scottish Government has sort of meeting with us next week, I think it is. So it would be good to maybe to have that meeting and understand better their perspective because at the moment it seems as if we've been stonewalled to this point. So I wonder what would be helpful for you from us in supporting you to have a robust conversation about population growth, what figures we are using or not using in order to have a sustainable and realistic amount of funding and to make sure that you've talked in the paper a lot about mismatch of expectations and the pressure that GPs and other workers in primary care are under. What can we do as a board to support you in those meetings or putting forward those papers that will allow you to unlock some of that because I don't think that's a healthy situation and obviously we need to make progress on this and not continue to have correspondence going back and forth that doesn't lead to anything. I think the first thing is just to acknowledge I think the fact that it's here today it's being reported at the IGB. The IGB has taken interest in this issue and noted it over the years. People have understood more as we've reported fairly on a repeated cycle on the population increase. And I think what would help is a conversation with NHS Lothian about this which obviously they are bound to use the NRS figures rather than the GMS figures and I think there is an intelligent compromise which is possible there but difficult to say beyond that. I'm struggling slightly. We have made representations saying we have real problems. The population increase is very real. The population increase which is projected is very real. Another 8,000 people have come into the city and join GP lists every year. That's net of those people who leave. We have roughly 50,000 people who leave every year so that's normal but the population is undoubtedly increasing and it is not because GPs are not taking patients off their lists that is happening. So we have a building concern here and if it's not acknowledged we will end up in another 10 years time with a mismatch which grows to around 100,000. So I guess maybe Chair it's for you. It's what can we add to our recommendations that we actually send a stronger signal or support David Moore in the robustness of conversation that he's enabled to have that says this board feels that we need to do more and the funding situation is untenable and will only continue to become worse. No, absolutely. Absolutely. We will take all the questions and comments and then we can think about the recommendations but just to reiterate what David has said, representations have to be made. This isn't new but it's becoming more and more acute because I think David what you just mentioned is always the question I always have is if we're here now but let's find where are we going to be and let's say five years time if we don't correct the situation now so it's the trend that I'm really interested in because once it gets past a certain point it becomes very hard to reverse. So I've got a couple of other people. Did you want to come into the specifics before I bring up people? You just have a quick comment because I really welcome the equation, Councillor Miller. I think what's important here is the wider context to all of this and I've been reference to earlier on a piece of work that were just recently commenced which gives us the wider context about where we will be for example between now and 2030. So we are seeing a projected population growth in demand but within contained there in there are particular complexities. We're seeing SIMD increasing in one but for example we are seeing multiple complex needs increasing. So there's the context of the demand overall. David had mentioned it there as well. What are our projections around positive asylum seeking decisions? For example in a city that has announced a housing crisis. So I think what's really important here is it's till we know in the evidence base as much as we can to validate the evidence and the data and present this and engage proactively with Scottish Government and just to give the IGB and sense of assurance and regular conversations with the Scottish Government and we haven't eaten actually this week with the Minister. So there's a lot of proactive conversations that have taken place just now but I think the evidence base is really absolutely critical to us in terms of our projections. Thank you very much Pat. Katrina did you want to come on to this point specifically? No I just wanted to make a comment rather than answer those questions. I'm happy to wait till my turn as it were. Thank you. You're sure? Okay that's great. Thank you. In our case I will bring in colleagues who have been waiting patiently. You, Gina, had you done next and then Max and then Tim. Thanks. Yeah and it's on a similar theme essentially paragraph 29 population and premises on a pretty much support Councillor Miller's effort to see how we can we can help in this situation but I mean just to reiterate the reality of this you know the GP service is one of the ways in which most people hadn't interacted with the work of the IJP and I attend community events in relation to regeneration of areas and people are there saying I've been waiting to get into a GP surgery for over a year and you're going to build more houses and there's going to be more people and it really is a significant issue. What I couldn't see is is the is there spare capacity in the GP lists? I couldn't find that piece of information and how many people are there on the waiting lists for GP and how long do they spend on that and it feels like that's the sort of stats which would feed into our sort of piece of information. So I don't necessarily need to hear that information now. It is very disappointing about the fair shares response and it does really feel like this is a problem we are building for the future and nothing about it feels like it's prevented over the minute and therefore anything we can do as a board to assist the situation would seem to be better than nothing. Thanks. I'm just to come back fairly directly to your question because we don't know is the answer to that. We don't know how many people are waiting in the population. We believe and we put down in successive reports that that number is growing from possibly a natural number of people waiting to get onto lists of a couple of thousand at any given time. That number will undoubtedly be going up and up and therefore the length of time that the average person waits on the list will go up and up. The experience of patients varies greatly from practice to practice and practices obviously have different ways of managing the demand. Many of them simply say well we know we can only register patients on a Tuesday morning or a Friday afternoon or we limit the number of patients that can register as new patients to about 30 or about 20 if that's the number that naturally leave their list every sort of time so they can't they're not allowed or sorry they can't afford to to increase their list size either because of the strength of the clinical team or the restriction on their on their on their premises. I think what we've simply simply tried to do is to appraise that pressure over I think three reports one in 2014 then 16 17 and then and then most recently at the end of 2022 and say what say where the pressure is occurring that we do understand that and also what what increased resources are required and that's that's what we're required to do and we've done that repeatedly but we just we just haven't had all of the resource that we require to respond to that additional population which is why this is you know continues to be a growing problem. Thank you David. Thank you Jean. Bye Max please. Thanks Chair. Unfortunately all my questions have been really asked because this came to P&D first and I wanted to ask them in a public forums account. The Miller asked the main one and then the follow up and I think what I was also interested in is what your comment will be about what we can do as a board to help push this through so that's been mentioned and I was wondering based off of a headline that appeared about private GP appointments and whether that level of usage is being captured as well because allegedly in this story which I only saw the headline unfortunately is that thousands of Scots are accessing GP appointments and I think it would be interesting to find out if that number is available in terms of NHS, Lothian / Edinburgh but also in the areas as well in terms of whether it's people who are able and happy to drop that hundred quid or whatever it is to to see GP lickety split versus the areas where people are maybe feeling it's very urgent and pressing and are making difficult decisions personally to be able to afford that. This is information we don't have. We've certainly asked those questions. I just wonder whether either Robin or Katrina might like to just comment on that area. They probably hear things from time to time around the use of private GPs. I work in Great Miller in Edinburgh so very few of my patients can afford private GPs I have very little experience of that but what I am seeing growing is people attending private secondary care at the private specialist appointments because they can't because of the long waiting lists and so people who can't really afford it and they're directing to get their hip replacements and every place that's done privately because the waiting list is so long and it's causing them huge in capacity. Robin may be able to just say more. I guess the other thing is that it's difficult to describe just the scale of contact with the population and general practice so Scottish Government estimates are over 10% of the Scottish population consults with their GP practice every week every week over 10% of the population and you know that's going that's in the face of a reduction in GP workforce within specialist numbers rise quite steeply actually over the last 10, 15 years and GP numbers have dropped. So there's huge demand on the service and I think you know one thing I might come back to later is just getting the big vision right about that balance between primary and secondary care and I might just put a quote in the chat from the order to general into the chat bar who says this go to the report currently so in 40% of our public spend in Scotland on the NHS but it's likely to go up to 50% as we have really shift towards more upstream preventative work and everything we heard from the Social Care report about you know every time we strengthen the front door that means we back people back into Social Care but also back people back into GP care so it's not just the numbers it's actually the complexity both as our elderly population rises but also as mental health mental ill health pregnancies rise and we've heard a little bit about that early in this meeting too and we haven't heard the mental health resource or workforce that Scottish Government promised and that has been deeply damaging I think thank you. Thank you Kishina, really really helpful, really interesting numbers, interesting sort of insights as well. But the job issue of the work kind of really kind of answering sort of Max's question but I appreciate I think the answer to Max to your question was we do not know for a lot of the more specific questions that you've asked but again you know logic would dictate that there'll probably be a mixture of both some people who are happy for some people who that's maybe the only way they can access they can access that service at the time which again obviously isn't right I mean I'm thinking that this is something that I can certainly raise with my NHS loading colleagues, executive colleagues just to see if there's anything more that can be done in terms of getting at least some insight into you know these types of questions so yeah but thank you thank you for asking the question as you said it already has been through this scrutiny at the Performance and Development Committee right sorry yes they're delivering okay very good is that okay yes I think so yeah the point about perhaps your role though was about that sort of 1.2 million of underfunding that we're getting because this also was touched on by the deputation you know yes there's um sort of almost a systemic problem here in Edinburgh underfunding yeah absolutely no absolutely thank you I had Tim down next there's still quite a few people Tim and then potentially Katrina if you wanted to come back in again thank you chair I think the question I want to ask is probably in relation to the points that Katrina was just making there actually but maybe I could just progress on that a bit I wanted to just quote one sentence from the accompanying report we have here which is in paragraph 43 which says that after decades of exhortation the insight primary care can offer on how services really work for people remains an opportunity so the way I read that is that we are missing a trick here in terms of you know extracting all the insight we can around the service in Edinburgh so and as I say I think that's what Katrina was referring to but what I want to know is you know how do we how do we how do you feel that we can gain that insight better for us as an IJB and generally because we're clearly not using that resource as we could by the sounds of it I think this takes us back to the aspirations that were attached to the whole of integration and if people need to get a handle on what it is that is I suppose we're gunning at in the report I just I just offer you an example from from some work which was done some years ago was which was that a young man died of a drugs overdose and a so-called deep dive deep dive was done into what had happened to that individual and what they found was that in the last two weeks of his life there were 22 publicly funded interventions to try and help that that man so the GPs had been in the social workers had been in the housing people have been in the police had been in drugs agencies have been in and a variety of publicly funded third sector organizations no one did anything wrong no one missed a trick but there was an immense amount of public resource focused into that individual in a way that clearly wasn't as impactful as we would all have have hoped and at the time the aspiration was for more local focus about coordination of local services and I suppose those aspirations are now arguably born by 20 minute neighborhoods and that that might be the vehicle where public services who actually have a lot of insight and information I think in particular GPs when I'm doing that I also think of a primary school teachers and policemen they have a huge amount of information about how things actually work in local communities and then if you draw in community activists and and and a third sector organizations arguably you get a better diagnosis of a more accurate diagnosis of about how things are actually working in local communities so it was just a just an opportunity I suppose to to say primary care has always been very keen to play its part in that in that kind of in that kind of working thank you thank you David okay I have Katrina, Peter, Brydie and Robin in that order so Katrina please yeah I'll be quick this time because I I've already spoken but I guess one just two things one is is the premises and David has produced excellent work with lots of data and argument over the last 10-15 years of out premises and we really are beyond a crisis point now and in the original report there were some examples of premises where we put in bids and applications we started planning the council has been extremely helpful but we haven't had the funding to take those through so 10 years ago the GP subcommittee estimated we needed a new practice every single year in Edinburgh and we simply haven't had that and just to give the example of my own practice we've gone from this size of 9,000 and 2019 to 12,000 now and the multidisciplinary team is welcome but they use a lot of space because they see fewer people in longer appointment times and they're often deal with one issue so although they're very welcome that is a lot of premises for the additional staff that we now have and a lot of premises now are just full so my own practice we wouldn't be able to expand our list size further because we just don't have enough rooms and I'm in this fabulous building on Adrian's Road which many of you will know and when we first moved into it it just seemed huge so premises is an ongoing issue we've had some very very key projects which haven't been able to to be taken forward and I think NHSN has to be fully held to account for that and just very briefly secondly obviously I'm on the leadership and resource group and that's where the decisions are made and I think Edinburgh has done extraordinarily well in being very transparent with GPs and practices very equitable in a way that I don't know of anywhere else in Scotland and taking into account factors such as the very elderly and health inequalities in a way that I think is unique in all of that was based on public Scotland, what's in our public Scotland data so public health Scotland data and I think that works extremely well so that's all it's going to say for now thank you thank you Kishina thank you really helpful okay I have got Peter I have two things to comment I'm in a welcome this report and the various committees as well so it's been another excellent report one thing I haven't picked up before is just to note in the actual report itself in paragraph 27 about the under-investment in CTACs I don't think we've mentioned that and then from an experienced part of you and people I've spoken to in various times I found the CTACs being extremely helpful and so the fact that we've under-invested in the past I'm curious about how you know whether that's just an anomaly really or whether there was a kind of resistance to the idea of CTACs in certain parts but I also noticed that we are in a demonstration on CTACs as well for the wrong report it mentions that as well so it's interesting dynamic say about CTACs but certainly I'm quite interested to see how that pans out and in future reports which we look forward to getting it would be good to see how these initiatives move forward you know success or unsuccessful in the lessons learned I would certainly recommend that for a future in future reports. My second point is to go back again to the discussion and I apologise on my hobby horse on this about the population issue. From experience if you collect data in two different ways on the same thing you will end up with two different results and what we've got here is data being collected in two different ways about the population so we've got the population change an estimation based on the GP or patient's register with the GP and then you've got the national record service which is based on a fundamentally based on the census and then estimates of incomeers and outgoers and so on and births and deaths. The problem I'm thinking of the case to put and how to modify our case because we can go along and say well however way is the right way however you know from the Scottish government's point of view they're going to say but hang on the rest of Scotland are accepting NRS law I'm assuming this by the way are accepting the NRS figures what is so special about Edinburgh. So I do wonder whether in fact you know if it's possible I'm not sure what the answer is by the way but to find some other way of arguing your case building on what we know which we know that there's huge developments of housing and I suppose the question is where are the people who are going into those houses coming from are they coming from outside or are they coming from inside the city. If they're coming from outside then that really strengthens our case and I suppose the question is why is NRS's figures so different from our from our GP figures and I think I said that the performance subcommittee that it would be good to ask NRS if they've considered in detail the special case of Edinburgh to see in fact if there is something about Edinburgh that's not being picked up in the estimation method it would certainly help our arguments so pause there. It's quite difficult to do justice to all of that but I'll try and just be a very very brief I'm on the CTIC I mean CTIC stories quite straightforward I think we have reported it on previous PCIP annual updates first of all we offered when we got the money from the government we offered the GPs we said to them what do you do you want this was work that Dr. Morton in particular was very very well embedded in and it was very well appreciated that that offer was made to the GP community they weren't convinced to the idea of of of of CTACs and they wanted predominantly more staff embedded within their teams very natural response at the time bearing on mind the stress and strain they were under and the comparatively you know an untrodden ground of new types of professionals distant from the practice so the other thing was a very very practical we had no room for CTACs we did not have spare rooms in our you know medical centers health centers that were available for that that kind of development. Later on then as we began to get going we began to make a bit more investment and and test them and began to grow the case began to understand how they could work for us the GPs in a sense we we had already given out the money and if you ask the GPs do you want more CTACs or do you want to give back your practice embedded physiotherapists or mental health nurses or additional ANPs they would say absolutely not we get much better value for money work load however you want to to think about it out of those people embedded within the practice than we do from CTACs nevertheless we're building up our our CTAC numbers I think I think it reported it's we've gone up to about 50,000 procedures a year and we're certainly looking with the current resource to go above that and we've probably got about the right number and what we're trying to do through the National Demonstrator project is is is show in us our model in a in a in one patch of Edinburgh in the southeast of the population of just over 60,000 what is the optimal investment into CTACs and also the farm therapy hub workforce to see if we can show the GPs that that actually that work load can be taken reliably out of out of the practices so that work will report at the end of 2025 and so bike to population again you know what why is NRS different I think you've said it yourself there it's information that's collected in a completely different way and what we go back to is NRS is simply an estimate and and and they don't seem to be sensitive to housing plans or the reality of the of the housing plans which is why the GPs report much more population increase and it seems to me that they underestimate population increase but again we've got a meeting with Scottish Government we will we will try to encourage them to get behind this because it's really their their central systems which which we need to address this it's also not a uniquely Edinburgh problem it is it is a problem that is equally shared by the other loadings you know we're we're we're in this together it isn't it is the loading is relatively unique though for the rest of Scotland so we'll keep going thank you David just to come out for some additional information I think the question in relation to the population growth and the question about people arriving from from elsewhere there is a piece of work underway just now I'm in very close relationship with the the director of housing in relation to this piece where almost this is not a delegated service I think what David's just illustrated there is consequential impact and often the impact of of policy change late 2022 there was a relaxation of local connections and I think it's probably fair to say without if I go to having the data right in front of me just now but given how attractive a prospect it is to live in Edinburgh I think that cities like Edinburgh for example will be adversely impacted by that and in the original view that there would be some who would be a net gain across the whole of Scotland I'm not sure if that is entirely translated but I think it's fair to see with that we've mentioned Cucrania later on we'd also mentioned the positive asylum seeking decisions as well so we should really be looking at the data that's playing into this um thank you hugely complex this is what I'm taking from this um okay thank thank you for that um I have got Brydie and then Robin it's Brydie okay as usual David a tremendous report and I think it's really interesting in terms of the types of questions and everything they're being thrown up here today um I think I want to build on Katrina's point about the auditor general that we need to invest in early intervention and of course David you've been a tremendous champion of the work of community link workers being based with GPs and we know that that's um really helping the mental health of JPs never mind actually impractical terms with an impassioned GP here at our last IJB meeting talking about the consequence of that this prolific amount of academic data that backs up the impact of community link workers but obviously you need a supermarket for those community link workers to take from of third sector and communities based services because if they are not there the community link worker ends up being caught up in the support of the person rather than being able to refer on you know the type of support that is maybe um a big return in investment is the befriender who takes somebody out for a walk after a stroke which means better rehabilitation sometimes we just think about it as being physical health improvements but actually sorry psychological health it can be extensive so I'm curious about some key recommendations from yourself in terms of that long-term thinking I was really interested you spoke to the local network piece um the GP and the team the receptionist and others who cross the door of local organizations in the community sector are often much more relieved as well to know what's available to them um we've seen GPs invest in community link workers even where it wasn't a budget allocated to them because they know the benefit um and and I think that place-based approach is really powerful that people aren't just passed on at the point of risk of homelessness or or whatever you actually get that better connection at the local level so I'm really curious about your recommendations that would actually be so this is a different point to the population point this is more early intervention to actually help GPs function better in place and we can maybe distribute the report that I know you know is available on community link workers so key recommendations in terms of that long-term thinking and early intervention to support GPs David thank you I think the key recommendation is they is um we want to keep funding link workers um and this seems to come and go as a as a national agenda item certainly Anne Crandall's who runs our um community link worker network for us is embedded within those conversations as are others from from from the network and as you say Brydie our our um experience of that has been very um positive uh I think I think uh always strategically we've seen that um primary care and the third sector are natural allies um and and that's helped you know that the embedding of link workers has helped embed that within practices practices now have an interpreter of the relevant local third sector that they didn't have before they are rather than just a sort of kaleidoscope of changing organizations and arrangements which you can sometimes be if you're in a busy primary care um team um the third sector is able to be you know interpreted as what's what's relevant to patients and and particularly um in in areas like Dr. Morton speaking from this morning in in in Craig Miller with lots of organizations um and there's a huge number of patients with um with with mental health challenges uh and actually getting them um the the right um support so I suppose the first one is to stabilize the the foundations second one is is is to go on doing what we're as suppose um getting the information out of the system to be able to support what the impact of what the link workers are are doing and certainly we've invested in the elemental system um which hasn't quite spat out um the um the answers that we we had anticipated but we we again we're we're we're hopefully um on on the way there but in terms of in terms of key recommendations um I I think it's it's it's it's more the the understanding of you know the importance of the dialogue at the local level about what resources are out there and that link workers bring that into um GP practices and they bring it in in a way that's um that that's relevant for the for the primary care team and I suppose I suppose recognizing that and increasingly I think the third sector recognizes that the link workers are uh as it were a Trojan horse into into into primary care which sometimes can feel a bit distant because people are just so busy um um that they they can't stop to um to engage at times so they are aware of a way of fostering that local dialogue just in reply whether we could make sure to share the report that David and I know is available in terms of the evidence on this and and with with all of the members and secondly it's actually really just to encourage imaginative thinking about place-based work about buildings rather than always having to build new buildings how can we work more collaboratively locally and I know there's lots of great thinking going on around that are there doors around the corner which might also help people access food pantries employability services and other things that are part of early intervention so that place-based approach at a local level has been discussed at community planning whereby community planning is looking at some of the resources across the city that is Andrew Kerr convened this meeting where the university NHS and others are talking to each other about buildings at the city-wide level in terms of resource Andrew was really excited about the thought that there could be a local dialogue around that as well so I think it's really important to wear a cognizant of what's going on with community planning in this room as a result we've asked if actually more representatives in IGB could go along and be available to community planning in terms of that dialogue for the future and just a final point in terms of your challenges will Tyler Gray comes to community planning from the Scottish Government and at Scottish Government level they come to homelessness meetings about our pressures why aren't we see Scottish Government in the room here on occasion about some of these challenges so those are two recent meetings and weeks my meetings have seen the Scottish Government in the room physically listening to the challenge of Edinburgh why are we not seeing that here to support David so I'm curious about that thank you. That's great thank you thank you very much for the suggestion Friday and I think if there is a report that's available I think that will be very much of interest to board members and with regards to Scottish Government being in the room I mean again representations have been made let's put it this way but you know I've got some suggestions around some of the recommendations for the board when we finish off with I think I've got Robin and then Katrina and then I would quite like to draw this to to close this item Robin please. Thank you Chair I was trying to time my raising off the hand so I went last as Max alluded to earlier the questions have been asked the answers have been given and all the discussions have been had the one thing that hasn't been said is that while primary care has its doesn't have its problems to seek one of its biggest problems is going to be the fact that David White is retiring and in my experience of 35 years he's one of the finest if not the finest health service manager I've worked with and the quality of the reports and the information you get is largely due to David and we David wants his team and the lnr committee so I just like the committee to be aware that and the end of this month David will be retiring to a well-earned retirement tour of Europe thank you thank you so much Robin I was gonna come into that that point but I think you here it coming from you made it much much more real so um Katrina Yeah just to come back to see tax as an example of some of the discussion around our new GP contract and the PCI P I heard about the good experience that a board member had at CTACs and that's great to hear but the CTACs as David outlined well it was a very planned program in Edinburgh responding to GP's perceptions of need but we also structured it so that the CTACs did complex tasks that were infrequently needed and there is now a growing debate nationally about why the CTACs increase health and qualities so this morning in my own practice we got over 70 appointments with our healthcare assistant of lobotomy and blood pressure had we got a CTACs those patients would have had to no doubt travel further if that activity was done in the CTACs but it just shows you the at the huge amount of work that would need to be transferred to CTACs if we were doing it all there that's just one practice in one in one day and I think you know we hear from other parts of Scotland I know in East Logan patients now have to travel to the East Logan community hospital to have a three-month year vitamin B12 injection I think many of them would prefer to go to their own practice so I think there's increasing scrutiny of the unintended consequences of some of this and I think Edinburgh did well to consider CTACs in the way it did and I think that's that's played out very well the other reason that we're focusing on it a bit more is that the demonstrator sites require us to look at CTACs and pharmacotherapy so that's the national requirement and part of the beta again and I'm sure that part of the reason that we will not bid only for interesting places to go on to do so was because of our day with excellent work I've worked with David from probably 15 to 20 years now I'm always in a representative function and he has always listened to two piece and he has I can't I've been said enough he's just been absolutely superb so thank you for my thank you so much Robin and Kishina for kind of really has to say giving us your testimonies and just a massive massive you know I would like to record a formal note of thanks to David I have certainly always been blown away by the quality of the reports the quality of the interactions the depth of understanding so I do feel like we we have been privileged and obviously naturally my my thoughts now turn to we you know we absolutely must make sure that that we do not lose some of the the drive and the just the focus on this David that you know you've built up and you've put in so basically we need to maintain your legacy just to put it this way so yeah massive thank you from I think everybody it was an absolute privilege many many thanks I'm overly generous and just to stress as I always do and I do this because I absolutely mean it is there's a fantastic team but do that or do all of this and they will be keeping going thank you that's good that's good that gives me some degree of comfort so thank you for that just before we close this office there's a number of recommendations here and so and I I'm not gonna go through them and we can all see them our members generally contend with them I think it was also obviously the challenge from a number of board members as well just to consider if we need to add to the recommendations as they're currently set out here and certainly what what I have been reflecting on having also listened to sort of some of the things that Pat is you know has alluded to earlier on it I think we probably need to add something to this as a recommendation to think or or consider a you know the proactive engagement kind of strategy so Pat exactly what you refer to you know all of that work that is currently happening behind the scenes by officers quite rightly whether you know whether we can make it just a bit more visible to the board you know so that so that we look at it as a this is obviously crisis this is what we've been hearing from colleagues we've got the data to support it we understand some of the difficulties we understand the complexities we understand to some degree why maybe we're talking a slightly different language to our partners or at least you know we acknowledge that we are talking a different language that leads to problems potentially issues not being addressed in a timely fashion so I do think that maybe one of the recommendations that maybe we can craft um not just now but later on I'm sure the minutes will reflect beautifully and you know is around the fact that we do need exactly to have that evidence base we need to kind of have that proactive engagement and just kind of have have that you know formulated because um you know obviously we will also have a strategy work that we'll be developing as well so this you know quite quite neatly kind of into the strategy work so I think we do need to have some sort of recommendation to make the work around primary care more visible to the board and to ensure that it is data driven um and that it is you know we're proactive and we are really quite vocal in the space because I mean I've said it last year I do think that really if if we don't get primary care sorted then all of our other issues are just that much more magnified as well and I clear you just you were nodding you wanted to come in there yeah I think I agree with that and I think the visibility first of all of what is happening outside of this room to all of us that we are kept updated on that and the progress on the conversations and whether actions are taken or agreed that take us in the direction that we're looking for but also something that empowers those conversations that says this board wants to see appropriate levels of funding for primary care is concerned about the lack of practice space you know those things that we've covered off in this conversation and then I also wondered whether we wanted to formalize what Brydie was talking about with the community planning and the premises um questioned about you know are there other places in which primary care can be delivered or take place and I think if that work is already going on it's maybe just something about acknowledging that and saying we want to make sure that we as a board are linked with that yeah absolutely I'm looking to my office at colleagues here because I have to admit ignorance I'm not entirely clear how the community planning this interacts with the you know the IJB so don't want to be agreeing to something that kind of steps on somebody's kind of toes so I'm not as into the thematic but again I would absolutely urge officers to consider what has been suggested yeah okay Mike just yeah no that's absolutely fine sorry the reason I'm probably just being thoughtful right now rather than rather than probably just more vocal and I guess there's two parts to this for myself there's one which is about just operationally how we strengthen those relationships and that's a very and that's an operational level you know so so Brydie you know it's just about how we how we you know have within our in our local communities you know people working collaboratively people working together you know and that's that's quite an operational aspect but then it's a part which is more strategic for the IJB in terms of what we do so apologies guys like I'm just trying to be thoughtful about how we can best support you with with you know in terms of giving that information at that strategic level and I think some of it will be about the principles that we're also building into the strategic plan that actually also help in terms of taking things forward and the interdependencies with other parts of the system so there's things that I'm thinking of that I think that we can do but apologies that I'm probably not articulating that appropriately right now so I know I think that's fine and like I'm kind of making suggestions which I hadn't tabled physically as a you know an addition to the recommendations so I think we're all kind of wrestling with that I wonder whether the action is perhaps actually to do that thinking between now and the next board meeting and these with people who have expressed interest in this and work out what is it that we want to see here what knowledge do we want to have at the board what information do we want reported at the board but also is there a missing piece in terms of what is the activity happening at operational level and what do we want to instruct and ask for so it's actually maybe not on the fly deciding on a recommendation it's actually working towards one next time absolutely I think that's that's immensely sensible yeah I see lots of nodding around the room perfect thank you so much for that well done right thank you David again and yeah I'm out of the stage I would suggest maybe a quick five-minute break before we tackle the next agenda items thank you everybody so much literally it is now if we aim to be as close back to to our first we possibly can but I appreciate six minutes my bit ambitious but we will aim for that okay thank you thank you right okay right and we are reconsidering the meeting colleagues thank you everybody for being back in a relatively functional passion so we are now which agenda item okay so we're about to go into item 7.3 which is adults within capacity just to remind members that there is a B agenda appendix to this item and we have Pat Toga and Craig Russell speaking to this report thank you everybody and actually before before I pass over to the officers again because obviously we've got a B agenda appendix there can I maybe just ask for everybody once we've had the discussion most people have good questions if you've got questions for the B agenda to wait until the end yeah okay perfect right thank you sorry Pat oh sorry Helen sorry and Katrina can I just ask for clarification what does B agenda mean it's not a term that I've seen on this board before so it'd be good to just get an explanation I'm glad I wasn't the only one when the subject of the B agenda came out in the agenda planning meeting and it's effectively a part of business that needs to be considered in private so there's a number of conditions that allow the board to consider certain items in private so the B the appendix B is the bit of this topic that is in private so that's why we will cover off the public session first and then we'll go into questions and then if there's any questions on the on the B item we will make sure that we seize the live stream for a period of time whilst you consider that and just in case people are wondering this is and I'm looking I'm looking here at colleagues the reason we're taking that in private is because they're potentially legal implications so they're you know yeah so that that's the reason why okay fabulous I'm sorry over to Pat okay thank you Chair for the purposes of continuity I would probably ask Craig to come in and present it about it please save my appointment by quite a number of years so can you go through the context of all of us and then we can against the questions thank you thank you Chair thank you Pat I'll just take colleagues briefly through some of the key points arising in relation to the A agenda report itself this report reflects a culmination of of work which has taken place over a number of years going back to initially a mental welfare commission study which identified that 457 patients were affected in a period between March 2020 and May 2020 concerning discharge arrangements during the the COVID pandemic there was subsequent City of Edinburgh Council quality assurance reporting on the matter and of the 457 patients and issues of concern 83 were identified as potentially unlawful transfers relative to adults with incapacity legislation those cases in particular were looked at in great detail by mental health officer colleagues and it's to their credit that they engaged with families on a direct basis in order to initially correspond and then latterly to meet with those families where specific concerns remained outstanding as a result of the correspondence that was to intended to assist them ultimately that followed through to 11 cases of particular concern where mental health officer colleagues engage specifically with those families on a targeted and supportive basis in order to assuage any any final concerns they may have my understanding at this date is that the concerns of 10 of those 11 cases of concern have been resolved to the satisfaction of the families involved ultimately matters that are before you this afternoon relate to recommendations which are captured in separate improvement planning reporting but just for for brevity i would note those to be commitments in and around investment in in social work services investment and commitment to training program regimes support in relation to a lot of local auditing arrangements and updating where appropriate policy and procedure arrangements and doing the very best that that is possible to ensure recruitment and retention of of staff so in summary health and social care partnership improvement plan has been improved by the mental welfare commission and understand there is an oversight board in place and audit oversight is in in training in relation to such such matters so they were probably the key points that i would just want to to cover this afternoon committee thank you and can i just add just one final point i had before we moved on to questions and correct touched on it the other has been fairly significant amount of improvement work within this in teaming up what are they oversight the governance arrangements in relation to this introduction of the principal social work officer for example and the reflections that we've had earlier on in the chief social work officers annual report for example and the proposed restructure of the organization also included within that in the draft paper there's a deputate chief social work officer that we're looking to bring in additional governance and oversight around social work activity and there's also the tightening up over response to LSIs and learning reviews processes as well as well as a recommencement of audit activity have been undertaken as well so we're in a fairly fairly strong position and however like all of the reports that we've been talking about today the financial climate really does play into this and we've noted that in the report a cautious approach to the pace of improvement needs to be duly considered and the funding that we had for the additional posts in relation to this has now concluded so we do need to rethink and to this and how will this how will our restructure around the support around mental health provision for example be able to be sustained thank you thank you very much Craig and Pat I would like to open up for questions members Claire please I was waiting sorry I thought maybe no if I paused for a beat and so it was on the financial piece so it follows on from Pat's comments actually I'm quite concerned about whether what is it that I'm saying I'm concerned about whether changes that we're making are sustainable financially I would like to get a sense of whether has do you have assurance do you have confidence that that changes that we've made to address the issues here and in the improvements are financially sustainable or are we going to see a situation where we return back to where we were a few years ago having spent money and then moved our focus on or had financial pressure. Thank you, Councillor Miller. I suppose like all of the discussion that's occurring now that it's very very difficult to give an absolute assurance that improvement is sustained when you're faced with 60 million pounds worth of savings plan however what we have said is very much an improved oversight arrangement a structure that I think will lend itself much better to the governance particularly the governance of the social work activity that's been discussed within the report and the realignment of our proposed restructure should hopefully go towards protecting this type of resource. What we have said from the outset over our financial savings plan is that we want our savings plan that gives us enough stability in the system and it protects our most vulnerable and uphold your statutory duties that is still our intention but there are so many moving parts within all of this in relation to where funding should proportionately sit so it is our ongoing commitment I would be confident that we have better governance and oversight arrangements in place now than we've had before for a lot of the in response to a lot of the activity that's occurred over the last year or two and so that will certainly go somewhere towards us having an oversight about where our particular challenges and points are within the system it might not entirely rectify the resource problem though. So that's a helpful answer and actually almost helps me to work out what my question is by hearing you saying that I think my question is where does the assurance sit within our risk and governance management like where is that risk captured and where is the assurance sort of monitored there and I presume it's an operational level because it doesn't sit within the risk cards for the IGB it sits presumably at a level below that but where is that and how do we make sure that we prioritize that? Is that the right phrase? To make sure that it is one which is seen as essential not something where we can deviate from our target risk level. Thank you. Thank you Councillor Miller. Again just a general note on the overall risk I think that our appetite and our threshold for risk will be significant challenged in moving forward and particularly in relation to what it is that we're prepared to tolerate and the structure is the partnership register risk register it will be captured there but I think the point that you made there around operation is really important as we've already touched on with the work that the Chief Social Work Officer and Principal Social Work Officers doing around all of the other activity I jointly chair the IGB Improvement Board that oversees the work of the Mental Welfare Commission and the two inspections that we referenced earlier on so there's a programme of what this also capture there and we are making we continue to make really good progress but we continue to note the risk so it will be in the partnership risk register. I'm just going to, that's good Rose did you want to comment on this point as well or? Yeah I just wanted to provide some assurance really because obviously it's an area that is important to the Chief Social Work Officer statutory responsibility and so in terms of the improvements that have been made over the last year I have seen significant improvements with increased capacity and structure that is going to support and even more strengthened it is difficult in terms of budgets but we have a statutory requirement and we are answerable to the care inspector and the mental welfare commission so in terms of risks it is a high risk and it's something that like adult support protection we need to prioritise along with our budget requirements. Thank you Rose that's really helpful you know to get your perspective on this thank you okay I see no further questions I suppose you know Greg that's just a testimony of your report very very clear we understand the historic nature of it to understand how it came about to understand what has been done to understand where we are now so that's incredibly helpful thank you very much for that I know Councillor you've got a question on the B agenda that's right so we are going to move into that session just now can we maybe just get the tech to suspend the broadcast for the duration of that everybody for the for the discussion and for the reports so we're being asked to note the content of the report and there's a number of points here again I'm not going to go through it because we can all read and I assume we've all read it so not consider this report and also note the legal considerations contained in the B agenda report as well our board members content to do that yeah okay perfect thank you very much indeed for that thank you Greg you've been very patient with us here today as well thank you for being here okay Andrew okay so the next item is item 8.1 proposed changes to the committee's terms of reference and we have Angela Bryton speaking to this item Thanks Chair and so this report proposes some minor changes to the committee terms of reference this also addresses an action from the IGB's response to the apartheid motioner's referenced in paragraph six and it relates to action two which was to review the scrutiny arrangements the scrutiny of delegate services currently happens in a range of different governance structures and that's referenced in the report the changes proposed ensure that the IGB is scrutinized and the totality of delegate services at strategic level but it's also ensuring that the IGB has oversight of operational delivery and line work strategic objectives the committee chairs of all seen that the proposed changes included appendix one and are contained with those changes and I'm happy to take any questions thank you very much Angela thank you to get views remember if there are any questions I'm probably too close to now because we've had some discussions you know outside as well with officers so I'm probably a little bit blind as to whether or not they kind of make sense to the less initiated I should say but I see no questions so I think that's always a good sign it means that they you know they make sense in paper so that that's really good just really re-welcome that so thank you very much for the report and the work on that Angela really appreciate that okay we're being asked to note that a review of scrutiny of the gate service currently this has been completed we're being asked to agree that the IGB takes two overall responsibility and accountability for the scrutiny of delegated services that's a big relief if we would agree to that I think and to agree the changes to the terms of reference yeah and everybody's content with that okay it's detailed that's perfect thank you so much for that that's really really helpful okay so the next item is item 8.2 the risk register and this is a referral from the IGB audit and assurance committee and we have Angela Braden speaking to this item thanks chair um so obviously as Andrew says this is the rest of the rest register report that was referred from audit and assurance committee on the 5th of March the main changes to the risk cards from the previous iteration are detailed in paragraph or paragraph 3 of the report to audit and assurance committee what I should say is that within the paper there is reference to the strategic plan coming to March obviously these risk cards were written kind of January February so the timelines actually been extended slightly to the summer so we will make sure that that's referenced in the next iteration that goes to audit and assurance committee in June thought I would just flag that and the other thing that is mainly changed from the last iteration to the iteration that's with the four year today is the risk 3.4 and that the IGB does not comply with the necessary legislative and regulated requirements because I think there's a recognition to take 60 million pounds worth of savings out a system may mean that the IGB and obviously the budget setting has meant that the IGB has made choices about what it commissions and what it delivers and that may impact on um the ability of them to deliver statutory and legislative duties and it is obviously just flagging that within the risk cards and I'm happy to take any questions. Thank you very much Angela. There should also say we also just relatively recently had a very very informative development session on risk management as well which I hope members who have attended have found quite useful so certainly I mean it's absolutely a risk management that's absolutely at the forefront I think of everybody's minds after that development session and I know this is something that we will kind of continue to keep a really keen eye on because I think it was coming through very very closely that everybody is very much aware of the fact that we are moving to a different environment as Pat always says is the broader context and in the broader context our ability to manage our risks within our appetite is just substantially reduced you know as exactly as I said because of the choices we've had to make so incredibly timely um thank you very much for the report can I can I see if there's any questions and thank you too obviously to you your and your committee for scrutinizing that as well um I can see no questions so we're all content to endorse the report then yeah perfect thank you okay so the next item is the review of the Edinburgh integration joint board standing orders I'll just go straight into the chair so the board is asked to approve the revised standing orders and to note that the next annual review of standing orders will be presented to the ijb in October 2024 in conjunction with the annual governance review thank you Andrew again I will assume that this has been read so our members continue to approve the revised standing orders and to note the date of the next annual review the clue being in the word annual I think so that's great fabulous thank you okay so the next item is item 8.4 which is appointments to the Edinburgh integration joint board and again chair I'll just go straight in uh it is recommended that the Edinburgh integration board and note the resignation of Heather Cameron from the eijb as a non-voting member the board is asked to appoint Hannah Cairns to the eijb as a non-voting member and AHP advisor and to reappoint Alistair McKillip to the eijb as a non-voting member okay thank you very much about Andrew I think you're of his content to do that well done thank you welcome Hannah formally as the AHP advisor um so so pleased to have you with us um okay that's good right done agreed okay so the next item is item 9.1 which is the committee update report and we have Angela Brydon speaking to tell you them thanks chair um this is just the overview that this just provides an overview of the work of the committee so for the January, late March periods um I'm happy to take any questions okay thank you Angela again we're taking the whole of nine together right does that members contend with it oh it's clear clear perfect clear please thank you and yet normally I wouldn't have much to add um on this but I did have a question so um in the minute of the um strategic planning group from January um it describes that you've looked at the draft climate ready and replan which is great obviously very excited to see that that was looked at and myself and George are both nominated as climate champions for this board um and I wasn't aware that that had been looked at at that meeting and was only made aware because I've read the papers for this board meeting and I just I suppose wanted to raise the question of what what you're being asked to do in that role because that doesn't feel quite right for me and I've had a bit of a yeah a lack of comfort around having that role but without a real clear set of expectations from the board of what is that the board wants me to do when I'm acting in that role and so would like I suppose just to use that as an excuse to raise it to say this is an example of something weird I would have expected that a climate champion would be taking a role but I don't know what that should be whether actually it's the correct thing for that committee to be looking at it solely or whether George and I should have been taking a part in that and what that would look like so quite honestly just a really open question maybe for the SPG to take away and I'm not wanting to put anybody on this board at this point. Yes thank you I just thank you Claire I'll just come in initially on that just to say first of all apologies because in in being the chair of the SPG and and having that discussion I'm really sorry that I did not make that connection so I totally put my hands up to that and you're absolutely right to remind me and but in terms of what actually happened in terms of practicalities this was a report that was brought to the attention of the SPG by one of our members by Flora Ogle the our public health representative and we agreed to take the report forward in terms of organising a further session to look at that a broader session to look at that so in terms of there was no actual discussion as such at the meeting as more that it was brought to our attention which it was you know it was very very good to Flora to do that and then we've got further out as flow from that but again apologies because I should have made that connection and I didn't but I think part of you got more to know I think it's a really valid point to this here and we should be clearly tapping in a particular skill set there in relation to that I mean it we could take that piece of work away we could take it out with the group and have a specific reflection on that given the topic and Councillor Miller but I would leave it for our time Mr Chair yeah sorry I just I mean perhaps as part of the discussion of that piece of work part of it should be around you know around the role of our champions within our board and that could be part of of walking out our best response to that that that was actually going to I suppose be the answer to my question I wanted to suggest because I feel that when I took on that nomination I did some thinking well that's something obviously extremely keen on and you know there's no reason why I wouldn't want to do that but what is it that I'm being asked to do and I don't feel like there's much of a pool from the board to say to me or to George what is it that you have done with that hat on what have you achieved what actions have you taken and to be honest I haven't really managed to go enough a lot and I feel that that's problematic so I would quite like and welcome there being a clearer steer from the board of what it is that you want from us but also then a mechanism to link in with things like that like that plan etc so I just think it is an important area I'm very keen on it but I'm not exactly sure how we best make use of our talents and our time absolutely no entirely legitimate point really really well made as well so I think we're all kind of violently agreeing here I will bring George in and then I've got Peter and Brydie yes of course I fully support what Claire was saying there I would like a real clear remit that of what we are supposed to be doing has been a couple of papers over the last years so that they've come to the board that had real claim that it is that we should be dealing with the first one is going to raise the second one is in relation to the audit insurance committee the minutes are inaccurate because I was actually at the meeting so I would like that I may need so this is two points I had to raise and this part of the agenda thank you George thank you I'm just going to bring in Peter Brydie and then we can you know finish the meeting on the highlight Claire we'll just I'll try to keep it quick first of all I think absolutely clear it's obvious that at some way George and Claire ought to have been involved in in some respects and that's because there are the champions for the ijb I've got two questions one is do we have champions for other things I've kind of forgotten about and whether we should just remind people that we do have champions and my second point is one about clarity for committees of the ijb seeing papers which might not necessarily this one by the way but might have interest to other committees of the board I mean example might be the strategy and performance committees for example is that maybe relationship is there a kind of mechanism allowed for subcommittee to to say that we should pass this on to another committee as well to see as well I know we do that within it's done within the the Lillian health board this is a kind of process it's been a greed to make sure that as many people see it as possible rather than everything having to come to the i the full ijb necessarily I'll stop there hi appear so within both the council and nature so then there's a team site that should have all the papers for all the committees so members can access them as and when they want to sorry I suppose the question is is it possible though for a committee to refer on or share a paper with another committee because that's a positive action rather than a passive out yeah absolutely we can absolutely do that as well but obviously there is minutes that are available for everybody and papers are available for everybody to view on their own time commitment but we can certainly do that federal route as well thank you very much Peter for the question thank you Anja for the answer I think you know as I said yeah so just to say it's kind of like a both way to restute but I would probably think that the chairs of each of the committees probably part of the conversation during committee will will quite inevitably be as is what our knock on impact is supposed to be really big to get items so if there's something that the chairs feel that they wanted to you know to share and it's good I think you know that that's I think that that's kind of how it works for interest loading as well doesn't it Peter is that at the end of each kind of committee session there's a bit of reflection is there anything here that's relevant for anybody else and that's supposed that's a really good kind of opportunity to take stock but as Angela says all of the all the papers are available for everybody and there is minutes as well so I think this is part of the prep for the board that's a really good suppose it's a really good discipline as well as to go through and kind of identify exactly like Claire has done you know scrutinized the the minutes and identified items of interest to her role as climate champion and George as well obviously so really good really really good really good really good really good conversation from a governance perspective there right I think I had you down next so yeah I just want to emphasize the of the importance of the champions being involved in terms of this piece of work also because there is an investment now in a climate hub in the city come from the Scottish government a local organization eCan has been set up they collaborate with EVOC we do work around for example collaborations between organizations that can do really great work at pace and communities to bring money in from outside of Edinburgh and investments around climate and nature restoration so I just want to offer help in terms of the connection with that example such as electrifying our transport fleet that actually provides community transport to health and social care so there's all sorts of strategic and operational things that I'd like to have with on that we are in that group but to support Claire and raising awareness of the wider links to communities thank you thank you Brydie thank you for that I believe you want to come in as well did you want to come in so before I bring Claire back in just briefly are there other champions this is the first time I've heard about climate champions great minds know that yeah I do not know I have to admit okay there we go that absolutely Max absolutely clear did you want to come in or yeah okay that's great right okay thank you for that really good discussion as I say really valid points and really really well made so and absolutely this commitment from officers to kind of make it more more clearer around the role of the champion so that's good right so either any other points any of the point nine items can't see any thank you very much the date of the next meeting is Monday the 17th of June 2024 and I think this concludes this meeting yeah fabulous thank you so much everybody thank you everybody online thank you but in the room thank you again for your contribution and we'll see you before that no doubt in a development session or two as well so fabulous thank you