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Right. [ Silence ] Good morning, everybody. Hello. Are we -- perfect, that's great. Right, okay. Good morning, everybody, and welcome to this meeting of the Edinburgh Integration Joint Board. I would like to draw your attention to the fact that this meeting is being filmed for live or subsequent broadcast by the Council's internet site. You should be aware that the EIJB is a joint data controller with the City of Edinburgh Council and NHS Logan under the General Data Protection Regulation, 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. And members, officers and attendees should be aware that the chat function is visible on the live broadcast as well. Okay, now with that out of the way, welcome again. And so I would really like to particularly welcome Councillor Alan Beale as the newest member of the EIJB. So welcome, Alan, really, really good to have you on board. Other than that, Andrew, do we have any apologies? Apologies have been submitted on behalf of Alistair McKillip, Chair. Version three of the meeting papers were published on the 14th of June and are available to view on the Council's committee portal. They are also circulated to members via email as a PDF document. If I could please ask members who have joined online to use the raise hand function indicating when you wish to speak so the Chair can bring you in order. The next item is item two, declarations of interest. The Code of Conduct requires members to declare any interests they have in the items being considered at today's meeting. These can be financial or non-financial. Thank you very much, Andrew. Do we have any declarations of interest or any connections that anybody wishes to declare at this stage? And I can see none. Okay, perfect. Thank you. Okay, so the next item is deputations. We have two deputations here today. Are the board happy to hear the deputations? Okay, so the first deputation is on behalf of the Community Renewal Trust in relation to item 6.1 and item 7.2. And we have John Halliday speaking to the deputation. Thanks, everyone. Yes, I'm John Halliday, Chief Executive of Community Renewal Trust. We're a group of community anchor organisations and two social enterprises, community anchor organisation in Muir House, that's Community Renewal Pennywell, for the Roma people, Community Renewal Roma Ameha, and based in Bingham for Bingham Magdalene Hayes, Community Renewal Lifting Neighbours together. I'm not going to make a habit out of deputations. I was here at the March meeting on the basis of as being one of the many voluntary sector organisations whose prevention and early intervention funding was being cut a little over a year ago, so I'm trying to make the point that there's wider lessons -- forget about our cut individually, but there's wider lessons to take. So I promised not to make a habit out of this, to be honest, but I thought there's a couple of bits worth following up in the agenda in this case. The first of which is the prevention item on your agenda, 6.1, which I think everyone will recognise is an excellent addition, if you so mean, that there is an element of saying prevention, of course, reduces our spend in our health care system, and this paper, of course, because it's IJB focused, is very much on things like the disease burden and relates to kind of how we can reduce health expenditure through improving health outcomes in other ways, but I think there's a more fundamental point that people like me with the luxury of being on the outside of such systems can say, of it's about more flourishing lives, as maybe Linda's strategy papers might say, more good days for the people who are least likely to get them if we don't work with them. I recognise that, but also maybe say the obvious thing that actions speak louder than words in the sense that a prevention paper is excellent, hopefully being embedded into some sort of strategic framework is absolutely excellent, but in a systematic and strategic reduction over the last few years, in the percentage of spend on prevention early intervention across the city, I think there's a bit of a worry, hopefully going forward with prevention at the heart of a new strategy of some sort from the IJB, and then also knowing that we have a prevention-led council increasingly, we can see some actions coming out of that, and I would like to draw your attention to some good practice I was brought to my attention in Sheffield recently, from the Sheffield Integrated Care Body, apologies, they've got a different language, in which the strategy around prevention and specifically listing improving voluntary sector capacity to support the communities most in need was raised at a strategy level, and following that there were examples where local health spend that was on crisis support and primary care was then redirected into community work as a result of that strategy, so I think that if that sets that ball in motion in that direction, that's excellent. The thing I most want to pick out in the prevention bit is there's a good list in what's called Appendix 3 of how we could tackle social determinants of health, it's a classic list, housing, money, employment services, living in a good place, transport, parenting, maternity cover, things like that, excellent. This could be in academic papers across the world, that's absolutely brilliant. It does miss something which is building local capacity for people to support themselves, and that's community structures, voluntary organisation structures and also peer support structures in the community for people to support themselves, which I think is a useful bit. What I most want to draw your attention to is that actually a lot of the good practice that's emerging, as I see it in the circles that I spend my time in, and this is something very important to me, is actually moving a little bit away from such lists, where we're sort of saying the IJP recognises and then wants to invest in those areas of housing, realistically is the IJP going to tackle housing in that way? That means that systemically it's no longer a social determinant of bad health in this area. Employment interventions, how much would the IJP even aspire to invest in employability interventions? So what we can do and what some of the best practice is talking about is change how we deliver public services around health prevention, and then specifically around health prevention, not end up supporting people who were the easiest to help. If you aim for more good days, sometimes what you end up doing is supporting older, richer, whiter people that are easier to help, frankly. And so how do you go about doing something a bit different? Well, what we're finding is examples like -- I'm listing off people that aren't us, by the way, so you don't feel like I'm saying oh, we'll come along and fix your problems. So people like -- if you haven't looked at the things that Hillary Cottam has done around radical health, it's sometimes called welfare state 4.0, it's exactly in this bit. The human learning systems troop, they have a whole bunch of academic study work in how you can do things. There's a model called relational services or liberated model, which goes some way in the prevention. There's things that I prefer better. And also the work of new local, which I noticed the big conference last week, I don't think Edinburgh was represented there, is a coalition of people doing good practice in this space, and all of them talk about what our organization's about, which is rather than say we'll deliver these as services, we can tackle housing, we can tackle employment, we can put money in people's pockets. What you do is you build trusting relationships with people in the communities that we know suffer the worst health inequalities. And then you use those relationships to go wherever it needs them, to build capacity amongst people in that community to do things. And I'm only pointing this out because sometimes a prevention strategy like the one that's being suggested here is excellent in theory, but ends up delivering good outcomes for people who maybe need it a bit less. So I could wax lyric about it, I promise, I promise I won't, because I also want to briefly talk about the cost benefit analysis bit, which is under 8.2, it was bumped up from Council, and I'm mostly saying this because I fear it comes from some of the statements I made in my last deputation. I am passionate that there is something in cost benefit analysis about us knowing what's right and having a sense of accuracy. What's a good investment of our public money in things like prevention? But actually to be precise about the answer, so I'm comparing being accurate and being precise, to be precise about an answer to how much cost benefit is taken, particularly on things like prevention, is really hard. You could throw twice as much money at evaluating something as you spend on actually doing it and you still won't get a satisfying answer to how much did that extra £100,000 spent on a prevention strategy actually save you. It's really difficult. But we do know the underlying details and we've got international good practice around cost benefit work to say which kinds of interventions work, ones where you build lasting infrastructure and community capacity to respond, capacity in people themselves to keep themselves healthy. These are the things that we know work around, particularly around prevention, but not just prevention, also around how the third sector deals in crisis prevention work, it's worth saying. So I kind of wanted to just specify I'm glad to see voting members interested in the cost benefit stuff. I think it might have been posed from things I said, but I sympathise with the officers in saying it's too expensive to actually do in practice potentially. I do think there's some middle space about saying what's actually needed and maybe what I really should have better said last time, and this is why I promise it won't be coming time and time again, is some kind of sense that when spend proposals are made, when cuts proposals are made, or where we're reporting on how well something that was delivered went, like a new strand of work around prevention, for instance, nudge, nudge, we could say is there not something that's not quite cost benefit analysis, but it's more like a dashboard of some sort of rag rating of saying for each item, to what extent is this about moving work into prevention and away from acute or crisis? If this was a risk assessment, people are quite happy to say on a scale of one to five, we're four out of five likely to not burn down today. So I think there's something about not being precise but being kind of accurate in that sense and providing information that says is this about moving money out of prevention, sorry, out of acute care and into prevention, is it about building lasting capacity in people and communities to improve their own health, to what extent are these particular proposals or proposal to cut actually going to impact on health inequity? Again, it comes up, but if we focus on the things about health inequity, we're going to get to the right people through prevention. And finally where, and again this broadly was hinted at before, but I think going forward and particularly for your work in future, around where it's going to reduce or increase other spend, particularly on acute spend. So effectively this is a long way of me clarifying that I think there is really important work around cost benefit analysis that should be done, and I understand what officers would say about it not being practical, but I think there's something about appealing for something that's accurate and not precise around that, about when is this an investment and when is that investment good return for its impact, if you so may, and potentially do that in a more potentially subjective way or based on external verification of that through external people saying this was better than this as an intervention in that space. And I'll just close by saying I don't think it's too late to say if this is the prevention agenda, is going forward there, if there's stuff to do around investing now to save money on crisis support, it's not too late, it's not too late this year, he says, far too ambitiously if you so may, it's not too late to invest in those actions as well as a strategy around prevention that speaks to that investment for cost benefit but doesn't necessarily pursue that as a rigorous academic source which is rather burdensome. So I hope that helps clarify some of those past points. That's great. Thank you very much, John. Thank you very much for coming again and for this very impassioned, again, and very informative presentation. Some really interesting points you pull out there around the focus of resources on most in need and, again, the cost benefit, again, something which I know is very, very close to all of us here at the IJB. So really, really useful food for thought. I would like to open it up for questions at this stage, if there's any questions for John. Vicky, please. Thank you, John. I appreciate what you said and I agree with all that you said. Something that is really difficult to capture is prevention, obviously, and a way to do that would be through more narrative case study capturing of people's experiences. Is that something you think could be built into your suggestions there and how we could maybe capture people's stories and use that as analysis? Yeah, absolutely. I think you're right, but I came from myself doing a lot of scientific work for a long time and I'm conscious that there's a group of people, including probably people in the room, where the suggestion of it being anecdotal data around case studies is a problem. But I think if instead we say we need to put a real narrative on what we're talking about, to make it real for people, it changes it. If you'll permit me a 30-second example of that. Alan is a guy who we started working with recently where he'd had a heart attack. Actually, sorry, it wasn't recently, about 18 months ago. He had a heart attack and he came in and was -- you know when you just look at someone, and this is what I mean by it's hard to make this scientific. He looked deeply unwell. He was struggling to stand. His whole demeanour was upset. There was more than just he'd had a heart attack and lost his job because of it and all this stuff. He was caring for two disabled people in his family. He was in the 2% poor st households in the whole of the UK when we met him. We had to work with everyone, including his kids, individually to work out what was going on. We had to work around his housing, his health, his mental health, his employment status, his benefits he wasn't getting. So his income went up about £30,000 over a year in terms of how we managed to get it. He got a new home. But his demeanour -- and if you're someone sitting in the room thinking there's something about, oh, no, we actually need more facts and stats and things, his demeanour is what changes and when you're at the front line and you see that Alan came in more recently and his shoulders are lifted, there's more that the front line team -- I'm taking no credit for this myself. It's entirely up front line workers. There's more that they did for his health and his family's health, including the two disabled people in his household, than any health intervention. It was only based on trying to have a relationship with him and trying to discuss things with him and knowing that he was the sort of person who faces health inequity so it was worth our while to double down on that. I think there's stuff in the narrative that says, yeah, we could say that was a five pounds out for every one pound spent or something, but doesn't quite capture that. So I think there's something around what you're saying, Vicky, about how we capture a narrative and use that to make change happen. Thank you. Thank you very much. Are there any other questions? I can see none. So with that, thank you very much. Okay. So item 3.2 is a deputation submitted on behalf of Unite Edinburgh not-for-profit branch. This is in relation to items 6.1, 7.1 and 7.3. And we have Des Renee and Emily Donnelly speaking to this item. Thank you very much, chair. I wish to thank the board for agreeing to hear our deputation today. Deputation consists of myself, Des Lockley, who is secretary of Unite Edinburgh not-for-profit branch and Emily Donnelly who is our new development worker. I will be speaking today. I'll comment on information in terms of 6.1, 6.3 and 7.1. I also wish to let you know that with Edinburgh Council, we are organizing a conference to discuss EIJB matters on Saturday, the 14th of September, 2024. It will be held in the St Augustine's Church premises on George 4th bridge. In reading the papers, we are aware that services are in a crisis. EIJB has reduced its expenditure by 56.5 million in 2024-25. We are looking for information to allow us to lobby politicians for better funding. We want to build an alternative case to put to politicians, particularly as it seems there will be a change of government at UK level. Comments I wish to make mostly takes the form of questions. We are looking for more information. In the papers, there is information that I have not come across before and it is new to me, both as a trading official and it will be new to my members. In report 6.1, power 5, it is said, and I quote, data also shows a high burden for mental health in the working age population. I was surprised to see that acknowledged and I wondered on what data it is based. What are the implications for present and future services as the problem is getting worse? Many of my branch members provide support for working age people with mental health conditions and that includes myself. My actual job is to work as a case worker for a project that is funded by the loading health and by city council. I have been working as a case worker since 2004 and I deal with this very field. That is part of my work. So I am really interested in what the board is thinking about when it comes to the future of these services. We are aware that the Scottish government has been making more money available for comprehensive work, that is supporting clients who are in difficult or stressful situations in order for them not to develop mental health conditions. So it seems to be prioritised this type of work and we are really curious about where the EIJ think we should be going. Stress at work is a big issue for trade unions and it is a conference as the report recently stated in society's toleration of precarious working. We welcome more information on the future that is increasingly placed on the health and social care services. I have noted in the report the references to the independent sector which I assume is a term that covers the third not-for-profit sector and the private for-profit sector. I would question whether the term should be used as the sub-sectors are possibly very different in costs and quality. I was surprised to read about the closure and circumstances of the Brains Hills home. As a trade union official I am sure that Bupa were planning this closure a long time before they gave notice to the EIJB officials. I think a flaw has been exposed in using the private sector. It shows that the EIJB and the services it provides is vulnerable to some decisions with financial consequences for the EIJB. I think, you probably contradict me, but the current high use of the private sector has a possibility of derailing EIJB plans. I seem to be reading the papers that after decades of encouraging the private sector, because it was supposed to be more efficient, is now realized that it is more costly than the public and third sector services. My understanding from reading parts of 6.3 is that investments in public sector care homes and care at home increase the savings by reduced burden on hospital provision. This type of investment also reduces the need for more expensive private sector provision. The state of 6.3, the Edinburgh, requires a new care home every year for the next 20 years as part of meeting the demand to deal with dementia. To achieve this will be a big challenge for the public sector, but in terms of modern buildings and staffing. The paper is unclear about how the challenges might be met and if the third sector and the private sector have a role. I hope that officials do not envision a role for the private sector as that will increase the financial costs and make it more difficult to achieve. I would like to know if planning for the provision of the new homes has started. Finally, as mentioned in previous invitations, we in conjunction with the Edinburgh Children's Council and community organisations are going ahead with the conference EIJB issues. It will take place on the Saturday mentioned before between 9.30am and 2pm. We are thinking of two penry sessions separated by workshops. The first penry session will hear information on the impact to date of the EIJB cuts on trade unions, community health projects and GPs. The second penry session will discuss the way forward in terms of changes in strategic direction and lobbying policies for money and resources. We then from this conference hope to establish a coordinated Edinburgh-wide lobbying network. Thanks for listening to me. I'll be happy to try and answer any questions. Thank you very much, Des. As usual, there is a lot in your deputation. Again, you have touched on lots of really important concepts there, mixed between private and public and, again, the use of resources, strategic direction. So lots of really, really relevant and salient points that hopefully we will touch on in our discussions as we go through substantive agenda items so that I'm sure we'll give all members sort of food for thought. I really appreciate that. At this stage, can I ask if there are any questions for Des? Tim, please. Thank you, Des. Interesting and thoughtful as always. One of the points you made there I agree with, which is the way that we here refer to the non-council provision, if I can put it that way, as the independent sector, which I think obscures the fact that there is variety within the non-council provision amongst, you know, between private providers, not-for-profit sector, the members that you represent. I just wondered, you know, from the experiences of your members, I'm sure there are very distinct differences between working conditions, terms and conditions within the private market provision, as opposed to your members working in the not-for-profit. I wonder if you could say a bit about the distinctions between those two sectors from your perspective. Yes. We have members who work for employees such as the Action Group, Penumbra, Arc Housing, Health in Mind, Cargom and others. And the first of all is that they're employed in better terms and conditions than in the private sector. And secondly is that from talking to our members who have sometimes worked in the private sector and have come back to work in the voluntary sector, in the third sector, we found out that the standards or quality standards are higher in the third sector, and we found that the general, not just wages, but general terms and conditions are better, and all around there's a quality service that also involves more people from the community as volunteers and also as greater involvement of users. So I've never been involved in a professional assessment of the differences between the two, and I notice that was touched on in the papers that there is going to be an assessment based on cost, mostly, but I think there's going to be an actual, in-detail assessment, which I think is a really good thing to take place. For our members of our real advantage in working in the third sector, to be honest, they all prefer to work for the public sector because the standards in Council run services far higher than even the third sector. Okay. Thank you very much for that, Des. Are there any other questions? Des, just now. No, thank you. Well, in that case, no further questions. Thank you so much. And again, I would like you to be assured that the questions, the points that you raise are incredibly important to us, and that's definitely something that we will be looking to, including any vulnerabilities in the private sector as well, so that is definitely a risk that we are aware of, and as I say, I do expect some more fulsome discussion once we get to substantive agenda items. Thank you. Okay, so the next item is Item 4.1, which is the minute of the Edinburgh Integration Joint Board of the 22nd of April, 2024, and this is submitted for approval as a correct record. Are members content to approve it as an accurate record? Robin. I haven't planned to hyphenate my name, but Robin Balfour-McRae does sound very glamorous, but I think it might be Robin Balfour and Jackie McRae. Good spot, Robin, thank you. Other than the hyphenation, I can see no further objections to the minute as an accurate record, so thank you for that. Okay, so Item 5.1 is the Rolling Actions Log. We have Item 1 -- sorry, we have four actions recommended for closure, those being Item 1.2, Item 4, Item 5 and Item

1. The board are asked to note the remaining outstanding actions. Thank you very much, Andrew. Is everybody content with the proposals around the action closure? Fantastic. Oh, thank you. Elizabeth, thank you. I am content with that, but I had a question about a further item on the Rolling Actions Log, Item 3, so I don't know if anyone else is coming in on the closures first, but it was just -- well, we're asking about this just to point out that question. Thanks. Thank you, Elizabeth. I think there's nobody else coming in on the action closures, so please go ahead with your point. Thank you. I just wanted to ask a question for Moira, please. Just on the Item 3, with a further update about the appointment of the chief risk officer, I imagine that everybody is feeling the same frustration as I am about how long things are taking, because I think we're now 14 or 15 months since the IGB agreed to appoint a chief risk officer, and I'm just wondering, do we have any indication of the likely timeline now following this latest hurdle? Thank you. So, just for completeness, the latest hurdle is that we have to get this job graded by both Council and NHS HR teams, and the NHS grading process is the thing that's holding us up now. The team who looked at the job description, which we submitted quite some months ago now, have fed back that they're unable to match the job to a grade, just because of its unusual nature. We're talking to the team about how we might address that. The original suggestion was that we had to complete a very, very detailed 40-page assessment, but Helen Fitzgerald and Angela have been working with the HR team to see if there's anything that we can do that maybe doesn't necessitate quite so much information. So, at the moment, I'm afraid it's very much in the hands of that grading team, but we are looking at some alternatives, because I appreciate the frustration. Thank you for that, Moira. Thank you for the question, Elizabeth. So, is that satisfactory, Elizabeth? I mean, it's not, obviously. It's not satisfactory as such, but thank you, Moira, for the explanation. That's very clear. Thank you. Okay. Thank you very much for that. Right. Okay. So, we're also, obviously, being asked to note the remaining outstanding actions. I know there are some that are not yet due. I mean, in fact, the ones that are outstanding are not yet due. So, again, are members content to note the outstanding actions? Yeah. And, again, I see no projections. So, I think that concludes this item. Thank you. Okay. So, the next item is Item 5.2, the annual cycle of business. And can I ask members have any questions on this item? No questions, it seems. Okay. Okay. So, that takes us to Item 6.1, a strengthened approach to prevention across the Lothian health and care system. And we have Ashley Goodfellow and Flora Ogilvie speaking to this report. Actually, before I just open it up to Ashley and Flora, just a quick note to say, I don't know if members have noticed, there have been, I believe, some of the appendices did not go out with the papers. So, what I was proposing to do, we have located the appendices and they have just been circulated to members. Obviously, I can't expect you to have the right level of conversation without having seen the appendices. What I was going to suggest is to maybe push this agenda item to the end of the agenda. We will have a break as well. So, that might give members a chance to glance at the appendices. Or, alternatively, we could move it to the next EIGB. I mean, my preference would be to cover it today if at all possible, but I do apologize. And I absolutely appreciate that it is difficult to fully have a discussion around something where maybe you haven't quite seen all the appendices, but they should be in your inboxes now. R, can I just take a temperature check? And I do apologize to Ashley, who seems to be so poised, ready to cover the item. But, you know, I am mindful of sort of the glitch with the papers. So, our members contend to maybe take it at the end of the session. We will give you a break. I'm afraid you might have to choose between lunch and the papers. I don't want to be flippant about this, but I am quite keen to cover it today if possible. Are members content with that approach, or would you prefer to push it? Oh, gosh. Right. I would suggest we take it at the end of the session. Is that okay? We'll try. We'll see if we can have a good discussion. I know, Ashley, obviously, you will be introducing the paper, et cetera. So I'm sure we will have the right level of debate. So I do apologize. I hope that that works with your timetable as well. Yeah? Okay. Thank you so much. And I do apologize for kind of changing it at the last minute. It's literally just having realized that members did not have all the papers available to them. I am mindful of your time. I'm very, very mindful of your time. If you feel like you would like to use your time this morning in a different way, I absolutely understand that. I think we will probably -- it would be good to have you back with us at one at the latest, I think. Sorry, Vicky? Yeah, absolutely, you could also dial in. Absolutely, Vicky, that's an incredibly sensible suggestion. I do apologize for this last-minute rejig. Perfect. That's great. Thank you so much. Thank you. Phil, you've got a suggestion. Well, probably not, Katharina, and I appreciate that you're trying to schedule it. I will need to leave meeting at 2 o'clock. If I can make one quick point around the -- I think the cover paper as well. It's just about the executive summary and the recommendations for the paper, and we are going to discuss it in detail later on. But I'm not sure it's entirely helpful to us where the recommendations piece of the cover paper points into the paper itself. It might be more useful to have the recommendations actually in the cover paper, especially in circumstances such as these, where if we don't see the arch appendices containing the recommendations, and also the executive summary, it would be quite useful if the executive summary just gave a summary of the paper. This one seems to give us a wee bit of the background to the exercise at hand. Thank you. Okay. Thank you. Thank you, Phil. I hope we'll still have you with us, and if you need to leave by 2, I'm sure we'll still have you with us when we cover this paper. But, yeah, thank you very much. Okay. Thank you. Andrew. Okay. So next item is item 6.2, the draft strategic plan and formal consultation period, and we have Linda Ervin Fitzpatrick speaking to this report. Hello. I wasn't sure if you wanted to introduce it, Pat. Do you want me just to go? Okay. So thank you, and hopefully people will have had a chance to read the draft strategic plan. We've done quite a bit of work on this probably since we last discussed it at the IJB. We've had a few events with our strategic planning committee, and I think what we're asking for today is your approval to publish a draft strategic plan for the formal period of consultation, which will be a three-month period from the 1st of July through to the end of September, and really take an advantage during that time of having our ongoing dialogue, that we've done a lot of dialogue over the last few years to get to this place, but using events such as Des was describing, the event on the 14th of September, for example, to really engage with our community members, with our staff members, and with our wider partners across the independent and the third sector. Thank you very much for this. Linda, obviously this is a critical document for us, something that sets out the strategic direction, which is at the core of the responsibilities of an integration joint board as well, so really, really important for us. And, yeah, I think we all did have a chance to review. We understand what the requirements are. I would really like to open it up to discussion and see what questions, comments, observations members will have on this. I see, Pete, you were first. Thank you. Yeah, thank you. A really impressive document overall, thank you. In reading it, there were a few places where I thought, well, we could word this differently, you know, that kind of feeling. And I suppose my general question then is, would it be appropriate or would it just delay things further to take minor amendments, so that I'm not suggesting I can do that. I mean, others may have ideas as well. Just to bring clarity or I suppose I was thinking the alternative would be you do the consultation and then you tidy it up afterwards. So I'm not making this specifically, but just to say that there were a few places where I thought, I think I know what you mean. I don't know if anybody else will or whether it will be generally understood what the message is. So I'll pause at that point. I'm really happy to take any other comments and any points that I think make this as clear a document as possible would be really welcomed. So we've got to the, if everything's agreeable today, we've got to the 1st of July to make changes, so I can work on this this week. So if people can come back quite quickly, that would be great. Sorry if I can come back. Unfortunately, I'm going on holiday. Well, it's fortunate for me. I'm going on holiday for this week, but if I send in hopefully helpful comments towards the beginning of next week, would that be useful? Yeah, that's fine, Peter. Thanks. Thank you, Peter. Thank you. Thank you, Linda. Okay, I've got, thank you for that. I've got Elizabeth down next. Thank you. Thanks very much to everybody who's been working on this document. I can see that a huge amount of work has gone into it. I just had a few questions. I do have some similar points to Pete, so I think it's better that I just similarly to him take it offline and send an email about a couple of the way things are worded that I had queries about. And I also had a few questions about where specific challenges are raised and how we will know if our initiatives are working. And I wondered if some of those may be needed to be slightly elaborated on and just to provide extra clarity. With regard to the national policies, strategies and frameworks and plans and so on that have been taken into account. I just wondered when there was a previous stage of this planning, like when Tony Duncan was involved, there was quite a lot of discussion about women's health. And I noticed that the Scottish government's women's health plan isn't referenced as one of the plans, and I wondered whether it would be appropriate to put that in amongst the list of things that have been taken into account and indeed make sure that we have fully taken that into account in the plan. And perhaps it's already been done. It's just not listed or perhaps there's a reason for it not being listed, but I just wanted to raise that. I also wanted to refer to the promise. So a promise is listed as one of the things that has been taken into account, and I think it's in the impact assessment at the end, but there isn't detail about the promise in the body of the plan, and I wondered whether perhaps something about that should also be added in. Thank you. Thank you, Elizabeth. And yes, I think absolutely all comments will be very welcome in offline format. Could somebody please come back to Elizabeth on the additional points that you referenced? With regard to the promise, I think that's a really key point, so we will have a look through and make sure that is referenced and that is included in there, Elizabeth. And the women's plan, women's health plan? Thank you. Thank you, Liz, for the comments. Yes, we will include the women's health plan, and thanks for highlighting that. We will incorporate that. And the wider discussion, I think your first point that you were asking is really just about the oversight and when and how we'll know if we're delivering on the four key strategic priorities. In response to that, I would say the principal group here is the strategic planning group for the IGB that will have the oversight of that. What will come forward is the development of four principal work streams aligned to each of the strategic priorities to make sure that we're delivering on all of that, so all of that will be fed back and it will be routinely fed in to the IGB. In addition to that, we are revising our performance reporting as well and having much more of an alignment, if you like, to the delegated services more specifically, and so there will be some differences in how we actually report on those as well. There's a number of other key strategic plans that will align to this as well, not least the IGB workforce plan as well, so that's subject to ongoing review as well, but it will all feed in to what are the proposed four key strategic priorities. Thanks. Thank you for that, Pat. Elizabeth, you've still got your hand up. Do you want to come back in? Sorry, I just had one more point I forgot to make. That was in relation to references to primary care, and I just wondered if we perhaps need to make reference to the multidisciplinary approach that's being very much embraced to try and help with the pressures on the system at the moment, because I think at the moment it just focuses on GP, but actually, of course, it's much wider than that, so I thought perhaps there's a big focus in Edinburgh at the moment, so I wondered if that should be reflected as well. Thank you. Oh, sorry, thank you, Elizabeth, that's really helpful. Okay, Phil, you have been very patient, please. Thank you very much indeed. Yes, I think it's a really good document and very comprehensive. Like colleagues inevitably with a document of this size, we can all spot a typo here and there, so I'll also feed in one or two typos I've spotted offline. I've got two or three other points I'd like to make. I'm using page – the page references I'm using are the meeting documents, just so that my notes are kind of the concurrence. So on page 46, meeting document, page reference, but in this document under table one, we do talk about reframing the narrative, and I quite like that. It's kind of transforming the narrative, and I think that tone helps move things forward in difficult circumstances. And under page 48, understanding what we do and deliver, going to page 51, again, we talk about transformative change. I think these are very useful directions, and I just wondered whether we might capture – there's a bit of that in the forward, but I wondered whether we might just capture a bit more about transformative moves in the forward, because we know that, given what's facing us, we are going to have to do things in different ways, and I think that would be quite useful to shine a bit more light on that. At page 55, under local and national inferences, there's a reference to the National Care Service, and to be honest with you, I couldn't quite remember what the status of that was, so that was just a question as to whether that's proceeding apace or whether, in the light of what we've seen recently, there's a pause around that. I think I've got one more point. On page 81, again, that's the meeting page reference under protecting the most vulnerable. There are pieces in this very good document about helping people into employment, and I wonder whether we might look at a little bit more of that, because we understand, don't we, in great detail, the benefits of helping people into employment, and I think we do talk about helping people into employment as part of the HSCP, but I wonder whether consideration they'd be giving to helping people into employment beyond the HSCP. That might be done already. I might have missed it, but that's just a question I'd like to leave. And finally, there's a piece at the end under managing the resources about innovation and digital, and I'm very keen to see that as well. So, good paper. I enjoyed it, and thank you very much. Okay. Thank you. Thank you very much, Phil, for these comments. Who would like to have a go? Thank you. I'll start, and maybe Linda can come in. Thanks very much, Phil. Genuinely appreciated. The first point about TYPO, absolutely spot on. I went through this report yesterday, and I noticed a couple of TYPOs as well. So, it just feels like this is a report that's been through so many different iterations. When I came into post in November, it was in its seventh draft, and it's really, really changed since. So, sometimes it feels like you're going to – you can't see the wood for the trees sometimes when you're going through it. So, yeah, I appreciate that. And any comments in the TYPOs? Yeah. A couple of other points, just to respond to the table that you had described in page 46. This is an example of where we are proposing to be going in relation to a strengths-based approach. The comments that you'll see within the report, there's an awful lot more work to do around how we maximize independence for individuals and support people within a community and strengthening that. And an awful lot of that will be led through the redesign of the front door. So, the report's not that explicit in relation to it, because we're on a journey and we're still starting. But as we transition through the strategy, hopefully we'll see an awful lot more of that. The comment in relation to supporting our most vulnerable and in the employment market, we're conscious that we will need to make that more robust as we move forward. This is a big challenge for us, not least in offering any opportunities we have within the HACP itself. As I've highlighted within the report, we are a workforce of 5,000 after all, so there are areas that we can do more of there. But if you look at the key delegated services, principally mental health, addiction, how do we support people closer to the employment market will remain one of the challenges for the IGB strategy. And the last point around digital and digital innovation, again, we are revising our system at the moment. We are hopeful that that will be in place within the timescales that's been proposed. And again, the redesign of the front door will play into that as well. Thank you very much. Thank you, Phil. Thank you, Pat. That's really helpful. I had Vicky or Rose, did you want to come in just on some of this specifically as well? Just to give you. Yeah, just very quickly, I just wanted to say in terms of it being really positive in terms of strengths-based work and what Pat was mentioning there in terms of the front door work and that becoming, picking up more early intervention and support there. And I just think, and I can pick this up with Linda offline in terms of making sure that we are checking in terms of the government direction regarding GIRFE, which, you know, fits alongside strengths-based practice and just making sure that we, you know, it's an opportunity to look at those messages there and whether we can include them at this stage. Thank you. Thank you, Rose. That's really helpful. Okay. I see Linda nodding. That's good. Okay. Vicky, please. Thank you. Thanks for this report. It's a lot of wonderful stuff and a couple of typos that I noticed as well, which I'll email over to Linda. My question is about people living with a learning disability and how we will convey this information to them and what your plans are around that. I know that in 2016, we made the very first strategic plan easy read and had an event for individuals who were used to, before that, having a strategic plan that laid out exactly the spending that would be spent in that service area and on which on residential services, on day services, on respite, for example. I think there is a group of people there who, with all the strength-based work in the world, are not going to be able to live without long-term services. So it's important to try and take that group of people with us where possible. So I'm happy to sort of talk to you about what we did in the past to speak with that group. Thank you. Thank you very much, Vicki. Linda, would you like to comment? Yeah, that would be really helpful, Vicki. I think what we've got the real opportunity to do over the next three months is really engage with lots of different communities of interest, communities of identity, communities of locality, and people who do have specific needs. And we're also looking at how we translate this into an easier-to-read document as well, so it's more accessible to community members as well. And, again, just to highlight the plan on the page where we set out a number of different delivery plans that will support the strategic aspirations. Okay. Thank you very much for that. I had Eugene who wanted to come in. Thanks. I felt it was an extremely impressive document, took quite a lot of reading to get right through it, and covered a whole lot of bases. And I make this comment with some trepidation, because it's been a very sort of immediate reaction that we're leading on the have more good days as the sort of phrase. And the document includes all sorts of reframing the narrative and positive transformation. And to my mind, more good days is implying we're all in the doldrums, and we're trying to grab our way out of it. And I'm not sure that all this fantastic work that's in there is being appropriately captured by that phrase. No, I'm not sure what the basis or how that was established, but that has been my reaction to the document. Thank you. Thank you for that feedback, Eugene. It's really, really good to hear your perspective. And I think it does resonate a little bit with something which was being said earlier, some of the deputations as well, a little bit around what does it actually mean, good days. And I know, again, I probably should have said that this document obviously has been discussed at the Strategic Planning Group as well under Tim's incredibly keepable leadership. So there has been a fair bit of governance around this phrase, and I know that we have had the benefit of kind of it being explained to us as well in terms of what does it mean. But if it doesn't translate, does it help or hinder us effectively, I suppose is the question with that catch phrase. We have the benefit of having it explained to us, but this is obviously going to be a public-facing document much broader than just us internally. So what does it mean? I don't know. That's a big one. It's a big one. I can see why you said you had some trepidation kind of making the comment. Pat or Linda, do you have any views? Yeah, Linda. Yeah. I think what is important to reflect on that we have had a long dialogue on this right back to the beginning of COVID where part of I interviewed 21 city leaders at that time to think about how we were thinking about health and care at a time when the whole world was thinking about what does health and care mean in the light of a pandemic. We also followed that up with focus groups of staff and with community members, and I just did an event last Thursday with over 100 stakeholders where people were saying back to me, well, we just want to have more good days. We just want to make sure that we are not losing the poverty of -- we're thinking about the aspiration of hope and that we have aspiration for our citizens. So it was really interesting just how the phrase has become owned by people, and I think it really translates things like getting it right for everyone that Rose mentioned or strength-based practice, because the way I always like to explain it is my good day could look a lot different to your good day, and if I had an accident or an illness tomorrow, my good day would look a lot different, but it doesn't mean I can't have a good day. So it just brings it back to people's individuality and the whole thing around people's -- playing to people's strengths rather than deficits. Does that make sense? No, thank you very much, Linda, again, for just kind of summarizing this and actually providing the context around the fact that it has been tested, and as you say, it's really interesting that people are kind of giving it back, are reflecting it back to us as well. So I hope, Eugene, that gives you some degree of assurance that it has been road tested with users. So thank you for that, but really, really interesting. I'm really glad that we've had an opportunity to discuss this now as well. Thank you. I think I had Helen down next, and then I think Pete, do you want to come back in? Thanks, Chair, and thank you for the report. It's really interesting reading, and I've obviously seen it quite a few times, but I wanted to specifically reference the workforce section, and in our previous strategy, we struggled to support the workforce strategy because of financial challenges we had and providing staff to actually support how we do that. So I'm looking for a commitment that we would actually want to have our staff -- I'm going to quote feel inspired, valued, supported and equipped to do their job, that we would actually do that this time. Thank you. Thank you, Helen. I'll come back to Helen's point. I completely agree. Absolutely. This is an opportunity. There's an opportunity to live it on that. It's an opportunity to live it on the workforce strategic plan as well. There's been numerous discussions about that very recently, and as a starting point, we have a fairly reflective report, which compares '22, '23, '23, '24, about where we are with the wider recruitment, retention, attrition rate, looking at all of this and making sure that the workforce feel well and truly supported moving forward. I should say that at this point, having recently discussed this at the workforce board, the figures that we had for '23, '24, were more favourable than '22, '23, by way of a reflection on how we've engaged with the workforce and how we're -- and our recruitment arrangements as well, but still in particular areas, an awful lot still to do. So it will be -- it is right and proper that it is one of the strategic priorities within this document and it will be a real key focus for us. Thank you. Thank you both. Pete, please. Yes, just a few points. I think it's worth saying because you may be able to deal with them now, as it were. And I'm not -- some of my points might be buried in this document. It's a long document and sometimes it's difficult to remember whether it's already been covered earlier on in the report when you're reading it just once, if you like, which is all the opportunity. But a few things that I thought didn't -- certainly in my recall of it, didn't come over as being in the document. I'm not suggesting it needs to be even bigger, but even stronger references. One is primary care. We have responsibility, or A, shared responsibility with Lothian Health Board for primary care, and there's very little direct reference to that. Now, that may be because things are stable and we don't want to go there too much. But I mean, I just felt that to illustrate the breadth of responsibility that the partnership and the IJB has, it didn't really come over as a strong issue. There's even a section in there about primary care. I think if there isn't one already, I apologize if there is. The second thing was demographic change. Now, I know you do reference that throughout it, but if we jump on to the third paper, the third big paper on older people services, we have, if you like, an advanced site of projections of need for care homes based on the modeling work that's been done, and it's a bit scary. It's not surprising, in a sense, if you take a step back, but it's whether the reference to the potential impact, or is it because it's a three-year report or strategy that perhaps we don't need to concern ourselves too much about the effect of demographic change on how we deliver. The other point is the whole system that we have response, I think this was raised by the Director of Planning for the NHS, the whole system itself is part of our responsibility as well, so that includes the hospital sector, emergency admissions into hospital, for example, and delayed discharges. It's whether we've kind of referenced the system aspects of the responsibility of the IJB in it as well, strong enough. And there are, in your list of challenges, I'm absolutely sure that you've made references, just whether it can maybe just be beefed up a little bit more. And my last point, I promise, is I see very little reference, there is reference to telecare in it, but in previous meetings we've been at, we've talked about investing in telecare and seeing it as part of the solution, but there's very little reference, even though we do talk about technology. I think there's a couple of places it's mentioned, but no more than that, and whether in fact that's because we've, if you like, taken it off as not seen as such a high profile part of the solution going forward. So I'll stop there, sorry, that's a lot. Thank you very much, Pete. Who would like to come in and provide a response to Pete on the points that he's raised? Linda? I think there's reference to the recent report around the change in demographics that NHS building have been doing. Around about page 51, we've been added in a few more challenges there around the need to provide more support for people to enable them to stay at home, to enable maximized independence, but also to think about future care home provision, and also I think the expansion of primary care and multi-professional teams, as Elizabeth's comment earlier, so I think there is some of that beginning to be reflected in the challenges, but I guess some of that will be picked up more directly in the delivery plans that will underpin this. And the digital data digital, my colleague Hannah is leading the session tomorrow, so she maybe wants to come in here. Yeah, it was just to say that we're just in the real process of working up a digital and data strategy at this present time, so it's quite likely that just at the timing of that, we're actually doing a large workshop tomorrow where we're inviting people to contribute and start to shape that strategy, that it's likely that we will slightly amend the wording in the strategy before the point where Linda has said before the 1st of July, so it's very likely that that wording and the use of technology and data and digital as enablers will be enhanced in the wording. So hopefully that will meet your expectations a little more. Thank you. Thank you very much for that. Really helpful. Pete, does that help to address your points? I was looking for reassurance on the primary care side. Is there anything else we could say, given the important role that primary care plays? I can look at that, but there are certain challenges in there where we have talked about the importance of being really data-led by the information that primary care have, so particularly when we're looking at addressing the inverse care law or we're looking at actually how do we do proportional universalism and understanding what the patterns of primary care are for referral into secondary care and acute care in particular, so are we picking up people early enough, are we doing screening enough for people who may be at risk of cancer or other heart disease, all of the more acute illnesses that we know kill people earlier. So actually I think that population-led data, and maybe that will come up more when Flora and Ashley join the conversation, because we've taken a lot from that prevention bit as well around reducing delay and woven it into the strategy, so hopefully we can strengthen that a bit more, but I'll certainly look at that. Elizabeth's point earlier on as well, I just wonder whether there's any scope for mentioning the integration of pharmacies and general practice and other services and how to see that in a certainly more integrated way to provide wider care. I'm sure the IJB has got an important role in overseeing those things as well as the board, the Australian Health Board as well. I see Linda nodding. Thanks very much Peter, I'm just in a kind of wider response. The HICP has a plan session on integration and how we move forward as an integrated structure. I think there's an awful lot of learning and reflection that we had across all of Scotland. Where does Edinburgh, for example, sit within that and how do we move forward in a way that takes full advantage of an integrated construct. So there are, as you could well imagine, we're a big, big workforce, we have a different interpretation, the interpretation is fairly broad, we want to come to a more consensus about what is the art of the possible as an integrated structure across such a big workforce. So that will be part of this as we move forward. A couple of other sort of fairly minor points, but just to respond Peter, you'd highlighted around the demographics, there is a piece of work that we are in the process of undertaking just now. It will likely be a longer term piece of work, I can't imagine it being completed any time too soon. But what we have started to do is by way of future proofing is to look at the costs associated with this demographic growth and looking at our statutory costs as we move forward and what that will look like. And of course the paper that we're going to talk about later on today is part of that, is part of the Older People Pathway. But what we are looking at just now is the wider context of policy change since 2016, for example, and how that has played in to where the IGB currently sits just now and where we are projected to be going and what that will look like by way of cost. And the last thing to say, which is perhaps the most obvious one, is that this is a strategic plan that's been through, as I said earlier, many different iterations, but a large part of the success of this will undoubtedly be predicated on where we are with regards to our financial stability. It's just to put that out there in terms of that noted caution and will be required to be resilient as we move forward and the strategic priorities will remain in sharp focus, but as I said, they will be dependent on about where we are financially. Okay. Thank you. Thank you, Pat. Claire, I saw you had your hand up earlier. Did you want to come in? I was swithering, if I'm honest, because I'm full of the cold and I had a thought and I thought, oh, maybe I'll share it and ask a question. I thought, I don't know if my brain is straight enough, so forgive me if my brain isn't straight enough to ask a question and make any sense. I'm really sorry. I've not had as much time to do this as I might have liked, so apologies if this is not awfully sensible, but what I was thinking about on the back of some of the other contributions was I could see that we've got quite a few emerging strategic themes going on, which are not yet included in this, and I don't know what the scope is that when we finalise the strategy after the public consultation, we might begin to bring some of those in. So I'm thinking about the paper that we had at 6.1 that we're going to look at later on in the meeting, for example, and to what extent can we bring in other things as we get to the point where we finalise the strategy after we have public consultation discussions. Thank you for that, Claire. Yeah, it's a really useful reflection, I think, on some of the discussion we had today. I get a sense that a lot of the comments today were around maybe drawing out some themes in a slightly more sort of not concise, what's the term, I'm lacking the word now, but to me it's just about making sure that the themes are very, very clear in the document. I think what I've been hearing is that there is a lot in the document, as Pat says, it's been through a number of drafts, and I think some of the things that people have been bringing up is they are in the document, but it's just about strengthening how they're articulated. So I didn't necessarily feel that there was massive gaps as such, but it's just about, okay, this is important, this is important, this is important. Because from my perspective, I'm thinking, so this is a document that we're being asked to do, and sorry, Phil, I'll bring you in in a second, but I'm just going to finish my train of thought. So we recommended to agree the draft strategic plan that can be issued for public consultation. Again, we heard that obviously the caveats to that are that people will be feeding in comments offline and whether it's type of stylistic things, and exactly maybe those points where maybe some additional clarity would be beneficial. So I think that's almost the caveat that sits around this recommendation, and the other one is agree the formal public consultation will commence on the 1st of July. So those two things that I suppose we're being asked to make a decision on today. And what I'm trying, and I haven't necessarily heard enough kind of concerns to say, no, we're not happy to agree the draft strategic plan, because it feels like if anything it's quite comprehensive, and it's just about making sure that the key themes are just really, really explicit and not being lost amongst all the other good stuff that's in there. So for me it's more a bit of an editing kind of thing, rather than we need to include and rewrite and whatever. That certainly is the consensus, and I can see nodding in the room. But I'm going to bring in Phil, and Tim, you want to come in as well. So Phil, please. Yeah, thank you, Jo. I mean, I'd agree with that and what previous speakers have said, and I think it's quite notable that the plan itself does complain the contain the strategy on a page or plan on a page. Flowing on from that, it highlights the four priorities and then talks about the delivery plans which will flow from this document. And I think many of us will look forward to that part, because that's kind of where the things that, if you like, get translated into real actions, because this is an overarching strategy document which gives rise to those implementation plans or delivery plans eventually. So I agree with what you and what Claire said beforehand. Okay, thank you. That's really helpful. And Tim? Yeah, just as Chair of the Strategic Planning Group, where we've seen the many versions of the strategy over quite a long time, I just wanted to sort of speak on behalf of the staff who are involved in this process. Linda is leading this process now and has inherited it from others, actually. But the comments we're hearing this morning are extremely valuable, and I know Linda is taking them all on, nodding, taking notes, and will incorporate them. But just to say that what we want to get to is a version that we are content to go out to public consultation with, and then we would hope for, we would expect and hope for, a significant response in that regard of ways in which we can make the document even better and land better for us as a public-facing document. But I also want to comment on, through the various iterations that we've had, the strategy document has grown and shrank and grown and shrank and grown and shrank so many times, as we say, we need it to be a comprehensive document that reflects all aspects of the IGB, and they say, oh, no, we need it to be an accessible document that people can -- so I just want to say we've been around the cycle so many times, and at some point we have to say, right, stop, this is the strategy. But all the comments are helpful and welcome, and Linda is obviously taking them all on board. Thank you. Thank you, Tim. That's really helpful to get your perspective as the chair of the strategic planning group. Really helpful. Okay. Right. I see no further comments on this, but I think we've had some really good debate here. I think just a couple of points for me to add. I know also obviously in developing the plan there's been liaison with our colleagues from NHS Lothian planning departments from the Health Board, and I know that some of the kind of comments that have been made is around potentially a reference in terms of some of the measures that the IGB needs to meet, as well as potentially, again, a strengthening of focus on some of the planning and commissioning that doesn't sit with the partnership but kind of sits within the set-aside business. And I know that dialogue is ongoing and that you're liaising with Colin Briggs on that as well, so again, there's no concerns there from the NHS Lothian's perspective, which is really good as well. I think if I can just kind of, as I say, I've already delivered a summary just before that, but I think everybody is in agreement. I see no dissent that we have a starting point, and that's exactly what it is, and that we can agree that the draft strategic plan can be issued for public consultation. Again, obviously as the consultation process goes on, we expect there to be feedback, input and potentially further iteration, as is right and proper. So I think we're agreed that it's ready for public consultation, and are we agreed that for the formal public consultation to commence on the 1st of July? Again, I see no dissent, so thank you very much for that. It's great. Thank you, Linda. Thank you, Pat. Okay, so the next item is item 6.3, the Older People's Pathway update, and we have Pat Thoger and James Cuthbert speaking to this report. Thank you. Welcome, James. Pat, over to you. So I'm going to let James take us through the report. There's probably just two or three things, just by way of a fairly simple introduction in relation to this, and this has been a massive piece of work. I think that it's very well illustrated in the work that James has provided here today within the report. I think it's also safe to say that it's been a fairly complicated piece of work for a number of extremely valid reasons as well, and again, I think that it's well illustrated within the report. A few things from myself, the Liberton site was sold now almost two years ago exactly. There is a requirement for us to get off the site, and this is what's informed an awful lot of the discussion. The date of the end of March is not necessarily an arbitrary date in its entirety. The initial deadline for that, when I'd certainly come into post, was December, and then we had proposed to push it back a further three months to give ourselves some more time. So that's the explanation for it now sitting at the first of March, just simply put, the very last day of March to give us as much time as we possibly can, recognising how complicated this is. As James will take us through in the report, it is to a greater extent a re-usage of savings, is well articulated within this, and I appreciate there will be a lot of questions in relation to that. And a couple of just final kind of fairly minor points again from myself before we kick this off. The proposal that has been set out does have considerable benefit, and I'm just simply going to highlight just a couple of them just now. First of all, care homes currently operating at 60% really is not their most cost efficient way of operating a service. I think there would be an overwhelming consensus on that one. So this proposal seeks to address a large part of that. It will also provide people with an environment that is much more conducive to end-of-life care as well, as opposed to what we currently have at the moment and what people would tell us. And also it pushes us into the need for dementia pathway redesign in a way that we know has been lacking in the past. And just the last thing really to say in relation to this is this is an arrangement that's been set up, a report that has been set out, and I think James has made it really quite clear within the report, this is not by any stretch a perfect proposal. It certainly isn't. We have to acknowledge there's an element of risk associated with this. And again, as usual, in terms of the ask of the IGB, there's a certain risk tolerance to be considered as we move forward. And in the very final point I want to say is we have included a section within the report about the engagement thus far. We recognise there's still to be continual engagement in moving forward, not least with the workforce and those affected, and we will be engaging with all of those arrangements as we move forward. But I think it's also fair to say that this has been a project that has had a fairly high degree of uncertainty attached to it, and this is an opportunity now for us to genuinely move forward and make those necessary strides to make this difference. So thanks very much, and I'll pass over to James if that's okay. Thank you. It was a long enough report already, so I don't intend to give you a lengthy introduction, but because you haven't heard anything from the programme as a whole, the Old People's Pathway as a whole, since I was last here in February, and because even that report didn't really say very much about Liberton, I thought you were entitled to the history of Liberton in six chapters. And the reason for that is really in summary that we're trying to get non-acute hospital care into a smaller number of hospital beds than there are now. And the mitigation for that is to use beds in other kinds of settings, predominantly in the empty beds or the unused beds in Castle Green and North Merseyshire, but also in a smaller number of beds that we can buy dotted around the city for people in their last weeks of life. And that creates risk of one of two kinds, I think. I'm going to probably oversummarise here, but the original version of the plan had it that we would manage with less psychiatry of old age, HBCC beds, which would have put more pressure on an already pressed acute dementia pathway, starting in the acute hospitals and running all the way through to the care home sector. And that, combined with executing this with no additional money beyond the savings that accrue to the partnership from closing Liberton, created a risk that clinicians understandably worried about, especially with the plan, significant parts of it anyway, happening over the forthcoming autumn or winter. And so the second version of the plan doesn't eliminate the risk, but it moves it to a different pathway. It moves it to the pathway for frail older people and people who need inpatient rehabilitation services or rehabilitation of any kind. And the benefit of that plan, while by no means leaving the system without additional risk compared with its current status, is of a couple of kinds. The first is that it will be -- if there are additional delays that we can't mitigate in hospitals, they'll be of a different kind. It will be a different kind of inpatient. And there is also, because we will delay the plan to enhance the care home model in our own care homes, this enhanced service for people with more acute stress and distressed dementia, because we won't be doing that until we have dealt with the wider issues in the acute dementia pathway issues that weren't originally in the scope of this program. We do have some funding available further to mitigate the loss of those intermediate care inpatient beds. And there was no such funding available in the original version of the plan. Numerous people, after I sent the paper out, asked me for a tabular representation of the changes in the bed base in every effective setting, in every effective setting. Now, I apologize, I should really have put it in the paper in the first place, but I have prepared such a slide, if that would facilitate the discussion. I'm very happy to put it up on the screen or distribute it. But it's kind of the final reckoning, as it were, of the plan that's in the paper. Last point. The recommendation 1 mostly encapsulates this bit of the program that's about closing Liberty and compensating that by opening more care home beds. The other four recommendations are supposed to leave the unanswered questions that that program leaves, and to give you updates about the other four recommendations in the program, and not least, how the partnership, or how the city will get on the road toward filling this apparent, if the modeling is right, an impending gap of care home capacity over the next two decades. So while I expect Liberty will be a preoccupation to start with, there's plenty of meat on the bones in later sections of the report. Okay. Thank you. Thank you very much, Pat, and thank you, James, for this, and thank you for kind of giving us a bit of a very brief recap of kind of what's come before and what is it that we were looking at just now. Really critical piece of work, so really welcome this, and I'm sure this will generate, again, lots of discussion and debate. I will open up for questions, and I see Claire, you'd like to come in, please. Didn't expect to be first. That's exciting. The disadvantage of being online, sorry, can't see from what everyone else is doing. I was interested in asking you, James, if you can sort of talk a bit about the difference between, well, so let me start with a statement. I think what we see in the paper is that the decision around Liberton is driving a lot of stuff. A lot of other things are being made to happen as a result of that, but I also observed in the paper that I don't think the Liberton issue is the driver in totality, and I think that there's, in my view, the way that I'm reading it and the way that I understand the issues is that there's actually two projects master reading as one thing here, and the fact that we're now defending to older people's pathways is that one bit of it, but for me, the Liberton bit and the bit about corporate property, like what is our property strategy, what is going on with our estates, is a logistical project, and the bit about pathways, which I think the clinicians have brought out in that work that you've done with them, is a slightly different thing, and we've mushed both of these big pieces of work together, and they've become one and the same thing. And I just, I suppose, one, is that right? Do you agree with that? And two, does that mean that in improving pathways, as per people's concerns about the pathways the way that they are, can we be making those changes and making those improvements to pathways and therefore outcomes for patients, regardless of where services are being provided? I have a couple of other questions, but that's my main one, really. Yes and yes. I think both are true. I've made it no secret in the paper that the work on the acute dementia pathway, but also end-of-life and also rehabilitation are things that this system and any other system should be focusing on right now. They're coinciding with a long-standing intention, with an update of the 31st of March, to close a hospital. They would need to happen under any circumstances, in my view. One of the fascinating things about the development of this program is that it, because it is so intensely focused on a deadline to close the hospital, it is really brought to the focus the work that needs to be done on those pathway programs. So yes and yes. Thank you for that, James Claire. Does that address you? Yeah, that does address the point I was raising. I also wondered if I could ask another question. There's two other things I wanted to ask. One is less complicated than the other. The complicated one first is the relationship with the comments made in the paper about the Western General. So I was pretty concerned to see that issues at the Western General campus are starting to become something which we're looking at in scope of this. I feel like we already have an extremely complicated and precarious and controversial piece of work that we're trying to make progress on. So I was pretty worried to see that problems at the Western General, which until now I wasn't aware about, seem to be being brought into scope. And I realised that presumably that's been on the long-term agenda of the management of that hospital. So it really isn't new to them. It's definitely new to us, I think. I wondered if we can decide today to try to, as far as we can, resist pulling that into scope because we already have a lot of complexity and hopefully signal to them that we feel that actually they need to deal with that risk themselves. So that's a slightly harder question. The hopefully easier question was, obviously James has indicated that his work with us is going to come to close in August. And I'm interested in what modelling capacity, skills, tools, et cetera, and what processes we're going to have put in place to be able to keep up to date with modelling that he's been carrying out around price capacity, types of care, et cetera, because I feel like we're going to need to keep an eye on that and keep it refreshed. So I'm interested in what are we going to put in place to make that a business as usual thing rather than a one-off piece of work that he's been doing for us. Thank you very much, Claire. I think Pat, you wanted to come in. Sorry, I'll let James respond to the complexity or the independencies here with the Western General. But I will answer the last question there, Claire. Sorry, Councillor Miller, in relation to how this work will be picked up as we move forward, given James' pending departure, we have appointed a new director of strategy who will be picking this up. There will be an opportunity for a transition, a hand-off, if you like. He comes into post next week. And James and the newly appointed director, Andy Hall, are familiar with each other and familiar with the process that's now involved. So I think we're in a fairly good position there, ensuring that there's enough capacity within the system and there's enough strategic awareness about what this issue is to carry that forward. Thank you. So the Western General, I probably will have to, not being an officer, appeal to Pat and Moira for a policy line here, but I guess what I'll do is explain the comparatively minor reference that I make to that in the paper. For the moment, there is no decision about the closure of the redo unit, or the move of the redo unit, I said the regional infectious diseases unit, into a ward that currently performs something like the inpatient rehabilitation that we've been discussing from Liberty. There is clearly some pressure in that hospital to do such a reconfiguration, but in the absence of a decision, it doesn't figure in the modelling or in the proposal that I've given today. I really can't say any more about it, I would need to Pat and Moira to give a line on that. Although I hope this won't be my last appearance before the board, because I'd like to bring another report in August, if I may, about the unfinished business. Just in the meantime, on the question about modelling, I wanted to pay the partnership and Edinburgh as a whole a compliment, saying that they've probably got some of the best statistical and analytical resources I've seen in five years in this business. So I think, and it's grown in its capability even while I've been here. From what I've seen of your new strategy director, I've met him a couple of times now, he will only enhance that. Very kind words, James, thank you. That's reassuring, I think, from our perspective. Okay, thank you for that. I think between both of you for answering Claire's questions. I see Phil, you've been very patient and then I'll, or Emma, did you want to come in on this point specifically? Okay, I'll bring Phil in and then I'll bring yourself in, okay, thank you. Phil, please. Thank you very much, Stu. Thank you for the paper. Really interesting, and as colleagues have said, it does touch on two really important areas, not only the older people's pathway, but the, if you like, the efficient management of our estate and the resources and the rationalisation thereof, so really vital. My point is actually kind of small in relation to the actual content of the report and more about format. We've had a lot of discussion recently about the process for directions coming from the board to NHS. I think it was highlighted by an audit report. And so I see the direction here and I'm relatively new to the board. What we see in the direction of the paper has, have the partners already discussed this? That's my first point. The second point is, I counted the one I made earlier about the nature of the executive summaries. Again, this executive summary, while useful, kind of talks a bit about the background and then directs the executives to kind of read the paper. That's not really, in my mind, what executive summaries are about. And if we, when we get forward to the finance report, which I think is at 7.1, there's a very good example in there of what the executive summary, perhaps you will look like. So I guess maybe we want to look at a wee bit more of the executive summaries to summarise the paper rather than direct the executives to look at it. And in so doing, we see that in the current executive summary, it refers to a previous report where there were six recommendations. And then we come into the paper here, and unless I'm missing something, which given my age might well be the case, I can see only five recommendations in this paper. So it maybe just needs tidied up a wee bit in that respect. Thank you. Thank you, Phil. Really useful, I think, feedback, and I'm sure something that officers will consider going forward as well, just in terms of what goes into an executive summary. So yeah, that absolutely makes sense. James, did you want to comment on specifically the discrepancies? Yes, sorry. The sixth recommendation was that my tenure here be extended by six months. So the five, that's the reason. And point taken about the executive summary. Thank you. That's really helpful. Thank you. Okay. Thank you, James. Emma, please. Yeah, thanks very much. And what I would say to begin with is the context of this is I think everybody's really aware it's an incredibly complicated and complex area. And James has done an amazing job with an awful lot of input from other people to try and simplify it. I think what I want to do, everybody's aware I come from a health point of view. I want to be very clear about what the risks are and the questions that I still think that we need to answer. So it's come out really clearly this morning that there's almost two elements to this. That there is that element of the practicalities of liberty and closure, and that needs to go ahead. And then there's almost that bigger picture which is the older person's pathway, and that's the older person's pathway for people in Edinburgh. That will be you and I in a number of years' time, some of us sooner than others. But that is something that we need to make sure that we are doing correctly for the future. And so in terms of that context, what I would say is that we have been told in the IJB that there was an NHS Lothian, whole Lothian bed modeling exercise, and I am aware that that is nearing completion, and I think we mustn't lose sight of that when we are looking at that bigger, older person's pathway for the people of Edinburgh. But if I come back to the Liberton Hospital piece, I think what I'd like to start with is almost the facts. What does Liberton Hospital do, and what are we at risk of losing and perhaps not providing? So Liberton Hospital does have beds, so we're very aware of that closure of beds, and in summary, that comes out as 50 beds. Twenty-eight of those are the HBCCC, and 22 of those are more that rehabilitation. And alongside that, we have a day hospital in Liberton that has 3,000 consultations each year, and we have a hospital at home service that has 2,000 consultations with thorough research. That's very much 2,000 generally acute hospital avoidances for people who come into that more complex part of the population. So I think if we look at the facts, we do have bed closures, and we do have a worrying 50-bed closure, but we do also have two services, day hospital and hospital at home, that we mustn't lose sight of. The second thing I want to really clarify is really the context, and the context for health services has changed over the last few years, and for some reason, we seem to see that COVID time as being a bit of a watershed, and we're now in a situation that we have far more delays in the acute system, and I've had information this morning that in the acute system for Edinburgh, we have 22 patients waiting for care home beds who are ready to move within our acute hospitals to begin with, so we need to make sure that what is being proposed is almost an additionality that is going to cope with libertine bed closures, and is not something that we needed already to cope with that pressure on the system. The delays are very much a contextual thing that we are facing at the moment, but the one that I think is really important and that we make sure that we are not making worse is the pressure on our acute front doors. So we all know that across the United Kingdom at the moment, we have huge pressure on our emergency departments. The College of Emergency Medicine has elucidated that as being excess deaths, so for every 72 patients who wait over 12 hours, we have one excess death, or they're estimating one excess death. And there is a real risk that we are going, with bed closures, we are going to put extra pressure on that acute system. I think from this proposal, there are positives that are coming out. I think the care home piece is absolutely necessary, and almost moving that care home capability from residential to nursing home is very welcome. And as I say, we do have a number of patients in the acute system at the moment who are waiting for care home places. But I think there are some things that we probably do need to clarify. So out of those 50 beds, how many can we be sure that we have mitigations in place that we are not going to put direct pressure on our emergency departments and really bring about a risk of excess deaths in the future? How can we be sure that those services, so day hospital and hospital at home, are re-provided? And how can we be sure that what is being proposed as the mitigations are really an additionality to what we needed to deal with the pressure on the healthcare system? Really, my big risk is the impact on the acute system. Thanks very much. Thank you very much, Emma. This is, as usual, a very insightful contribution, really, really helpful. So you've crystallized risks. You've crystallized the risks. You've really focused on the risks that kind of come from the decision, notwithstanding the excellent work that James has done. These are probably some slightly kind of broader questions. So am I looking, Pat, am I looking at you to kind of give us some degree of assurance that we're not particularly around sort of Emma's point of impact on the acute? I'm going to let James give some of the operational detail of what we're describing here just now, because we're very aware of delayed discharge. I think there's not a single IGB up and down the country just now that are not getting additional pressure in relation to all of this. But one thing that I would say is that we haven't fully realized the capacity that we have within the care home provision that we currently have at the moment. So this will look different in relation to care home provision that we have. We have a number of -- we have a couple of care homes, for example, I think, that you're familiar with, Emma, that are not -- that we have in each capacity, so they are completely underoccupied just now. So that will go some way towards rectifying this, and that will be a large part of the mitigation here. And I think that James has set that out, and he's set that out in some of the template and the information he's provided here as well. So it goes some way towards the mitigation. It's a considerable way towards that. But like anything, I suppose, that we agree here at the IGB, there's -- the mechanism for completely negating risk altogether just doesn't appear to be there. So there is -- it will come back to a sense of tolerance and what an oversight of all of that risk is, making sure that we are collectively engaged in the process of mitigation and risk as and when that occurs, and that we're able to take some corrective action wherever it is we possibly can. But I'm going to invite James and Behezil to come back in here in relation to the operational part of that, about how that's mitigated against what you have quite rightly highlighted as the risk to take care of those answers. I thought those were excellent questions. So part of this is -- the answer to the question about how the mitigation will happen is partly due to confidence in the nature of the mitigation. The -- if you just look at the broad sum of the number of acute hospital and care home beds in scope before and after this proposal, it's almost identical, minus 0.3 or 1%. It doesn't follow, however -- I think clinicians' nervousness about this are due in large part to the replacement of a non-acute hospital bed with a care home bed in a city that I've already argued has a comparatively small stock of care homes for its population. That was what the February report said. Now, the mitigation for that is, first, that in this new version of the plan, we'll be commissioning beds that are for people on the frailty pathway in two care homes that the partnership controls. They're owned by the council and they're controlled by the partnership. And those additional beds, which I think we're already in the process of mobilizing -- those additional beds are already ring-fenced for this exercise. There's no competition for them from the other parts of the system that, with the best drill in the world, just looking at the delay figures every day, will be competing for them. We've also -- because we found a specific kind of demand for care home beds that is not well-catered for a more redesigned system, allowed budget for additional beds around the city for people in their last weeks of life. And that funding is not tied to any particular care home at the moment. But the intention is that for people -- last weeks, maybe just two care homes with ring-fenced beds aren't the right solution for everybody, so we've allowed an extra six. And some of that almost exactly offsets some of the beds that we use. But I do acknowledge that there is a job of confidence building because those beds are not just naturally equivalent. We're not trying to reconstruct those beds, nor could one. But there are -- among the concerns, especially for those people on the frailty pathway who may have quite a short life expectancy, is the length of time that it takes, typically, in our normal figures about delays for people leaving hospital, the length of time people waiting to move. And for somebody, again, at the end of their life, an average of 30 to 40 days is clearly unacceptable. And this is where the ring-fenced beds come in. And second, that later on in the paper, the enhancement to our care booking service, while it might feel like quite a sort of operational tactical proposal, built into that is something that I witness working very effectively in my last job in a large county in England, and that is to have specialist dedicated brokers whose job it is to affect rapid or fast track, as they were, discharges to care homes for people in that case. So a typical discharge from an acute hospital to an HP/2C bed is about 12 days. The purpose of the brokerage team is to affect a similar speed of discharge, so that people aren't waiting in whatever setting they are to get to a care home, who would, in the current arrangement, have been waiting to get to HP/2C, but for fewer days. There are two areas of uncertainty in the modeling, and I'm sure that people didn't miss some sort of not unquantified, but ranges, as it were, of risk to do with this plan to manage without a number of inpatient rehab beds, these ICF beds, while we look at the broader questions, especially about the dementia pathway. One is that the number of beds that we won't have, physical beds that we won't have during that period, is one figure, but the estimated consequence of that reduction is a different figure, and I'd imagine that that is probably quite puzzling, so I'll just try to clarify that a little bit more now. And here we have, I think, a range of risk. The physical number of beds at stake, the number we would have to manage without during the term of this temporary reduction in ICF is 19 or 20, depending on how you count it, but it's either 19 or 20. There's then a figure that I've quoted about the consequences of that. How much does that equal in lost capacity during that period of temporary reduction, and I've quoted the number 11. And that difference is due to -- it's a consequence of a couple of things. It's mostly because we estimate that we can get more productivity out of the beds that we will continue to operate, and that offsets some of the difference between 11 and 20. You get more productivity out of the beds that continue to operate, the gap is narrowed somewhat. That is still somewhat controversial, and we are still unpicking it. And then there is another good news story -- I hope it came out from the paper -- about recent changes in the productivity and the effectiveness of the very ICF services that we're talking about, which have both improved their productivity -- they've seen more people per year in each of the last two fiscal years -- and at the same time improved their effectiveness. More people have gone home, even after those shorter lengths of stays. And the combination of those two things is what creates this range, this difference between the physical beds and the number that we think will be a consequence of managing with fewer in the meantime. And we're still working on the difference, but what we do know is that it's somewhere between 11 and 20. And the last point to make about that -- I'll repeat something I said a little bit earlier. In version 1 of this plan, there was no leeway in the budget that's created by the savings from Liberton for us to do any more mitigation than was already in that plan. In this new version, some of that capacity gap that I've just been describing between 11 and 20, we can offset with a degree of investment from some spare money that we have. And the spare money is just because we won't be operating the enhanced dementia model in our care homes during this period, because we won't need it, because we'll still have the HBCC in psychiatry. And that sum is about 0.6 million. So I wouldn't want to pretend that this doesn't have risks, but on balance they seem to be risks that we have more prospects, best prospects of mitigating this coming up into winter. Thank you. Emma, would you like to come up? Thanks very much, everybody. I think we're never going to be absolutely certain what the impact is going to be. I do have concerns that even if with modelling we're only looking at a smaller number of beds, I think 11 beds, even on the acute system, big difference in waiting times in the emergency department. So I think that needs to be considered, even if that is the best case scenario. The one area that I am concerned about is the day hospital and hospital at home provision that we haven't discussed and we haven't found a solution to that. That's not inpatient, that's not a bed, but I think that is lost. Thank you, Emma. Yes, so there's no intention to not continue to provide those services. What we're doing at the moment is working very closely with NHS Low then in order to find a suitable alternative site to deliver them from. Thank you for that assurance. So services will continue, it's just where I suppose this is what you're currently trying to work through. Okay, that's understood. I mean incredibly complex. And Emma, I really, really appreciate the forensic kind of dive into this. I think what we have been hearing is we're trying to make more use out of the bed base overall. I'm hearing that there is acknowledgement that it will be very difficult to mitigate the risk fully. And I think that's well acknowledged. I understand your assessment that even that small reduction is likely to have some degree of impact on the emergency department. And again, I would expect that that -- I would expect it to be feedback loops between us and our colleagues in NHS Lothian and on the ED side. I think whatever the impacts will be, we will see them. We will notice them. We might not be able to mitigate them fully at the very start. I 100% agree with you. My preference would be to have the mitigants in place and have the capacity in place so that we don't go into that. But I think at the very least I'm thinking there are some detective controls. We will see if there is an impact. And again, that will be then another kind of -- another point at which we will need to say, right, do we need to do things differently. But nothing is risk-free. But the sense I'm getting is that there has been a fair -- a really decent level of sort of thinking that went into what is it that we need to do to try -- to at least try and manage some of those risks. And there is dialogue ongoing with colleagues across the wider system. So that gives me a degree of confidence. But, you know, as we just heard, nothing is risk-free. Thank you for that. Helen, I think I had you wanting to come in and then Pete and then Vicki. Yep. Thanks, Chair. Just to pick up on that point actually about finding a home for the day hospital, that's actually been an issue for about two years. We've known about it for quite some time. So I admire your confidence in thinking we'll find a solution because we haven't yet. So I think it's worth saying that. And that is a real concern for those services and staff. But my point was about the paper in general. I've had several discussions in the past week about this. I'm really concerned about this paper. I know a lot of work has gone into how we need to re-provide those services because we have to get off the Liberton site. The concern I have is for the staff involved in these services now. So the change in direction, forgive the pun, in what we're doing -- sorry, my screen just went over the wrong time -- is significant for our staff. I've discussed this with Pat and James last week. So I'm glad the paper has been changed slightly to recognize that we need to consult with our staff. I didn't see the directions until this morning because they were only sent out very late last week. So I wasn't aware that there was going to be this amount of detail in the directions. So currently our staff don't know that this -- or they do now because we're having a public discussion -- they didn't know about this reconfiguration. So the communication to staff so far has been we think we're going to have to change, there will be these beds that are modelled, but they now know. And I'm really concerned that the first-time staff here about this is at a public meeting. I don't think that fits with our staff governance standards. And I guess my concern -- because the question was asked already about directions and whether our partners have been engaged, so I can't answer that and I think it wasn't answered, so I think we need an answer to that question because the other point I want to make about the detail in directions, which I don't think is required for us to continue on this pathway, the problem I have with the detail is that it doesn't mention the NHS staff governance system where we need to get this agreed at our partnership forum, which is enlisted in here as one of the governance areas. So my question is, if we agree this today with the detail we have in the paper, which has, I believe, implications for staff that haven't been worked up yet, what do we do if the partnership forum don't agree? So we've asked that it goes to the partnership forum, but we are effectively telling them they have to agree, but if they don't, what do we do? And that is my real question about that, actually, and I would love to hear the answer. Thank you. Thank you for raising this really important point, Anne. There is a fair bit of detail in the recommendations. I think when you mean directions, you mean the recommendations in the paper specifically. No, I mean the directions. So I mean the list of directions and the bed modelling and who goes where, because there are staff groups linked with all of those different services. So when we change the modelling, we change the staff model as well. So that has implications for us. That hasn't, as far as I know, been worked through because I certainly haven't seen the implications it's going to have on our staff. Okay, right. No, I understand your concern. Thank you for that. I would like to bring Pat in or officers just to -- Yeah. Thank you, Helen. And I've not disputed the points that you've made, both in discussion we've had last week and the revised version that was issued of the paper that sets out the wider engagement process so far. As I pointed out when I was introducing the paper, we note that and we will action it and we'll take that forward. Now, we do have Heather on the call just now. Heather, I don't know if you want to add anything here by way of what is the plan for those staff that are affected? Hi, everyone. My name's Heather Tate. I'm the hospital and hosted services manager, so the operational manager for these areas. I would first off by just recognising that I don't disagree with anything that Helen has said. I think given hindsight, we may have done things differently. However, we felt that we need to come to yourself today to get a clear direction on this project, given the change in scope that we're proposing here. So I do acknowledge, as Helen says, that we haven't fully consulted with our staff, those who will be affected with this change of direction directly. We have done significant consultation on the previous ones and been out to meet all staff. So the next steps for us will be to do a full staff meeting, as we did previously at all sites, to update them, ensure they're fully aware of the change in direction. And as Helen says, take it through the IHS slowly and parachute forward process for approval. We do need to do the full workforce planning. So we have an indication and we've engaged with our operational staff lead. So we have an indication of what the impact on workforce will be, but we haven't done the full detailed workforce planning alongside these proposals as of yet, just due to the timing of this board and everything alongside it. So, yeah, I want to recognise Helen's point and acknowledge them and say we haven't forgotten about it and we will be doing that in consultation with staff going forward. Thank you for that, Heather. Helen? Can I just come back in just for clarity? So the very specific question I'm asking is, and I recognise the complexity and how difficult this all has been for people, but if our partnership forum don't agree with the proposals, what do we do then? Are we then in dispute with our trade unions, which has never happened before and it's part of our staff governance standards that we try and work in collaboration with our manager. Thank you. Thanks, Helen. If that is the case, then we'll need clearly to take us there from HR. We would prefer we're able to engage with the workforce in relation to this, given all the conversations and engagement so far. And as we pointed out earlier on, there has been so much uncertainty around this and I'm not suggesting for a minute it explains absolutely everything about where we've landed here right now, but it does explain partially in relation to this with just how complicated this has been in the shift from December to March, for example, as well. Okay, thank you. Heather, you would like to comment again? Just to say, I would hope Helen and we obviously work closely together. I would hope that the partnership forum would be in a position to support this, given I do think we have a good rationale around the difference in approach now and why we're doing it. But, yeah, I acknowledge that the partnership forums is the body there to make the governance decisions and if they did decide to not support it, then we'd have to regroup at that point and think who's the best way to take this forward. Mindful, of course, around the time scales that we're working towards for this project. But I wouldn't want to subvert that process in any way and I hope that we would be able to work together to get through that. Thank you, thank you. Really good to have that surfaced and to have the commitment from Heather and Pat and, yeah, so complexities, additional complexities, additional risks to the project. So, thank you for that. Right, I have got Pete and then Vicky and I see Phil wants to come in as well. It's very hard to follow Helen's question, which is obviously a very profound question. So, my questions are probably relatively trivial in this grand scheme and maybe not fully thought through yet because the eyes have not been dotted yet, the T's have not been crossed. But my question was about double running. At what point would a new pathway that saw Liberton no longer being part of that occur? I suppose it's a question, have we thought about running down the Liberton facility? Because the way we're speaking, it's like we've got until March, but actually there might be advantage. I know there's cost issues, but there might be advantage in seeing a new pathway emerging well before that so that the numbers in Liberton actually are relatively small so the patients themselves and some of the staff will already have whatever will happen to them in that timeframe. So, that's one question. My second one, which is just a curiosity question is about on your paragraph 32, you make reference to rehabilitation in the community being potentially available. I just wondered to what extent that could be exploited further or whether there's a capacity issue on that. Thank you. Thank you, Pete. Heather, I saw your hand going up as Pete was asking the question. Did you want to comment on part of Pete's question specifically? Yeah, I could answer the double running part. Tell you where we are with that. So, we did have a work double running proposal for Proposal 1. With the new proposals, we're in the process of working up what the timescales around that would be. So, for Liberton, we wouldn't be running that down fully because some of the patients in those wards at the point in time would be transferred to a new ward area. But there will be an element of running down some of the wards to reduce the beds. And in our fail elderly ward, we've already started the process with staff around looking at how we can reduce the beds. In fail elderly, we have two fail elderly wards and we'll be going to one fail elderly ward. And that was part of the original proposal. So, we're already in process around that. And from our care home point of view, we are in process of recruiting to those additional beds to bring them, get them open as soon as possible to allow us to get that pathway in place as we move towards the date with the end of March. That's great. Thank you very much, Heather. That's really helpful. And James, do you want to come in on the specific curiosity point? Yeah, I'm well spotted. I'd forgotten the paragraph number. The idea, quite coincidentally, work has been going on to look at whether everything that happens in inpatient hospital beds, rehabilitation inpatient hospital beds, ought to happen there. And I've only seen the very earliest and most tentative results of that work. But they indicate that there is more potential to work out with hospital in settings like care homes and that home. That was all I was referencing there. But I see results coming from that work a little bit further down the track. I just wouldn't want to put a closure plan as urgent as this one, make it dependent on that work. I think that's a longer term bit of work and would require more fundamental pathway change. That said, if we're just looking for some cover over winter, there are plenty of other places that do bed-based rehabilitation in care homes. It's a budget that may fund that. We just haven't worked out what the commissioning plan would be. Thank you very much. Thank you, James. So I have got Vicky and Phil. And then I would like to draw this item to a close. Vicky, please. I think Heather might have just answered this, but I'm a bit confused about the amount of current beds open. In Liberton, is that 50 or 46? I think I might have said 50. Forty-six. Forty-six. Forty funded, six unfunded. Okay. Thanks. Next question was about the day hospital and hospital at home and if that's being delivered anywhere else in the city or only from Liberton. And the last one is a question about staffing at Castle Green in North Markeston to increase the bed capacity and how we're going to recruit for that. Thanks. Thank you. Who's best pleased to answer Vicky's questions? Heather, please. So in terms of hospital at home and day hospital, Liberton is the base for hospital at home for Lothian and for day hospital for South Edinburgh. Hospital at home also runs clinics out of various locality areas across the city. But it's primarily based at Liberton Hospital. In terms of day hospital services, there are other day hospital services across Edinburgh. So there's one at Leith and there's one at the Western General. They operate slightly differently. And as I say, the Liberton service is aimed for the south of the city. And again, we do do some locality clinics out with Liberton at health centres in the south of the city. Thanks. That's helpful. Thank you. I think Jackie McRae, if she's on the call, could give us an account of where we are by way of recruitment. Sorry, I've had to transfer to my phone. I'm at Marionville Care Home and the signal's not very great here. So yeah, we will be starting to recruit as soon as we've got the budget finalised. We will start to, we also have to be mindful that we're closing two care homes. So we would be planning to accommodate staff from the two care homes that are closing into North Merkerton and Castlevania as well. Okay, thank you. Thank you very much for that. That's great. Right, Phil, please. Thank you, Geoff. It was just to go back to the point I touched on earlier, given the conversations that we've heard from colleagues. The question of the process for directions appeared in an audit report. And forgive me, I can't remember where that audit report itself appeared. And almost certainly, as we all know, when somebody appears in the audit report, there'll be recommendations alongside that item appearing in the report. So I wonder if it might be useful, Chair, for somebody to put their hands on that report and just make sure we are proceeding in line with the recommendations which are made, which I think could be helpful. Thanks. Thank you. Thank you, Phil. I'm sure this is something that officers can take forward. I think it might have been an AHS Lothian internal audit report, if I remember correctly. We might have both seen it at the Audit and Risk Committee. Yeah. Yeah. More confirms that that is indeed the case. Okay. That's absolutely fine. Thank you. Right. Emma, absolutely last word on this. Please. Yeah. I think it's becoming clear that we've got two pieces of work that are coming out of this. One is the reprovision of Liberton. And that seems, hopefully, it's very complicated, but hopefully that's a discrete piece of work. But this piece of work is titled The Older Person's Pathway. It's obvious to me that there's a huge amount of work of evolution of what that's going to look like in the future. And probably this NHS Lothian bed modeling needs to be fed into that. And it's just a question of how we're going to continue to make sure that that is active and alive and continues to be taken care of. Thank you very much, Emma. That's spookily exactly aligned with some kind of my own thinking around how do we keep visibility on this, because you're absolutely right. The Older People's Pathway will not end with the decommissioning of Liberton. You know, if anything, that's just the beginning of the start, so to say. So, again, I would like to pose the challenge to officers to see how, you know, and at some stage to outline to us what is the best way to make sure that that piece of work continues to receive the visibility, potentially, exactly under consideration of all the other pieces of work that may be happening by our partners that are relevant to this. I'm not expecting an answer now, you know, unless you've got some basic vision as well. But it would be good to keep that. No, and I certainly don't have the precise answer to that just now. But what I did want to highlight here is that we present this project to an oversight board, which is chaired by the interim chief executive of NHS Lorian, and it has many senior members of the staff that are there. And we report on the progress and how close we are to the target date of March and all of the implications in relation to this. So there's a very established group of governance arrangements that sit beyond just simply the project team, and we had a discussion just in relation to this as recent as last Monday, and if we're required to review some of that governance, we'll do that, to be able to deliver on this and move forward. But it's well cited in a number of groups and happy to make sure we come back here with some additional visibility in terms of the progress. Thank you very much for that, Pat. I think that's really helpful, and it's that past of the project, once the Liberty Project has closed, I think that's what Emma is aiming at, it needs to go past the closure of the project, because that's likely to be something that we will be continuing over the next two years. And the other thing that I also kind of picked up from the conversation around obviously the contributions made by Emma and Helen, and also Vicky's questioning, is this the hospital at home and the hospital? Understand that it is being progressed. I think it would be quite good for us just to have another update about that specifically at the next IGB, because that is a risk. Having listened now to the concentration of that in Liberton and the fact that we're so close and despite conversations about this, it would just be really quite good to kind of get a better sense of what the latest thinking is and how feasible it is and if there is any risks that are attached to that, because the consequences, as Emma highlighted, on the acute services, on the acute front door, are potentially quite large. Moira, please. I was just going to suggest that members might want to consider another recommendation, which is about as a board writing to NHS Lothian, because the identification of an appropriate site sits with them, albeit we're working very closely with them. So just a suggestion. I think it's an excellent suggestion from my perspective. I think any additional governance we can put around that is good, because that's definitely, for me, it's been one of the largest risks that's been crystallised just now in the conversation. So let's do that. Okay. Right. I see no other hands, and I will use this opportunity to draw this item to a close. So I think we know we're content with the report on the progress with each recommendations relating to a people's pathway. I think we're content with that. We direct NHS Lothian to reconfigure the ICF and the HBCC services in the City of Edinburgh. The City of Edinburgh accounts for 40 new beds in Castle Green and North Murchison care homes. So we've got that. I understand the concerns around that as well. They've been noted. But I think we are at this stage in the interest of progressing at pace. We're content with that. And then we will add a third recommendation to this, in which the EIGB rights to NHS Lothian, specifically highlighting the concerns around the alternative provision, alternative location for the provision of these two services that are currently being delivered out of Markeston. So we're content with that. That's perfect. Thank you so much for that. I think that brings this agenda item to a close. I'm conscious we've been going for over two hours. So can I maybe suggest that we reconvene for a quarter to one, and then try and progress at pace with remaining items? Because obviously we've got still the 6.1 to go as well. And our colleagues will be joining us at 1 o'clock. I think, as I said, Ashley, if you want to, should hopefully be with us online from 1 o'clock. Thank you, everybody, and enjoy your break. And don't forget to read those appendices, skim, maybe. Thank you. Thank you. Thank you. Okay. So the next item is item 7.1, which is the financial update. And we have Moira Pringle speaking to this report. Thanks, Andrew. So I'm conscious this is maybe not by the standards of some of the other reports on the agenda today, but for a finance report, it is longer than usual. So I just wanted to say a little bit about the kind of three sections that it covers. So the first part is about the out-turn for last financial year. The second section deals with the update to the MTFS, the medium-term financial strategy. And then the third section just says a little bit about the emerging financial position for M24/25, the year we're currently in. So I just wanted to make a couple of points about each of these three sections. So, firstly, for last financial year, very positive news in that we were able to report a balanced position, obviously subject to audit. To get to that point, we've been reliant on some additional funding, just under $4.5 million from NHS Lothian, which has been agreed, and $19 million from the Council, all of which, with the exception of $2.6 million, has been agreed, and that $2.6 million is going to the next Finance and Resources Committee and next Council meeting, hopefully, for the agreement at that point. So a positive outcome for last financial year, albeit reliant on support from partners and also reliant on some in one of the non-occurring measures. The second point I just wanted to highlight was around the medium-term financial strategy. So, as with all financial plans, it's a set of assumptions based on a point in time. And we have now updated those assumptions, and the updates are set out on page 7 of the paper. Overall, the position has improved in that the financial gap that we are working to for this financial year has reduced. I would just want to highlight, though, that that doesn't actually mean that the underlying position has improved or that we need to make any less savings or have additional funding for investment, and that is also set out in the paper, hopefully, clearly enough. The final point to make is just about the current year's financial position. Now, the Council only reports from the first quarter of each financial year. This is across all departments, not just health and social care. So we don't have any finalized financial monitoring information as yet, but given the seriousness of the financial challenge that was facing health and social care, the finance team have done an initial assessment of the kind of key areas of spend, one being workforce and the other being purchasing. They did this at month one. They repeated it at month two. And the findings of both have been fairly similar, which is that the baseline position -- so before we think about savings, the baseline position is more or less in line with what we would be expecting. Where we are starting to get concerns, though, is with the savings program, which the board signed off in March. We've been making good progress on some schemes, and in the paper it says that we've delivered just about 10% at the point this paper was written. However, there are a number of schemes where we have seen more slippage than we had been anticipating. So the chief officer has instigated some initial thinking about mitigation. Once we have the formalized position for the first quarter, it's extremely likely that we're going to have to be considering -- if we can't drive the current plans that we've got harder and faster, then it may well be that we need to consider alternative solutions and remedies, even just on a kind of one-off basis for this financial year. So that would include potentially things like reviewing all discretionary spend. It could mean additional controls on workforce and additional controls on expenditure generally, and that would include packages of care. So with that, I am happy to take any questions. Oh, and sorry, the final thing I should say is that this -- the out-term position should have been considered at performance and delivery earlier this month, but that meeting had to be rescheduled, so it's happening now next week. So it's just to let members know that that detailed scrutiny has not yet happened but is scheduled to happen next week. Okay. Thank you very much for the paper and for the update, Moira. Other -- I would like to open up for questions. Yeah, Max, please. Thank you. And thank you very much, Moira, for the report. I suppose the question I have, I suppose, is about the last financial year, and it sort of seems quite rosy, but if the Council still hasn't made a decision on the 2.6, it feels like there's not actually a full stop there. It's sort of a dot, dot, dot, and it's to be continued, and I think there's always that concern as an essentially political organisation that what of politics goes against the assumptions made in this report. So, yes, so the officer's recommendation, which will go to F&R -- I think F&R's Financial Resources Committee, pardon me for those of you who don't know the Council's Financial Resources Committee next week, is that that additional budget is delegated to the IJB. If agreed by Financial Resources, that would have to go to full Council for agreement or otherwise. You're quite right. There is a chance that either of those two committees or corporate or entities don't agree. Hypothetical, I know, but then what? What if it's a no? Well, then we wouldn't break even for last financial year, but what I would also say is that in the NTFS we have built in the repayment of that sum of money as brokerage. So what that would mean is that we would recoup it over the next three years just in a slightly different way from planned. So instead of having to effectively borrow the money for '23/'24 and repay it back in three installments, we've built into our plan that we repay it back in three installments. We wouldn't have to do that anymore, but what we would do is use that money to offset the deficit that we were carrying. Thank you. We'll explore the hypothetical option. Absolutely. Tim, I think I had you down next and then I've got some people on the screen as well. Thank you, Moira. The point I wanted to pick up on was the very last one you made as part of your report there saying that in terms of the savings that we were achieving within this current financial year, there were some concerns as to how effectively we were meeting our targets around that. In one sense, obviously it's a good thing that we are very much in touch with that and monitoring and aware of that and aware at a very early stage so that we can take remedial actions and make sure that we do land on target, but at the same time, obviously it brings with it its own concerns if we're having to look at other actions. You mentioned one approach may be that further review on care packages, for example, and I just wondered if either yourself or maybe Pat could say a bit more about how that might be approached, what that might mean in practice. Thanks, Tim. There's probably a few things to say about this. This is very, very recent, really the end of last year, last week, sorry, where we had the update about where we are and where it's just outlined that. We've always said, and we said this in March, given the volatility of not only the marketplace, but also the savings plans, all 24 savings plans and the assumptions that are against them, that we would be required to come back with corrective action as quickly as we possibly can, and that's now. So we're three months into the new financial year, and this is as quick as we can do it. So there will be decisions that we'll need to come back to the IGV on, and there will be operational decisions that we can continue to take. There's a number of areas, and I'll come to the point of your reason there, Tim, that we'll need to give due consideration to, for example, the organisational restructure, for example, the workforce and the savings that's been applied, is that enough? The savings plans that we already have in place, is there any of them that are actually working well? Can we go further with them? And we need to come back with further options in relation to this. But there will be, and there will continue to be, significant implications in relation to all of this. The question, Tim, that you're raising is specifically in relation to care packages, for example. And the slowing down of the provision of care packages can have an impact, not least on the individual, but on our reputation, on our statute of duties, for example, hospital discharge, all of that. So there will be a requirement for us to determine what is the risk associated with that, and where can we mitigate risk wherever possible. We have explored options before about the difference between substantial and critical, and we have taken legal advice in relation to this as well. And we've got a lot more thinking to do, but we're going to have to do it really quickly. Any of these decisions that we have to take in terms of further savings plans will really need to be done within this next month. We need to stand any kind of chance of reconciling the financial position. We need to do it as quickly as possible. The further we wait, it's all time critical, and the less chance we have of achieving any of it. But there will more than likely be another speed of savings that we will need to come back with. Thanks, Pat. I can just come back on that. I appreciate the openness, I appreciate the awareness and the honesty and sharing that with us as an IJP at the very earliest opportunity. Our next meeting is August, another quarter away more or less. How will we get the governance that we need on some of these decisions between now and August? Whatever we can, wherever we can take operational decisions, that's what we'll do. Wherever there is a decision that will require approval through the IJP, it's going to be really difficult waiting until August. And I think that it will be determined once we have the first output beginning of July, and we'll know more accurately where we are at that point. Wherever there is an emergency decision that we can make, then we will be asking for that. And I think that what we have done is we've reflected on previous years, we've reflected on the fact that we haven't had a balanced budget before, that we have planned in place, and what we'd agreed to do back in March was to take corrective action as quickly as possible. And I don't think for some of these it would be a considerable risk to wait until August. We need to get the detail in relation to this. As I said, this is us bringing this here today in the interest of openness and transparency, given where we are financially. But really, these discussions were only starting to emerge at the end of last week. Thank you. Thank you very much for that, Tim. And thank you, Pat, for outlining this. So basically, it sounds like there is a potential for some, as you say, emergency decisions coming into July. That's kind of what you're thinking. Okay. Good to know. Yeah. Yeah. That's just a point to add to this. This has not all been on the performance of the savings plans itself. This is also partially in response to the closure of Braid Hills. So we had a number of people there, I think about 40 or so, that we've had to do provision care for at an additional cost. So this is really significant for us. So it gives us an indication just about how precarious all of these savings plans are and a lot of this, and certainly in the case of Braid Hills, is out of our control. Okay. That's a really good point to note. Thank you for that clarification, Pat. Thank you. Okay. Claire, please. Thank you very much. And thanks for the report and also for the time last week to go through some of the details. I really appreciated that. I had a couple of questions that I still wanted to sort of raise here with the board, if that's okay. So one of the things that Moira and I discussed was the reserves appendix. And I was asking her for a bit more information to sort of help me expand that table and understand it in a bit more detail. And I think I would quite like to see if the board has got a view on whether they agree with me or not on what to do with this, because I feel like for me seeing that as an appendix, it didn't really tell me a couple of key questions. And I don't know whether it's that we need a regular report on reserves or whether we need a slightly expanded version of that appendix when we see our financial updates. What I was interested in was that the movement figure is actually a net figure. It includes both money coming in and money being spent out of reserves. And so I would be interested to see both of those columns and then that net impact. I also didn't understand from the table and Moira's helpfully going to supply me with the information was what did we think we would spend against each line item versus what have we actually spent and therefore are we on target? And is the money being carried forward against each line item what we would anticipate or is that not what we would have expected? So just a little bit more kind of clarity around the reserves in the same way that we look at the revenue budget out-turn figures. And also, yes, so that's on reserves. And so I guess the question of the board really is do other people agree with me that that would be helpful information because I think that we should have our eye on that given that there's such a significant amount of money sitting in there and given how much of a pressure we're under financially. And if others do agree, then do we want to ask Moira to do that as a kind of slightly expanded appendix which does financial updates or do we want to ask for a different report? I'm open to either, but I just wanted to kind of put that out there as something which I've been kind of exploring with her beforehand. And the other thing was that I have a question for maybe not so much for Moira, but I can actually see she's in the room from the savings and recovery program management office, but I feel like the story of last year was that almost none of the projects hit the exact number and it would be estimated that we would do savings that they would deliver. Some of them massively over-delivered, some of them under-delivered. And I think that for me, you're never going to hit the exact number, but I'm interested in how do we get better at estimating how much we are going to deliver from a savings initiative. So I would like to know what work is going on to kind of identify how do we get better at that estimation process and how do we make sure that when we put together a savings program that we are pretty confident that the numbers are going to match up to what we said we would save when we set out on an initiative, just so that we can obviously get better at this in future years and get them that we're going to need to do it every year. I don't know, stopping when. So that's more of a question for officers if there's somebody there available for that. Thank you very much for that, Claire. There were quite a few points, I think you phrased there, so I will kind of be working tomorrow to come in and potentially address some of them. Just on that very, very last point that you're going to make, if I understand you correctly, it's what are the levels of confidence when we're building savings programs out? What are the levels of confidence that those savings will be achieved and how trackable are they? Is that kind of what you mean? Yeah, and just like the accuracy around if we think that we're going to save 2 million by doing X, then if it turns out that we saved 3, was that because we did more of it than we thought? Is that a good thing? Or actually, are we having a higher impact somewhere else? Is that a bad thing, that we saved more money there than we expected? If we said we would achieve 2, but we achieved 1, why was that 2? But also the bit about if it feeds into next year's cycles, do we understand that we can do that better? Yeah, absolutely, and I can absolutely see the rationale for the ask and the logic, and it would be incredibly beneficial. I suppose I'm just trying, I'm remembering your conversations. I think we've had either as part of another development session on a slightly different topic or whatever, but it's the state, not the state, the nature of the data, I think, has historically been an issue, what is achievable, because I think what you're describing is almost kind of like really something that would require real-time update, and my understanding is that there is such a substantial lag between spend and next year when it does turn up in our finance systems, that to achieve what you're suggesting, whilst it would be like utopia from my perspective, because I think everybody who's ever kind of managed a change project, that's exactly what you'd want, is you'd want to forecast your savings and you want to track them almost in as real-time as possible. I think there might be challenges, but I'll let Maura come in, because you've raised a number of really, really important points there, and I know you've had conversations with Maura as well offline, so maybe if I let Maura come in to kind of more fully answer your questions. So I know, Councillor Miller, your question for reserves was aimed at the board and not at me particularly, but if it's helpful, I'm happy to share the information that the team are pulling together for, Councillor Miller, and also to include something in my next finance update so that it's then available in the public domain. And Pat's going to pick up the other point. Thank you, Councillor Miller, and I'll let any other officer come in here if they want to reflect on the kind of previous year, but what I can say is it's effectively two processes in relation to how we develop the savings plans and the oversight that we have, so the process, I appreciate we've discussed this previously, but the process was effectively taking a thematic approach as opposed to taking a percentage approach to this. I think we spoke about it in the middle of March, and I think where we're going, it's going to be both. I think there's a thematic approach, which is more of an informed way to deal with such a big financial deficit. You want to take that type of approach, i.e. a restructure of an organisation and take X amount of money out of it, as you do, but I think the position that we're going to find ourselves in is that we will also have to apply a specific percentage to specific parts of the service, and I don't think that's a million miles away where we thought that we might get to in order to take corrective action. So it was the process, and then secondly, the governance. I'm more than happy to organise a team session, for example, to walk us through what is the governance around this and how well it's performing for us at the moment, and I'll wait, and if there's anybody within the IGB that would welcome that, I'm happy to set that up, and I can walk through the precise detail in relation to this, which includes the savings governance board, which I chair. There are other finance meetings that senior managers have in place. We have agreed the templates which set out the tracking of the savings plans and also sets out the mitigations in order to get us back on track, and also where the key barriers are to achieving any of the 24 savings plans. So I'm happy to share all of that. It might be worthwhile, particularly at this point, given we're three months into the new financial year, for me to set up that arrangement. I don't think it will take particularly long, but it might give a sense of assurance into the system that the governance and the oversight this time round is stronger, and it has been a reflection of how we performed in the last year or so. So the governance oversight, the arrangements and the templates that we're using, and the detail that we're going into to make sure that we all remain absolutely accountable for the savings plans are as robust as I think they possibly can be right now, as well as additional governance savings groups that have been stood up by way of approval for, for example, high-cost packages of care and low-cost packages of care. All of those arrangements all look materially different now than what they did do in the previous years. But as I said, I'm happy to give a summary on that and walk through my members. Thank you. Would that be amenable? Firstly, from my perspective, I think if Mora could share the information around reserves with the wider boards, I think that would be beneficial, absolutely. That would, I suppose, get us all kind of on the same page when it comes to reserves and how they're being presented in the financial reports. And I think, secondly, Pat, the offer that you just made to us, again, absolutely, I think it would be very sensible to set something up. And then, as members, if there is that interest and people can dial in, so from a kind of more, you know, informational perspective. So that would be really helpful. Claire, does that cover your points? I think that mainly covers your points, but as I say, there was quite a lot, so I just want to make sure I'm not sort of missing anything in particular. Yeah, sorry, I'm not really succinct here. Apologies. The call has -- Not at all. Not at all. It's me, it's not you. I'm sponsored by Kleenex and doing my best. And I think the only thing was just that bit about a lessons learned in the program management office around, like, are there ways in which you have picked up that, you know, in the previous year a project set out with the intention of delivering something and it either didn't -- couldn't do it or, you know, the savings weren't as expected, et cetera. I just think, like, it's less about the data that you were making the point about. And more about the sort of discursive piece around, like, just doing obvious stuff with lessons learned and then how does that feed into improving the process in future years? So as with any estimate, there -- you know, the assumptions are based on the best information we have available at any one point in time. And with a program that's as diverse as the one that we've got, there are, you know, any number of reasons that we might vary from target, either positively or negatively. And depending on the actual essence of any one scheme, then the implications of that under or over delivery would potentially -- would be very different. I don't want to kind of assume too much, but I know, Councillor, that one of your -- your proposal is that we run the lessons learned session on the whole budget in advance of the September date that I had proposed. We could roll some of this discussion up into that, if it was agreed and if that seemed to be helpful. Thank you, Maura. Okay. That's good. Right. Max, please. Chair, thank you. I suppose listening to Councillor Miller and thinking about what I sort of touched on in terms of the savings program, and perhaps I'm jumping the gun here in terms of the lessons learned workshop. I just wonder about the, you know, seeking to achieve a balanced budget and whether or not, you know, looking at the situation that we're potentially coming to in just a couple of months' time, if actually there needs to be not just looking at balance, but I don't want to say overreaching. And I don't think any of us particularly welcome or enjoy the idea of additional cuts, additional savings, however you want to describe it, but ultimately having a slightly more, a longer list really, of savings for next time. Because it seems like in terms of, again, jumping ahead to lessons learned, each time we're sort of struggling in a way and either having to go to partners to ask for additional funding, which may or may not happen, and, you know, or having emergency situations whereby officials are having to make either emergency delegates decisions and then inform us of them or indeed ask us as a board to sign them off and we're involved directly in that decision-making or not. I think that's perhaps more of a statement with a question mark at the end of it. I mean, Pat, do you want to come in? Yeah, thanks. And that's an entirely reasonable question. Absolutely, absolutely is. Going back to the planning around all of this, the lead officers were all asked to come up with savings proposals which were achievable, acknowledging that they're going to be held to account, so they have to be achievable. So there was an awful lot of thought that went into them. It took us a long time just to get into that space where we had a reasonably consolidated view about what is the art of the possible here to make these savings. And when you're dealing with stuff like demand-led type services where we have statutory duties, it's a really hard place to get into. So their reaction was to try and have a Plan B or a contingency type plan. And we looked at that as recent as a month ago. What we paused on at that point was not necessarily a Plan B. It was about saying, okay, where in your savings plans can you go further? Where can you achieve more? And at the same time, given these are big, big, chunky 24 different financial work streams, and everybody's working absolutely flat out in relation to them, what we didn't want to do was distract people by telling them to go away and then start to produce even more plans when we didn't know yet whether or not they'd delivered on the current ones. But in the interest of such a time-critical project, we are back in that space. So we will be doing that. So that's what we'll be coming back with. We'll be coming back with our savings proposals along the lines of what we've just described there. But to start the new year, the new financial year, with our kind of Plan B is an extremely, extremely difficult place to be in relation to this, beyond what we have said within the savings plan around the kind of waiting list and kind of holding on the line with the approval of certain packages of care, for example. So we could do that, and that would drag. That would give us some more finance in the system. But again, there would be always risk. It would go with that. But to answer your question, yes, we are now working up what will be an additional suite of savings plans. That's really helpful. I think that is really quite helpful. Right. Sorry. Pete, did you want to come in? I'll bring you in, and then I do want to bring this item to a close. Thank you. It's really a question here about the very interim figures you've got for this financial year. Have you got a sense of why we're not achieving what you might have anticipated? I suppose what's in my mind is whether we've overestimated the phasing of savings, and it could be that, you know, I'm looking for straws here to grasp, but it could be in a couple of months' time we will be at the level that we had intended to get to, but it just took a bit longer to get to that point. Is that a possible analysis of what's happened there? Thank you, Pete. I think there's a few things here, and it's a bit more complicated. But what we're looking to do is take a really quick corrective action. We are only three months in, we have recognised there's some slippage in some of the key savings plans, and a large part of it is what you just described there, is the phasing in, making sure the messaging, for example, is landing, some subtle changes that we need to make to systems and processes. There's things like that that just take a bit longer. And we couldn't move ahead with it, of course, really, until we had it approved in the middle of March. So what we are doing and we're doing, I think we're doing really as quick as we possibly can, and that is to take the corrective action. But there's another factor to this, and we've explained this on a few occasions previously, and it's in relation to what we set out as our joint strategic needs assessment. It doesn't get you from A to B in the way that we are dealing with just now. So the closure of Braid Hills will cost us somewhere between one and two million pound. That was never factored into our savings plan. But it gives you an indication about what is unexpected, which you could not anticipate. So we now have to produce an additional savings plan, not simply because of slippage in our savings, but as a consequence of our care home closing, for example, a private care home closing. So we need to work that up and we need to come back with a further savings plan. It just demonstrates how volatile all of this actually is. Thank you, Peter, for the question. Okay. Would you like to come in? Can I just ask a quick question? Of course. I noticed in the 23/24 plan there was an underspend for employees of four and a half million. So I just was wondering if that's been factored into the 24/25 plan in any way. Thanks. Yes, it has. Our financial plan for this year and moving forward is heavily reliant on the number of vacancies that we're currently holding. And I guess just for the emphasis, at this point in time, these are not vacancies that we are not looking to fill. It just reflects the fact that we are unable, I guess, to get to full establishment levels. Good question. Thank you. Okay. All right. I see no further questions on this. So we are being asked. Oh, yes, of course. I do apologize. Yes, we've got the proposal by Councillor Miller. Claire, would you like to speak to your proposal briefly? And I think it's a very nice controversial proposal. Yes, super quickly. Do you know what? I've ended up having to do this because I think when I withdrew those two proposals at the March meeting, it was a lesson learned for me. I should have just said, Can we add to the recommendations that we make sure that that workshop is scheduled by a certain time? And I didn't do that. I trusted that it would happen. I recognize that it's not being scheduled because of diary problems. So I understand it's not an intent not to have the workshop. So, yeah, I saw that the next budget working group that we're going to have for the upcoming cycle starts in September. And I think it would be helpful to have the workshop that we talked about before we do that, or either that or spend that development session on the workshop we spoke about. But either way, I would really like to make sure that we've got ahead with that before we get into the meat of the budget cycle. So, yeah, it's just to get that back on the table, make sure that it's agreed as a formal action, and hopefully get that scheduled for August. Thank you very much for that, Claire. I really appreciate that. We appreciate the proposal. And I think it's non-controversial. I see kind of no objections to that. So rather than kind of going through the full shebang, I think I'm quite content to just accept the proposal and the recommendations. Perfect. That's great. Nodding all around. Excellent. So there's a couple of recommendations that we have. It's to note, subject to an audit break-even position for the last financial -- it's reported for the last financial year, notes the level of breakdown of reserves as at 31st of March 2024, notes the updated draft medium-term financial strategy, agrees that the medium-term financial strategy will be finalized in parallel with the updated strategic plan to ensure alignment, considers the initial assessment of in-year position, recognizing that full data will only be available after the first quarter of the financial year, and requests that offices prioritize holding the workshop on the budget-setting process in advance of the first budget working group and the schedule for the 3rd of September, with inclusion of the proposals as a key input. Are we all content with that? Yes, I think we are. Perfect. Thank you. Okay, so the next item is item 7.2, which is motions from full council, and we have Pat Tolger speaking to this report. Thank you. The report is in the pack. I'm going to assume that people have had the chance to read it. I'm just going to invite any questions in relation to this. Thank you. Of course, so right. Who do we have? George, please. Yeah, a reserve comment. Have we ever done an analysis of how much it actually costs the services of IJB to affect the services requests from council, both at officer's time and actually in resource? And have we ever done an analysis on how that slows up the processes within IJB? I would like to see if we've actually done anything like that, or can we do something like that? I'm sorry. I'm certainly not aware. Maybe somebody else might have more of the history and the background to that. Maybe there's two things. First of all, I'm not sure entirely what that would tell us. And secondly, I think that what we're not seeing is we're not seeing that these are not always legitimate asks. But on this particular occasion, what we're seeing is that our absolute priority here is trying to deliver on a savings plan that's absolutely massive. And it really is all hands to the pump here just now. And the workforce are really, really pressed on this. So I think it would be remiss of me as chief officer not to be pushing back on that. And I think that's explained within the report. Thank you, Pat. Vicki, you'd like to come in? Just quickly, I think the ask came out of an ask from some of the voluntary sector. And I think John was quite helpful today in his comments when he came earlier from community renewal. So I absolutely agree that there's no capacity within the partnership at present to carry out such analysis. And I think the voluntary sector also seemed to agree with that. Not that I want to speak for all of them. Thanks. Of course. Thank you, Vicki. Tim? Neither request is unreasonable in terms of the question it is posing. And both of them relate to areas of work that we have focused on a great deal. And indeed, in this very meeting, we've looked at some very detailed work, workings around care home provision, for example, and so forth. So I think this discussion here represents a formal response to a formal request. But informally, the information is there. We can share that information. We can have those discussions. That isn't the issue. It is the formal aspect of having to respond to a formal request. What I'm saying is I don't wish for us to be – you ask us this and we say no. Well, of course we can work together on these things. But in terms of the formality of the request, unfortunately, we have to give a formal response. I think that's a very sensible kind of position. It's a very sensible new answer, Tim. Thank you for that. George? Yes. I'm trying to understand, you know, one of the motions is actually to look at the provision of council housing, of council provision for care homes. I mean, we can't really do anything about that. If the policy is within council, if the council decided to go forward with these types of provisions, we will obviously engage with that process to see if we can actually utilize the potential of new care homes. I don't see how we can actually advise. You know, we can give them the figures of what are the requirements at the present moment, how the basis review is going on, but that will never actually be able to shape the council's actual own decisions as to whether or not to invest in care homes. So I'm just trying to understand how we can actually assist with that and what information the council is actually looking for when it's really a policy of council and a council provision that needs to be taken forward. So I'm just trying to get my head around where that comes into this and why it's been requested of us. I understand what you're asking, George. I understand what you're asking. Why is a probably more tricky question to ask, but I think we understood the ask and I think Pat and the colleagues have worked through, and I think the response just now describes exactly what Tim is describing, is that we understand the ask, we've considered at the moment there is no scope to do that, and I think that's probably as far as we will get at this stage. That's kind of just my sense. So the ask has been made why. It's not up to us. I don't think I can ask Pat to answer the why, but certainly I have seen that there has been a really robust process of truly understanding what is being asked, engaging with it, seeing what's possible. And as Tim said, this is a formal response to kind of create a record of at this stage we cannot do X, Y, and Z, but that's not to say that we won't be engaging with our partners going forward through all the other business as usual channels and processes that we have of engagement. So I think that's probably, for me, this is kind of drawing a line, so final, but it closes off a particular series of formal interactions, as Tim said, and the informal things absolutely will continue. So I hope that that kind of satisfies our kind of questioning at this stage. That's my thing. Pete. Just to add to this point, I think on a case-by-case basis, if we realize we need another care home, we could carry out an option of appraisal on whether the solution is to use the private sector, charities, or to ask the council to purchase one and provide a service. I mean, that's an economic approach, is an option appraisal on a specific thing, rather than trying to do a kind of broad rush that's not actually going to be implemented in any reasonable way either. And back to the cost-benefit analysis, I think, I mean, that's a big piece of work. It's nine months' work, and even then we would still not have a report that we would all guarantee that we would agree with the results because of the soft data that we'd be using for the benefits side, and the hard data on the costs, you know, it's quite tricky, so it's not a straightforward – I'll shut up now, thanks. No, no, absolutely, Pete, absolutely. I think we're all agreeing. I completely agree, Peter. I think that if we're ever going to be pulling the report, we want it to be able to stand up to scrutiny. And with the resource constraints and the lack of capacity in the system, we would never be able to do that, and the prospect of putting something like that out independently would obviously incur a fairly significant cost. So I would completely agree with that. What I would say is, and hopefully by way of a sense of assurance here, is that we are looking at how we commission and how we review our commissioned services, for example. And within that, it is about best value as well. And as we move forward, we will be looking at how all of our commissioned services are aligned or otherwise to our IJBE strategic priorities, and what is the outcome and what is the difference that it makes to individuals and the people of Edinburgh. So we will be taking a more concerted approach to all of that, just, again, hopefully by way of assurance in relation to how well money has been invested. Okay, thank you. I think this concludes this agenda item. What are we being asked to do? We are being asked to consider a request from the City of Edinburgh Council for a cost-benefit analysis of the voluntary sector, and consider a request from the City of Council for a report on options for expanding council provision of long-term care as per the report. Okay, great. Thank you. Okay, so next item is item 6.1, which is a strengthened approach to prevention across the Lothian health and care system. And we have Ashley Goodfellow and Flora Ogilvy speaking to this report. Thank you. Thanks for having us along today. I'm not sure if people have had the chance to look at the main paper now, but Appendix 1 is the key paper in the pack. So the purpose of the paper was to set out a strengthened and more consistent approach to prevention across the whole health and care system. So system-wide preventive approach. And aside from trying to improve population health and reduce inequalities in there, we're conscious about trying to limit the future disease burden on our services. And what we wanted to do was try and identify the best areas for investment, particularly within the current financial climate. So investment where we would expect to see impact within the short and longer term and a return on our investment. And there's something here about we know that delivering health and care services obviously is important. But actually, in terms of shaping health, there's a lot of action the system can take on the wider determinants of health, the building blocks of health. And we wanted to ensure that was captured here. So what you'll see in the paper is we've reviewed some of the evidence around prevention. We've presented some data on the overall burden of disease and what that might look like in the future, as well as the burden on our services through years of life lost to disability, which takes in the morbidity aspect. So as part of that, we also engaged with a number of stakeholders across senior management teams within the system, so the four health and social care partnership management teams, as well as in secondary care and primary care. So just very briefly, what we found was that the biggest burden of disease is unlikely to change as we go forward. It will still be from cardiovascular disease, cancers and neurological conditions. But from a morbidity perspective, in terms of impact on our services from ill health, you can see mental health and well-being coming through and some of the data there and the impact that that has on our services. And some of the data, appendix to it, does contain some supplementary data. We've tried to minimize what we've put in the overall paper, but you'll see we've used examples where there's some clean inequalities in terms of service access and on some of our waiting times. And the example we've used is around tier 3 weight management services. And I think what we can see in the data is the opportunities it highlights to target more defiable disease risk factors, particularly through structural and environmental interventions. In terms of investment, I think what the paper does do is highlight the value of investing in primary prevention. And it's not to say secondary and tertiary prevention are not important. I think we need a package of preventive interventions, but we're really trying to look at that upstream approach and the value that that gives us. We've prioritized the areas within the paper, continuing our action on the social determinants of health, so income, employment, education, housing, transport, that we protect and invest where possible in maternal children and young people's health, because we know through the evidence that those interventions give us the best chance to reduce inequalities and improve population health in the future and they are cost effective. And the third priority is about trying to tackle those more defiable disease risk factors and that future burden of disease. Now we won't stop what's coming, but we're trying to limit that and reduce the impact on services. And so how do we embed prevention in some of those disease pathways and how do we maximize the use of the preventive interventions that we have? And there's detailed actions under all of those priorities within Appendix 3 in your paper pack. In terms of the recommendations in the paper, and that's what we're seeking endorsement from today from the IJB, I suppose you can cut these up in different ways. I think the first, there's a couple in there around data. So how do we use the data and evidence here to inform impact assessments that are being undertaken on financial decisions so that we have the, I guess, least worst impact on future population health as we make these difficult decisions. And how do we use the data to inform our strategic planning across the system? We want to continue our commitment to developing ourselves as an anchor institution and how we increase the pace of our activity with our community planning partners to work on those building blocks of health, where we know in the longer term that will make the biggest difference. I've mentioned maternal children and young people's health, and there's some recommendations in there about how we start to embed prevention within healthcare and healthcare services. And specifically, we want to try and do some work around cardiovascular disease pathways, and we've already started some work on Type 2 diabetes because we know they're going to form quite a large margin of what's coming at us. And there's a recommendation in there about how we integrate this prevention activity into the existing Wodian health and care system strategy and the program board infrastructure that surrounds that, rather than it being seen as something separate, we want to make sure that's weaved through everything that we do. Just very briefly on where we are in next steps, this paper was approved by the NHS Wodian board in April, and one of the asks from that was that we seek endorsement from the four IGBs within Wodian on the recommendations within the paper, so we hope to do that this month. We have a workshop planned on the 1st of July where we want to undertake an equality in children's rights impact assessment on this work before we start to formulate more specific plans, and that just allows us to ensure that prevention works for everybody and helps us and takes the best action to tackle inequalities that we can, and there'll be representation from across the system at that workshop. We then plan to have a high level prevention action plan by the end of July, and we've committed to taking that back to the NHS Wodian board for an update on progress at that point, so I'll stop there and I'm happy to take any questions on the paper. Thank you very much, Ashley, for the paper. We do have the papers now. All good, so thank you, and thank you again for being so flexible to both yourself and Flora. Apologies for dragging you out and then kicking out and you coming back in again, so no, that was really, really helpful. Thank you. I would like to open up for questions, and I see Phil, if you'd like to come in. And you're mute, Phil. I wonder whether that would be an improvement, but thank you, Ashley, for the paper. I know a lot of work has gone into it, and it's really interesting what you brought up, because it's all happened. I missed the April board at NHS Wodian, so I'm delighted to see it was approved and to see it in the minutes of the last board meeting. How do you see this actually getting infused into the implementation plans of the Wodian LSDF strategy, and equally, how do you see it getting infused into the strategic document that we saw earlier on today and the implementation plans that will flow from that? Thank you. Thanks for that. So in public health, we've been talking to the director of strategic planning and others within the health board about how we integrate that into the LSDF structure, so the Wodian strategic development framework. And there's a possibility of the anchor institution programme board that already exists, which gives us really a vehicle to work on the building blocks of health, potentially morphing into a population health programme board for this work that probably naturally fits, although we want to work with the other programme board leads to make sure, for example, primary care programme board, how do we see prevention embedded through those plans and so on and so forth, scheduled care, unscheduled care. Still got a bit of discussion to have around it, but my hope would be that's how we embed it. In terms of the local strategic plans, so I know that Flora is here today, who leads the local public health team in Edinburgh, and obviously we have leads in the four areas, and part of that work is about sort of being a conduit and working with partners around strategic planning at local level and how we make sure that actually we're all working towards the same priorities, notwithstanding local needs in each of the four areas, but actually there'll be all on the same page in terms of working to the same goals, so we'll use those connections as best we can, and I know Flora's been involved working with Linda on those plans already. That's great. Thank you. Thank you very much for that. George, please. Yeah, I'm glad you got the appendix, finally, and Flora declared her interest as chair of the community planning partnership, so that should be noted. I mean, there's currently, you know, engagement that you're saying should be taken forward by your community planning for strategic plans. Is that going to be possible when they're currently being reviewed within the council and in the partnership? My own opinion is it could weaken community planning partnerships, so has that been taken into consideration, and have you had that at these discussions? Sorry, just to clarify, do you mean review of the local outcome improvement plans that are set within community planning? The LCPPs have been put to consultation, there's been a lot of work done around that, and that's been through the community planning partnerships, and that's obviously concerned next to now reviewing the community planning partnerships, and how they actually take these forward, so that could dilute the whole aspect of that when they were trying to devolve down into these forums, and it looks like we're actually going to change the form completely, so that they don't exist in the same format, so that's concerning, and have you taken that into consideration? I might let Flora come in on that, she's got her hand up. Thanks, Ashley. So I suppose the first thing on that, George, is the work that's being done in the Edinburgh community planning sphere at the moment is that transformation approach, and that is ongoing, so nothing has changed to any structure, so in terms of the work that we need to do now, in terms of promoting the next steps and the actions that Ashley talked about being ready in July, that will be within the current structures that we have. I think the work that's being done within community planning at the moment is very much looking at how do we get the most effective structure for community planning in the city. There's no dispute that the things that we want to tackle through community planning are the same things that we want to tackle through prevention. I think the Edinburgh Community Planning Partnership's two priorities are reducing poverty and addressing climate and sustainability, and the actions that are set out in the prevention paper will help us to do that, so I think once that current review process comes to an end, whatever structures that we have, we will absolutely work with those to deliver against the prevention priorities, and the fact that those structures are being explored at the moment doesn't mean that we can't still engage with the partners we have at the moment in the planning partnership. This whole process is going out to consultation shortly after the decision last week, but that's a potential year of actual communication and consultation, and that's going to create a major delay, and that is concerning from my aspect of it. Okay. Thank you for that. That's an interesting perspective, George, and thank you for answering that, Laura. I think I had Pete who wanted to come in. Thank you, and hello again, Ashley. I hope you don't see me as the opposition here. I am genuinely on the same side. I raised questions at the NHS board about this, and Ashley addressed some of those questions. Just because it's now being asked to the IJB, my reservations about some of the paper—most of the paper, absolutely. Some of the paper was I felt it didn't fully take account of multi-morbidity, so it's very disease-focused, and it talks about individual diseases and the incidence and prevalence of individual diseases. But in fact, for much of the work that we have to support, both in emergency admissions to hospital but also in delayed discharges and also all community side, particularly for older people, multi-morbidity is actually a critical element to their support and their needs for support. I don't think, as it's currently drafted, you've really kind of drawn that point out yet, and I was hoping—probably you want to give some consideration to that, because I want this to be on the same side as this one. I think there's a lot of good data that you've shown, but I think we need that extra element, because that is where it gets critical, particularly in older people, which again, you've not filled out quite the implications of the support and prevention to enable older people to remain independent, which is very important. Because of the implications for the hospital sector, if you look in beds in an acute hospital, you'll find that most of the people there are certainly aged over 65 at any point in time. And obviously, the community supports social care and so on, and a lot of our service users and public are older people. You've heard my argument before, Ashley, I just want to reiterate that for the IJB. I do think we need more on that, and I know it might require a little bit of work, but I certainly hope that you'll be open to give some consideration to that. Thanks for the question. Yeah, we talked a little bit about this at the board meeting. I think sometimes our data around multi morbidity is a bit more difficult to unpick, so I suppose that's the first thing. Although it seems quite disease specific, because that's how we report the burden of disease and look at data across some of our services, when you work back, actually the modifiable disease risk factors that we want to look at, so diet, smoking, alcohol intake, cut across a number of these disease pathways. So if you're looking at specific individual risk factors, you're probably tackling more than one disease or health outcome. But that doesn't negate the need for, whilst we're looking at this at a population level, that holistic care and some of the work that we've talked about in terms of embedding prevention is about that making every contact count. So just because you turn up to secondary care for a condition doesn't mean you can't be looked at as a whole person and do you need income maximisation support? Do you need any vaccinations? How do we promote screening in that space? So it's actually making the best use of all of our health care encounters. But how do we do that easily when the clinicians are firefighting and the system is bursting at the seams? So we need to think about how we do that. In terms of that older age population you talked about, again, because we're trying to think fairly upstream in terms of prevention, we do have false prevention in there as a sort of well evidenced, cost effective intervention. And actually when you work back from that and think about some of the things that contribute to frailty and perhaps increased risk of falls, those are the types of things that we're trying to think about in the prevention space. So I think it's a fair point if it's not explicit enough in the paper, but definitely part of our considerations in the round. And I think more of this might come out of the impact assessment session that we're going to have as well. Thank you. Thank you very much for the question. Thank you, Ashley, for answering the question again. I see no further questions on this agenda item. And we are being asked to note the content of the report and to endorse the recommendations set out in Section 7 of Appendix 1. I think we're content to do that, which is excellent. That brings this agenda item to a close. Okay, so the next item is Item 8.1, which is the EIJB appointments. I have nothing to add to this report and I'm happy to take any questions. Great. Are there any questions? No? There's quite a few recommendations here. A number of appointments. I saw appointment of Alan Beale, Councillor Alan Beale to the EIJB as a voting member, to appoint Councillor Alan Beale to the Audit and Assurance Committee and Performance and Delivery Committee as a voting member. Thank you very much for that, Alan. That's you really pulling your weight in terms of committee membership as well. Thank you for that. We are also being asked to appoint David Belfel as a non-voting member and citizen representative, and to appoint Ben Owen also as a non-voting member and the trade union representative. We're also being asked to reappoint Helen Fitzgerald to the EIJB as a non-voting member and NHS trade union representative, and to note the resignation of Councillor John Davidson from the EIJB as a voting member, to note the resignation of Kirsten Hay from the EIJB as a non-voting member, and to note the resignation of Brajesh Rowan from the EIJB as a non-voting member. So are we content to do that? Yes, we are. Thank you very much. I just wonder whether it would be appropriate to acknowledge the contribution of the members that are leaving. Yes, absolutely. Thank you very much, Pete. You just prevented a massive chair fail there again on my side. I've got my eye on the clock. Clearly this is German efficiency in action. No, absolutely. Yes, it would have been nice to have had the members here for a final session. We don't have them, but absolutely for the record. Just to really acknowledge their massive contribution that you and Kirsten and Bridie have made to this EIJB, and they will be very much missed. Thank you. Okay, so the next item is Item 8.2, which is the Edinburgh Integration Joint Board and committee dates for 2025. Again, I have nothing to add to this report and I'm happy to take any questions. Are there any questions? Claire, please. Thanks. Yeah, I just, having been burned by this in the past, I took a bit of time to look up what the school term dates were because the council recess usually mirrors them pretty accurately. And there's some dates which clash with council recesses. So I just wanted to flag that up and ask that those ones are not approved today and that they look for revised ones. So there's the 11th and 12th of February and the 15th of April and also possibly the first week back in August as well. So if it's possible to approve these dates but not those ones and to look for alternatives for those ones, then I would be quite pleased if that would be okay. Thank you, Claire. Thank you for doing the due diligence. It's incredibly important, I have to admit, much to my shame. I haven't done the due diligence, so I'm really grateful that you've done it because it will impact me as well. Is it possible that we, yeah, okay, we will approve, just for the record, we'll approve the ones that don't clash for the school holidays and go back to a drawing board for the ones that do clash. The February one, the April one and potentially the August one, did you say, Claire, I think. Pardon. Yeah, 15th. I can pop in the chat the one thing that I'm referring to, if that's helpful for the action blog. Yeah, why don't we take the action, exactly. Andrew's suggesting that he will liaise with the chairs of the impacted committees. Max? I think it might have been handier to have this in writing first and I think there's a lot, should we maybe have a discussion rather than just make the decision now? Okay, they are sensible. Okay, so Andrew will have a conversation with the chairs. We'll just take this agenda item and I'm not making any decisions on the dates just now. Okay. Good. Thank you. No, it makes perfect sense. Okay, so the next item is Item 9.1, which is the committee update report. Again, there's nothing to add to this and I think officers are happy to take questions. I was just going to propose that we take the whole section 9 as 1, because it is committee updates in minutes, so maybe we'll do it by exception if there is any questions on any of the 9.1 through 9.4. George, please. Yeah, I mean I'm not probably approving all these, but obviously what we just highlighted regarding dates is very prevalent to that. I mean both myself and Pete weren't able to attend the actual clinical and governance meeting because it clashed with the NHS Lothian meeting. So we have to be really careful when we're setting up the subgroups as well as the main bodies that there are no clashes between all partners, which doesn't seem to be really working very well at the moment. So just to highlight that for consideration. Thank you, George. Thank you. Yes, no, absolutely. I think that's been noted and that's what I was going to say. Andrew is going to pick up with the chairs and also make sure that there is some liaison with NHS Lothian as well around the dates. Because I think Phil, you and I, we've missed the auditiveness committee today as well, so to be here. Sorry, just to take it back to agenda items 9.1 through 9.4. There is no questions, comments or observations, so we're happy to note the work of the committees and the draft minutes. Is that correct? Yeah, perfect. Excellent. And that leaves us with the date of next meeting, which is Tuesday, the 20th of August. And I think that concludes our meeting here today. Thank you so much, everybody. I know it was a very long session, but thank you so much for the discussion, contribution of papers, reports, et cetera. Really appreciate it. Thank you. Have a good rest of the day. Thank you. [BLANK_AUDIO]