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I also think we need to make sure we're working with the town councils on this side of the county to make sure that they are lined up and following the same approach, but it's something that we've heard and we'll take away. [BLANKAUDIO] But the experience of working with worker or cross boundary on bus services has been pretty appallingly poor, so I'll say that with that. But not an anticipatory approach. And as part of the approach we've taken on prevention, it's absolutely right. We need to be taking a really a firm line on anything like this because the more you allow it, the more that happens. Yeah, certainly the Manchester yesterday, last weekend and just confered and the bits of Manchester have significantly declined in the last couple of years. I have a regular running room there where people they seem to have stopped the cleansing and it's just getting worse and worse and worse. Anyway, sorry, was there anything else you wanted to add? My second question really, just to thank Tammy and the officers and wept for the swift reaction on Burtfield, PLC, the owner of the Burt Western Railway. I'm getting the Trovish station reopened. It was closed for months because I hope you don't accept what's not in the government's contract. Mark Harper would need to wear a bit. But as the local rail service between Salisbury and Bristol and Gloucester is devolved, it was taken a miracle by authority, about 35 billion pounds now. I think we need to make sure that we're talking to a worker and the officers and our composers know what rail works there and charge a rail, but also working closely with department and with first and make sure they do collect the fares. Maintain our stations and actually maintain the contract. And I think with devolution, that's probably a bit more for workshop council to do, working with the Western gateway and work out to make sure stations are not closed. And they are stopped. And they are stopped by the contracts. People might mess up these vouchers, but they're not stopped. We can't get on. So in some of them, so I'm very grateful for what we've done. But I do, but I have no devolutions in play. The Secretary of State, but the new one is, but what Mark did is we now told them to make sure we are holding first first group to account who are the contracts with South Western Railway and Great Western Railway in providing that. Thank you, David, you're absolutely right. As I said, we have a close working relationship with Great Western and with Network Rail and obviously with through the strategic partnership as well. Clearly, you know, we anticipate that Great British Railways will come to fruition. And so, clearly, we will continue to keep a watching brief on that and be very involved in those structural and contractual changes as they are likely to happen. All I would say that I hope that we don't share with the rest of the South West. But when that actually comes about, is actually part of the devolution deal. We're on to be a somewhat more complex topic with devolution, where much more important areas or areas around the city are getting that we're starting to see a significant variance in the benefit that can come with devolution if you are part of a combined authority with a mayor to the rest of the country. And it's proven to be a really tricky thing in rural areas where, honestly, people don't seem to like the idea of a mayor, I think, with good reason. And the one size fits all approach that has been taken is not particularly helped rural areas. We need to see what happens post, do you like a fourth bus to the approach of a new government to devolution. Thank you. Yeah. Sorry, it's a boring caveat, but it's a real one and it's frustrating. Anything else you wanted on your other questions. I think the only other issue really is, we welcome the bus service improvement plan. And we just want to make sure that because we're sure obviously fits in with the Southwest, but also a bit with the South of England, with Hampshire, that we have cross boundary links with our bus services into places like room. Bath, such wind and also bond with the pool, but also south of the maintaining and also maintaining Western gateway. And hopefully improving the coaching network, plus candied mega bus barriers and national express and we do work in the work. Certainly do work in the working on source because station. But I think it was a regional element. We just want to make sure that our bus is in what should have stopped it. I think we agree. Thank you. Yeah. All right. Marvellous. Thank you. Council button isn't here. So in your question. Did you have a supplementary. Oh, it's fantastic. Yes, my apologies actually, but I put the question in. About 10 minutes before I got a very, very comprehensive answer from Nick. And so personally, thank you to him for the detailed response in relation to the additional investment in the planning service. My only request is I think Nick's happy for us to do this is for his replies to me to be amended or appended to the minutes of this meeting because they're much more detailed than the response that I've had the question on the paper. So if he's willing to do that, but I think very positive news and a really helpful and comprehensive response to my question, Nick. Thank you very much. Yes, well, well subject, obviously we had a very brief chat about this before the meeting started and I don't have a problem with that because I took, as you know, took the view that I wasn't going to amend the answer that was offered up because you'd already had an answer. Absolutely. So I think if there is a takeaway, it would be useful if duplicates were withdrawn from the system because even generating a non answer does require a lot of office at a time and, you know, it's a approval process. It has to go through and then it has to come to me and it goes back and whatever. So I think, you know, that would be a very helpful thing. But yeah, I don't have a problem in passing just to help you print it out there. That's very helpful. I very naively assume that all these questions do go to members of cabinet. And therefore you would have been able to strike out my question and, as it were, put in the response. They do, but there's a process in the system by which they come in and we make sure that responses come back so it doesn't come to cabinet and then on to officers, it goes out. And then the responses are pulled together and approved collectively. So I mean, I would have amended, you know, had had we not have had a not exchange with you that I would have amended the, because we are given an opportunity to, to amend the answers that are given. I would have done, but not in the circumstance. I thought I don't worry. Yeah. Yeah. I think when you look at the speed or the way in which the timing we have to turn our questions with the deadlines. There's no, I would love to have a process where they came in and we had a good look and said, yeah, whatever, and then passed to officers and then came back, but we just don't have time for that. Particularly as you're then dealing with Friday, which I don't know about the rest of you, but I tend to be doing more things in my division and Friday is quite a disruptive day in terms of being out dealing with the public more. So, right. Okay. If we then move on to the agenda item, which is urgent care at home. Jenny's in here, so I will attempt to give a summary. You may need to come in, but let's, let's see how I do. This relates to the better care fund and relates specifically to a contract with med Vivo to provide urgent care at home. So it's, it's about making sure that we're trying to reduce unnecessary hospital admissions and make sure that people are getting appropriate treatment at home. If they're in that kind of emergency situation, but where it isn't so severe that hospital is the only option. The, that there are various sort of national sets of national guidance in the way this ought to be done. We've had contract running with med Vivo. We were looking to try and get a 12 month extension to that. However, that has not been possible. We've not been able to agree that extension with them. What we have done is agree and extension. I think it was to the end of July. And so, because we're not able to extend the contract further, the proposal is that we are going to be wanting to bring this in house and provide it. Excuse me, provided alongside or in conjunction with the rehabilitation service. We think that we can probably do this in a more effective way than perhaps been happening in the past, that it's a sensible approach for us to be taking. I think that's as much of a summary as I can remember from when we discussed this a couple of weeks ago. My apologies. I wasn't aware game wasn't going to be in until a couple of minutes before cabinets. So I have not completely reread the paper this morning. So the proposal is that we look to bring it in house for a year. And then that we, there's a delegation to, I think it's probably Emma and Jane to go through the details of that. Have I missed anything that needs adding? That's great. Thanks. I need to say that it will be ongoing as opposed to just for a year. And then just to add the part of the reasoning for doing it very quickly. And it's a say in the report that medieval wouldn't sign up to a contract with the local authority because they used to NHS contracts and obviously we can't offer that. So that was part of the rationale as well. Thanks. Thank you. Is there anything anyone can cover that wants to add there? So if we go through the normal process in. You come before grandma my list today so sorry you do. The mind field out here is who gets to go first and who doesn't. And I suppose the first thing I would say having read the paper is this is very positive news. My view is that if we can bring services in house on the whole, I think that these services are likely to be better delivered. But I have got one or two questions or one to comment. So it is the first question. If this doesn't require a moment of part two is it's more clarity as to what. You may have made the point about nature of contracts but whether there's anything more that prevented us or indeed medieval from continuing the relationship. My second question is and it's a kind of question about bureaucracy I seem to remember. We had or you had a discussion here a few cabinets ago with regard to a very large part of the better care fund about 10 million pounds. And this was going to have to be procured this particular project was going to be procured via my all of our good friends at the ICB. So I'm just wanting to understand how positively we get to do this but we couldn't get to do the procurement of the much larger some. And then my final thought is probably quite wrongly and inaccurately I read the report and thought gosh this could have been me in the sense that I was without boring everybody yet again. Had eight months in in the IIH in solitary confinement also it seemed. But then I've been back to the IIH on three more occasions with particular issues for short periods of shorter periods of time. And it may be somebody will say to me or know understanding more about my position. It wouldn't have been appropriate but I'm just wondering and again it's just a question because I'm very interested now in these issues as you might imagine. Who would know who would know that I would have benefited from this particular scheme. Would it be my GP would it be the hospital. I'm very, very. It was not the right works I want to be positive about things about in terms of who knows what and who's communicating what. And I'll give you one unrelated experience and that was I had a number of drains put in me. And there was a big debate at the end of my eight months as to whether I could leave hospital with the drain. The view was well surely the district nurses could drain the drain. All you do to drain the drain is just press a valve. It then turns out district nurses are not trained to drain the vein. I was then sent out to get a district nurse to flash a quarter calf. I think they call water cans and hand up again to find that district nurses don't do that. So there's a broader question which I know we won't answer this morning around. The earth knows what's happening. Who does what who communicate but more importantly in relation to this paper. If I was a candidate for the kind of service we're talking about. Who would know I would need it. Who would tell me because I would never know. Thank you. I think on the wider point perhaps you should come along to an ICP meeting and ask some of these questions because I'd love to hear the answers as well. Because dare I say it there are times that the NHS is clear as Mark in getting an understanding of precisely how the different pathways work. And I'm using a lecture speaker I'm trying really hard not to I'm spending far too much of my life trying to learn this myself. Having spent most of the last week up at the NHS convert and trying to get a better understanding of how some of this particularly this interchange between the acutes. Sorry hospitals GPs and councils and the elements of social care work because I think it's fair to say erratically it's about the best answer anywhere in the country anyone could give. My understanding here is it's a health and social care referral but that that's a pretty broad term isn't it so it could be coming from social care it could be coming from from a GP but. I'm just going to answer a couple of the others and I'm going to go to our resident health expert which is a so in terms of the 10 million. So that there's a cabinet report coming back in July regarding that issue so that that fund was a better care funding that was for community health services. So what's currently provided in Wiltshire by Wiltshire Health and Care and the ICB are commissioning across the whole of the system so Wiltshire, Baines and Swindon for a single provider or a collaboration or whatever it will be and currently going through that procurement process. So in terms of the decision around whether or not we will support the 10 million in the better care fund that will be coming back in July. I'm just trying to think what there was one other point I was going to make before Emma came in in terms of the how would you know. Elements I can't remember what it was. Oh, yeah it was. So it's not it's not in scope for the whole community health provision and we know the only reason we know is around the contract essentially. So quite technical reason but do feel in a position to be able to pick that service up and as you say you know it's positive and there are synergies with having that service and other services that we provide but Emma can talk about the kind of referrals. I'll just come back in very quickly on the better care fund that that relationship between integrated care boards and councils and it shouldn't be a relationship because we are part of the integrated care board. But that that conflict is something that really does need to be broken down and resolved again countrywide it's it's a consistent issue everywhere. And in fairness to the integrated care boards they are very much focused on funding issues that relate to hospitals. But one of the ways to reduce some of the demand on hospitals is to make prevention work. So that that really is absolutely vital. And it it's probably going to take some NHS central leaning on on the systems to force this to be done. It's, if I came away with one, the one thing I came away with on my notes from two and a half days last week is the fact that we have got to I have got to sit down as chair of the ICP not as leader of the Council and have a very serious discussion with the Chief Executive and chair of the ICP about how we start freeing up some more resources. One of the best examples, I think Kent and Westminster, where they've given small amounts of funding to GPs to the primary care system as a whole, a pound per person. So, I mean, not massive amounts in the scheme of things to focus on prevention and some of the returns there in terms of reduced GP appointments, let alone other referrals has been really quite good. So, yeah, the evidence is starting to come through, but as a country, it's in very small isolated pockets and it's going to take a more dynamic approach from the integrated care board. So, coming on to this will be a really good way of trying to try to make this point. Sorry, Emma. That's okay. And yes, on your final point, our own, who would know and how would you access the service and what this actually will do, it should make it easier, because at the moment we have the medieval contract, and we also have wheelchair support at home and the wheelchair management service, kind of doing something similar and comparable. This will actually amalgamate all of that capacity into one larger county wide service, it gives us much more on the economy of scale and a single route in. It would largely be through a GP or through possibly the paramedics or through a service that is delivered called to our crisis response. So, that is delivered by the community health provider and that is, it's a national requirement, but it's sole focus is to deliver a crisis response within two hours and then put in the care behind it that is required. So, that is up and running in March and asking for some time there are some quite strict criteria that are set nationally rather than determined locally, but this service that we're proposing will absolutely enhance that and should actually make that service more successful because often when the nurses have left, it's the care that's required then to maintain somebody staying in their own home. So, we will absolutely have to think about those referral pathways in. So I think the first step will be bringing it in house amalgamating it with existing service, but then making sure that the right people beyond GPs beyond wheelchair health and care are aware that this exists. Another thing it can do is support where there's been a care a breakdown. So, for example, if care and needs to go into hospital and actually the person they care for remains at home, this service can step in and provide overnight care, so that they actually are safe and secure in their own home. So there's a whole range of issues and things that we can address via there, but the point is very well made in terms of the communication around that and streamlining those routes. I don't want to take up too much time because I think we're going for a record in terms of the shortness of the cabinet meeting. So two things, one, I'm sorry if we can speak as it were outside the meeting about this is a fascinating important area I'd like to understand a bit more. My only other point and again I'm sorry to bring it back to my personal experience is whether this service or maybe there are other services that step in when GP practices can't provide the service. And my specific example relates to, and again I'm sorry to bring it back to me because it's me me me, but in terms of dressing of women's for example. So I had a massive wound and my GP told me that they had no contractual responsibility to dress or pack the wound and that somebody else would have to do it. I just don't, I don't know whether this particular, I mean I ended up back in A&E trying to get it fixed and ended up back up the IUP. So in a sense it would fit perfectly with what they're talking about this morning and I'm just wondering if that scenario would be covered by your service. I think it's probably a development that is coming and expanding is NHS at home, which is what is often referred to as a virtual ward. So it is designed to be an effective ward, but not in an acute hospital in the community. So you have initial nurses, therapist, doctors who will sort of wrap around somebody in their own home. Now this is a relatively new service that is being delivered by Wilshire Health and Care, commissioned by the ICD, but that probably is the kind of type of issue that you would be describing. And the aim of that again is to support people at home, either enabled discharge earlier or prevent that admission in the first place. So we're optimistic that that is going to be successful in reducing our reliance on acute hospitals. Just very, very, very briefly, and that service would be known to the GP, for example, so he or she could say we can't do it, but we know somebody that that's very helpful. If we can speak at some point in the last few days, I would appreciate it. Thank you, Richard. Marcus, thank you. Right. You're going to pass straight on to Gordon. Gordon, over to you, his health select. No problem. Good morning, Paul. Johnny, Jane, and I had a briefing from Emma that's Friday on this subject, which was based around three basic questions. The first is what is the biggest risk to the council. It was felt that the benefits would outweigh risk on the services seem to be the extension of the existing in-house service was to support home. It would allow greater governance oversight of care, economies of scale and support, more flexibility of care provision and the ability to deliver within the budget. Other resources in place to deliver the service reassured that the council were able to resource the service to be staff will also be able to recruit staff at present. What will be the difference for the people receiving care, unlike me though, the council will not be, will not be providing the response to the telecare service between 10 and 10, 10, 10, 10 am. Do not have clinical staff, but also feel a better option for telecare to be contract paramedics, if necessary, and family members. Thank you very much. Thank you. So if I then open this up to any other members who have any comments. No, in which case change you want to put the recommendations. You'll need to put the mic on. You're already logged in. In which case the recommendations are as follows. The cabinet approves the delivery of the urgent care at home and telecare response service to wheelchair council in-house services from the 1st of August 2024 at an annual cost of 1.665 million to be funded from the better care fund to delegates to the director of adult social care and consultation with the cabinet member for adult social care. Send an inclusion to finalize operational matters to ensure a safe transition transfer of the services. This will include the 2P transfer of eligible staff and the purchase of the necessary resources such as uniforms, laptops, phones, equipment for service delivery and the use of fleet vehicles. That's another one, isn't that? No, but that covers it. That's everything in the papers. Thank you. All right, I'll second that, all those in favor. Thank you. That then comes to urgent items of which there are none, so thank you all very much. We can all go back out to our job of delivering the leaflets and knocking on doors and officers to get back to work. Thank you. Cheers. [BLANK_AUDIO]