Transcript

Okay, good afternoon everyone and welcome to this meeting of the Bracknell Forest Health and Wellbeing Board. As it's the first meeting of the municipal year, are there any nominations for chair for the municipal year please? I'm happy to nominate Councillor Megan Wright. Thank you, is that seconded? I'm happy to second that Andrew Hunter. Thank you very much. Are there any other nominations? No, then it's over to you Councillor Wright, thank you. Thank you very much Lizzie. So next thing on the agenda is to appoint the Vice Chair. I'm allowed to nominate the Vice Chair aren't you? I'd like to nominate Nicola Airey to be the Vice Chair. Any seconders please? Andrew Hunter, I'm happy to second that. Thank you. Okay and thanks, welcome Nicola as Vice Chair and then on to apologies. Do we have any apologies please Lizzie? Yes, I've had apologies from Sue Halliwell, Councillor Michael Carim, Sonia Johnson, are there any others that I've missed? If there are let me know, thank you. Okay thank you and then if we move on to agenda item number four which is declarations of interest. Members are asked to declare any disclosable or affected interests in respect of any matter to be considered at this meeting. Have we got any declarations of interest from anyone please? Oh Andrew, go for it. Just to say on the item relating to the new Skimford Hill development, there is a live planning application and as I sit on the planning authority just to be aware of that. Okay thank you very much, thank you. Anyone else? Okay thank you and then if we move on to agenda item number five, urgent items of business. Do we have any urgent items of business? No chair, none notified, thank you. Okay thank you very much. On to agenda item number six, minutes from previous meeting. To approve as a correct record the minutes of the meeting of the board held on 14th March

1. Before we do that, I just want to say there's a little item 40 in the minutes which I think is on page eight. It says MPARENT has a question mark following it and I was just wondering if that was the name of the organisation or if the question mark following it was because you hadn't confirmed the name of the organisation. So this is on page eight, I've got this down. That won't be the name of the organisation, it might just be a typo, I'll look into that, thank you. Okay it says the contract with MPAR has been extended to provide support, okay so it was just to confirm. I tried to google it and work out if it was something obvious and I couldn't see so I just, yeah it's obviously something that needed to be clarified. Okay thank you. Okay so do we have approval of those minutes? Thank you Nicola, thank you. Okay any matters arising from those minutes? All right thanks. I'm not very accustomed to Zoom, I've forgotten how it works. If someone's put their hand up but they're not on my screen will I see that there's a hand up, it will come, it will show, okay thank you. All right then so we don't have any public questions, is that right Lizzie? No okay so no public questions today so if we move on to agenda item number nine which is the Skimpethill development and I'm handing over to, is that Jane Worley Batty for this, is that right? Yeah I think you just call me Jane. Thank you, right Jane, thank you very much, over to you. Lizzie I think we've got a presentation. I'm aware that we've only, between Andrew and I, we've only got 10 minutes so I'm going to focus on two key elements, one of which is why we're doing and the other is our time scales and how we're going to deliver this. The Bracknell Forest Centre for Health, the new centre for health is a response to three key elements, population growth in Bracknell Forest, you'll all be absolutely aware of the the amount of population growth that we've had in not just the town centre but across Bracknell Forest itself. That's increased need and demand for health services. Secondly, integration of health care, it's been a policy and a driving force for how we deliver health services so that all our service providers are able to work together for the betterment of patients and delivering for their health needs. That's limited sometimes when we haven't actually got the estate for them to deliver those services out of and the Bracknell Forest Centre for Health is something we've been trying for since probably about 2017/2018. I think before then there were earlier examples of trying to do something for the centre of Bracknell, recognising that the Skimpyd Hill health centre is past its sell but I think is the nicest way of putting it. We're very conscious that with the current needs for clinical services, the kind of estate that our primary care services and community services need, that the Skimpyd Hill health centre is limited in how far we can proceed with it. The right next door to Skimpyd Hill is the Brownfield site that's laid vacant for some time. There have been a number of different plans for it. Working with the council, we asked if we could use it as something that we could do a clean new build, predominantly clinical services that we were going to be putting in. You'll see from the note we're talking about primary care, our community services that are delivered by Berkshire Healthcare Trust and maternity services that are delivered by Frimley. Now predominantly these are services that are delivered out of Skimpyd Hill but also it brings in services that Berkshire Healthcare in particular are delivering across a number of different sites so it will give them a more centralised coordination of their services. It also means that whereas before we were looking at saying well let's dispose of Skimpyd Hill and let's build somewhere else that's new, what we have found is there are very few sites actually in the centre of town that can be redeveloped. So by taking this route this does allow us to take, retain for the future an opportunity to redevelop the Skimpyd Hill's health site. Now there's no money in the pipeline at the moment for doing that but if we did dispose of it then even if we had the money we'd still be trying to find somewhere to buy. So in taking a longer term view, one we retain the site for an opportunity in the future but also it allows us to use the existing site for some services and they can spread out a little bit more. Some of them are quite cramped and not in conditions they should be in, in terms of current medical standards. We will also retain use for the admin staff and instead of being in little corners of rooms and places they will actually have the space but they'll be nearby their clinical services. Predominantly this is bringing together primary and community care and one of our key work streams is how do we make the most of this and that's something that as we've got nearer and nearer being able to sign off on getting the funding and making things happen we're now focusing on how we make that happen, what do we really want to happen, how do we want to focus that and make it really work so that the estate works for us and for patients. Where we currently stand at the moment, the funding is in the process of being finalised by DHSC and the NHS, NHSC. It usually takes a long long time to get these things signed off and approved. This one has gone through in record time. I believe part of this is because we have a record of delivery and we also have a record of delivery with Bracknell Council. So lots of positives there that are really working for us in doing so. The funding will be signed off, subject to planning approval, our agreeing of a contract with a building contractor and finalisation of some of the detailed plans. But the funding is there, we've already had a significant amount of funding in advance to enable us to pull the designs and the business case together. It's not about whether we do it, it's just making sure that we've ticked all the boxes that need to be there to make it happen. Clearly no one's going to put millions of pounds on to something that we haven't got planning consent for. So they're reasonable restrictions, there's nothing that I believe is onerous at all. Now in this presentation there's a lot of detail, far too much for me to go through. But there is something to be circulated. Lizzie, if you could whiz through quickly with a quick flick, these are about the location. Next one. Some of the external appearance and visuals, these are being updated as I speak. We're getting some better pictures that will be more realistic rather than architects' drawings. Next one. Some site plans and floor plans, these are pretty much there at the moment, giving you a flavour of where the different services will be, how the floors will be working. We're putting as much in there as we can and can afford to develop. Next slide. Access and parking. Parking's always a challenge at Skimpyd Hill, mainly because we've got so many people parking that aren't actually anything to do with Skimpyd Hill. We're not waiting for the planning consent issues, we're starting working on that now with Property Services, who own the Skimpyd Hill site, to actually put some practical management. It hasn't been managed for quite a while and therefore people have felt able to take advantage, so to speak. That isn't waiting for the new build, we want to make it happen now. We're talking with Property Services at the moment. Next one. This is a key slide. This isn't about something that we go out and, yes, we get permission for and then everyone sits there and two years later nothing's happened. This is the same right. April, we put that planning application in. By July, we're hoping that mid-July we will get the determination of the planning permission by Bracken Forest Council and then we're looking, you know, we're rolling. This August we want to be starting on site, the plans there, subject to planning and so on. With the avowed aim of March 25, we expect to have completion of the build and then the following months we then expect it to be open for business and ready for patients to come and see. It's a very aggressive programme and that's probably why I've said spring 25 rather than an actual date. It assumes that everything goes right and so far we're doing quite well. We've stuck to programme, we're there, there's a few little glitches coming in but you'd expect that but it's doing well. Andrew, did you want to jump in? I don't think there's anything more to add from my perspective only to say that, as Jane mentioned earlier, this is a project which the Council's been there to support and enable to take place with the NHS leaving in terms of all of this work. Obviously, we pay a part with the determination of the planning application but we are keen to see something happen on this site and keen to see something on this site soon so that it just complements further the abilities to support our newly completed flats in and around the town centre and the growing population in that location. So, probably nothing more to say than that other than to say that it's in process and so far this has been the swiftest and probably most pain-free partnership working we've done. I think it's a product of us learning from each of the projects that we've worked on, so nothing more than that. There's just one thing that I think, although we've got an aggressive programme, I think just to give people a bit of confidence that it's not me being terribly, terribly optimistic. We've taken the approach of going for a modular build. That has a number of benefits. Most of the construction will happen off site and then be brought in which means that very swiftly we will get to a point where we've got a contained building. So, in terms of construction noise, I think that will probably be as low as you could possibly make it on a construction site and speed because they can start working off site and then bring things to us. It also ticks lots and lots of boxes for the NHS liking their MMC, which is the technical word for it. It's the anything doing it off site and so on. I get lost with some of the construction acronyms, I'm afraid. I can manage the NHS ones but not so much the construction ones. So, I'm really confident. We've got a good contractor that we're working with. They're just in the process of completing two builds for property services over in Norfolk. Both have gone really well into plan. So, we're really happy. I'm sure there will be little hillocks along the way that we need to climb but we will get there. Any questions, I suppose, if there's time? Thank you. Any questions, anyone? Okay, I've just got a couple of questions. Andrea and I communicated prior to this about transport and access and that's not really part of today. That's about planning. I suppose one of my things is, as we've got the town centre redevelopment happening at the same time, it would be really nice to think about that when we're thinking about moving the bus centre because I think access from the south is still quite limited to this side of town and it would be nice to see improved access through public transport to the area. The other thing I was interested in was looking at the size of the rooms. It was quite hard to work out the size of the rooms, Jane, and if they're fit for purpose, when you think of some people who are coming in in wheelchairs who might need hoisting onto, I just wondered if there are certain requirements for these treatment rooms, are they the right size? Yes, the rooms are being built to the health HBN standards, so a consulting room is 16 square metres, which is actually quite substantial. That's the same with the corridors and the doorways and so forth, so we're not specifically setting a room up for a particular bariatric. We are talking with the GPs in particular and potentially the HFT with some of their leg ulcer people, so it has to be designed with access in mind. One of the things that we're doing is changing how the parking will be on the Skimpyd Hill site to move more of the disabled parking spaces so that they're nearer the entrance to the site. The challenge has been for us that because we're taking pretty much all of the sites, there's no parking on the site apart from an emergency ambulance bay that we have to have, therefore any parking needs to be on the Skimpyd Hill site, which is why we're so keen to discourage the people who are getting their freebie parking that aren't there for the benefit of their health, shall we say. Fantastic. And then another question I had was when I was reading on in the sort of agenda pack looking at sort of disaster preparedness and pandemic preparedness, and I was just wondering if there's any scope for these buildings like this to be upgraded if there was a serious pandemic or something that they could be used for sort of more extensive medical treatment. I don't know. When you say upgraded, what do you mean by upgraded? I suppose one of the concerns was during the pandemic, you know, we had to build those Nightingale hospitals and we had to, you know, we just realised we didn't have the scope to separate COVID patients from non-COVID patients. And I was just thinking about forward planning for the next pandemic and do buildings like this have anything in-built in them to sort of be ready to upgrade to having overnight patients or giving people oxygen or whatever what might be needed if something like that happens again? This particular building I would not say is not being built to do that. In effect to do that you would have to be building a hospital site. Now, the Nightingale things that were thrown up were dealt with in a very specific way and therefore all the bits that came into them, the elements that were needed, it was done so that they could do that. Taking an existing community and primary care centre and saying that you'd upgrade it, it's being built so that it can be utilised easily in a pandemic. We've learned from the pandemic, some of the GP surgeries had problems because they didn't have an entrance and an exit so that people could come in one way and go out another. We have a rear exit, we can deal with that. So there are elements there that you can maximize the community use rather than the number of patients you could have there would be fairly minimal because you'd have to have them isolated. To be honest, I don't think it would necessarily be. It's built with those things like looking at patient flow and looking at kind of. Yeah. Well, that's interesting. All right. Thank you. They were my questions. Thanks. Anyone else? Any other questions? It's a hand up. Oh, is that? Oh, sorry. I'm not too hung up. Oh, it's you, Hema. Sorry. Hema. It's blended into the grass behind you. Yeah, go for it, Hema. No, thank you. I think this is welcome. And as you said, Jane, this is about prevention and, you know, primary care. And this is really good. Perhaps a solution to some of the things we have been looking with PHFT in terms of the services that they can provide in Breckle Forest. And in particular, I'm thinking about the sexual and respiratory health services, which quite a lot of our patients have to go right up to Slough. So I think in that there is the opportunity to do more work within Breckle Forest. And it will be useful at some point when everything is done is to look at, you know, how we can use the accommodation more flexibly so that we can have more services which are preventative in terms of Breckle Forest. So we would welcome that from public health to have that discussion. Yeah, I mean, the concept is building a building that can be utilised doesn't have to just be utilised during the day. Ideally, we'd get utilisation up to, I'd have it working 24/7, but that's probably just a tad unrealistic. But there are ways that we can look at the opportunities. It's also freeing up space in Skimped Hill Health Centre, as well. And one of my tasks is to try and persuade property services to spend a little bit of money on that so that it's striking the balance because if we want to knock it down and can knock it down in say five or 10 years time, you don't want to spend a huge amount on it. But it would be good if we could perhaps put some, get some rooms available that were useful more flexibly as well. So I think all conversations are on really. Thank you. Have we got any more questions? Okay, thank you, everyone. So if we move on to, and thank you very much, Jane, for that. If we move on to Agenda Item 10, Health and Wellbeing Strategy Update, and we're looking at priority three, which is social isolation. And I think this is you, isn't it, Hima? Yep. Thank you. So we have been bringing reports to Health and Wellbeing Board on the Health and Wellbeing Strategy delivery. And we've shifted a little bit about because you've got the action plan, which we have been looking at in terms of progress in different actions. And the way we have been doing it is updating any new actions and update by using a red font so that, you know, these are the new updates on each of the actions. Last time we looked at the priority, which was priority five. And this year, this time, it's a priority three, which we are going to do some more focused reporting on. And so Phillip Bell from Involve is with me. So he will be also joining me in terms of talking about priority three. Some of the things that I think are important to note, which I have got Emma Presley from my team who has also been looking at some of the social people who connect with services, who connect and are quite happy to talk on the phone and also have home visits. But also, they're not they're not housebound, but yet they somehow they don't want to join in with any social activity. So we've been doing some work on some behavioural insights. And as I said previously, our delivery plan is very much iterative. As we learn, we try to put in things to learn more in terms of what needs to improve. So she will be just presenting on her work. She's been doing on a group of people from social prescribers who are kind of, I would say, not ready. But yet we don't we need to understand why they're not ready to engage in social activities. But in terms of other highlights that I want to mention is that most of our teams are working together across. It's not just public health, but it's a multi agency. All the teams work together very jointly. And that's been quite good because you would expect with all the changes that are happening, there could be some dropouts. But what we are noticing is the commitment to health and wellbeing delivery has been very strong across partners. And we are still seeing, even if people are leaving, there's somebody else in that place who has been delegated to join the health and wellbeing task and finish groups and the oversight group. So that's something which I just wanted to reassure the health and wellbeing board in spite of all the changes, both in terms of ICB as well as what's happening in primary care having so much demand. We are seeing really good delivery and support in terms of delivery of that. So that's something which you wanted to definitely highlight. And that's where you can see most of the actions are being progressed. There's one action which is red. So I want to just talk about that a little bit, which is about the suicide prevention toolkit, self-harm toolkit. And as we brought the suicide prevention strategy last time, so that is now progressing in terms of we have a group and we have a strategy. So I think it will come in terms of the next steps in developing a toolkit, but that therefore has been delayed. So it might be coming next year other than this year. So that's the only one which has been delayed quite significantly. But what I would like to bring is Philip, do you want to come in before Emma talks about her behavioural insights to say a little bit more about what's happening on priority three, individual isolation and loneliness? Yeah, no problem, Hema, I'd be delighted to. So colleagues will have in their pack kind of the overview documents which talk about each of the elements that we've identified or each of the actions that we've identified for this particular priority. So I'll just pull out some of the core elements I think are worthy of note and celebration too, because this is a very active space. And I think that myself and Hema are united in our wanting to work together to target those most vulnerable to experiences of social isolation and loneliness. And we have that kind of shared appetite really to growing our assets and to growing the communities around Brattle Forest to support people that are disproportionately impacted by this experience, because we know that the health implications of social isolation and loneliness are considerable. So the more we can do in this space, actually, hopefully the better the well-being of our population. So we have seen and we continue to see an increase in the number of services and groups that are being developed and maybe are being illuminated too, in regards to social isolation and loneliness, are recognising that we need to grow kind of ward assets in order to ensure that people are connected within their own unique communities. So that's one of the things that we're very focused on. And that's been enabled by, of course, our community map, which has grown actually by 10 assets in the last quarter, but also by some of the work of the Older People's Consortium, a consortium of organisations that come together to think about kind of the lived experience of people over 50 within Brattle Forest and what we can do together to positively address experiences or disproportionate experiences of social isolation and loneliness. And again, we've seen assets grow and we've seen partnerships, people coming together with shared ambition, positively then targeting elements that we know we can do better together that make a better experience, ultimately, for residents that are living in our communities. The final element to that is around our friendship ambassador, which is a new post that myself and Hima have been nurturing over recent months. And within that, the determination to build friendship tables, or worse that effect, we don't know if we're actually going to call them friendship tables within Brattle Forest. We're doing some work around what we should name them. They're called that over in Wokingham Borough. So this is a model that's recognised in another local authority area. They're very much building social spaces, again, within communities that are within walking distance of a resident so that they can come together, they can share interests, they can share conversation. And again, positively address those experiences of social isolation and loneliness. All of the kind of the work that we're doing is underpinned by every contact counts and kind of that methodology. And we're looking to really build that across the whole system. So our conversations are really, really underpinned by that MEC training. Just a few other things worthy of note before I hand back to Hima. We're in an active volunteering, which is something now that's been up and running for about 18 months. It's grown significantly. I think it's surpassed all expectation with, I mean, even in the winter months, we were seeing about 650 hours per quarter at the volunteering and about 50 individual volunteers plus corporate volunteers involved. In the summer months that grows again, because people prefer to be out, obviously in our green spaces in the spring and summertime, which makes absolute sense. But we are positively targeting people who, again, are disproportionately affected or impacted by social isolation and loneliness. And seeing real results as a consequence every quarter, we are running surveys with people that are engaging in this particular area of volunteering and we're seeing an 85% since self reporting improvement to people's physical health and a 60% improvement to people's mental well being. That's really significant as well as obviously the great stuff that we're doing within the green spaces at Bracknell Forest too. We are looking to make better utilisation, as I say, at the Community Map into the future. We're looking at what we can do together more and more and how we make best use of the resources that we do have. I think I'll pause there, Hima, and hand back to you if that's okay. Sorry about that. So just following on from what Phillip said about looking at how do we support people who are more vulnerable. So one of the work with the Community Map has been doing is they have been talking to People Power to see how people with disabilities learning difficulties, and also with some of the children, families of children who are autistic, how do they use Community Map and what are the barriers for them to use Community Map. So they've been doing some great work, getting feedback, co-designing with them, some leaflets training, and also they're now a category within the Community Map so that they can very easily identify activities that are suitable for them. Today morning, in fact, they had another meeting with People Power, and all the work has been now finalized, so we'll be updating the Community Map to reflect what People Power have provided in terms of feedback, which are the activities they feel are more suitable, and then the two categories which they have asked us to put on that so that families and people with learning difficulties or learning disabilities, autistic children, can very easily access the Community Map. So I think that's again sharing how together working with everybody on both the voluntary sector and service users, we are making a difference. And the second bit which I'll hand over to Emma to quickly say what she has been doing in terms of understanding some of the populations which are still not engaging, but should be able to engage because they are mobile, they're not housebound. So Emma, do you want to quickly say about the behavioral insights work we've been doing? Yes, of course. Did you want to share the slides? Did you want me to share them or just talk through them, talk about them? I think everybody has got the slides in the pack. So I will ask if time permits or whether you just want to just highlight what you've been doing. You can share the slides but just keep it very concise. I'll give you the highlight reel, it might be a bit quicker and you've got the slides if you want to see the full details. So basically, I'm the Behavioural Insights Officer in the Public Health team and I also work part-time as a social prescriber. And as a social prescriber, we sort of noticed this trend of people who were more than happy to talk to us over the phone, they were more than happy for us to go and do a home visit, but we couldn't seem to kind of cross that barrier of actually getting them to come with us to an activity. And we'll always offer to go with them. We've done travel training with people, you know, help them walk to the bus stop and get the right bus and we've kind of, we're doing all of those practical things, but why could we not kind of actually get them to participate? So I carried out a survey with this list of clients that we had and spoke to them, kind of, did they understand what social prescribing was? Did they feel like they had the right options in their area? Was there something that they were interested in? You know, we chatted about travel, about physical ailments and kind of all the potential barriers to try and understand the underlying factors with that lack of engagement. And what we found was actually really interesting. I say we, me, what I found was people had a really good understanding of what social prescribing was and I found that personally quite interesting because we always say, or the biggest barrier is that the name is confusing. People don't understand it, but they did. They had a really good understanding of what social prescribing was. They felt that there was plenty in that area that they were interested in that they kind of would potentially like to engage with. So I think that's a massive kind of demonstration of how the community map is working. You know, we've got 500 assets on there and I think people do feel that there is something on their doorstep. The biggest issue was motivation. We found that our older adults, they find getting in the car quite painful, sitting down for long periods of time quite painful. So that was kind of a physical issue. In terms of motivation, we're seeing people that have been at home for years, pretty much since we went into lockdown and they've become used to being at home, leaving the house feels really overwhelming to them now. I spoke a lot to our clients about kind of that social anxiety, the anxiety of maybe not being able to think of a conversation topic. The other really interesting thing was that a lot of them had tried a group before or found it really unwelcoming, had a really horrible experience and that's put them off trying again and echoing kind of what Phillip said with the friendship ambassador. I think that's going to be really helpful. We've already had a chat with her about how we can address that. Because quite a few groups that we've been to, our social prescribers, it comes from the group leader. There's an unofficial seating arrangement and it just makes newcomers that are really anxious really put off by the whole experience. So that's one of the outcomes of this project. I'm a qualified MEC trainer, so I think what we're going to do is we're going to offer all of the volunteers for kind of like the coffee drop-ins and those people that are running those groups a really tailored kind of MEC session. So we can really talk to them about do you feel prepared to kind of welcome people that are feeling really anxious, potentially haven't been in a community setting in years and kind of running through some MEC conversations with them just to kind of build up their confidence as volunteers. And also with social prescribers, I'm going to be running some, again, sort of based in those MEC foundations, but also more motivational interviewing about how we can really work on that motivational aspect with our clients and kind of work on positive intentions and how do we really build that intrinsic motivation. And going forward, hopefully we'll get people engaging in community groups more. And all of this has been mapped by ward as well because I wanted to see if it was kind of travel related or is there certain wards where people are struggling to engage a bit more. So this is an ongoing project and hopefully it will coincide really nicely with the community map and we can kind of keep an eye on how people in certain areas are doing, different age groups as well. So yeah. Thank you, Emma. So I think now we'll stop there and take questions. Wow. Thank you. If you've got any questions, I just had one Emma. I mean, do you speak to other social prescribers? Is this an issue? Have you found out about what's happened in other areas and if what you're seeing is similar to what people have seen in other areas? Yeah, so we do try and work as close as we can with the PCN link workers. But obviously we operate as a team very differently. They typically have triple the amount of caseload that we do. And as far as I know, I don't think they do sort of home visits or meet people in the community as much. I know for kind of like the larger practices, I know that that social prescriber typically does one phone call as a signposting call, and then it's down to that patient to get back to them. But I know that's only in the bigger practices. I think we're all doing as much as we can to try and provide more activities in the community. But yeah, I think maybe some more work needs to be done to kind of carry out those actions that we come across, and get them to kind of fulfil those as well. Thank you, I can see Nicola's hand. Is that your hand up, Nicola? Yeah, I can't seem to find my bottom for my hand. It's more entertaining, isn't it, if I have to wave in a sort of foolish way. Emma, I think we need to do a little bit more work so that we can see our social prescribers as one virtual team, as opposed to the level of disjoint that there is at the moment. I wonder if we could pick that up, and I can help you on the PCN side. But for our populations, they shouldn't see us as being two different types of social prescribers. It should be a sort of more joined-up approach, I think, if we can. Building on the strengths on each side, but I think maybe there's a little bit more work we could do there. Sorry, Andrew, you've got your hand up, sorry. Yeah, just building on your point about some people sort of worried about going to the asset, if I can call it that, the group, whatever. How will the friendship tables play into this? Because they sound like a kind of a good stepping stone into the opportunity to then move from that to going to a club or a society or a coffee morning somewhere else. Is that the intention with that initiative? I'm really happy to take that. That's all because like Nicola, I can't find my hands up icon. But yes, so the friendship ambassador will initially host those tables. The idea is that the space, whatever that might be, will host the table in time. There'll be a certain etiquette and values base to each of those tables, so that's really important. So there's some continuity, and people do get the welcome, the warm welcome, because that's what will keep them coming back ultimately. That's what it's all about, so we need that continuity. But the friendship ambassador will also do some one-to-one work, so they will be available and they will be very much in tandem and partnership with the social prescribers, as well as with the likes of our educator, Berkshire, who have volunteers, for example, that will help people to get out of home. So again, it's just about how we work together as a whole system. I think our consortium will help no end with the planning for that. And we have Jo Pittard, who obviously works alongside Emma that leads social prescribers within public health, to help us in that conversation so that it is aligned and is more joined up. Great, thank you. Do you have any more questions? I've just got another, oh sorry, Hima, go for it. I just wanted to come back, not questions, but following on from what Philip said is the friendship tables is not just for older people, it's we've kept it all age so that young children, young people and families can come there. And one of the things we are looking at is working with HomeStart in terms of health visiting. Similarly, what we are doing with the older social prescribers is looking at how we can support families, young families, as well as children and young people to get more connected because we do know that's a problem even in the younger population. I just have a couple of questions. I was wondering if there was any sort of cultural divide here, if it was people from different sort of non-white, non-British that were less likely to take services, if there was, if there are any things there where we can signpost people to things where they feel more engaged with that community. And then my other question was about, like, what does success look like in social prescribing? Is it when you've got someone engaged in one or two activities that they're doing regularly and they're not needing any further interaction from you? And when do you kind, when do you kind of decide we've tried everything and they're still not engaging? Like, how long would you give it? Thank you. In terms of ethnic minority groups, that's not something that we've noticed in terms of our caseloads. But we largely get white British referrals, which is something that we've been working with David, Brian and Annie. So that's an ongoing project we're trying to really kind of, we've been working more with faith communities and kind of really trying to access those wider communities. So it might be that going forward, that is an issue. But right now, as most of our, I think, I think it's something like 70 or 80% of our referrals are white British. So that isn't something that I've noticed with this data set. In terms of what does success look like? So we take a number of measurements, kind of like loneliness, health and well being, we take a lot of kind of data measurements at the beginning, in the middle, if you like, and at the end. So we're trying to make that kind of evidence a lot clearer in what we're doing. We typically say we work with people for about three months, but we can have an extended programme, which goes up to six months for those that are more complex, because we don't just support people into the community, you know, we kind of try and signpost to financial housing. There's other areas, it's not just kind of that loneliness and isolation aspect. Because it might be that someone needs support with housing and finance before we can actually even take a look at kind of their social isolation. So yeah, typically, we'll try and get them engaged, we'll offer to go with them one, two, three times, if we feel that that's making a positive impact. Obviously, we can't just keep going forever, because it's not, you know, that it's not sustainable. So once someone's really engaged, or we've signposted them on, and they're well connected with another service, and that's when we were typically discharged. If I may just just, we'll be working, or we are working in exactly the same way with David and Annie as well. So when we're thinking about our tables, we're actually growing across the whole of Bracknell Forest, taking into consideration cultural sensitivity, we're looking at cross generational friendship tables, we're looking at all kinds of different friendship tables, they're going to look different in different communities. And they should look different in different communities, they should align with what our communities want and need. So those considerations are very much in our thinking. And can I just add to that. So another project which we started, which will come in the refresh, is we just started the work on looking at the six largest communities, which are minority are still largest within in terms of their size, looked at the data that we hold in terms of where they live, what they do, and we are engaging with them with, we did a cafe for you know, World Cafe type. So to get them to understand, what are their needs, what we have in terms of what we see from the country that they come, what are the health needs as well as social needs. So we have started a project in terms of understanding those communities working with them. And hopefully, that will then help us to understand if there are barriers, if our services are culturally competent in terms of providing with them with the services. So we hope that that will bring will bring that to the, I think, when when we do the refresh in terms of what that plan is, but it's quite interesting because we're getting some really good engagement. We did one with the new arrivals Hong Kong, and we had one on the last with the Nepali community. And the Nepali community has started their own walks for well being. So it's all progressing. Sorry, that just reminds me, Hema, I had a quick sort of side question. Do you know what the uptake and the walks for well being is? Do we have like numbers on these events? I don't at the top of my head now give you the data, but we presented it last time, we do collect data. So all our services, we do collect data in terms of, so we do have people who are repeat who continue and new people who join. So whether it's walks for well being, whether it's fit for all classes of the Tai Chi and yoga and others. And we are trying to encourage, so for social prescribing, we have implemented the software Joy, which also the one receptor use the same service. So we are trying to encourage all the services to start using that so that we collect data, we collect data not in terms of people's attendance, but in terms of outcomes. Good. Fantastic. All right. Thank you. Are there any more questions on the social isolation presentation? Okay, thank you. Any more questions on the strategy update as well? Anything anyone wants to ask about? I just wanted to quickly say it's really good to see all the increased visits to the community map. I mean, it's kind of gone up but maybe a bit less than 10 times, but that's fantastic to see. Thank you. Yeah, thanks for that. All right, shall we move on to agenda item number 11, review of the Bratton Forest Health and Wellbeing Physical Activity Service. And so again, I think this is okay. So this is this is being brought in response to the question last time. But we were planning to bring it at some point with a part of the health and well being delivery. So just to give a little bit background, everyone active who is our leisure provider had a proposal in terms of how they can support people with long term conditions and normal sort of groups, which we would see being referred from GPs to help them to develop their physical activity. But also it's part of some of the exercise referrals that we know for some of the rehabilitation is done in the hospital and others, but then how do we do that in the community once they have been discharged from that rehab and other exercise referral programs? It was a good proposal. There also was as part of that Berkshire Active had just brought in funding from NIHR to evaluate it. So as part of increasing our access to groups of people who are more vulnerable, we funded the health coach at Everyone Active to undertake this project and the other rest of the funding was provided by Everyone Active itself. And NIHR did an evaluation after one year to look at how the service is progressing and what the outcomes are. So I have today we have today the evaluators from South Bank University, which are part of the NIHR. So I'll hand it over to them to do the presentation. Is it Katja you are presenting on your findings? Katja, you're muted. The usual thing. Hi, everyone. Is it OK if I share my slides? But before that, I'd like to introduce myself and my colleagues. My name is Katja, Katja Mileva. I'm a professor in human physiology. I work at London South Bank University and lead a research centre in sports and exercise science. In addition to being a member of the centre which runs the evaluation of the Bracknell Forest Health and Wellbeing Service, the centre, the first centre at South Bank University is led by Professor Suzy Sykes, who is attending the meeting today. She's a professor in human health and our centre impact and dissemination manager Emma Duhan. So we are very grateful to the board for giving us this opportunity to present the findings from our evaluation and for giving us a forum to discuss them and most importantly to decide together and raise the conversation about how this can help your strategy and the work that you're doing. So I'll share my screen and quickly run through the slides, considering the fact that the pack with documents submitted to the board today already contains the briefing document we compiled from our findings and that gives an outline of what we did and what we found and what we recommend etc. But just as a starter for the conversation, for the discussion, let me see how technologically clued I am. Right, so that one, share. Can you please tell me if you are seeing my screen now with the presentation? Just seeing a blank screen just now, it says your viewing catches the screen, but there's nothing on it. So it's the connection probably being a bit slow. I don't seem to do anything. All right, screen share. Your screen share is loading, it says. That's very annoying, I'm really sorry about that. And nothing happens to be, nothing seems to be happening. Still a blank screen. I will stop, yes, I will stop this share and try again and if it doesn't work, I will just talk through and ah, okay. Right. Yep, that's how it works, I can see it now. Yeah. And it's, some ghost is managing and listening through the slides. Anyway, we're here now. Right. So I will not go back into the full screen if you don't mind. Is that visible or not large enough? Yeah, that's fine. Thank you. Right. Okay, so as Hima already said, what we're going to present today is the finding from evaluation that we run on the Bracknell Forest Health and Well-being Physical Activity Service which was commissioned by the Public Health Department in September 22 and delivered by everyone active. The interesting thing about this physical activity service was that it was meant to be established on a well-known exercise referral scheme but to incorporate some novel features in order to improve the engagement of local structures and agents and the flow, the intake of individuals from the society. This, the Public Health Department applied to NIHR for evaluation of this service and it was entrusted into the hands of our first South Bank team, Public Health Intervention Responsive Studies team. NIHR has established eight of those teams across the UK and at the moment, they are undertaking about 30 of those, Susie will know the exact number, some at different stages of development, some already completed, some ongoing. But the main aim of this research team is to work together with local health authorities, with the Public Health Department and other agents involved in the wider health community to develop evidence which will support the knowledge in the area, to identify interventions that are impactful and collect evidence from them in terms of what is working for whom and in what context. Most importantly, to develop models for evaluations of such interventions via co-production in order to build and improve on the local capacity for conducting such research and evaluations on a high level and naturally inform future local decision. The aim of our evaluation was based on the aspiration of the Health and Wellbeing Service to be an exercise referral, based on exercise referral scheme model but we incorporated novel features so that it can improve the integration between the local agents involved in health and wellbeing agenda as well as attend to the traditionally well known inequalities in engagement and retention of people in such activities, something that I heard the board has already discussed today. So our evaluation set to address the knowledge gap related to how best to set such exercise referral programmes so that it incorporates elements known theoretically to facilitate good cohesion between the agents and good intake such as support and supervision from the staff in the form of volunteers, health coaches, et cetera, improve the accessibility, reduce the cost to reduce the barriers. Another question was how can a scheme, a service like this help to reduce inequalities in physical activity and help to build a sustainable wider system which truly engages all local structures of social prescribing and the traditional GP referrals. What we did was first we did some desk-based research and in collaboration with Physical Activity Network in Bracknell Forest we did a system mapping of the physical activity system there in the local system. We used the actor mapping methods in order to establish, identify the engagement, the interaction, the collaboration between the different actors, different players in the system that has allowed us to interpret the whole system approach from whole system approach how well the local network is functioning. We also did qualitative interviews with participants engaged on the service to understand how they got engaged, why did they stay or why did they leave, et cetera. But we also did statistical analysis, deeper analysis of service data collected by the joy system in order to evaluate the impact of the service on health outcomes and cost effectiveness. Most interesting for myself in particular was the element which involved street intercept interviews with residents in four of the most socioeconomically deprived wards across the area which are supposed to be amongst the main target population for engagement and identify whether they're aware of the system, of the service and why they're not engaged. What we found is that in Bracknell Forest there is a very well developed and wide system of structures and agents engaged in the agenda for health and wellbeing via physical activity. The system is wide but it's very complex and not very well linked together. Most importantly, the connection between the network and the deliverers of such activities is one directional. What I mean by that is the link between the referrers and the people who actually deliver the services, in this case everyone active. In terms of pathways for a referral, majority of individuals who engaged in the service, these were around 320 people, came primarily from the GP practices and social prescribers which was great and showed how potent and powerful this route is but it also showed that there are untackled resources for referrals into such services from the wider social agencies in the borough. These are not very well engaged services. Another in terms of pathways finding was that the service was not very well marketed which was identified through the street interviews and statements from people that they do engage with GPs because they do have lots of health conditions and other health scares which can be attended to by engaging with physical activity initiatives but they rarely are being informed by the GPs practices. Nearly 70% of those who engaged in the period we interviewed people were not informed of the running of this scheme. In terms of service uptake, those who came were well engaged. More than 80% of those who were referred engaged with the service so it was attractive. It was something that people started engaging with but unfortunately they did not remain engaged consistently to the level required to induce significant health benefits. Only 15% met the recommended frequency of engagement in the classes. I already mentioned about awareness and engagement. The awareness of residents in the deprived areas was quite poor and that can be an action point for future such services. In terms of service impact, despite the low numbers of people who completed the full scale of required engagement, there were measurable and valuable benefits in terms of physical health, metabolic health but most importantly is the improvement in mental health which is not a surprise how engagement in such programmes benefits mental health improvements. In what our findings are to the evidence base is two points related to the potential for pathways into community-based physical activity services via the primary care. 80% of the service users came through this route which means it's a very strong group which can appeal to people, engage them and direct them into such activities. On this graph I summarise the three main groups of such pathways via the acute NHS trust, the primary care networks and the social prescribers in the council were the primary referring agents but also points to the fact that there are still services and agents, local agents who did not engage in referring individuals more from the social care perspective. In terms of participants, mostly women were engaged. The profile of people engaged matched quite well the profile of the local population. What we noticed, though, is that very few individuals were referred with complex health issues. Majority were referred with people in need of mental health problems resolution or obesity or people with one health condition like cardiovascular or respiratory, musculoskeletal etc but not. Very few were with complex more than two or three health conditions which probably talks also about confidence in referring such individuals into these services. In terms of inequalities, subsidising of the scheme and helping people who are on benefits to access the scheme on a free basis was extremely successful in terms of addressing inequalities and engaging with the target population but self-referrals were low in line with the low awareness of individuals of the existence of this service and the existence of such offers for subsidising and supporting the participation, making it very cost effective. In terms of novel features that were meant to be incorporated into the service, the interviews particularly with people engaged show how important it is to have an interaction with the health and wellbeing coach, this personalisation, this human touch accompanied by a professional who is competent to recommend and assist their engagement with the service was very highly valued. People valued the longer duration of the programme that it was not only 12 weeks but six months. The only thing that people did not value much was that the service delivery was restricted to the facilities within a leisure centre and opportunities for engagement in activities outside the leisure centre were not explored enough, not on offer as initially intended. Details about and numbers, detailed data about the basis for these conclusions are presented in a slide deck in the research briefing which you have as part of the document to the board and we are producing an infographic and moving animation materials that will be at your disposal for dissemination across the agents, across the services, across the population of the local area. Very briefly I will run through our main recommendations formulated which are structured into recommendations specific for this service because we do see value in continuing to deliver this service and as I understand from discussion with HEMA and everyone active, the intention is to do so. In order to be successful and even more so, this service should continue to be offered but not on a standalone basis but as a part of a much wider offer of systems designed to increase physical activity. The free or subsidised offer is valuable and it makes difference and it's worth extending. Better marketing will help to improve the engagement and the flow into the service. The referrals were sometimes not very smooth. The communication between referring agents and the program delivery, the service delivery were with certain delays and misunderstandings in terms of why, what and who is being referred and what they can be offered. So this link can be made smoother. The feedback loop between social prescribers and the health professionals with the deliverer can be improved in our opinion to the benefit of the service so that a good follow-up on the health benefits from engaging into the service and stimulating the continuation of engagement can be assisted. More health coaches will increase the number of people who can be supported because the service was aiming to provide some one-to-one sessions at entry point and throughout the service. People with more diverse skills and competencies in terms of physical activity prescription to attend and raise confidence in the people in their ability to adjust the prescription to their health condition in order to reduce the barriers for access and retention. Probably the full scale of initial intention to implement novel features needs to be brought back into the service. And also we believe that the service will benefit from engagement and connectedness between this particular service and any other service and programmes that you were even discussing here around better use of the green spaces, better use of different other initiatives under the management of the public health department. In terms of general recommendations for such schemes in principle, not locally, people did mention difficulty with access. They did mention how much they would appreciate having much more diverse offer rather than just local facilities in a leisure centre. They did appreciate the free and subsidised offer and more engagement with the social prescribers and what I hear volunteers can achieve is really something perceived as valuable from the other side, from the receiving side of the local people. For mental health, which was also an aspect discussed, I understand that was mentioned as well, providing more opportunities for people not just to come in and leave but to connect while engaging with the service is something that has been raised in the interviews as an aspect that will improve engagement. What we would like the board to consider in the strategy and in the future support of such services is probably a better coordination between the strategies and the different plans for initiatives for tackling mental health, obesity, health inequalities. I understand the activities of the board are so wide, they must be better coordinated and as soon as people perceive them being part of a wider system, that will improve their sense of engagement and probably will bring them back into these services rather than expecting them to be delivered in their houses. Probably better engagement with other services into referring into the physical activity initiatives. There are untackled capacity and agents, actors in the whole system map, who could do much more to get people engaged in the service. The data system, I discussed this with Hima, the JOY system needs to be very carefully monitored so that it's properly used and the data are taken seriously when reviewed because the system is not perfect and sometimes missing data equal missing opportunities to understand them and use them to inform future initiatives. So that's all from me. Thank you. I would love to hear your opinion on these findings and any advice really any plans how these findings can be helpful in what you do. Thank you. Thanks so much for that Katya, I can see Andrew, you've got your hand up. Yeah, yeah, two points. So one, thanks very much. It's really detailed and really interesting and I think Hima sits within my department, but we also manage most of the public green open spaces so the connection and the bleeding out of the service into that space, we could do a lot more with I think so that that would be useful. One of the things and it may not be for directly for you but one of the findings about improving the frequency of attendance which sort of aligns to something we talked about a little bit earlier on the board about, you know, you might be able to get somewhere, someone to something once but how do you keep them there? Is there any advice that you would give for that or equally is there anything that we've done in terms of the service specification going forward that would pick that point up? Susie, do you want to attend to that from the interviews with the participants point of view? Yeah, I can do. I led the piece of work, the qualitative interviews with service users and we interviewed them at three time points when they first joined the service halfway through their programme and at the end point. So we got their kind of their journey kind of captured and one of the things that came out very strongly was that they kind of the very complex lives and life situations that people being referred into the service experienced and as a result of that the very, very real barriers they faced in accessing the service on a routine basis and kind of developing habits where it became normalised into their routine so real barriers that they faced that needed to be acknowledged and kind of worked around and certainly the extended programme, the extended duration of the programme, so most exercise referral schemes are shorter and the extended length was a really important factor in maintaining that attendance because participants had perhaps large periods of time where they were unwell or in hospital for example where they couldn't attend so that extended period did mean that they had an opportunity to re-engage which a normal shorter programme which is typical of exercise referral schemes prohibits. So that's certainly something that we would recommend was maintained to accommodate that. And just very briefly the other thing that came out strongly from the qualitative research was the fact that people really valued the opportunity for social connection that came through any engagement with physical activity and then because many were attending with both physical and mental health kind of issues so many were asking for even more opportunity for social connection than they had and they felt that that would be an additional hook to maintaining attendance and attendance at the service so opportunities to link with other people on the scheme to be some form of a cohort or social aspect to it. Okay thank you, any more questions? I've got a few questions, some of them are slightly technical and some of them show my ignorance. So this is part of a, a sort of, is this something that's funded, this referral programme, is this a kind of finite funding for a project over a certain amount of years? Hima would you know that? So this is, we funded this for three years, the health coach for three years too. As Katya said this is quite different to an exercise referral and we wanted to see how that works and this evaluation is very helpful because it helps us to improve and everyone active and us together we had that feedback to just see how we improve. So it's for three years but then we need to look at the outcomes and as you know we have got quite a lot of other programmes which are free and out and about in the neighbourhoods like Rocks for Wellbeing, IT, et cetera, is how do we then as they have recommended how do people refer onto those services so that people can continue, they don't have to come to the leisure service. But I think after three years we'll have a better picture of how we can take this forward. It's too early at the moment because it's just been one year so starting of the service, getting GPs and others to understand but I think the recommendation about using MEC which is the Making Every Contact Count to increase awareness of all professionals, clinical and non-clinical in terms of the service where people have got. So we had a criteria was that they had to at least one long-term condition whether it's a physical or it's mental health was one of the criteria. So people can be in a deprived area but quite able and you know not having any impact from COVID or others were kind of not the target population because you've got other programmes which work with that. So yeah but I think the evaluation has been very good for us to understand how we take this forward. It's interesting, it makes me wonder if moving forward if actually there's a role here of overlap between the health and wellbeing coach, the GP social prescribers, the council, you know it's almost like you need someone who knows about all those services who acts as a single point of contact for the person referred rather than this kind of different people for different services. I mean and the fact that the health and wellbeing coach it sounds like they're only referring to activities at the leisure centres and within everyone active and yet there are as you were saying Hima there's so much more going on and people might be more interested in the water wellbeing or tai chi or all those. So there's definitely scope there to kind of widen the roles and look at and to sort of prevent that kind of I don't want to call it you know to have make sure that every option is available to everyone that should be. And then the other question I had was about you were saying that the subsidies for membership was extremely effective and yet we only had a 15% you know you're saying about the 15% success rate so what was that was that I can't I'm sorry remind me was that sort of a year later? Yeah that is a little more it's a when you present something briefly it you sometimes the context gets lost in the brevity that is the beauty of the programme because the programme is announced for six months and when someone enters the programme not at the very beginning and they don't attend on a regular basis three times a week and they get the number of attendances within the one-year shot we because we have a very restricted shot of one year evaluation only 15 people continued and completed the full scale of the recommended number of attendances but more than 60% were still engaged they were still going they haven't completed the full scale yet but because of the programme is for offered for six months that still allows them to continue and catch up and and accumulate the amount of physical activity that will start making a difference to their health whether mental or physical and that's why so when when the programme started we started very early exactly what Hima said we wanted to find out how the how it goes how it starts how how the it works so that there is time within the funded period to make adjustments and make it work better by the end of the period of three-year subsidy at the start the intake was very slow very slow majority of people in the slide deck you will see data showing that majority of people actually joined the programme in the second half of that one year so it didn't finish even the six-month period yet so that is why it looks as a number low but in fact they are still going on they're still continuing what we also established is we did look at their health improvement measures even at halfway through the programme because the that's one of the features of the programme that the health coach is evaluating their progress in terms of health benefits at the beginning where they start halfway through and at the end of the six months majority of people were somewhere around halfway through and there were percentages of improvement of their health measures but not significant yet and certainly not as the superior ones of people who have completed this yet again confirmed that the system works so if you do take the full scale of what's recommended you will benefit throughout you just keep accumulating benefits until the end so that's the 15% sorry for the long explanation fantastic no no I understand that now and then my other question was about on the slide deck we talk about the cost of the service and the sort of the savings with due to improvement so you've got savings there with regards to body mass index waist circumference mental well-being where do you get these numbers from how do you how do you I mean because obviously it is it looks fantastic you know and so the cheapest is to help someone improve on mental health right according to these numbers and that is the beauty of what we don't understand that these programmes are the best solution we have for this way too long staying behind COVID mental health issues that population is suffering but these numbers come from information collected from the public health department so this accounts for their investment into the everyone active and also the salary for the delivery like salary of the health and well-being coach delivery of the services facilities and etc so that was the normal way of accounting how much invested money went into the service and what percentage of average health in index changes were observed so if for example I improved on body weight I wish 20% someone improved 10% on average we let's say improve 6% and for one person that's costed x amount of pounds to achieve 6% improvement on that health index that's how it was calculated does that make sense or not quite yeah it makes sense so these figures you've got here are actual figures from our people in our programme so we were measuring we had some kind of we had some kind of scale to measure their mental well-being and then and then we were retaking their blood pressures measuring their BMIs measuring their circumference that is how great the programme was and that was the uniqueness of the role of the health coach because that was the person that was the person who was engaging with people and taking their progress measured objectively the joy system holds all this data as a database okay and those improvements I mean that's a very simplified chart isn't it like because obviously some will improve some won't have done yeah was that taken across the whole sample size or just ones that had engaged over a certain amount of time so these numbers are taken the ones that you're seeing in the slide deck are taken from the people who completed the programme right but they are calculators and they are existent for people who are with at least halfway through measurements there are lots of people who registered they started but they didn't get even to three months engagement yet because of course no change can be evaluated for them and is is there any scope I mean is there any scope to then follow these people up a year later and see if they've managed to absolutely you know manage to keep those to keep their waist circumference low and yeah because that would be really interesting to see when we started together with public health with everyone active with representatives from the whole network Susie organized three co-producing workshops when the point was to understand what's the aspiration what's the plan what we can do etc and build the design the evaluation it was designed on a logic model based on the theory of change behavior the logic model accounts for short-term outcomes and long-term outcomes of course with our shops one year only we can only evaluate the short-term ambitions of the program but the long-term ones remain and it will be absolutely pity not to use this unique opportunity to follow I've just got one last question you did you looked at the geographic location of some of these people most probably deprived areas etc was there any was there any kind of distribution there any change I mean were we seeing improvements across the whole all the areas or a change in terms of intake you mean oh well just in terms of adherence I mean yes although with the fifteen percent completion it was quite more sporadic yeah yeah to to make a big judgment out of it but these data are existing as well we were very very pleased to see that more than forty percent nearly half of people came from those most deprived wards which means that the referring agents are doing their job okay fantastic all right thank you that's really good presentation and lots to think about there any further questions okay brilliant thank you so much that was really really useful and really good report thank you thanks all right so if we just move on now to agenda item number 12 briefing on the new ICB structure and that's over to you Nicola verbal report thank you that's right so the ICB restructure is still part way through the process there are four stages and we've just completed stage two so we have some of the senior posts in place but not all staff are have been through the full process yet I think what is helpful to inform the board is that there is one director responsible for all five places now we used to have directors for each of the places and that role is being fulfilled by myself so I'll have responsibility for all places not just Bracknell Forest we also have appointed two associate directors one director will cover East Berkshire the three unit trees in East Berkshire and the other person is covering Northeast Hampshire Surrey Heath and Farnham I'm pleased to announce that Martha Early will be the associate director for Bracknell Forest and the other Berkshire areas she's currently program director for partnerships and communities in Northeast Hanson Farnham some of you may already met her she's got a wonderful and an enthusiastic approach to partnership working she's also a social worker by background and has been corporate leader for public health and partnership work in Kingston so she comes with a real talent for working in partnership and should understand the issues in your organisations we're still working through when she'll move into that new role but she will start reaching out to people key partners to meet this month and next month and at the moment it's looking likely that she'll move into her new role sometime in July the other thing that is happening is we are having a governance workshop between some of the very some of the senior directors in the ICB and the offices in the three Sparktures to begin to talk about governance structures and how we'll work together that's on the 1st of July and we'll come back for wider socialisation at a future date so we're just starting that co-design process so that's that's kind of the the quick update of where we're up to I'm really happy to answer any questions that people might have but it is a work in progress some people that you're used to working with have landed in roles for some people they're still going through the process and that uncertainty as to where they will land in the future so it is a it is a difficult transition period for the staff within the ICB if there's any questions Councillor Wright otherwise that's that's where we're up to Thank you congratulations Nicola on getting the director for five places I wonder if it's really quite a big job and you're maybe wondering if it was a wise thing to do so so it will still be you though at these at such meetings and at the place meetings and everything or will we will we be working through Martha? I think I think that that's going to be part of that that governance redesign piece and clearly we've got fewer people to cover a number of meetings so we'll need to work through who attends but until anything changes it will be me. Okay fantastic sorry Andrew your hand is up. Probably the same point I was just going to say hopefully we might see Martha at the next one of these meetings if that's appropriate but you know if we could invite her that would be great. Yeah I will send you her contact details Andrew it's quite appropriate to invite her to the next of the meeting as long as the chair's happy with that that would be lovely. Okay fantastic all right okay thanks for that yeah that's so yeah I think there's nothing there's no other real implications for us is there there's no other thing it's does this have any other further implications for how we work or not at the moment? So I think our aspirations remain the same for our population and our approach to partnership working I think it may change some of the way we organise meetings it may change who you're meeting with as individuals and I think it gives us the opportunity to have a line of sight across all five places which means we can learn from each other and also a line of sight across the three Berkshire unitaries and there may be opportunities to do things once three times two times rather than doing five times all the time so I'm seeing it as a real opportunity to use the structural change to keep improving the services to our communities in a positive way whilst recognising that it is a significant reduction in head count and therefore there will be fewer people. All right thank you if you've got any more questions on that please yeah okay guys all right should move on to the final thing thanks for that Nicola thanks so much have we got any other business or any updates from anybody? Is everyone happy? All right thank you so much Andrew is there anything else I need to add before I close the meeting? No you're okay all right well thank you everyone for attending our next meeting is in September I believe is that right so we'll see you in September and yeah look forward to following up on a few things certainly on the everyone active stuff I found that really interesting that's brilliant okay thank you guys thank you so much.