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What I'd like to do, if everybody is happy, is just to take any immediate questions first. And then what we'll do, I think, is we'll work through the questions that are in the paper at paragraph eight. But as you'll see from paragraph four, when is going to cabinet, they did agree to add this additional recommendation, which is the one in paragraph four. So it gives us an opportunity to offer views about the role and how we see it. But if there are any immediate questions from the paper, then please ask those now and then we'll move on to the more detailed questions. If everyone's happy to do that, that are in the paper, and anybody, anything immediately want to ask. Okay, if not, then we'll move on to the detail. That is, I think, probably work through the questions that are in paragraph eight. So I think the first one really relates to the shape of public health in BCP Council and what, what kind of role we want this job to be. So I think this first question about, you know, do the committee agree with those criteria or are indeed, are there any others. So these were the, the kind of models that Sam referred to in his presentation about what it is we would like to see. And I guess my immediate question is, are we looking for something which is a combination of all of those. But, you know, depending on what the issue is, you might want to apply different skills to or different aspects of those skills to, to the particular situation. But that's my sort of immediate reaction. Are there any other, any other comments on that particular bit? Joe. So this is the expert critical friend, the advisor bit. Yeah. My following correctly. Yeah. I do what I should have asked Sam about 10 minutes ago. I just be really curious to see which one he considers himself fulfilling at the moment is either, yeah, which one of those four flavors. Thanks, Councillor. Sam, and I think it's partially covered by my response to Councillor. The way that we've currently been operating as a shared service means that the director of public health has been more in a strategic space, particularly in the system. So you may not have that explicitly sat out in your paper, but I would say that my role over the past five years has definitely been as a strategic leader in the system. Okay, any other comments on that. And I'm really. Thank you, Chair. I suppose my question really is, it's quite common, we're not amalgamate quite a few of these. As far as I know, research says that if we can reach the hard to reach communities that has far bigger gains more quickly. So if we can focus to a large extent on more deprived communities, everybody benefits. And I'm not sure which that fits. Would that be the last one. The community advocacy leader. Yeah, it would that would be a very, very good fit. And I think many DPHs would say that they have different sides to their role. So in the models of practice paper, it was exploring. The way that directors of public health were having to work at the time when director of the public health was starting to be jointly appointed between the NHS and local authorities. But naturally, you'll find people will gravitate towards one style or other. A really good DPH should be able to flex and change us the situation demands although I've been doing a lot of strategic leadership in the integrated care system. I've also worked very, very closely with the poverty truth Commission and BCB Council. So it will depend on the experience and what the director of public health is wanting to achieve in terms of their objectives and of course that can be shaped by collaboration with, you know, other directors, other members, and the direction that the council's going in. So that's why the link back to what's BCB Council's ambition about in terms of its corporate vision and its corporate plan is really, really important. I wanted to just pick up on a further point about that community advocate model as part of the paper. I think one of the things that that paper draws out as a sort of spectrum of different roles. As Sam says, DPH's play different parts and at different times, but the community advocate is a very particular type of DPH who I suspect we've all seen operating in parts of the country and particularly during COVID, who can sometimes become an almost political figure, such as their presence and their kind of reputation and their, and their reach, they can, they can sit almost, almost outside the council. And I think for some councils that the feeling is actually that's not that's not quite what we want. We want a clear separation between officers and members. And so that's one of the things that that is trying to tease out. Okay, thank you. Any other thoughts on that? And I just say, Chairman, that we've got the list here, which obviously people are just watching on the screen can't see probably, but there's an element called the provider, which members can read and see, which I think is that it's, it's more of an internal role, rather than, and the one that I thought was very worrying, which is the one about the conscience of the community. Because although that sounds wonderful, I think the trouble with that is that it will be very, very much fighting off people's other people's opinions. And I think what we need for this role is very much somebody there who can do the job without having to worry too much about what social media is saying and what other members are saying. So, if the one, the actual characteristics that I thought was that they take on far more of an internal role management budgetary responsibilities and demonstrate operational best practice. So, if we are now tasked with recommending something to the cabinet, I would like to see something more like that going through. You can see that's helpful in the comments. Sorry, just to say like I completely agree with Councillor deadman one of the, but I like to give praise when I can, but she said that now on the head and I think there's, there's certainly, there's so many organisations that can do the advocacy for us we've got, you've got help watching the positive truth Commission and stuff, we don't need someone else shouting from the rooftops about about what people want with fortunately in an area where there's so much information about that which we can all probably do a bit more to get more, but I do agree with you on the wrong state. Any other thoughts on that. Okay, so if you can go back to the list on item eight. So we've covered the first two, I think. And so can the committee see any particular opportunities for public health influence across the Council. I mean, that strikes me as huge in terms of what it is we want to do. In some ways, this comes back to the list that we looked at, and whether or not the role has a function as being a catalyst for change, and obviously what the nature of that change we want. But any other thoughts on on that. Yeah. Thank you Chairman. There's a mention in item eight, which I think I'm looking at right. About having responsibilities for example, at libraries. And what I wouldn't like to see this Council doing is burdening this job with a lot of other jobs, which, which would also seem to the outside world to be. That's good. I mean, I've seen it so often in other in other companies that you take somebody on and they do three or four jobs that somebody else was doing. And I think we need to very much avoid that implication. I'm not saying that libraries are not very important to health. I think they absolutely are. And I think that what we're going to have to do with libraries is very important to the community. But I think what we need to avoid when commenting to the cabinet is not that we're burdening the new, whoever this new director will be with all these other jobs. I think it's very much. This is the main job. And then if you want to have some responsibility for things like libraries and I think there was a mention of something else that I noticed. A community libraries and regulatory services, quite happy with the regulatory services fine, but it wouldn't, it shouldn't be spread too wide. It's what I'm trying to say to him, and it shouldn't be picking up all the other jobs along that list. I would say something about the impact on other services. Yeah, I agree with Councillor deadman that we need to create a role that isn't spread too thin that if we are combining services we need to be doing it for for a purpose. I think my impression is that some other councils have moved into these rules quite pragmatically. They've had a step at a time they've had someone competent and capable and they've decided the broad and the rollout, as I say, pragmatically. We've got the opportunity to design something and I agree with you that we should keep it focused and not overburden the core role. I have had some conversations thinking about who we can attract to the role, what would make the role an attractive role. We're getting some indications that having a broader portfolio might be something that will attract some people to it. But obviously it's important what those functions are and we need to take care not to brigade functions together that require very different professional skill sets because that won't make sense at all. So in conclusion, I agree. Any other thoughts on that, Mary? Thank you, Chair. I do apologise. And just thinking that really when it comes to public health, how do you separate out all the social determinants? I think they are so integrated that failing to do one means that the whole system falls down and you're quite right that you can't have somebody doing everything. But I do wonder if somebody who has an overarching kind of advice, kind of intelligence led advice that actually can guide some of those other really important aspects like libraries, like public spaces that are all really hugely important when it comes to public health. Thank you. Thank you. Any other thoughts? Okay, we'll try and sum up in a bit. But in terms of functions reporting into the DPH, this is similar question in a way in terms of what would work well. June, could you say something about how the conflicts of interest might arise in terms of other services like regulatory services or whatever, where would the conflict possibly be? Yeah, I might pick out the example that Councillor salmon was asking about in the in our briefing earlier around travel, active travel and transport and I'd be interested in some may want to offer professional views into this as well. I think the director of public health has to have a level of independence within the Council to be able to offer appropriate, appropriate advice. And there might be some areas where I'm actually taking on the responsibility for the for the delivery brings that into into conflict. Issues like travel, whether or many different drivers going on in the policy decision making around it public health being an important one but there being other factors to the DPH could find themselves conflicted around the democratic decision making that then takes place and so that's what I had in mind really areas where we should avoid creating creating a role that leads the DPH into into quite politically contested species which they then have to deliver so that they can have the freedom to give that advice without fear or favor to members. I'm hoping that Sam agree, although if Sam doesn't agree, he can independently say so. Sam, I think it's best explained by a model called the golden triangle. So if you're working in a frontline setting, it's important to understand public health interventions that have a good level of evidence. They're scalable, but the third point on the triangle has to be political support and acceptability. So I agree, you don't want to have stuff in your objectives that might be difficult to gain traction political support political buying. And that's some of the skill of navigating a complex unitary is that what looks like a public health mission that might be self evident to address republic health is the right thing to do. You will have very, very different views when you go right across the breadth of operations of a council and indeed it's politics. So you need to be mindful of how to navigate that. And you need to understand how to, I guess, do that with appropriate boundaries and seeking appropriate advice and support. But it's really, really important. Otherwise, you're right. You won't be able to deliver. You'll just lead to frustration and ultimately resentment in the longer term. Okay, any other thoughts on any of these things on item eight or paragraph eight. Yeah, I don't know if it's the appropriate time to ask this question but I noted with the briefing the presentation before this meeting. The BCP area, drug and alcohol services retains 9.3 million budget amount. Why is that massively different to dorset county council can we have an excellent enough of off that I didn't pick up on why that is exactly. Thank you able to help without some. Yeah, so it's not it's not 9 million on drug and alcohol, the BCP retains about 9 million in total, but it's about 4.5 million in total for drug and alcohol services. And then the dorset council area. I think the total amount of our driven alcohol commissioning at the moment is about 2.5 to 3, plus because we have a lower proportion of services effectively the need is lower so we don't have a service that costs as much. So the remainder of that 9 million is made up by investment in children services. So we put about 3 million into early help services. And there's a number of other smaller contracts as well, but public health grant pays for, but it's not 9 million on drug and alcohol spend. I'm wrong. Okay, thank you. So I always feel like I asked stupidest questions, but I want to make sure I've understood. So essentially Sam currently basically wears two hats a door sit hat and a BCP hat. You know, cover or essentially covers two areas. And the idea is that we will now have those two hats won by two separate post holders potentially. Just be really interested to hear from Sam's point of view what the low hanging fruit exists for us where he's like, yeah, if I had a double. This is what I will be doing. This is the area we should be developing in the next few years. I mean, in short, I would say smoking we've got good plans for. I think over the next few years you'll see that really fall culturally young people aren't that interested in taking up smoking. So I think it'll be a generational change. At scale. So rather than putting money into small physical activity schemes. The evidence suggests that getting people to build activity into their everyday life patterns is the best thing that you could possibly do. And that means walking and cycling. It means getting a better mix of transport use. I think some of the things BCB Council's already done with micro mobility, the barrel bikes, the barrel scooters, investing in walking and cycling infrastructure has been really, really good. Getting that behavior change bit at scale right and making sure the mix of incentives are all working together to take down those barriers. That's the hardest bit because people love their cars. That is our culture in this country and it's going to be hard to change, but I think the council's well placed to think about those incentives and barriers and to do some really interesting things. So, physical activity would be my top tip. Just to follow up on that, because it sounds like that's such a broad spectrum of stuff. Are we absolutely dead set that actually having one single person in this role is the right approach and are there other ways we could fulfill this function that doesn't just have a single DPH or whatever. Are there other approaches that we may be missing here that other authorities do? I'm just curious. Turn to that general. There are a whole spectrum of different examples in different places. So that's why I picked out just a, just a few different ways of doing things. I mean, what what we absolutely are required to do is to have a director of public health with a role, which the department for health and social degree is appropriate and will ensure the delivery of those fundamental mandatory services that they require of it. So, so we do have to have one person who can carry out those things. The question is whether they can do other things in addition but that that can be done in a way that's focused and for a purpose rather than as canceled and pointed out just a structure that is put together but doesn't make sense. But yeah, they're absolutely a whole range of different scenarios out there. I think what I'd like to do is try and summarize, if I can, to give some feedback. So I think what we're saying is that primarily this role is an internal one under what's described as a provider in the list of options. It's exclusively so, and we're open to it being combined with other services such as regulatory services, but that needs to be focused and it doesn't. It shouldn't be to spread too thinly in order to allow it to get as maximum benefit from having a specialist director of public health, who can intervene and offer that intelligence led intervention into other services. And also, who would be able to be that independent voice and still be someone who officers and we as a committee even could refer to or defer to for that kind of advice when these issues come forward. Is that anything like a fair summer. Chair, do you want to try and formalize that into a decision of the committee so that that's formalized as a group, or do you want to just pass a summary of your findings. At the moment, that's not a recommendation with us with a second. We do need to formalize that in a way that we can feed that back to cabinet for formally as Lindsay was indicating. I think she just tested me to see if I can actually write it down in a meaningful meaningful sentence. So, just to just to clarify you're actually being asked to feedback to the director for well being by the end of May so you can pass it to cabinet for their information. But that's who your recommendation would be to do you want to take a couple of minutes for us to try and formulate something that you can propose as a recommendation. Shall we do that we're part about for a minute and come back to it, I think, while I'm writing something. We could perhaps move on to the next item and come back Lindsay's looking at me. Okay, Lindsay's just suggesting we do a journal for a couple of minutes so we can formulate this to something which looks sensible. Thank you. We'll do that. 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In relation to knife crime, I know there are lots of errors to talk about public health approach. Basically, just means using your intelligence function really, really carefully and being able to work collaboratively with other interventions. A lot of the work is carried out by community organizations, people going into schools, bringing that together and being open to a bit of challenge, particularly around the evidence base for interventions is where you could use your public health function really carefully. So I've used the word function advisedly because it's not all about just the role of the DPH. There's also going to be a team with a lot of specialist skill as well, being led by the DPH. So it's about getting the right fit for a director of public health, but also making sure that the function of public health is placed well within the council, so there's lots to consider in that. Okay, so are we content to what those examples are accounts to some and has mentioned into into the wording of this. Thank you. Can you remind me sorry Patrick my short term memory. Does it have that it's independent that the role has a level of independence that it doesn't actually just have to do what. It says offer independent, expert, expert advice. Is that okay. Are we happy? Well, just. Yes, I'm a bit confused about the knife crime aspect, because that isn't in my view is not so much to do with public health you don't advise people. Not to commit a life crime do you. Or is it just because if you kill somebody, it isn't very healthy I can't see that that is part of the remit. I would think that the remit certainly the bit about the library is that is a remit probably. And planning, for example, is more of a remit because they want to have these 15 minute what to call it sit it not not cities. Areas what they called. Yeah, so you can walk to the shops, but knife crime seems to me to come totally under a different remit like the police like you know that sort of stuff. Can I just say as well, Chairman on the there's an element here on. Can you see any particular opportunities for public health influence across the council and then we go down our paper and we see summaries of summary of legal implications summary of environmental impact. Nowhere do we see summary of health implications and that would be handy one would need to see how it impacts on health, but that's totally different from what I was saying about life crime. And on knife, so the work on knife crime, which is going on at the moment, which is, which is high profile and rightly so is, as you say, is led in BC be cancelled out of our communities team, with a focus on community safety and working with others across community safety partnerships. So that's the locus of it. I think the connection to public health is a good one, though, and many places. And I think of where I come from up near to Glasgow, where there have been significant problems with knife crime or other aspects of violence have taken what they call a public health approach, guided by Sam saying it's just being intelligence led. But on the basis of issues which are found to be endemic in communities. And that therefore a health based approach to it can help find some of the underlying problems in tackling some of those cultures in a place so I think that for me the connection is a is a is a helpful one. And I could see aspects of that influence coming and coming in. So I think what counts us is suggesting is that we use these as examples are marine. Thank you so to be a pain. And I would Leslie your idea about planning and housing and stuff about is a really important one when it comes to health. Is there any way we could stick in it in there about early intervention, because I think that speaks to the knife crime. We don't get knife crime if we have early intervention or we get far less very pardon knife crime if we have early intervention into education job opportunities, youth centers, et cetera, et cetera. So that kind of early intervention will kind of encompass quite a lot of stuff. If it's doable. Any thoughts on that. John, I was just going to say I think when we look at the, the. Stabbings that have happened in Bournemouth, I'm not going to talk about any specifically. But I think actually if you look at the context of a lot of the stabbings involved young people, there were, there were chances for intervention that were missed, not just from a policing point of view, but from a health point of view. Whether those people should have had engagement with services, but maybe they fell through the cracks. We always talk about the Swiss cheese model of damage prevention, you know, if something goes wrong, you've got your slices of Swiss cheese, all of the holes have to line up for something like that to happen. And actually a lot of those holes exist. Earlier on the process of a root cause in our health institutions and in our health services. That would be where it needs a public health approach. I ain't a lot of our problems, maybe call everything health, but these are our. That seems like a lever we can pull to tackle the problem. I'm sorry I'm sorry I'm not putting as well as Julian. Thank you. So just to emphasize what we're talking about here is just my wording of. Areas of influence and leaving it quite broad, but. Colleagues are suggesting that we. Give some specific examples, but they are only meant to be examples. So I'm happy to. If you're happy to include life crime early intervention active travel and drug addiction into those examples stop at those as examples into the wording of what I just run out. Is. Thank you chair, now I asked I was going to comment before I'm actually quite happy with that way of doing it, because ultimately having examples of other illustrative purposes. So I think potentially that that's kinds of, and it's come back to the point that Sam made about being intelligence led because intelligence changes as well. So what we don't want to have is a model which's really restrictive, but I think actually having some examples as illustrative ways for it potentially is a good idea. So I'm happy to go with that. Thank you. So are we content then with as an outcome. I need a second to cancel from. Yeah, I'm happy to second that. Thank you very much indeed. Are we okay. Yeah, we can. Not everyone happy. Yeah. You could attest my ability to read my own handwriting. Okay. Thank you very much indeed for that. That's really helpful. Thanks again. And so I'm going to move on to the update on home first brackets intermediate care close brackets development across doors and ask Betty if you be kind enough to present this paper. Yeah, thank you chair so myself and my colleague have a short presentation that summarizes the paper so I'm better about them for those of you who have not met me before. I'm the director of a social carrier and basically a council, my colleague by Becky will is the deputy director of urgent emergency care and flow operations director within the integrated care board. So if I just take you back to the recommendations initially in the paper for committee to to consider as we go through committee are requested to note and respond. As appropriate to be up to provide it with it in the paper. And with a recommendation for a further paper and with a further update to come back in 12 months possibly March 20 or May sorry 2025. That's the recommendations. I will just we're going to share the slides Becky and I. So you will hear from both of us. So I'm just going to provide a little bit of the background. So the background to this was the door said intermediate care redesign program and brackets home first was initially mobilized in a response to the pandemic. And since that it's a fault within the door said system and wider nationally as a structured program for improvement and delivery, which focuses on a number of key areas for our population, which is about improving access to intermediate care. Reducing the excuse me reducing the time that people need to spend in hospital with a clear focus on prevention, but also on enhanced discharging at the earliest opportunity, ensuring sustainable community recovery models are in place for our population. So some of the core objectives within the program have not really changed that much since it's introduction. The one of the key objectives was that there was a universal rollout of discharge to assess otherwise known as D to A to the professionals that are involved in the work. And this is about ensuring the people who come out of hospital or who have stepped up into a provision to prevent them from going into a hospital can recover and have their long term needs assessed in the right setting. And we all know that in acute hospital environment is not the right setting for lots of reasons that that we've talked about before, but are, but are pretty obvious to most of us. And to ensure the idea of hospital intermediate care offer across our door said footprint is right. It is right for our population, but also is the right size and the right shape for those that need this service. This next slide is a rhyme so just a little bit further detail just around the discharge to assess. And as I've said, we refer to it as D to A. So D to A is a model of care. That is about people leaving the hospital as soon as they are practically able to leave hospital. And they no longer require an acute bed. It's really important, as you know, all members know this, but we need to free up acute hospital bed capacity for those people that need acute care to minimize reduction of ambulances needing to queue up and for people to have the response and the care and treatment in an acute environment that they need at that time. The goal is to provide people with additional time to recover recovery is the key thing here before me before making any long term decisions and putting in any long term provisions in the way of care and support. So fundamental to the discharge to assess principles is comprehensive assessments of long term need in the right place at the right time. The key provider of recovery support in the community is around local intermediate care services that are right for that community, because our communities across stores that may differ. It's like getting it right for each of those, and that this is short term recovery and rehabilitation so that mixes rehabilitation short term recovery and rehabilitation, which is intermediate care together and to have both of those models work in effectively. Within our door to area, we currently discharge around 85% of people leave and hospital will go under the discharge to assess pathway. And we're ideally looking to up that percentage is how we possibly can to around 95% nice really important to note that not everybody who leaves hospitals and a small percentage of people overall who are in hospital, who need support to leave hospital. So people go in and out of hospital and never come across any health or social care systems to enable them to leave hospital we're talking about the percentage of people who need the help to be able to leave hospital. And I'm going to pass over to my colleague. Thank you. Thank you Betty. She says really the, by having a well designed intermediate care model, underpins by that comprehensive discharge to assess approach for the dual benefit of both improving the long term outcomes for individuals. As well as kind of having wider system benefits by the way we use our resources and how we get the best values and outcomes for the population from that. The recent report for which there was a link in the main paper that was published by the county council network supported by Newton, which has quantified some of these benefits at a national level. So one of the big things that we're trying to kind of shift our attention to locally is how we could prevent people going into hospital by using intermediate care to keep people at home with the, with the support they need to recover there. And similarly, how do we get better early discharge planning to enable people that when they go into hospital they are unable to return to that ideally to their own homes as soon as possible. If we could get that right if we could get the balance of services right get the response times right for people that would have longer term benefits in terms of people's long term outcomes and that's ultimately the goal that we are trying to get to. And to give you a quick summary I guess of how the intermediate care and D2A offer currently works within our area so largely organized into three main pathways a recovery at home pathway, which we call pathway one typically around 60% of people leave on that pathway. Recovery in a community bed so these are people that might need to go to a community hospital or some form of care bed for a further period of recovery before hopefully being able to return home. Those are people that we typically call them pathway to and about a third of people that require intermediate care, need that services and then we have a smaller cohort somewhere around 10% where have much higher need discharges are probably more likely to end up in long term care and often need a slightly more bespoke solution those are the individuals that we call on pathway through three in the BCP area most of the pathway one and pathway to offers are provided by a combination of local authority and health services. As are the pathway three offers. And we have a range of services that are currently in the mix that do this for us and part of our role through the intermediate care workers to say how do we get the best alignment of those how do we get those in the right size and shape to be able to deliver the outcomes and the objectives that we've set. Just a little bit of background around intermediate care and where the demand comes from, as Betty alluded to to around of the total discharges that come out of University Hospital stores it which is primarily where obviously most BCP residents will will have their acute hospital say this accounts. It's demand for intermediate care is about 13% of their total discharges so it is a small number. But within that you've got around 65% of people coming out pathway one so roughly around 40 people a week, 29% leave on pathway to so going to some form of community bed which is around 20 people a week. And then 4% that leave on pathway three so around five a week they're in that slightly more bespoke more complex area. One of the issues that we're trying to chat face and trying to solve for the system is relates to flow so typically at the moment we still have around 150 people at any one time that are waiting in the acute hospital to receive some form of intermediate care service. The time it takes so we see about 65% of those will leave within five days but there is a tail to that where particularly for more complex individuals and you'll see that has impacted the average so on average for a pathway one discharge it takes around 18 sorry eight days and around 14 days for a pathway to discharge our aspirations to get that down so that everybody leaves within five days when they need that intermediate care offer. I just moved on to talk around some of the work that we're doing this year that that is a build on the work that has started over the last few years so I work in 24 24 22 primary areas. So continuing to focus on that targeted improvement that's reducing at the amount of time that people spend in hospital. This is primarily about bringing forward our discharge planning arrangements so we know that if we can start planning discharge at the point somebody goes into hospital. We avoid some of the complexities and delays that often keep them there for longer than we would like. Similarly we are doing that full review of our intermediate care model so looking at the size of the set shape of services we currently commission and provide and trying to address whether we know there are gaps particularly for complex more complex individuals to try and get those into the right size and shape so bringing back to where Betty starter is off. Some of the things we're doing in this first quarter of the year is really looking at some of the work our decision making processes so we're in the process of setting up an acute based transfer of care hub on each of our acute sites, which is really about trying to expedite decision making by bringing the right individuals health professionals and care professionals together into one place so they make that decision together quickly and in response to having set an early discharge which is informed by an expected discharge date. At the same time we're looking at the standards that we set so that we all have an expectation of what good looks like for people when they need to leave on a discharge to a safe pathway. So we know what people should expect to wait at each stage and supporting that is how do we share information across partners to both inform that but also escalate and resolve issues where we know we need to. At the same time we are just in the process of a piece of work that's supported by the National Better Care Fund team who are undertaking a review of our D2A model to help us set the foundations for what that redesign needs to look like. Betty I shall pass back to you at that point. Yes, so just wanted to provide some performance and data around this particular area, so it's not, it's not overall so specific to this. So the hospital discharge, there was reporting in the adult social care outcomes framework otherwise known as ASCOF, but that was stopped in 2019 when the pandemic started, and then ASCOF being used to be around for delayed transfers of care. Which is where people are delayed in the hospital when they're ready to leave for whatever that reason might be. But that's now I've been replaced with the in this particular area with the client level data so CLD as we refer to it. That came into being around April 2023 and what that does, it gives us data about how many referrals come to the council to come into adult social care in one way or another for support for people leaving hospital. And when I talk about support, I mean, actual support in the way of a support care and package. So it's not everybody because a lot of people will come into adult care as part of their discharge, but it will be for professional support and to work alongside creating a pathway for them, but it may not result in an actual support package and provision for them. So you need to be mindful of that in these figures. So on average, the client level data told us that over the last year, 99 people per month had come into adult social care for a number of reasons, but where they would need some kind of care and support from us to be able to facilitate their discharge to be able to leave that. Moving forward, the ambition that we have is a wider, dorset wide hospital discharge and work and system is that through the use of the dorset intelligence and insight service that we have, which is where we capture and share a lot of our partnership data that we will be able to provide and all partners will be able to provide information into this around our integrated care system. And this will help us to scope the data that we need. And she use that wisely to inform the way that we go forward in commission and the service provisions that we that we will need and what will best suit the people that need those services. We're also doing some work with ADAS around regional work around discharge. So there is a big focus on data around discharge and then analyzing that to see what kind of care and support and provisions are needed for people. The Better Care Fund, otherwise known as the BCF also has metrics, metrics is within that report on performance. And I just wanted to bring to members attention I'm sure that you know this, that we will be bringing a report to the next Council will be in board which is around the BCF and that that is where the BCF is reported into, you know, for us within the council so important just to note that also in very specific to this particular area, the discharge to assess and not overall within social care and health. In 2021 that we know that during the onset of the pandemic and during that, that period that when discharged to assess process was introduced there are around about nine complaints that we received around people's views on the hospital discharge that they experienced. These were all responded to jointly or individually by a health or social care partner dependent on which, which, you know, which was more with it towards which partner to communicate. And I do for those, we know that one of those went to our local government on this men, however, that was, that was not fine to be at fault so it wasn't, it wasn't upheld. And we do take the learning really important and I'm sure that members will remember when Nikki, who's our head quality and performance came and shared the complaints report, the really detailed complaints and compliments. So I'm not here to go into that because you get a yearly report on that and not that long ago had one that covered everything to do with every aspect of complaints and reporting and learning. And, but what I would say is in 2022, 23 complete numbers fell in this particular area to three. And, and there, there were failed to fail to three and there were four complaints and the themes for these were generally around. I guess, the regionally around funding or fees and placements, and what, what was available to people at the point of their discharge. And again, learning has been taken from them and some of our core offer, which we refer to as our core offer within the health and social care system for discharge. We have enhanced some of that, taking on board some of the learning from people's experiences. So we have some rehabilitation beds, etc. within within environments within residential buildings for people to be able to go into. So, and I can see Louise is, is, is at the meeting and just wanted to say that the council is working with health watch. And as we roll light feedback, and we, we continue to do our learning around hospital discharge and around people's experiences really important that we capture them because, you know, when people don't have a good experience around hospital discharge, it can have quite detrimental impacts on them on their family. It's really important that we go through that. So we're looking at how we can really capture that and use that and get people's experience by whatever method they keep that. And then just finally, for me, I just wanted to give some financial details again, very specific to this area, not inclusive of all the metal care. And so when I talk about the schemes, the value of the funding for the discharge to assess games in 2324 was 10.2 million. And off this 8.3 million was funded by health and 1.9 is funded by BCP console through Pacific grant for discharge. So the Council's discharge fund. And that's ring fence to this particular area. There is further funding within the better care fund, which covers a number of areas and early supported discharge is one of them. So there's a number of areas but discharge and early sport is one. And there's around 6.4 is health funded in this area 2.9 is within BCP and it's within the better care fund grants. So again, it's very, it's very much focused to this area. And I would just remind members that I've said that there will be a full report going to the health and wellbeing board around the better care fund that will cover all of the usage of the better care fund and the funding was in that. And what's important to note is that 2425, that the reduction of system funding available for our hospital schemes and number of our hospital schemes has reduced from 10.2 million. 95.1 million. There's reasons for that. But what that means is that as a system and as a council, we need to be careful how we are using the money that we have and really prioritize the schemes that give us the best. I come forward discharge and you can see there that I've put, you know, that the council is planning to use 3.1 million of the hospital discharge fund towards higher cost of care. When people leave hospital and I've said this before at the point of being ready to leave hospital. And we need to, if people are going into a building based environment, the cost of that can be quite high at that time of discharge, or they may have enhanced care and support needs at home that we need to work with them to recover. And that's why in the presentation earlier, really important that your law people time to recover before you set their long term needs because you don't want to create a dependency, neither do you want to put something in place long term that is not needed for long term. So, and then just important to note there as well, that there was the inflationary increase to sell to us important to note that 5.6%. So where we're at for for nine with regard to the integrated care system funding is that we're, we're in principle. And I hope likely to be allocated 5.1 million. That will, we have worked out what schemes that will go towards. And as I've said, those schemes will be all around discharge, and they will promote the home first model. And how are we get the best outcomes for those individuals. Some of that will also be your staff mentioned rehabilitation and enablement around some of our block book care homes, such as coastal lodge and I'd hospital rehabilitation, where we're able to give people a period of time for the development and or enhanced rehabilitation, hopefully to get them back home to the bed that they initially came from, which is their home bed, and where they want to go back to. So that's the end of the presentation chair. Thank you. And I think we can stop sharing. If that's okay. Thank you very much indeed. And thank you for such a detailed report and for referencing so much data in the. Any questions. It's just a very quick question so looking at say, for example, pathway three. That's not NHS continuation care, that's them going into intermediate care at that point. But how to just sort of understand that. So, it's sort of almost, it almost seems like the NHS is massively financially incentivized to put somebody into intermediate care, where essentially they may be thinking well, you know, this bed is costing a certain amount each night. And we put them into this intermediate care and then after six weeks, that's PCP's responsibility and, and, and not as. Am I being too cynical or. So I'll pick that up and then Becky can come in. So I think, I think what's important is to note the difference in the three pathways. There are four pathways. Pathway one pathway pathway one, two and three of the pathways that we are heavily involved in. There is a pathway zero, which is people go back to what they had before they come into hospital and we system to do that. And the majority of people do go home on pathway zero. And that takes me back to what I said about not everybody comes into hospital need some support to be able to leave, but just looking at your point around intermediate care. And pathway three, particularly, is, is around. I'll try to give you an example of somebody who would go on on intermediate care pathways for age. And pathway three is, is the smallest number of, of, of all of the pathways, that is for people who are not optimized. They are not, you know, they're complex, they're not optimized at the time. We have decided with them and their families that they are complex and that they are not ready to be able to go home at that particular time. And that's based on risk. And that's based on us collectively as a system and I would emphasize this is very, very system oriented. We do this in partnership. So that every professional, we have the right mix around the table. So this is the point somebody could go. I mentioned coastal launch. I mentioned, you know, some other bed based somebody could go into a bed in a residential or some kind of building based environment, where they need to have a structured program off recovery for them to be able for them to be able to be optimized to then return back to their home with support and care if they need it. But if they don't, that's great. What it does is allow people to leave hospital when they are able to leave hospital and don't need a clinical real clinical care, but they're not recovered to be able to go into. Into their own home or can be managed within the community, other than in a building based by the numbers are low, and the numbers are low because we use pathway. We use the other pathways. We use pathway to in conjunction with pathways race people. Some people will dip into both of those pathways and pathway one, why you talked a little bit about intermediate care and the six weeks. People get really hung up on this six weeks intermediate care, which, you know, if you look at the criteria around it suggests intermediate care is free up to six weeks, or can be over if it's agreed by all of the professionals. But intermediate care and rehabilitation should should be constantly being reviewed. I would consider that a lot of people do not. Well, I know for a fact, actually, because our records and our involvement tells us that a lot of people do not need intermediate care for that duration, nor would be the same for rehabilitation so that you keep using up to allow lots of people to use that. So, I guess, I guess halfway to is about really understanding that recovery, and giving people the opportunity to recover somewhere where they need to recover, rather than sending home to their home where they're not able to be managed. And they're not able to be optimized to get them back to the level of independence that they had prior to admission, or get into a level that enables them to be able to return back to the environment. What they want to go into. So pathway to and pathways very sometimes people will dip in a night of both of those pathways quite naturally, depending on where they are. But I wouldn't advise that people get hung up on this perceived this perceived few that intermediate care is for six weeks, it can be longer, if we, you know, if there's a clear need, but it can be a lot less as well. And it's like, I'd argue, if you're in that, you're in that pathway, have I missed anything back. No, I mean, I think it's a really good question. I think it's important that the intermediate care is a universal offer. So if you need it, you, you should have it. And it should be based on your needs. And I guess the people that fall into the pathway three categories, they are very small are often our most complex often because of a combination of this kernel from mental health needs, which means that actually the reason for putting someone into a pathway is because they need something that's a bit more bespoke. So it needs a slightly more intensive look, a lot more joint working across health and social care. I think for a lot of people on pathway three, they're unlikely to get to a point where they leave hospital or leave intermediate care with no ongoing care needs at all. That might be because they had something before, and it's intensified as a result of their acute episode, or it could be there's been some catastrophic kind of event that's driven them into hospital, which means they now are more likely to need long term care. But I guess the goal of pathway three is no different than any of the other pathways is about recovery. It's just the levels of recovery might be slightly different. But I would, but I was completely support Betty's, Betty's points I think we get hung up on the pathways, but really I think it's about the intensity of planning that goes alongside those pathways as often why we, we go down that route, but it ultimately it's about still doing the right thing for the individual. Thank you. Okay, thank you. I'm just going to say, and then I think we need to move on. Thank you, it's just about something Betty mentioned, which is not been explained in our papers that health have reduced the level of funding better you just said there are reasons about it but it's halved. That's quite a quite a draconian reduced, you know reduced or halved. Are we able to ask or should I not. No, we are. And again, I'll bring Becky in, and I think what's important to note, this is across the whole health and social care system the funding has has been reduced, but I'm Pacific in here about BCP because I'm reporting on BCP console. So our health colleagues have had funding reduced, so our acute hospitals as well, our doors to council colleagues, everybody has seen a reduction, and that is simply because we do not have the system of funding available within the pot. If you like to be able to, to continue to do the same as what we did the previous share. And some of that is because we had more money available. And we had more government one off. You don't, you know, we get a lot of last minute. Here's money for discharge spending on discharge, and you know we have more available at that time. But what we have done is we have all come together. We have looked at all of the schemes that we fundamentally believe we need to come wrap up responses one for us to help people leave hospital with a wrap up response service that can enrich to take the might and take them back home. And so that that's really what I would say on that consider minutes. It's system wide. It's because the funding justice and isn't there or there has been reductions in some of the one offs. But we need to raise up because it has impact then, and we may in adult social caremanship and carry in more of the weight to what we did last year. So it's really important within our budget set and then our budget planning that we factor all those risks. And I don't know Becky or anyone else wants to say something on that. Thank you, Betsy. I think, I mean, I think you've explained it. Well, the biggest, the primary difference in the reduction this year is that we haven't had the non recurrent funding that we would typically have in previous years. So these one off. That we were able to kind of bolster service offers with so that isn't available this year. And hence we've had to kind of cut the plot accordingly. I think it's what's really important to know is what we're trying to do collectively across health and care is get more from the resources we do have. So we've got opportunities, for example, to reduce delays you read me talk about at the moment, on average, it takes some one eight days to come out on pathway one. If we could get that below five days as a not more people flowing through those services. So actually there's opportunity that comes with with a with a tighter budget if you like that we're looking at which is about how do we use the services we've got to maximum impacts both from an economic perspective but equally from an outcomes perspective. Thank you. Thank you for coming someone and then we really must move on. Thank you. I'm really curious about that 20 to 25% figure what the plan is on that because that's that's crippling in a sense that's a quarter of the capacity of those hospitals was eaten up. And it sounds like that's been quite hard to shift. And I'd just like to know if we've looked at what the forecast demand is compared to the resources we've got coming in, and if that's a figure you think can be shifted through this scheme, or if that is just as a result of resourcing issues elsewhere. And we're always going to have that 25%. I might have missed it in the report, but I'd just like to know where we see that number going. Just so that I'm clear. That's your referring to the 25% in. I think it's you HD. So it's born from Paul. Yeah, I think you've only got data for born from Paul. I'm working on the day for Dorsey health care over a minute. So it is coming along. But yeah, 20 to 25%. It's going to pass back in and I'll come in if needed on that. Thank you. Thank you. So I think there is opportunity to absolutely reduce those numbers down. We have seen a reduction in the numbers of people delayed and the length of delay over the last year, but we've got further to go. So if South Souths are fairly ambitious targets system to almost half that again this year, some of that comes from from the things that we've already described. So if we know we could plan someone's discharge earlier, we know that that would reduce some of the avoidable delays that we often see in somebody's journey because we're picking those things up at the point of admission and we can start that planning. If we can get people moving through our intermediate care services at a better rate, whether that's in a community hospital bed or in care at home, then we will create more capacity in order to be able to see people. But equally, it's really important that we recognize as a cohort of individuals that really don't need to be in hospital in the first place. So actually, the game changer is if we can move our whole intervention further upstream. So that actually we're using intermediate care services before someone even comes into hospital to try and maintain them in their own home. We can do all of that, then we will get it right. It does ebb and flow. We have an opportunity always over the summer months when the pressure is less to try and kind of get the models working better and that's certainly some of the things we're working on right now. But I think we've done a lot over the last few years of running this program and I think there's a real opportunity to make some of those in those this year for that reason. I think just finally on that as well. I think we've got almost five key areas that we're really focused on. And one of those is around expected dates of discharge, and making sure that when somebody comes into a hospital that they haven't expected to discharge, kind of set with them, and with the clinicians and with this, you know, the MDT multidisciplinary team. And you work to that discharge. So if somebody comes in presenting in a way, but I don't know whatever way they present whatever the episode might be that's happened to them. Then you can gauge what you think is needed for them to stay within hospital in the way of days. So you set your expected date of discharge. We've got much more robust at looking at that expected date of discharge and working towards that, rather than just letting it drift with like really challenging that, and also looking at people's likes of stay. And you'll, you'll know some of this terminology around, you know, reducing the length of stay. And as Becky said, really looking at pathways where intermediate care comes into that and enhancing the number of people that go home on pathway one, because that's the pathway that we really want most people, we practically can to go home on that pathway because it is better for them and their families and just their whole experiences. Thank you. Was this an additional point of clarification because I do need to move on. Just very quickly, I think Council sounds touched on an important point about the resources elsewhere. So we know that there's gaps in the capacity within therapy across the system, both within adult social care, but also within health care to help people on that recovery journey and I don't think we should avoid seeing that so we can make efficiencies, but we've also got to bring the resources together so that we can really tackle the gaps in their therapy services that they have recovery. Okay, thank you. What I'd like to do is bring us back to the recommendation in the paper. So I'm happy to move from the chair that we note the report and don't response within it. And that we include a recommendation that a further update is presented in 12 months in May next year. Anybody happy with that. I really will do as well as I'll probably try and beg. Let's see if you'll let us have a copy of the report on the better carefulness going to the health and wellbeing board. Well, big film. I've got mine to a bag as long as I get it. That comes through my, my, yeah, part of the wellbeing directorates. So I'll make sure that a copy comes to committee once that's published. Thank you very much so much grateful. And I'm sorry for having to cut it short, but we do need to press on. So I'm going to take the next item, which is the data working group, the final report. And I'm going to ask Lindsay if she would say something, but before she does. I would just like to thank her way more than I can express for the work that she's put into producing this. I'm grateful it makes us look professional and I think it's an excellent piece of work. So thank you Lindsay over to you. Thank you for that chair. Yeah, if I could just give you a quick overview and bring you back to why we did this work. Before we go to the recommendations. It is quite an internal piece of work internal looking and very much about how you will work as a committee and we always try to do pieces of work that sort of have an impact. Outbiddly. So I think it's important to note why it's really valuable and that's because scrutiny should be evidence led. And particularly important when you're looking at areas impact on our vulnerable residents like children and adults. And it can be really easy, I think, in scrutiny to get used to the reports that are given to you by officers and partners and to take those and be updated. But it's really important to test and challenge and I think in areas where there have been failures before. It has been noted that scrutiny had a role in that where they didn't ask the questions and look at the data and test and challenge. So what this group has done through its work is have a look at all the data sources that are out there and try to bring that together in a toolkit. So the toolkit that's appended to the report aims to give you both a guide on how you can approach data and policy. So it's not just data but the sort of policy landscape that's all relevant to your work. And also a list of all those data sources so that you can access them easily. You can see a synopsis of what they are and how they might help you in your work. The reason it was structured like that is to make it very much so that you can self-serve as a committee. And there is an understanding that that's something that will grow over time. And I think the working group very much acknowledged that and officers in terms of how it's used. But it's hoped that this can be something that you can use independently to help make the work that you do more robust as you go through it. So just to go to the recommendations of the report, there's 12 recommendations in there. Most of them really relate to how you'll implement the toolkit and also how you'll communicate it throughout the organization because the working group was really keen that this is a piece of work that could be rolled out by other committees as well. And I know we have feedback from officers who work with us and offered great enthusiasm, partners and officers to support scrutiny in its use of data, which was wonderful. So let me just draw your attention to the ones that I think you really need to be happy with as a committee in terms of how you will work. So, Recommendation 3 is suggesting that there's a standard data request for all your reports, so wherever possible. The working group said that they would like this standard set of data information to accompany all your reports. So they, in effect, they're asking officers in advance for this information to accompany your reports. So that's set out in the data toolkit. And I think it's page 53 of your pack if you're on modern Gov system. So asking for historical trends, regional and national comparisons, demographic comparisons, costings and budget and an outline of any limitations in the data that should be taken into account by the committee. So what the working group saying there is, as standard, every time you have a report, they would like that to be included. So we're asking you as a committee to sign up to the toolkit, which would include that standard data request. In addition, there's an expectation that members will use this independently to horizon scan. So to keep an eye on what's coming up, basically, any areas of concern, any red flags that you need to highlight into committee. And to help you know where to plan your work on where to direct your resources. So, recommendation. Recommendation five is about you doing that independently. Recommendation seven is about using the resources highlighted within the toolkit within your work programming, so that you use those annually to help direct to work programming and recommendation nine that it also lets highlight is about using key lines of inquiry more regularly. That's something we're rolling out with all the overview of squishing committees so you can use, there's a standard template. You can use that to set out what are the key questions that you want to ask with a piece of squishing work. And what are the data inclusions that you would like within that piece of work to help you answer those questions. A few things there that really fill out some ways of working for you and that you were asking you to be happy with in terms of agreeing to the recommendations and report. But I think the rest of the toolkit and recommendation speak for themselves hopefully but if you've got any questions, do ask me. Are there any questions on any of that. If not what I'd like to do is just to focus on those recommendations and to if I formally move them as a block of all 12, whether they're already comments you want to pick up on in terms of those recommendations and obviously look for a second. I think it's great to have all the uniformity in there as well because we're simple folk councilors and we can look at reports and they look the same than that helps us. Any other comments, comments, just a comment or two comments that it's a fantastic piece of work so thanks very much all that shared in it. I was glad to hear Lindsay say that officers are very enthusiastic about providing all this data. So that's going to be really helpful. So, are we happy with these 12 recommendations. Yeah. Okay. I'm not going to bother voting on it. Lots of nods of heads. So thank you very much indeed. I'm going to move on. Thanks again for everybody involved in producing that. So we've gone on to item 11, which is the health watch updates on NHS dentistry so if Louise if you're okay. Thank you chair. I think I prepared some slides help watch slides as a presentation. There was also presentation I shared that I got from NHS door set, which I won't talk to because that isn't mine, but that's for information. So if you could. If you could share the slides Louise. Sorry Louise, they've been circulated as part of the report pack so all the committee have access to them. Oh yeah, Chile. Okay. If I talk to them, should I put them up on the screen? Would that be helpful? Yeah, okay. Okay, so yeah, thanks for inviting me to come along and talk about dentistry. As you'll all know, I'll just re-trade what health watch is for anybody watching from public. So health watch still sits the independent champion for health and social care services. We find out what local people think and then we share that with decision makers really to make a difference. And we also help people find the information they need. NHS dentistry is still the top issue that people contact us about trying to find a dentist to take on new NHS patients or for urgent care. And there's a quote there that's a kind of an example of the kind of queries that we get every day. We share feedback about dentistry with NHS lawsuit and with NHS England Southwest. And the insights that we gather the feedback that we gather from people have helped inform commissioning locally, including a child friendly dental pilot practice that's in where them. And an additional I think it's just over 100 urgent care appointments a week for people who don't have a regular dentist. So, by kind of sharing the stories that people bring to us we've been able to have a few impacts locally. I think I must stress so it still is very difficult to find an NHS dentist. But we have been able to have an impact on the information that NHS door sit share on their website. They've they've added some frequently asked questions that were based on the feedback that we gather so that we can kind of help direct people to a website that gives answers to the questions most people are asking. We've had an impact on rapid commissioning so looking at commissioning additional capacity and there's some additional capacity for dentistry that's been opened up in pool just in just recently. The NHS door sit now working with the chiropractic college to develop an oral health institute, and the other slides I chaired for information were from NHS door sit about that, that development. And then that will tackle kind of work workforce issues that are happening locally. And then addressing the backlog of special care dentistry in hospital settings, and oral health education in schools and communities. So, the first dental steps initiative which is running partnership with the with the local council with BC council. And that's part of that oral health education. But as I said, it's still very difficult for people to find a dentist taken on new NHS patients. I did speak to somebody just last week who we'd sort of they contacted us because of trying to find dentist in the area. And we said, you know, keep keep bringing around because they do open up appointments. And especially on a Monday morning tends to be if a dentist has got some appointments to open up that would be the time to call. And she did bring me back to say that she had been given an appointment, actually, which is really nice to hear. So, so it can happen, but it is still very difficult. What we'd like to see the recommendations that we're making are want to see a much more rapid and radical national reform of how dentistry is commissioned and provided. Clear information for the public. There's a NHS website that you can look at to find a dentist in your area, but it tends to not be updated. So it's very difficult for people to find any clear information about which dentist might be taking on new patients. And then that means people are ringing around and, you know, kind of losing hope really ringing around. Whereas if the information was clearer, that would be really helpful. We're recommending more oral health packs for communities facing health inequalities and we've been doing some work with local food banks. We'd like to see and working with public health actually to look at when the next lot of oral health packs are available, some funding for them that we could give them out of food banks and within other communities. And we'd like to see the developing integrated neighbourhood teams link or health to other key issues that they're looking at in communities such as weight management and smoking sensation. And then finally, there's just some contact details for us. Please do sign up for our newsletter. We send that out once a month and we give updates about what we're working on. So it's a good way to see what we're doing. I did speak to Councillor Carl Brown. I think that was probably just over a month ago to gather some feedback from her about trying to find any test dentists for the people that she serves. And yeah, if anybody has any questions. Thank you very much, Louise. Before I just open it up for questions, I thought I might just pick on a colleague from the NHS, just to give us a bit of an update from their perspective. Thank you, Chair, and thank you, Louise, and NHS DAWSAT has been working and engaged with Louise and health watch. So thank you for all the work Louise that you've done. As you said, you know, it is really difficult. The current contract is really challenging for dentists. We've had an increased number of dentists hand back there in NHS contract. So it's not going in the right direction. The hope in that, and it's still early days, is to develop that training hub, because that training hub will also deliver services. And there's a model in Suffolk that has just started that we've actually gone up and we've had conversations with them. And we'd like to look at what we break and bring into DAWSAT, because of course the workforce is a big challenge. We don't train dentists and DAWSAT. So that it's like community pharmacists. So it makes it really difficult to track them into the county. So we're quite excited about looking at the training hub, but particularly because it will deliver services. So, and we really want to target the health inequalities that we've got. So that's the intent. It will take some time though to develop that model, but it's the right direction to go. In the interim, though, we're doing everything that we possibly can to work within the national contract so that we can increase the current capacity that we've got. As as Louise said, we've put some additional capacity in pool. We're also focused on looked after children, because we appreciate that there's a challenge there that's been brought to our teachers. So we're trying to look at how we can do serve that population as well. So we're just looking at going out to market with an expression of interest to see if we can attract some of the dentists to come in and actually focus on some of those areas and the priorities. So that's what we're doing. So it's, it's a priority for the ICB over the next year. Thank you chair. Thank you very much indeed. Any questions or comments on any of that. Okay, in terms of the recommendations that some health what you've indicated on the slides. I'm making a huge assumption, but I don't think any of us would argue with the first one, which is a more rapid and radical national reform. I found dentistry is commissioned and provided, but I'm so far. Thank you. I was being patient there. I think you were occupied. I'm just going to ask and mention about capacity and increasing capacity that does that relate to funding or does it make is that to do with not having enough people trained actually as dentists locally or nationally even thanks. It's probably a mix of both, but we've got dentists. It's at the moment. It's more lucrative to be in private. The NHS contract is not very, you know, it doesn't cover cost. So we've got a challenge. So for, you know, for dentists that do provide NHS services, they're doing that at a loss. And that's why we're seeing more contracts being handed back. So what we're trying to do, because we can only work within that contract, the national agreement, we're trying to actually uplift the current price. So there's some work going on around that, which is a on a national level. So everything that we're trying to do equally NHS England has just invested a bit more into trying to look at workforce, because they recognise the issue and that that space so it's a combination of workforce and just the contract. I'm told I can use my discretion to invite Councillor. Thank you chair. I won't be asked twice in that case. It seemed appropriate as Louise mentioned that I'd spoken with her. So what happened is at the end of March, I rang every single dental practice in Bournemouth, trying to find an NHS dentist, every single one on the NHS website that was not that was saying that either the details weren't updated, or that they were offering NHS appointments. There wasn't a single one in Bournemouth, not one, and I did ring everyone and I spoke to somebody at everyone, which I thought was really quite astounding. So I just thought I'd, you know, flesh that out with what Louise mentioned, and that's what I followed up with her, because I thought that was so outrageous. But I do, you're talking Kate, you were talking about the, that you've got budget, but you haven't got capacity, and I just wonder what is the, what is the sort of, because I think money gets returned, doesn't it to the NHS, if it's not spent. And I just wonder what the current level of that was, please. Thank you, Kate. We have a budget for dentistry. So within that budget, often it's under spent, so it's not delivered because we don't have the capacity to meet all of that, but it gives us the opportunity now because of the flexible funding. We can actually do a little bit more within the contract, which enables us, for example, we're going out to the market to see if we can find additional capacity around, for example, you looked after children for those that we can for inequality. So there's some work that we're doing within the budget, we can't exceed the envelope, but we are trying to maximise the use of that funding for dentistry and that's why there's a priority for us. Sorry, Kate. So would that be offering a contract or a sum of money to a dentist somewhere that would provide that service. Effectively, yes. So we're trying to find those that might actually take on a specific cohort, so that they can support, for example, up to children. Yeah, and that would be paid for out about the job. Thank you. Any other questions on that? I mean, I just think sorry I'm reading. Thank you. I'm just wondering how close to fruition this idea of what the AC and C is. I have we. And it's literally just started so we're just scoping it but as I said before suffix got a model that I've implemented so some of my team, along with the college went up to visit Suffolk and just to really get a sense of some of the challenges. Because if we can move as, you know, more quickly by learning from others, then that's what we intend to do. But it will take a few years to probably establish it's a training kind of offer in model. Thank you so many. Long time ago when I worked in London, that model was operating in some of the university hospitals in London. Any other points. I think it's just something that we're just going to have to keep coming back to and grateful for Louise for keeping us up to date with the work. I'm sure her workload will not diminish of this. So thank you again. Any final thoughts. Thank you. Okay, I'm going to move on to. To the item 12 integrated neighborhood teams. So I think Kate and June are going to take this. Yes, it's, it's a joint paper between the two of us here so I'll kick off and if that's all right Kate and then, and then Kate can come in as well. So it's a, it's a quite a brief and to the point update on integrated neighborhood teams. It is still early stages on the development of the program. So the paper focuses on a few developments. Since we last provided a briefing note to the committee. The governance is taking shape a pandemic program board has been put in place. With a broad representation on there. And then importantly, agreement that the program will report in BCP and in daughter council into the two separate health and wellbeing boards for the areas to ensure that place based oversight and scrutiny of the, of the work. Some of the discussions that have been ongoing within that program board around. What do we mean by neighborhood for the purpose of these integrated neighborhood teams and we were broadly settling is around a recommendation from the Kings fund and, and they're working on integrated neighborhood teams which, which defined a neighborhood is between 30 and 50,000 people for these purposes. And what we've started to look at is bringing together a different ward boundaries into into clusters that teams could be formed around. Now, of course, 30 to 50,000 people doesn't necessarily represent a neighborhood. It represents many neighborhoods working to working together, but it's about finding the right balance of a space where that integrated team approach can make a difference. While still being formed around neighborhoods that look like broadly neighborhoods, it replaces that people would recognize as having some connections between them. And then some work on going on on metrics and outcomes and making sure we've got some some clarity around that. And again, the right balance of having, having teams contributing to that overall ICS strategy and the five pillars that are defined within the strategy, but also leaving some space within within those teams when they're formed to focus on what are the priorities in these places and and draw some learning from from communities and from from data in the places that you want to draw out for the committee. Thanks, Gillian. I think it's quite important in terms of the conversations we've had around when we talk about neighborhoods and integrated neighborhood teams and there's been a lot of confusion. I think about just exactly what we mean. So when we brought in the National Association of primary care that worked with health to look at actually what would our out of hospital model look like, because we have quite a fragmented health system in the community and it's really important to know where to go to access care. So what we looked at was actually how we going to organize ourselves certainly within health, but not lose the wider opportunity to work with partners to really address the wider determinants of health, because it's not just about what we do in health. So we've got, we are currently looking at what we need to do within health, though, to bring particularly our community services together with general practice. We've had three practices in the west of Dorset that have had integrated community nursing teams for 27 years, and we haven't scaled that up. So, so we've got a working example of what an integrated kind of the start of an integrated neighborhood team would look like. And so that's what we want to do, but we, as Jarian said, this is broader than just what we do within health, and it's really important to make sure that we do this at a place level, because they're quite different in terms of the demography and the challenges that we face. Thank you. Any questions on that. I guess the one from me. It's just about time scale, really, because we were previously thinking about pilots and things like that. So, just wondering if that's still where we're going, or whether it's still multiple or different things to do. It's an important point, actually, I'm glad you asked about that. You might have spotted that the language and the paper has shifted from talking about pilots to talking about early adopters. And I think where that's coming from is an ambition, rather than to do as I think system and some systems have done in the past, have a few pilots pause, take quite a lengthy period of time, before a wider rollout or no wider rollout, which I think has sometimes been the experience instead sort of there are some early adopters and then some fast followers and the ambition, you know, moving across all areas, quite quickly. But, again, the discussions about exactly what that rollout looks like, how we would approach it, how quickly, how, you know, what, what it looks like to get a team up and running is still very much the detailed work that's going on now. Okay, any other questions on that. Okay, we're going to move on then. I think you for that report, an update. Thank you. So we're supposed to take the update from the portfolio holder, but council David Brown has senses apologies, and has given us a few points of things that have happened. So with your agreement, we'll incorporate those in the minutes, just so that you're aware, let's circulate those. It's basically just some brief updates about what was currently happening. I think at some point you need to declare an interest in these meetings, so I declare that fairways residence. Care home is in my ward. Mr Homsby and I have been exchanging emails about it. But other than that, I think I think we can just circulate the comments from David. Okay. Thank you. So we're going to move on to the forward plan. That has been circulated. So as a kind of starter for 10. Perhaps we could just look at the things that I've tentatively suggested that we might look out at the next meeting in July. And then we can take any other comments as well. So, what's we looking at an update on maternity services, because we are aware that there is a review of them since that maternity service is taking place. So we hoping that we might be able to get from the university hospital to come and talk to us about that. An update on Tricuro and their business plan from from Tricuro is coming to Camden at this week. But this was more about trying to do a bit scrutiny on the work and what that business plan might actually look like. So we'll see that report is in the cabinet papers, but we'll bring it back with a bit of an update, hopefully in July. That that's a plan anyway. And I have asked Betty, whether we'd be able to have a look at waiting times within adult social care, just in terms of the wait times for people that are needing an assessment. So that's not an exclusive list is just some suggestions. And we probably will need as Jane alluded to have another look at the public health stuff in July as well. So any thoughts about that or about the other items that are listed on the where we haven't actually allocated the date. Yeah. Would now be the right time to bring something up that I would like to add to it. So I'm going to be totally honest. I'm more bringing this up because I don't want to be complacent, rather than it being something I'm concerned about. But, so I've been told we have a massive problem with the gender identity services in Dorset, and that there is a terrifying school to clinic pipeline that we should be worried about. It doesn't match my lived experience at all. My understanding, well, most parents, I know who've got children or mental health problems that complain is, I can't get referral anywhere. But I've been told and I've seen some figures that show we set above the national average for referrals to gender identity services. So with 57 per 100,000 in the population for under 16 referrals, national average is 38. It's not massively over, but I don't like to be complacent, even if somebody does call me a counting performative fool, while they're telling me about this, I can't just go, no, I reckon it's all good mate. I wonder if that is something we want to put on our agenda. I know it's a horrible topic that it pays toxic, but I've been asked about it. I said I'd bring it up. I shouldn't even thought someone else. Sorry, we can bring something back to the committee, because it has been a challenging issue in terms of closure of tevastock and reopening of two services. And you're right, we do sit above the average for referral or have. Yeah, if somebody tells me that worried about chem trials, I feel I can be quite confident in telling them they're talking wrong. Where is this? I've got no expert knowledge or date full back on and I'd like that. Is that something you'd be able to help us with? Yeah, I'll take that back to NHS store sit and we can put that on the full plan to come back. Thank you. Any other thoughts, comments on the forward plan. Yeah. Just to say, Chair, that after this meeting and before the summer is planned, that there'll be a work programming session that we have annually that's fed into from all health partners. So just to say that that's that's in the planning stage. Yes, thanks, Louise. So don't think that this is your last chance to raise issues that are of concern. We're constantly besieged. It seems with issues that keep emerging. And now, not least closer to the practice and general access to GP services. So we'll just keep up a close eye on that. And if anything does emerge, then just please let us know. Is that okay. Well, thank you very much everyone. And I'll close the meeting. Thank you. [BLANKAUDIO] [BLANKAUDIO] [BLANKAUDIO] [BLANKAUDIO] [BLANKAUDIO] [BLANKAUDIO]