Transcript

Good afternoon and welcome to the first meeting of the health and well-being board in the 2024-25 municipal year. Due to Councillor Bannon, the chairperson not attending the meeting today, we would need to seek a chairperson for today's meeting from the board members present in the chamber. Prior to this, I will just run through the apologies received today. We have received apologies from Councillor Christine Bannon, Wayne Longshore, Sharon Marsh, Leigh Thompson and Leslie Marsh. and Leslie Martin-Wyse. Can I now seek nominations from the floor for chairperson for today's meeting? Thank you. Can I agree with Councillor Dal Arnelle, be chair for today's meeting, please? I'm happy to second that. Thank you. Is the nomination of Councillor Arnelle agreed? Thank you. I will now hand over to Councillor Arnelle. Thank you. I'd like to welcome you all to the first meeting of the year from Dosely's Health and Wellbeing Board. I'm happy to second that. I'm happy to second that. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. I'd like to welcome you all to the first meeting of the year from Dosely's Health and Wellbeing Board. For those of you who don't know me, my name is Councillor Dal Arnelle and I'll be standing in today in place of Councillor Chris Bannon, the chair of the board for this municipal year, 2024-25. Before we make a start, I'd just like to remind you all about the importance of switching your microphone on before you speak and off again when you've finished. This ensures that those watching at home can see and hear what's taking place in the room. Can I also remind board members to switch off your mobile phones or to place them on silent, please? As this is the first meeting of the year and we have some new board members, I suggest we do a quick round of introductions. If all board members can briefly state their name and who they're representing today using the microphones. So I'll start. So as I said, I'm Councillor Dal Arnelle, I'm the portfolio holder for adult social care and I'm a Page Moss Ward Councillor. Pass over to you, Alison. Thank you, Councillor. My name is Alison Lee, I'm the director for Knowsley for NHS Cheshire Merseyside. Sorry, hi, I'm Tim McPhee, I'm the AD for Integration, Transformation and Partnerships for Mersey Care. David Aspin from HealthWatch Knowsley and I'm the rep for the Knowsley Engagement Forum. Mark McDonagh, Chair of HealthWatch Knowsley. Hi, I'm Sarah Smith, I'm the exec director for Health and Social Care at Knowsley Council. Rachel Jones, I'm the Chief Executive for Knowsley, which is the infrastructure body for Voluntary Community Faith and Social Enterprise in the borough. Karl Baldwin, I am Superintendent for Merseyside Police for Knowsley. Jonathan Jones, Executive Director, Children's Services, Knowsley. Councillor David Lonergan, Cabinet Member for Children's Services for Knowsley and Cherryfield Ward, Member. I'm Brian Gouldson, I'm the Chief Officer for Citizens of Ice Knowsley. I'm Lesley Dixon, I'm Operations Manager at Merseyside Youth Association and I look after our detached participation in health services. Hi everybody, my name is Elaine Basswood and I'm the LCO and founder of Zontold. My name is Becky Rudig, I'm the Programme Manager for Start and Weld for Knowsley. Good afternoon, I'm Lisa Simpson, I'm a Service Manager for CYP Mental Health Services in Mersey Care Trust. Hello, I'm Jane Hovingwright, I'm Deputy Chief Exec at Listening near Merseyside. Hi, I'm Natalie Haller and I'm a Public Health Registrar, I'm currently based at Knowsley Council. Hi, I'm Councillor Robert Austin, I'm Chair for the Health and Wellbeing Scrutiny Committee and Councillor for Paysmarsh Ward. Hi, I'm Cameron Simpkin, Managing Director for Valair, representing Leisure and the Natural Environment. Thank you. I'm Richard Holford, Consultant in Public Health at the Council. I'm Sarah McNulty, I'm Assistant Exec Director at the Council for Public Health. One then please, which is the minutes of the previous meeting. Are there any objections to the minutes of the meeting held on the 19th of March being accepted as a true record? I've got a question, just a clarification on page 7. I asked about the mental health, the second paragraph on page 7, I just wondered if it had been clarified. I'm sorry. I'm just trying to find it, page 7, ok. I'll probably get back to you. Ok, thank you. Thanks a lot. Agreed please. Agreed. Thank you very much. Minutes are agreed as a correct record. So, moving on to declarations of interest. Ok. Thanks to you, no declarations of interest have been received. Thank you. Thank you. And then on to the governance arrangements. This is the first item in relation to governance. This report provides an opportunity for board members to note the formal governance arrangements for the Health and Wellbeing Board for the 2024-25 municipal year. This is to be presented by Patrick Torpey, Superintendent and Partnership Coordinator for Knowsley Council. So if I can pass over to you, Patrick. Thanks very much Chair. Just as you said really, as in the first formal meeting of the new year, members are asked to note those governance arrangements to allow the board to fulfil its role in an open and transparent way. So with that being said, the board is asked to note the arrangements as attached in the three appendices to the report and agree to monitor the operation of the governance arrangements throughout the year. So I'm happy to take any questions. Thanks. Thanks. Just one question if I may. So page 30 of the pack, labelled 26 at the bottom of the page, the NHS provider trust representative under section B, St Helens and Knowsley Teaching Hospitals is now Mersey and West Lanx. So if you could just make that correction, that would be great. Just a formality. Thank you. So if there's no comments or questions, if we can turn to page 15 of the agenda pack. Are we happy to note the contents of the documents which form the governance framework within which the Health and Wellbeing Board will operate during this municipal year? And do we agree to monitor the operation of the governance arrangements during this year? So I'll take it that everyone is in support of formal governance arrangements and it will be recorded that the arrangements have been endorsed by the board. Thank you. OK, so we're motoring along on to item four, which is the annual report for 2023-24. This item provides an opportunity for the board to reflect on the achievements of the board in this last year. And again, Richard Halford will present us to us. Thank you, Chair. Yeah, so I'll assume that the report basically details the activities and achievements of the board over the last 12 months to provide the board with an opportunity to reflect upon how it's operated and identify any suggested ways for strengthening the board moving forward. It provides an overview of activity against the joint health and wellbeing strategy priorities, which as a reminder for new board members is reducing health inequalities and mental health, improving mental health and wellbeing. Also included is a reminder of the in-focus items that have been covered throughout the year, which are items which we go into depth in and discuss as a board and that identifies the actions agreed and the progress made. It also details how the board has delivered and met its statutory duties in section five of the report regarding needs assessments, promotion of integration and system assurance. In conclusion, overall good progress has been made on the implementation of the strategy influencing the social determinants of health and delivery of statutory duties. I welcome any reflection on this report and the way the board's operated in the last 12 months, but there will be more opportunity for an in-depth conversation around this to reflect upon the progress made, new priorities and development at a board informal, sorry, at an informal board development session, which will be taking place in the coming weeks. But I welcome any initial thoughts. Thank you. Yeah. Um, just to say I've really welcomed, um, the continuing in-focus items. So that opportunity to do deep dives into specific areas. Um, so some of those best start to life housing and health, adult mental health falls, healthy weight and childhood obesity. And I think we've got some real traction in some of those areas, which has been really positive. So, um, yeah, very keen to see that continue again this year. I welcome the opportunity for those in-depth discussions that we're able to have a lot of these subjects need to keep coming back to us so that we can keep gaining that traction and make some headway. So thank you for that. So subject to all comments being taken on board. Are we happy with the way the board operated during 23, 24, and are we satisfied with the activities undertaken and achievements made to deliver statutory duties? Yep. Thank you very much. I'll take that as noted. So item five is our in-focus children and young people's mental health. This next item will give us an opportunity to take a focused look. We have representatives from Listening Ear, Mersey Care and Zuntold joining us to deliver this presentation. But we'll start with Jackie Ruddock from NHS, Cheshire and Mersey. Over to you. Hi, thank you. As we just explained, this is going to be a joint presentation by myself, our members of our Thrive community in Knowsley. What we want to look at today, what the story we want to give is that element of performance. So how has the performance been managed across Knowsley? And what we want to do is we want to actually talk through that story rather than just sit here today and just give you facts and figures. What we actually want to do is talk about what does Thrive mean? What does it mean for that young person when they're sat there in front of the GP or in front of whoever and they move them through that different service, those different stories? How does it work and how are we working together as a system? So what we've tried to do today is pull that presentation together. I'm just going to hand over to Elaine, who's going to start us off. Thank you. Thank you. Thank you, Jackie. Hi, everybody. So the Thrive model is what's so positive about the Thrive model is it sees young people holistically and understands that for some young people's mental health, they might need different sorts of help at different times. So in the first quadrant, you've got getting advice, which is a part of the Thrive system that all young people should have access to, and that is delivered through a variety of different kind of providers. So, for example, in our service, young people can come to us and they can get access to lots of information and support around mental health through books, poetry, novels, self-help manuals, which they can listen to or read in their own time and maybe have a one-off session with one of our counsellors. That's open to all young people and they can either do that face-to-face or online. That's just one example. Getting help, which is the second quadrant, is probably where a smaller proportion of young people might go who need a little bit more support than just advice. And that, again, is delivered in really accessible ways across Nosley. In our service, for example, when you sign up, you get immediately allocated your own counsellor who you can start seeing immediately through book sessions or through a drop-in or you can sort of ask to see a counsellor in school. So that's an example of how that works. And then a fewer young people will need getting more help, which is more sort of specialist work, so that might be longer-term counselling, that might be more than six sessions, more than 12 sessions, which is something our service provides. And as my colleague Jamie explained to you in a minute, other services across Nosley do as well. And then a smaller cohort of young people getting risk support, which is where young people would probably enter into sort of specialist services or either with a social worker or through CAMS. So, yeah, so the Thrive Model is, in many ways, it's revolutionised, really, mental health services for children and young people. It sees that some young people might sit in two of those buckets, not just one, rather than the old-fashioned system where you were kind of measured by a tier, like tier one, tier two, tier three, tier four, CAMS. It's much more accessible and young people can get support and not have to wait inordinate amounts of times to get that support. So we're really proud as a provider to be part of the Thrive Model in Nosley. It's a great place to work, great place to be. So I'll pass you over to my colleague, Jane. Thanks Elaine. So this slide here illustrates service delivery in Nosley against the Thrive quadrant, so it mentions a lot of the players along, we called it the snake. In Nosley, the core mental health delivery partners have formed a collaborative mental health offer, and this has been called COGS, and that was talked about at the previous Health and Wellbeing Board. The core partners within COGS are currently CAMS, the mental health support team, Listener, Zuntold, the Nought to 25 Health and Wellbeing Service, and Merseyside Youth Association. And we've been meeting on a regular basis to try and transform children's mental health into the Thrive offer for Nosley. So the vision for COGS is to have a collaborative approach to referrals, to triage, to assessments, so that children receive an appropriate level of support from across the collaborative, from across all of the services, without being redirected from service to service. Collecting and monitoring data across all the core mental health services through a data dashboard will be key really to enabling, to refine COGS over time. Thank you. So this is a kind of starting point for the data collection, and I just have to say it doesn't talk about every service in Nosley, it hasn't got all the data from all the services yet, but it is an ambition to try and bring everything together. We need to kind of acknowledge that COVID happened in this time period, and it does impact on some of the numbers of referrals and also some of the numbers of the children seen. Some headlines from the data are since COVID, referrals to CAMs are decreasing across all of the services. But for example, the referrals to the mental health support team is increasing. So what that might be telling us is that the lower level issues have been picked up by a more appropriate service within the system, and not automatically all going through CAMs, which might have historically been the case. Listening air referrals are kind of holding, we've got a good number of referrals to our service against the capacity that we've got to support children, so we can support about 400 children within per annum. And we're getting just around 500 referrals, which allowing for those who don't want to engage is pretty good. Elaine might want to say more later at the Q&A stage about the Zoom told numbers. They're a new service within the collaborative replacing Couth, but you can see that they've already seen 78 children in that first six weeks of their delivery against 500 over, you know, around about over the previous years. So we're all aspiring really to provide early help for children and young people so that issues don't escalate to requiring a higher level of need. And the data shows that we're starting to see the green shoots of that in the form of a mental health collaborative coming together. So I'm going to hand over now to Lisa. Okay, so I'm going to talk through the performance narrative really for the MercyCare services in particular. So that includes the community CAMs teams, the mental health support teams, the children's eating disorder services and the crisis response team. So if I talk you through this first slide, this is a mental health support team, which was an initiative really from the green paper, the transforming CAMs green paper, and it looks to have mental health support teams in every school. Now we know currently we have on average about 68% CYP school age population coverage, which is really positive in terms of benchmarking regionally and nationally. Yes, we aspire for that 100% coverage and working with NHS England and bidding for the funding to grow those services is definitely within our plans over the next couple of years. Nosy have two teams, it's two teams but one service, and we cover a number of schools and that very much is that early offer, early prevention, targeted support, very much a CBT model to look at low mood anxiety, working within that school, looking at the whole school approach, supporting teachers, supporting parents, supporting children directly and indirectly, and very much at that kind of getting help part of that five quadrant, which we've already spoken about. If I move us down to the next slide, yeah, thank you. This is a community CAMs team, so these are the specialist services, so these are the getting more help, getting risk support, so on average 10% of your CYP population in Nosy will access these services. 90% will access all the other system and partnership services as we've spoken about. So for CAMs, we are seeing a reduction in referrals, which is really positive because actually what we're seeing is a development of a partnership and a wider offer, which means that it's a graded kind of need analysis, if you like, and lots of access, improved access to wider emotional and mental health services, which mean that not all kind of roles lead to one service and that service gets overrun. So in terms of community CAMs and the specialist support, in March 23 for Nosy was the busiest month, and we are unfortunately seeing a significant increase in accuracy and complexity of the children and young people who are coming through to CYP mental health services. A lot of those children are requiring a significant multi-agency requirement, presenting with a really high level of need, right at the point of referral really, often with significant neurodiversity needs or complex needs. So the amount of referrals might have reduced or seem to be tailing off a bit, but the accuracy and the complexity of the children that we're seeing is more significant than we ever have done really. But that's just a picture of some of our demand data. We have two main KPIs in CAMs in terms of access. The first one is your six-week target for first appointment. So this is your first assessment really, where you get to see someone who will look at your needs, why you're there, what your risks are, how we might look at supporting you going forward. And as you can see from the data, Nosy is the second line. It was quite hit and miss in terms of that six-week access target for a variety of reasons, for demand, but also capacity, some workforce challenges, which is a national issue across the NHS. But what we have seen is we had a targeted improvement plan back in May 23, which led us to achieve in the target in August 23 and sustaining that target since. We're quite proud of that. It's not an easy thing to do. As we say, the acuity and the workforce challenges, we still experience some of those, but all teams are now achieving that and it's consistent across the patch. So very much Mersey Care taking a wider stance in terms of capacity and quality, I think, more importantly, making sure that that's consistent for that six-week target. I'll take you to the second slide, which is about the follow-up target. So this is your 18-week next appointments. This is your access to treatment target really. 18-week is your planned appointment. That doesn't mean to say that you're sitting waiting for nothing else in between and you can't access anything in between. You've got a named key worker, the psycho-education, there's crisis access, there's lots of things that you can access whilst you're waiting for this second appointment or wait to treatment, if you like. However, this is just how we kind of quantify it to make sure that we're managing any therapeutic waiting list really. So as you can see, in Knowsley, it's remained relatively static from May 23 to February 23, 160 children waiting, but significantly the time that they're waiting has reduced by 11 weeks, from 27 weeks to 16 weeks. And all of the young people waiting in Knowsley for that second appointment. The next bit, this is just a bit of a snapshot really of consultations for the mental health support teams. We have a significant amount of indirect activity, clinical activity for mental health support, which is around almost skilling up the teachers and the TAs and the school staff and education staff, and this just outlines some of that activity as well. And then I'll take us through to the Cheshire and Mersey eating disorder service and some demanding activity. So for 23, 24, 75% of the total referrals were appropriate, which is really positive because a lot of the work in this area, it's a very highly specialist service, so we see less referrals to this in comparison to say your generic community specialist team. But what we are seeing is that we're achieving the access target for this, so it's 100% for routine and urgent referrals. We did receive five urgent referrals in quarter four, and all we're seeing also within the five working days. Currently we've got 127 patients on this caseload. Again, similar to picture and themes in terms of the acuity in cams, we're seeing an increase in demand around this area as well, particularly disordered eating, which isn't necessarily an eating disorder, and the emergence of a new diagnosis, which is ARFID. And the system is trying to kind of get to grips on what the evidence base for that is and what the demand might need to be. Really positively though, we've reviewed our service level agreement with the, with Wiston Hospital, who support our emergency pathway with some increased funding. We've been able to increase the capacity, which means that we can see young people and make sure that they get the right care and treatment within that hospital environment with that in reach from the ED team. So that's the performance picture. I'll just go over to the cams response team. So this is our PAMBORA service so it's across Warrington, Holton, Nolesley and St Helens. It's the crisis team. We went and introduced a national model, and it was around 24 hour access and taking us from a 24 hour KPI to a four hour KPI, which is significant because if you think if a child turns up with their parents to A&E, and it's 10 o'clock at night, the previous model would mean that that young person needed to be admitted to a children's ward to be seen from nine o'clock onwards the next day. That doesn't happen anymore. We can see them within four hours. So having that access around the clock is really beneficial, not only to that family, it's a better experience. You don't have to feel that they need to be admitted. They don't need to be stuck in an acute trust. But what also it means is, you know, the capacity on the acute trust is better and we're managing to not utilise those beds. What we are seeing, again, not necessarily an increase in referrals and potentially an explanation of this or a positive outcome of this is with round the clock crisis care. What we're seeing is less children going into crisis and also with the six week target in CAMS being met, the access overall is improved in all different parts of that system. So that's a real positive to be celebrated, I think. In terms of the admissions here, the little graph, and I know it's quite small apologies, but what you can see is the admissions to the acute trust for self-harm has completely tailed off. And again, that would support that view that, you know, less kids are being admitted because of that round the clock access to crisis treatment. We've also seen a 23% reduction in section 136s, which is the police powers to detain, which again is a real positive improvement. That's a real traumatic experience for a child. And to have that reduced is really significant as well. So we have lots of contact with the police who can kind of give us a call. We've got this young person, how can we help bring them to the site as opposed to detaining them under the mental health act, which again, just overall positive improvements and outcomes for children and young people. Do you think that's it for my performance part? It's back to me, I think. So within the patient story on this slide, this is a listening ear patient story. The referral was acknowledged on day three and the assessment booking process started at week six. There's fuller details on the slide pack and you'll see it's historic. It's from 2023. But the issue with this referral, so we ended up going back to the school who were the referring agency to get their support, to get the assessment booked with the parent carer in the first instance. Once we'd made contact, then the assessment was actually booked on the next day and took place the next day. Sessions were booked just less than four weeks later, but they were booked to start after the school holidays, so that was two weeks later. So it's kind of a, it gives, pulls lives within schools and trying to liaise with different agents. Timeliness of the service sometimes. The therapeutic process and the outcomes for this patient are contained within the fuller pack. And I just wanted to say, average wait time at listening ear from referral to assessment was 1.75 weeks and in April it was 2.19 weeks. So within the collaborative as well, we've been doing that kind of looking at how we can improve through pops, if you like, of children, young people and learning from some of, looking at our data. So what we try to do today is just to give you that overview of that performance narrative and what it is we're looking at as part of five. Now, we know that one of the things that we do need to do is look at an element of a transformation. So what we've just got here is the children. I see the beginning of the children and young people's. We didn't want to run through everyone because we know we've got a lot of tech, there's not enough time, but we just wanted to put these up on screen just to give you a little bit of a snapshot of this is what the priorities will be right across across the system for what it is we're looking at. We're just going to focus in just on one. And that's back to Jane. So the aim of working as a collaborative, which has been branded as COGS, is so that we can direct the limited resources at each level of need to the most appropriate, nosy children, young people for that service. Also that care is seamlessly handled amongst the collective, taking a Thrive approach to mental health service delivery. So we know that children shouldn't be advised that you haven't come to the right service and you need to refer somewhere else continuously. Once the referral comes to COGS, the idea is that we hold that referral and we find the right support between us for that child. So Listening Air has been commissioned to take a kind of lead approach to developing the COGS collaborative and we're assessing, you know, we're investigating technical solutions now to a collective referrals, triage and assessment process. And you may all have heard us the AS ONE solution, which has been adopted by St Helens in Liverpool. We are looking at AS ONE and we may adopt that or we may not, but it's been investigated. And just to say also at Listening Air, we're assessing all of our referrals now for the collaborative. And we explain that as part of the assessment process, so if we're not the right service, we explain that care might be transferred to another service within that collective. The current status of COGS is that it exists and we've done some of the development work as part of the collective, ironing out some of like the memorandum of understanding, really getting a high level decision that we all want to work together, but there's still a lot of work to do. And obviously we're only focused on a small number of partners at the moment. And the ambition is to broaden that partnership over time once we've got some of these basic operational technical solutions in place. So, yeah, that's all from me. Thank you. That's the end of that presentation. So are there any questions that we could answer? I just wanted to make a point for board members. So within the pack, there is a lot more detail. So there's examples of other case studies, additional performance and extra detail within the pack. So I suppose if board members want any additional information around that, then I'm sure we can share that post the meeting in terms of discussion around it. The other point I just wanted to make, going back to Martin's point at the start, I just got clarification that the figure that was referred to in the paper, which is related to children, young people's mental health as well in the notes from last time. So the 60 to 75 percent children, young people who experienced mental health issues were not receiving the support they much needed. It is a national figure, not a local figure. Thank you. Thanks, chair, and thanks for that presentation from from all of you. There seems to be some really positive stuff going on throughout all of that, although it didn't answer the question I came with, which relates to a couple of cases that we've seen recently. So on page 88 of the pack, I suppose Health Watch would welcome this development that you're talking about, working with Chesham and Merseyside ICB in reviewing opportunities to support the system and envisaging an opportunity around best practice for ARFID cases. And the reason I raise that is because we have been made aware of a couple of cases recently, ARFID cases where the children required hospitalization. But as I understand it, there is no eating disorder service available to nose residents from either wisdom or from older hay. But if you live in Liverpool or Sefton, there is. So that's confusing parents. It's confusing us. It seems to be confusing some of the consultants as as well. And I'm aware that there's a community service that you've talked about. But it's just that discrepancy around hospital services that I'm not clear about. I want to answer that. So in relation to ARFID, that is correct. At the moment, do not commission that particular pathway. And again, it is a little bit confusing because just across the way, you've got Alderhay and Alderhay have an ARFID service, which is commissioned by Liverpool and Sefton, which is only available for Liverpool and Sefton. And so, yeah, I do appreciate that. It's a little bit difficult. And what we are doing is Cheshire and Merseyside, and I think if you've seen it, it's actually in the bullet point. They've got awareness of that. And there's actually a group been established to review what is the offer across Cheshire and Merseyside for ARFID. It's a very specialised service and it is a little bit difficult. And it is not something there are. We have different things that we can put in place as a nose lead commissioner. If there is a clinical need for this particular service, that can happen. But I appreciate it. It's a little bit different. It's not as easy as going into your A&E because it's such a specialist service. But Cheshire and Merseyside, as part of the plan, will be reviewing what it is we need to do for an ARFID service. So it is a gap at the moment. We are aware of it, but we do have some plans in place. Hope that helps. Thank you. I was just making a note of that, so thank you. So thank you. I thought that was really, really helpful. A couple of sort of observations and questions. So the COG service, I think it was called, or the collaboration sounds really important. And it was back to the point we raised last time about there being no wrong front door. So even the cases you're talking about, we should be able to make sure that children, young people and their families are sent to the right service at the right time. So that sounds really, really important. I guess my question is, are any providers missing from that collaborative who you think should be around the table? Anything we can do to help get them there? I noticed, for example, that general practice primary care isn't represented and I know a lot of children and young people will be going to their GPs or trying to get access to the GPs for that service. So be interested in your views on that. Also, how are we getting the voice of children and young people into this? You are experts in your provision, but I felt what was slightly missing from the presentation was that experience. How are our children and young children experiencing this service? It goes back to Martin's question. Nationally, 60 to 70% are not receiving this report, the support they need. We should know our own number on that if we don't now. So how do we get that number collected? There was some patient experience in the presentation, but it was more around the patient stories rather than as a system. How are we monitoring the experience of children and young people? And then I guess my second or my plea is when we do something like this again, there are so many acronyms and abbreviations that even me as a quasi expert within the NHS field would find it quite hard to navigate. And I think as a principal chair, I'd encourage that we really do try and speak clearly and simply in these sort of forums because there's such a breadth of knowledge and expertise in the room that it's sometimes quite hard to navigate these. So if we keep an eye on that in the future, I'd find that really helpful. But thank you. It was really, really good reports. Thank you. The initial stand for. So, yeah, thank you very much for that. If I could bring in Rachel. Rachel Jones. Thanks. Again, excellent presentation. Thank you so much. Thinking about meeting our young people where they're at, especially in wider community settings. I'm interested to know where's the connectivity to build those pathways into community settings, especially thinking about getting advice, getting help, that low level intervention. Has that been developed or is there an opportunity for us to think about what that looks like and do some more development work to build those pathways into the community? I think there's there's definitely an opportunity to develop it. You know, that that dashboard was just a selection of some of the partners that are involved. We need to look at what is our data telling us really importantly and be informed by that data in terms of provision and development and growth in services. So absolutely thinking about the whole partnership and that whole systems approach that that will be our next steps almost going into the next year. Are any additional people that you'd like to bring in perhaps our half term activities program could be a part of that signposting on a on a larger scale. So thank you for that. Just say, we're finalizing who the providers are for the holiday activity program and we will be doing a pre delivery session. So perfect opportunity to do an engagement piece with those providers. Thank you very much. Yes, just to say as well, we had organized a visit for council abandoned to attend our hub in mostly where some of our services are based. So if anyone has got any questions and wants to look in more detail at some of the performance numbers, we'd like to extend the invite to others as well to attend the next session. We did have to cancel it, but we will be scheduling another appointment with Kenson Bannon. So if anyone else wants to join, happy to go through any of those numbers. We do provide an awful lot of data and that can sometimes overwhelm people as well. So happy to send out data and sort of maybe look in more detail if people have got particular questions and maybe a bit of feedback as well about how we can share that as well, because there is lots of data. There's lots of stuff out there on the Internet. Just been looking at some benchmarking dates and we benchmark really, really well nationally. You know, and so maybe we can get our feedback from partners as well as how would you like us to play that back in a way that's helpful to you rather than overwhelming you with what looks like a operational report is quite confusing. So yes, some feedback would be really good. Thank you. I was interested to hear around the capacity and if you have built in additional capacity. I know you've talked about the numbers around the eating disorder unit, but do we have extra capacity if those numbers continue to go up so dramatically? Yes, so we have worked with obviously our commissioner leads and our partners to look at our service development funds and look at the provision in place and what those schemes need to be and building in and investing in that capacity and eating disorders was certainly part of that, as was MHSTs and as was the community cameras, but equally some of the other VCSE schemes as well. That's right. Thank you very much. All the conversations we've had and the actions that we have discussed, do we agree to continue to think about what more we can potentially do both individually, collaboratively, which we've mentioned, and then through others to address the agenda? Yeah, agreed. Thanks very much. Thank you all. And that takes us on to our item six. So this is an update on smoking, vaping and tobacco control strategic action plan. So we've got Natalie Halloran from Public Health Speciality Registrar. She's going to take us through this item today and I'll pass over to Natalie to make a start. Thank you. Yes. So I'm Natalie Halloran, I'm currently based in the Public Health team here at the council. So you may remember Sarah McNulty brought a paper here back in January, which was the Joint Strategic Needs Assessment on smoking, vaping and tobacco control. And that needs assessment really highlighted the high level of harm we have associated with smoking here in Nosley and the high level of the impact on inequalities caused by smoking. Alongside the JSNA, we also brought a project plan which outlined the next steps in terms of developing our strategic action plan and how we address those that high level of harm are high levels, high rates of smoking and our inequalities going forward. So since then, since January, we have held engagement. So we've held first engagement both face to face and with a survey hosted on our council website. And we've also held a stakeholder engagement session, which is really well attended by many of our partners and stakeholders. Some of you in the room may well have attended. We then use the findings, so the feedback from that engagement and the findings from our JSNA to inform our strategic action plan. And the strategic action plan you'll see is in the appendix of the paper. And this is a draft version. So this covers the period from 2024 to 2027. So it's a three year action plan and provides an overview of the smoking picture in Nosley. So sort of like a brief version of what's in the JSNA. It also presents our ambition to create a smoke-free Nosley, which obviously matches the national ambition. So to where 5% or less of our adults smoke. And the hope is obviously by reducing that rate of smoking, we will reduce our smoking-related harm. Denormalise smoking in our communities, prevent our young people becoming smokers and reduce inequalities associated with smoking. And also in the action plan are five key delivery themes with short, medium and long term actions detailed within them. Those five key delivery themes cover sort of prevention and education for our young people around smoking and vaping. Denormalising smoking in our communities and protecting non-smokers from secondhand smoke. Enforcement around illicit tobacco. Also how we support our smokers to stop smoking. So in terms of increasing quit attempts and then how we also support our smokers in priority groups and ensure that the support they need is tailored to them. Alongside that we've also formed the Nosley Smoke Free Alliance. So this is a group where we unite partners across Nosley who are involved with the smoking agenda, work really close with our communities. And it's around getting them all around the table. We are going to meet quarterly and that group will be responsible for taking forward those actions that are outlined in the action plan. They will also be responsible for providing feedback on the action plan and they will sign the action plan off in the next couple of months before we kind of go ahead and start implementing those actions. We met, we had the first group meeting yesterday. It was really well attended, particularly given its pre-election period and some organisations weren't able to attend for that reason. And the action plan was really well received. So I guess in terms of the asks for the Health and Wellbeing Board today, we firstly ask for your feedback on the action plan. So as I said, it is in the appendix. So we welcome any feedback you have on the content of the action plan of those actions outlined within it. We'd also ask for your feedback on the membership list which is in the paper. This is the membership list for the Nosley Smoke Free Alliance in case there's anybody you think would also benefit from being a member of that group. And I guess for support for implementation of the plan going forward and support for implementation of those actions across Nosley is obviously just a sort of a brief, it's just around kind of bringing that paper to your attention today and asking for your feedback and then the plan is that we will bring the final version back sort of September/October time and present it in its final version and outline the actions going forward and how we sort of intend to implement those over the next three years. That's great. Thank you for that answer, Liz. Do we have any comments or questions at this point? Sarah and Potty? Yeah, I mean, just to reiterate just how much this is needed and how the timing of this is really good. So, I mean, you know, we made the case with the Joint Strategic Needs Assessment that was presented, was it January? It feels like yesterday. You know, the legacy that tobacco has had and continues to have on our population. And actually, you know, we described that the people who are tending to still be smokers now are those more vulnerable groups in society. So this really is an inequalities issue as well. It's also well timed because of that there is work at Cheshire and Mersey level, Merseyside level, so we can get some really good economies of scale and joint work there by doing this work locally as well as regionally. And also, you know, fingers crossed that the legislation will go through maybe in the next Parliament, regardless of who gets in. And so that national policy has also brought additional investment into the Stop Smoking services. So it's really, really good time, you know, we need to get prepared to support people and really encourage people to quit and to keep on trying to quit because, as you say, you know, this is about increasing quit attempts and doing all that we can to help people. So I'm really, really pleased with this work and Natalie is putting lots of work along with others across the council and with our partners. So thank you for giving up quitting and to just to push that message about living longer in good health, as opposed to that kind of stark facts and figures that we have around that. So if I could bring in Alison Lee. Thank you Natalie, I thought it was a really good report. Sometimes you can feel that you're kind of always waiting for national action to be taken and we can't get on with stuff locally, so I think this was landing the things that we can do as a partnership locally, so I thought that was really helpful. Sarah was going to make the point that there is some additional funding, isn't there, going into this at a Cheshire-Mersey level. I know, Sarah, you've got a strategic lead on that, so I think we're quite optimistic that that's going to have some traction across health and care at a Cheshire-Mersey level as well. We have as NHS Cheshire-Mersey, so I've been able to identify some funding to go into that. So that's really important. The question I had for you was obviously a lot of the figures in here are really difficult to read because we're at the wrong end of where we want to be, but I was curious about the difference in Nozli about more women than men smoking and that was bucking the national trend. And obviously that would be an enhanced priority for us to help women quit and keep on quitting, but I wondered if you had any insights as to why we were different and bucking that trend. Thank you. Yeah, thanks, Alison. I think this is an interesting one and it does buck the trend. It's different to what we see nationally. I think, and I think I'll just ask Sarah to check on Mike with this, but I think it's similar in terms of we have particularly high rates of alcohol use within our females as well. So I think there's a potentially an understanding that we know our females within Nozli maybe aren't prioritising their own health. And I think that is something that we do need to prioritise going forward and making sure that the access that we have in our stop smoking service is there. So females can have a variety of options when they're trying to access a service so that it suits their needs. But yeah, I think it is really important to consider that. Can I just confirm that we are going to bring this back in that kind of September, October time? Yeah, that would be really valuable for it to come back to us and to see what traction we've managed to gain between now and then. Richard? Yeah, I can answer that. Yeah, we'll stick it on the forward plan for then. Yeah, I think this is a real good example. Outside of influencing the social determinants of health, tobacco is the major cause of health inequality. So it's a really important one for the board and partners to be engaged in. Even if you just look at respiratory disease and the differences across the borough and link that to smoking. So in Northwood, respiratory disease, premature mortality is five times higher in Northwood than it is in Robie, our most affluent ward. But actually it does very much mirror the proportionate universalism approach in terms of putting the resources to where it's greatest need and then lowering it as you go closer to the most affluent. And it's a real good example of this because the smoking rates are really high in Northwood. But then if you go to St Michael's or Page Moss, the ones below it, they're high there and the rates go down with smoke as well. So I think it really is something that we need to get grips with. And if this paper doesn't really give it justice in terms and the needs assessment, there's a hell of a lot of information. There's a hell of a lot of partners already doing what there's more we can do around this area as well. So we will definitely bring it in September. OK, well, thank you, everyone, for your valuable contributions so we can move to the recommendations on page 93. Taking on board our comments, do we all agree to review the draft strategic action plan and provide feedback to highlight any additional members who should attend and to endorse and support the implementation of the strategic action plan? So unless anyone indicates, I'll take it that the board is agreed. Thank you. Thanks very much. So that takes us now on to item seven on our agenda today, which is the pharmaceutical needs assessment. So Richard's going to take us through this item again. I'll pass over to you. OK, thank you. So I'll see him. It's that the paper just sets out the requirements and steps needed to produce a statutory pharmaceutical needs assessment that assesses the pharmacy needs in Knowsley. This will be the third one that has been produced. And it's, as I say, it's a statutory requirement for the health and well-being board in each local authority area to produce one. It include the report includes the duties that the board, the deadlines in which the board must must must meet. So basically, by the 30th of September next year, the needs assessment has to be produced. The key milestones are detailed in Appendix A of the report. And we're bringing this just to highlight that the process is going to start soon. So the board is specifically asked to agree the proposed arrangements, including agreeing a board level sponsor. The suggestion is that this be the director of public health who is who has led it the last couple of times and the establishment of a steering group. And also to note that the significant work is needed to produce the report, including the statutory consultation period and significant intelligence support. So the board is asked to note this as well. Welcome any questions on this process? Thank you, Richard. So not questions per se, but just more of a couple of thoughts. So I think this is really important this time. I know we always have to do this, but we know in Knowsley we spend far more on some of our prescriptions than we do with other similar areas. So there's certainly something to go out in making our offer different and better and better value for money as you know, as a public service. So I think to linking with our local medicines management team that are part of NHS Cheshire Mercy, some of that intelligence would be really helpful. The other thing I was going to link in, David, is the work that you're starting to do with our Heart Street Pharmacies as Health Watch and starting to get some of them engaged and getting feedback from the patients who use those services. So we've already got some local survey work that the Health Watch are doing with those providers that I think would be a helpful time scale. That's probably about right as well. You won't have anywhere near all pharmacies as we know, but you have got a group who are very keen and have got their patients engaged in what's working well in local pharmacies and what could be better. So I think that would be a helpful link for this as well. But I'm happy to support Sarah as lead on that. But input as necessary. So yeah, thank you.

Thank you. So thank you, everyone. There's no one else who'd like to speak for you for your contributions. And again, moving on to our recommendations there on page one for one and one for two. And we need to agree Sarah McNulty as assistant executive director of public health as the board level sponsor and our champion for this pharmaceutical needs assessment and the proposed arrangements that are in place for the production of a new PNA. If necessary, due to time scales, can we can devolve final documents to the pharmaceutical needs steering group and note the specific significant breadth and depth of the information that is required. Specifically, the pharmaceutical and the chemists and our dispensing chemists. So any indicating to speak in objection, but otherwise I'll take that as agreed. Thank you very much. Okay, so now we're on to our working well program. And we have an update again from Richard. Apologies. It's me again. Yeah, I think we really wanted to share this with an update on the working well program because it's been a real success in the border. So again, I'm just bring out some salient points. The report provides an overview of the news, the working well program, which is funded by public health, but delivered through the nose, the Chamber of Commerce across the border. This program supports employers to prioritize workplace health and well-being for their employees. The report highlights the success of the program and the plans around extending the program further and includes the number of businesses achieving the accreditation of the standards. Examples of activities undertaken, including significant amount of training, updates on a grant scheme that's available for the organizations involved, which helps them to introduce health activities for their employers. There is some real positive outcomes being observed both from the employers themselves as organizations, but also in terms of feedback from employees who are receiving the changes in practice. Additionally, I'd like to draw your attention to section 3.11 in particular, where there's examples provided of where the links have been made between businesses and the community and voluntary sector. We've really been extending the support, not just for their employees, but in terms of the wider community and you can see some real good examples there. One thing we're looking to do with Why Do We Partners is expand upon that because it's been seen as a real positive outcome from the program. Board members are asked to consider this paper and also consider how they themselves as an organization can support the program, either by signing up as an organization or by supporting some of the activities that the employers are after. I welcome comments from the floor. This morning I attended an event at one of our local businesses that was a showcase for other businesses and also some of the services and the work that's being done under this program. It was just completely inspiring, is all I can say. This program just helps facilitate some of that. What I got from it was the value of the program, but also the energy and ideas and commitment from some of our local businesses as well. All it takes is a little bit of support and they will come up with their own ideas. They really are invested in their workforce and some of it's just joining dots and I think this program really helps to do that. I came away just really inspired. It warmed my heart today on a quite cold day. Thanks, Cher. I love reading those success stories and again, you know, we can point to many examples. I'm just keen that as a strategic partnership and approach in the borough, we've invested in digital transformation in this space with a volunteer platform, which we host as the accredited volunteer center. So in that spirit of joining up the dots and maximizing the offer and making sure we just don't duplicate, we don't all want to be approaching the same companies or saturating what the offer of support is in the sector. If we have that conversation about how we maximize the volunteering platform to broker exactly these kinds of wonderful success stories. Thank you. Yeah, that's great. And I know that it has been conversations around that. Certainly it's not seen as duplication. These are organizations that are engaged with the working well program and they put an offering, but we do need to look at some of the finer details on some of the other things as we expand the program, because actually it's just one person who runs this program. So we've actually, as a council, committed to fund an additional person to support the rollout for more businesses to be involved. But clearly that has implications in terms of the more volunteers needed worldwide support so we can have the conversation outside the meeting. Thanks, Richard. Yeah, absolutely. More support and resource and capacity in this space is really welcomed. Just really keen that we avoid duplication because we've got quite a significant program in this space as well. So, and, you know, let's together target those businesses that we'd really be keen to support and encourage to do more and connect more with our communities and pay it forward and give back. So, you know, happy to link in about how we get that service up and running. It's relatively new national funding and it provides mental health and wellbeing support. We'd much rather do that whilst people were in work than actually them not being able to cope in work because they can't get the right help and support and then trying to do that later down the line. So, yeah, we'd really welcome a conversation and we join things up there, Richard. Thank you. Thanks, Richard. It's really encouraging to see the success of the program and the fact that it's been going for so many years is a testament to that interest and I was speaking with Lesley yesterday about how we develop it potentially further. We've been involved in it for quite a few years and it will be great to see that spread further. Turn to the recommendations then on page 153 in our packs. So unless anyone indicates an objection, I'll take it that the report and the continued growth and success of the program has been noted and that members agree to consider whether their organizations could support or, as we've said, join the working well program. Is that agreed? Agreed. Thank you. So it takes us on to item nine, which is our make your mark findings. Lesley Dixon from Merseyside Youth Association will introduce the item so I can pass over to you. Thanks very much. Thanks very much. I try to avoid jargon, but there is quite a bit of jargon, so I apologize. I did try and put it in brackets, but I mentioned it last time I was here. Make Your Mark is a national survey of young people's issues across the country and I'm really proud that we had the highest turnout in Knowsley in the Liverpool City region. And that's because our team and our young people worked really hard to make sure we engage young people in their spaces. So a large proportion of these young people were engaged in schools, but we also reached young people in specialist projects as well, meaning that we were able to make sure we were diversifying what young people were involved in the survey. We had 2688 young people take part, so in terms of a youth voice piece, this is pretty big, and that's why we're really proud of it. You can look at other areas across the northwest and compare if you're that way inclined, like me. I'm really, really pleased that we were kind of the ninth highest turnout across the northwest. So yeah, we had quite a high turnout in terms of 18%, which is probably not far off what we get from an election, a local election. So you can read the whole report. There are some recommendations that we've made, and I haven't made them, our young people from the Youth Cabinet have made them, and I think the one I really want to kind of highlight really is the cost of young people accessing leisure and health services. And I know you mentioned it last time. Outprices are young people. A lot of our young people live in poverty in our borough and can't afford a gym membership, and also gym memberships are always that accessible for young people, so they have a saving window that they're allowed to go into the gyms. And I personally have witnessed young people be turned away. That was one of the recommendations that they were really keen to put in this report, so that's their voice, where you can see. I think the other thing that we just want to highlight is that there were a couple of schools that didn't take part in this, and I won't name them in this space, but I guess in terms of this next time, we need to make sure that we have every school buy into it. Every young person should be able to take part in this. We did a great job, and just two mainstream schools didn't get involved. And I know our youth cabinet are meeting with different organisations from around these tables, so just welcome you to come and speak to the young people. We can't delve too much into this. We don't know exactly what is meant by them voting for health and wellbeing as their top issue, but they would like you to come and ask and delve and get more involved, and I know, David, you've met with them. And a new part of my role is I've took on health just kind of this month, so we've now set up a health steering group as well, so I really enjoy being at this meeting, this board, and just want to make sure I join some of our thinking up with everything that we talk about around the table. But yeah, that's it from me. If I can bring in Darren Simpkins, please. Thank you, Cheryl. Thank you, Leslie. We're interested in pre-empting one of my questions of can you give me a bit more detail, but we can pick that up offline. It's great to hear that young people have got a greater interest in physical activity and wanting to be involved more in leisure services. We do have a sizeable usage of youth in leisure services, but we can increase the appeal and increase that usage. That would be great. So I'm more than happy to explore that with you and directly with some of the youth representatives. Yeah, hi. I think the report is really, really useful and I will be sharing it with all of our children's teams as well, but I think that mental health for schools team, I think would be really useful for them to get that because they are out there in those schools and ask those questions about, you know, we are a relatively new service. Get that feedback. What is it that you need? You know, how can we contribute to making your mental health better and working with your teachers so that it's the best environment it can be in our schools for? On page 171 in your packs, can we share the contents of this report, as we've just said, within our own organisations and with other key stakeholders and to identify opportunities to maximise health and wellbeing outcomes for young people as detailed and in our discussions this evening. Is that agreed? Thank you. So this brings us on to item 10, which is our subgroup update. This is our final item this afternoon and. And it focuses on the activities undertaken at the health and wellbeing board subgroups, and it'll be presented by Sarah McNulty and David Aspen. Sarah. So, as usual, we'll do a double act and I'll start off just presenting just an update. So I'll assume that you've read an update of the Health Protection Forum and our update just describes the last meeting, which was just at the end of May. Again, childhood immunisations was touched on. You know, we do touch on that and there is ongoing work to improve the uptake of childhood immunisations. We also raised, I'm sure you'll have seen in the news, the national rise in Pertussis whooping cough notifications. And we've been engaged in work, particularly promoting the maternal vaccine for that. I guess the only other thing to note is some positive news around the breast screening programme. So there's a coordinator that's been appointed to help improve screening uptake amongst our women and the public health team, along with our partners will be working alongside them to hopefully increase some of those screening rates there. We've also talked about extreme weather, which includes heat waves, but we're not going to see one of them in the near future, it feels like. But we do, you know, we do do work each year in anticipation of warmer weather, particularly looking around, you know, how to keep cool and hydration. I think the hydration message probably goes regardless of the weather, but does get worse when it gets hotter. There's probably nothing else from that unless anyone wants to raise anything or ask any questions and I'll hand over to David if not. Thanks, Sarah. So just following on from that then, my report around the insight gained through Nosley Engagement Forum and the various partnership boards and from Health Watch, Nosley begins on page 237. And it's interesting, much of it, much of what we've reported seems to link very well with conversations that we've had that have taken place today. So starting with the engagement forum, we've highlighted a couple of topics there that the forum has brought forward around concerns that have been raised about air pollution in Nosley and not for the first time issues people are raising about property pool plus. Both those topics, we do need to go away and do a little bit more work with community members. So, for example, around air pollution, we're hoping to hold some further engagement in the autumn and I expect to be able to report back on both of those items at a future meeting. Items from the partnership boards, Nosley Older People's Voice isn't one of the partnership boards but it is one of the probably lead agencies within the Older People's Partnership Boards. So we've referenced there a further set of roadshows that KOPV have delivered in May with a list of topics and I think we've invited agencies represented on this board to get in touch if yours is a subject that you'd like to be featured at future KOPV roadshows. On to an item from the Learning Disability Partnership Board on page 238. So there is, I think it's still in draft, but there is an excellent document in production which is around explaining for young people the transition between children's services to adult services. And as I say, the part in that lending its experience around producing easy read documentation. So if you get the chance to see that, do take it because it's an excellent document. Moving on to insight from Health Watch, a couple of usual stuff around dentistry. My thunder on page 239, I've talked about the survey that we're intending to do around pharmacy, so I fully expect that that will provide some insight for us in terms of the item that Richard spoke to us about. And I think the only other thing I wanted to highlight on page 240, Lesley spoke to us about the survey of young people and that's something that Lesley spoke about last time. It really sort of struck a bell with myself because if 13 to 25 year olds are saying that health and wellbeing is their top priority, then our local Health Watch is missing a trick if we're not speaking to those young people about that. So we have made contact. One of the interesting things that came from that initial meeting was young people were saying that Health Watch and the council and others often start their surveying with people who are 16 or older and they felt that that was a bit of a barrier to some of those younger cohorts. We've gone away and checked with Health Watch England, is there a particular reason for that? There isn't. So immediately we've said that we're happy to accept feedback from people who are 13 or older. So I have contacted the group, but I've not heard back. If you just give them a little nudge for us, that'd be really good and we can take that forward. Thank you chair. Richard? Just a quick comment. Obviously I was at the engagement forum and I know how passionate people were talking about air pollution. So just to highlight to the board, there is an air quality strategy which has been drafted and is going to be launched relatively soon. So I'm sure that either the board consider it or we need to consider how the engagement forum find out about that air quality strategy and engaged in that process. And then the other thing I suppose is there is appendix C to the report which I just wanted to highlight that does highlight some updates against two in focus items that have happened over the last few boards. I just wanted to mention healthy weight. So obviously we continue to develop a new healthy weight action plan. But rather than just stand still, we are doing actions as we go along. So a new healthy schools programme is being developed for primary schools, which will start in the autumn. And really importantly, we've been engaging with parents over the last few weeks with Health Watch and others around the national child weight measuring programme. And I think that's really important because the parents received a letter that their child is overweight or underweight and they're not engaging with services. So we're really looking at different ways that we can engage with those parents in a different way. We are restricted to a degree because it's a national prescribed letter, but there's various animations and various things we're doing based on the consultation with our parents. So I just wanted to highlight that we're not standing still on some of that sort of stuff. Thanks. It's great that you're able to change the age. But sorry to burst your bubble, but make your mark is from 11 to 18. And then, you know, just to go a bit further, we can be asking young people at a much younger age what they think about the services, but make your mark is 11 to 18. Sorry to indicate they'd like to speak. It will be recorded that the board agrees with the recommendations on page 231 in the pack. So subject to your comments being taken on board and those younger ages coming in that we're happy to agree the recommendations. Agreed. Thank you very much. Okay, I have no other items of an urgent nature. And I'd like to indicate the meeting closed and wish you all safe journey home. Thank you very much indeed. Thank you.