Transcript

Mark Harvey and Nia Thomas. I'm not aware of any of this at this stage unless anybody's got any? Nope. Has anybody got any declarations of interest to make? Okay, thank you. Is Councillor Paul Collins? Thank you, Chair. On the agenda, I see that we have a report about Health for Life. I'm a Trustee of the Eastwood Community Centre, and Health for Life have hired our centre out this year over about, I think, eight different events. It's a non-pecuniary interest, but it's still an interest nonetheless, as I'm a Trustee. Thank you. Thank you. Councillor Borton? Thank you, Chair. Agenda item 5, domestic abuse, EPUT's mentioned, and my daughter works for EPUT, and agenda item 8, a better start, SEH is mentioned, and I'm now on the board of South Essex Home. Thank you. Thank you. Sorry, I can't see your name, and I know your name, but I've gone with the blank now. Councillor Judy McMahon? There appears to be an issue with the microphone. Agenda item 5, I work alongside EPUT, non-pecuniary. Thank you, Councillor McMahon. We'll now go on to item number 3, public questions, and we've got two questions from the public, from Mrs Cowdery. Would you like to go ahead with your question? Sorry. Thank you, Chair. It's Mrs Cowdery. Essex Learning Disability Partnership includes learning disabilities partnerships from Mid and West Essex, and North and South Essex. The partnership is currently undergoing an evaluation, next steps, and improvement plan process, and is considering a decision to recommission or extend the Learning Disability Specialist Healthcare contract from November 24. It is a contract delivered across the Southend, Essex, and Thurrock footprint. This contract covers learning disability in patient mental health assessment and treatment beds, psychiatry, clinical psychology, enhanced support, forensic services, specialist learning disability nursing, occupational therapy, physiotherapy, speech and language therapy, and in some areas, dietetics. It is open to adults with learning disability who may or may not have other diagnoses, such as autism, ADHD, dyspraxia, etc. It's also open to children and young people with learning disability and behavioural issues. Despite concerns expressed by some service users and carers, it appears that a decision to extend the contract for two years is being recommended. I am concerned that, although Southend is clearly part of the partnership, and therefore affected by any change to contracts or services, Southend Health Watch has been excluded from this process, and as a result, Southend residents with learning difficulties, or who are neurodivergent and their carers, have not had the opportunity to have their say in any changes and therefore have no voice. This does not reflect the spirit of co-production, which is allegedly at the core of E-Put values, which state that they are determined to encourage a culture of peer involvement, genuine reciprocity, and complete brutality between staff, patients, carers and families. Can the Southend Health and Wellbeing Board clarify why Southend residents have been excluded from the consultation and how it can ensure that their voices are heard in developing services and in essential decision making going forward? Thank you. Thank you Ms Cowdery for your question, and I now have an answer for you. The Learning Disability Specialist Health Care contract is due to come to an end, but with an option to extend the existing contract. This decision is currently under discussion. As part of this work, presentations and discussions have been held with both the Experts by Experience forum for the LDAHE program, which holds delegated authority to commission this service, and with the collaborative partners across SET, local authorities, and the ICSs. Both Experts by Experience and the collaborative partners identified improvements that they would like to see from the current provider. There are at least of these a significant and improved commitment to co-production. They did agree that though there was a need to carry out a thorough recommissioning and procurement process, the Experts by Experience forum was particularly aware of the need to consider the scope of delegated authority, and the consideration of services for people with neurodiverse presentations, not just learning disability. To comprehensively scope and review the commissioning across a complex collaborative partnership with thorough co-production and organisational governance at each stage, it would be necessary to give sufficient time and utilise the extension so that this can be done correctly. This decision has not yet been formally made and will be subject to proper governance processes. During the extension period, it is proposed that a series of service development plans and/or clinical quality improvement notices be used to address the issues identified, and these will be fully developed with both the collaborative and the Experts by Experience forum. In the meantime, to address improved engagement with people with lived experience, the delegated commissioner has contracted with Health Watch to carry out survey and interviews with people who have used the services. Health and THERUC have not been excluded from this engagement project, but are separate Health Watch organisations and are being engaged individually. There was some initial confusion on which Health Watch was leading, but lead commissioners have now contacted all three Health Watch organisations to begin the process. The timings may differ, but all responses and reports will be brought together and presented to the Collaborative Partnership and Experts by Experience forum in due course. Thank you. We have a second question from the public, from Ms Mitchell. I hope I'm using the right term this time. Thank you Chair. It has come to my attention through residents that there is an increase in underweight children in Southend, and it is apparent that the challenges of good nutrition for children have been increased. On the 6th of December 2023, I raised a question with the then Portfolio Holder for Children and Learning regarding easily accessible, consistent and sufficient free school meals, given we know nutritional value and portion sizes may well be compromised by pressure on finances. It seems a commitment made by the previous Portfolio Holder to meet with the Chair and Vice Chair of People's Scroogely on the subject, particularly in relation to primary schools, was not undertaken, and children's health and readiness for learning continue to be compromised. Please could the Health and Wellbeing Board explore what they can do to (a) establish a consistency in free school meals fund allocation, and (b) how nutritional standards and portion sizes can be met consistently across primary education? Thank you Ms Mitchell, and I'll now give my answer. Funding for free school meals is triggered through the Department for Education's National Schools Funding Formulae. Through the school census data, which identifies which children are eligible and is allocated directly to all schools within that formula, schools manage and set the pupil FSM rate internally and set their own menu prices. This was confirmed through work undertaken by previous Youth Mayors and the Youth Council, which was presented to the Council's People's Scroogely in the 2023-24 municipal year, meaning what a school meal costs and what it will buy does differ across schools. We have and will continue to have discussions with our schools to establish more consistency, but as most of our schools and all our secondary schools are academies, our role is more than one of influence and persuasion. And then for part (b), how nutritional standards and portion sizes can be met consistently across primary education? We will explore nutritional standards and portion sizes with our primary schools. This is a question from Owen Roberts from Health Watch South End. Thank you Chair. I'm sorry to come back just on the first question and answer that was given. Just for clarity, your response to say that the delegated commission in Richard's Essex County Council has contracted with Health Watch. Just for clarity, that's Health Watch Essex. We have been approached through Health Watch South End to be part of this. Clearly, we're going to have to think about our resources. We are a small service. It's not one of the things we currently have in our work plan, so we'll have to have a conversation with the Commissioner to see how we can support that process. Thank you Owen for the information. Are there any more questions on these two questions from the public or points? We'll now go to item number four. The minutes of the meeting held on Tuesday the 5th of March 2024. Is this a correct record of the proceedings of the meeting? Is everyone agreed? Then we'll just sign off the minutes. Thank you. We'll now move to item number five which is for discussion. It's a recommissioning domestic abuse services report from Katrina Edwards. Thank you. I've put forward the updated report in relation to the recommissioning of domestic abuse services for consideration and discussion. I don't know if anyone's got any questions that they've got. First of all in relation to the report. Can you hear me? Thank you. Yeah, thank you Katrina and Chair. So members of the board might be aware that I've had to start South End Commissions to IDFAs that are provided for by Safe Steps, which focus on clearly the early years pregnancy through to four or five, age four or five. My concern about the report as presented is that it doesn't seem to consider the services and the fact that those services won't be provided from next year in the context of the overall strategy or commissioning strategy for the city. I don't quite know why. It may be of course that a decision is made that those posts are of less priority in the broader sweep of domestic violence services. I think I would have a concern about that if it were the conclusion on the basis that domestic violence can very often start in pregnancy and of course in the early years young children can be used as leverage by a perpetrator in the context of that developing family relationship. These are very highly utilized services and even in the context of diminishing resources available I would have thought the effective cut of IDFAs for the early years that sort of removal of specialist support in the city was worth discussion in the paper with members being able to make an active decision about whether or not they felt that that was an appropriate way forward. So as you can tell Maxine I have concerns clearly in austere times and you know we need to think about commissioning services creatively and imaginatively. But this effective cuts to really key posts that are delivered by safe steps seems to me to be something that members need to be aware of in signing off or otherwise the report that's in front of us. The question I think to you Katrina is to what extent has these posts been considered in the formulation of the strategy? If they're not a priority for commissioning why are they not a priority for commissioning? Is there any specialist support for early years offered in the commissioning plan for domestic violence for the city? And has early intervention in this context been given the proper consideration it needs as we look at the whole system of domestic violence provision that's sort of in front of us now? If the conclusion is that this needs more work and thinking, Chair I'd be very happy to make available our expertise, our data and our officers both in City Family Kick and in About to Start Southend to work with commissioners on potentially adjusting the strategy to take account of these factors. Thank you. Katrina would you like to answer that point? Yes certainly. So we are not in any way saying that early years IDVs are not a priority. I just want to make that very clear first of all. The funding that is available it will presumably report breakdown of where the funding is coming from. So where you're commissioning you paid for that separately that is a separate entity. It's something that I believe your colleague actually has emailed us about separately and we did respond earlier this week in relation to it. Because of the funding pot that's available to us and where we're having to put the funding we're not putting funding specifically marked for an early years IDFA or any type of specific IDFA. It's going into the main pot for that to then be taken out for the provider to break that down when they're coming back to us with the bids. If you wanted to continue to fund an early years IDFA that is definitely something we would support and be happy to work with you on. How that would look obviously we don't know what's going to happen so that would be something we have to work on together and look at moving forward. Sorry I'm just having a look at the rest of what you said. There were four different options and one included to tailor to local circumstances. I think it was option three was it? I don't know whether that could be considered in that particular option. Within the current progress that we've been making there is no reason why we can't commission that sort of thing separately from the main project on a South End specific basis. So we could look at doing that to include that in specifically for South End that wouldn't be an issue at all and we could work with you on that. In relation to the early years interventions there is any additional work stream that we're actually looking at developing around early intervention. But it is quite a unique area so it's one that's still being developed before we can take that any wider and look at what that's going to be looking at. But they're looking at setting up an innovation panel to explore what that potential offer would look like. So we are working on that as well. Anything you want to say about that now? Thank you Katrina. I appreciate to put you on the spot on this and the intention is a very positive one. I think for members of the council around the table we need to be confident that the strategy is a strategy for the city and not just in the context of the resources that the council has at its disposal. I think it merits consideration of this early years factor. As I said we'd be happy to provide the detail. If that results in a developing strategy as you indicated Katrina around early years and early intervention then so be it. But equally we could find different ways of as you're saying Maxine localising the approach for the city. But next year two highly utilised specialists it was for the pregnancy in the early years will go from the city. I think we do have some urgency that we need to have our eyes open if that's what we think is the right commissioning decision then then that's fine. And clearly if the evidence backs that then you know and the money is such that that has to be the outcome then that's the outcome. But I think that's an outcome we would want to try to avoid or find a credible way of mitigating in some way. I think I'd like members to support some further work on this if you know because I think it's warranted and we could be at a sort of cliff edge for that form of advice next year if we're not very careful. Thank you very much I think your points are noted and we will see if the officers could take that forward. Councillor McMahon. Thank you Madam Chair. If I may take the last point that the gentleman made my apologies I'm not familiar with your name. Regarding further work it does actually appear to me that the complexity of this 168 page document. My apologies 138 page document may have been better presented to this committee with a presentation that goes through step by step. So rather than being presented with quite a substantial paper with such massive implications for the use of service we would have been able to explore more thoroughly the options that are being presented to us. So I would support the recommendation for further work including points the gentleman has said about pregnancy and you know early years. My question if I may Madam Chair regarding the option one which is poor funding. Point two point one makes the recommend date highlights the disadvantage that this model would bring which would be larger providers and implies that these may be national providers but caveats it by saying that we should include local specialists. My question on that point would be how will you achieve this please. Thank you. So in relation to including smaller providers the local providers that's actually something we've been working really hard on. So we've been running regular market engagement events which we've opened up to a wide variety of different organisations and a lot of them have actually been local providers across the whole of Essex including providers from South End. So in offering them the opportunity to meet virtually and in person to be able to look at forming potentially collaborate collaborations for them to work together to put forward bids for this work. Thank you. Can I ask how did you make the selection of you would approach for instance did you include such an association of voluntary services. How did you select this pool of people you would engage with. We advertised the work that we were doing. So we went out to sales and other organisations to make them aware of it. And then also we went through and there's a procurement list that the procurement team have access to. I'm afraid I don't remember the exact name of it but they went through that to select providers that would be appropriate kind of like domestic specialist providers for that as well to invite them along. And then obviously once we've made them aware of it they could come along to whichever events we were advertising but we always make sure they receive the adverts for them. Thank you. How will you monitor that local providers in their form of proportionality will be represented on what is the Conglomerative Board between different areas Zurich, Essex etc. What will the proportionality assurance be. That's something I would need to double check. I don't know that answer off the top of my head I'm afraid. But we are working closely with them to make sure that we have a specific board set up to oversee this work. And also we'll be sharing all the work that we do in terms of kind of the contract management when it comes to it. But I don't know what that number would be I'm afraid but I will make a note to find that out. Thank you. Yes. A written response to all members of this committee will be acceptable on that point of proportionality. Thank you. The do excuse me the second question could you actually tell me with regard to print aids. I'm somewhat surprised. Well first of all what is the rate the research base upon which these service delivery standards and principles were actually recommended. What was the evidence base that has given the parameters for this service to be provided in the manner of those outlined in 8.1 please. Sorry I was just double checking the point. So the yeah. So over the last two years research has been being done and was commissioned across the whole of the set in relation to the work that's been being done around domestic abuse and looking at the best way forward. The way things currently stand in terms of the resources that would be available. We are benefiting significantly from the work that we do with our partners across that and we will continue to benefit from that which is the reason that we've made the recommendation because of those ongoing benefits for South End. If I may add to the question the fact that that seems rather an oblique approach to a situation where. I think these are for questions not comments at the moment. Thank you Madam chair. I am moving to a question but thank you for your intervention as I was saying it does appear to me that this is rather flimsy for the once the better word and surface provision to people who are in situations where as you do to yourself and potentially in situations where homicides may actually occur and the research base in your answer was includes me. Can you clarify again please what the research base is rather than just the analysis of set forms over the last two years. I mean what I'm basically asking is this funding driven or is this research driven place. Certainly. So the so the points that you're currently referring to a report that was actually submitted in March for the March board. But when that didn't happen it was obviously I've just kept it in there for information purposes. But it's based on the statistics and the data that we have within South End for us to be able to make that decision and based on the work that we've been doing with our colleagues across set and also from speaking to colleagues within South End about what is currently available. A lot of the decision has had to be made based around the finances. We are restricted in what we have available to us and we have to be mindful of how that's being spent. And we have spent considerable time working with colleagues to be able to develop an offer that will provide the support that we feel is that people feel is necessary. And then obviously we're also working with our lived experience participants as well to make sure that what we're proposing within this offer is actually what they want and what they need and is doing and providing the support that they needed or would have needed and need now as well. Thank you for that response. Are the police one of your partners? Yes they are. We're working very closely with the police and probation around this work. Thank you. Further question. 6.2 shows the benefits which is populated throughout the report that one of the outcomes to be achieved and it's given quite high priority in quite a number of places. Is that victims feel better? Could you tell me how you measure feeling better? Sorry where is that? It's throughout the report you ordinarily attached well specifically the 6.2 but ordinarily it's attached to all of the outcomes as defined within the report. But my question is wherever it appears in the report which is copiously scattered how do you measure feel better? Thank you. I'm not sure feeling better is quite the right terminology and I'm afraid I can't find a specific reference to feeling better at this time so I will have a look for that. In terms of the measurements obviously we will be looking at measuring the proposed outcomes which are setting out kind of feel and are safer. We're focusing on physical, mental and emotional well-being as well within those measurements that we'll be taking. And that will be done by the providers throughout the support time that they're supporting individuals through the process and the time that they're working with them so that we can measure them as they come into service but also as they come out of service. But also obviously the plan is from my perspective for South End we would like to set up a co-production board so that's something that I'm actually going to be working on over the coming months so that we can actually measure that through that work as well through the co-production board. Thank you very interesting but as for instance on page 84 and 6.2 of the report that was forwarded to councillors. I'm sorry to interrupt you while you're talking could we just make that the last question so we can give others a chance to give questions and then we can come back to you at the end thank you. Madam Chair I don't think it was appropriate for you to interrupt you in the questions you could have waited till the end but thank you for your apology which I accept. Page 84.6.2 on the first note of the papers that were circulated to councillors shows about the impact as an outcome. It will be feeling and being safer my original question is how do you measure feeling safer feeling better just that not all of the other caveats that you added to it can you just tell me how you might measure feel please. That will be based on the feedback that we receive from the individuals using the service so if they feel safer then they will be getting what they need out of that service because they're feeling safer and in a lot of respects a lot of the time they feel safer is because we have helped to make them safer by changing whatever needs to be changed to support them. Thank you I'm not convinced about the answer but I respect the chair's intervention. This is my first time on this board and I know some people around this table but I don't know all of them would be very helpful if they introduce themselves and be if they turn their nameplates around thank you. Thank you for that concern for cover under that for the next meeting okay. On page nine it mentions about commissioning managers and about £80,000 for hospital ID VA's which cover Broomfield, Basildon and Southend hospitals. It also mentions that other hospitals were approached but that hasn't been successful I just wondered do we have any idea why that. Yes so unfortunately the I'm sure you know the different ICB's covering different hospitals and different counties and everything it's all been really quite complex so it actually came about for us from me presenting at the Children's Safeguarding Board. They wrote one of the representatives from MSE approached me afterwards about it and we had a conversation about it then and that's when they put forward their offer to be involved in it. They then put me in touch with their colleagues so we met with them with some other colleagues from PDAC to see whether they would be interested. Unfortunately at the point at which we're approaching them the amount of work that they were then asking us to do just wasn't going to be possible before the contract goes live. They wanted various approaches to the different ICB's and additional work that we just don't have the capacity to be able to do for them. So we what we've actually said is we'll wait and see kind of how it hopefully they'll see how it works for the other three and then they may want to come on board at a later point to become involved at that point. Under point five implementation it mentions about the tenders etc and it says if we find after six months that South End residents are failing to receive a community offer we will look at either reprioritising spend or contract or seek further funding. How will that be done? Will it just be a survey contacting the recipients or I just wondered how that will work? Yes so that's something I think that will be based upon working with whoever the successful provider is and the work that they're doing in South End and also speaking with our colleagues not only the provider but any other colleagues and whether or not the ones that we're currently working with so within Children's Services Adult Services Housing to see whether they've noticed any change as well. And then if it's possible for us to speak to people with lived experience and get that feedback as well then we'll be able to do it that way. Do two more then and then if anybody else has got any then I'll come back. I think at 3.4 it mentions the about the South End Domestic Abuse Partnership Board. I just wondered who's on that because it doesn't really say on. Yes the South End Domestic Abuse Partnership Board has all the food we have. We have Public Health, Adult Social Care, Children's Services, Housing, Education and that's within the council and then outside the council we've got the police, probation, we have our current providers for both victim services and perpetrator services. We have the ICB representative from the GPs, we have MSD represented as well, South Essex Homes are there as well and we're looking at options around working with other housing providers for them to be able to link in with us on that as well. And I think we've got SETDAB colleagues as well on the board because obviously they cover the whole of SET. Thank you, how often do they meet then? We meet quarterly and actually I've just seen that, the corner of my eye actually just seeing Anthony move, reminding me that SAVs are on the panel on the board as well, sorry. So yeah we meet quarterly, yeah quarterly. One more then and then I'll hand over to somebody else and then come back. At 4.2 it mentions about safe steps and refuge and it has seven beds, I just wonder if there are any plans in this document to increase those beds at all? Yes there are, so the current, based on the research and the numbers, per population count we should have 15 beds in South End. We are slightly below that because obviously we have the refuge accommodation but we also have our move on accommodation as well so that puts us I think about 13 or 14 beds. So we have factored into the recommissioning for us to increase that so that we do have a minimum of 15 beds within South End. I do apologise, it mentions South Essex Homes, I just wonder how many units there are there? So there's five dispersed accommodation and that includes crash pads which is available kind of like last minute for someone if we can't get them into something else because we need to make sure that it is safe accommodation under the DLUC guidance and the requirements under that. Thank you. And I have a couple more if that's alright. If I go to 7.1, it just mentions about South End has, oh no sorry, about the children. It says in a report about South End, one of the offices, it's noted that South End leads with the support for children but other services across Essex do not have such a level of provision. Is there any work being done with the other authorities to find out why they've got a lack of provision and are they looking to increase that? Yes, so they are looking to increase that as part of the new recommissioning that we're going through and are looking at the work that we've been doing in South End as part of that to see where they can kind of maybe borrow and learn from that work as well. We'll share our good practice with them. Thank you. Can I interrupt you now? Can we go to another question and come back to you? Yeah, that's alright. Sorry, Owen Richards from Roberts. Sorry, I can't read. Oh sorry, it's Anthony first. Anthony Quinn. Thank you. Thank you for the report, Katrina. I'm really just picking up the thread, I guess, or the theme of Alex around the specialism and localism. Looking at the options, does Option 1 not exclude the local specialist provider around criteria around the financial envelope, the threshold of annual income? They could not possibly go alone and would be forced to find partnership but be at the mercy of larger organisations to accept them into a partnership or may not. Possibly leaving them unable to access the competition and be part of that but also putting at great risk the local knowledge and expertise that sit in the city. I guess one of the points in that is around about we'd benefit from the economies of scale and cost efficiencies from procuring as set, including better value for money. But is there not a conflict with localisation and specialism within that? Because scales of economy are possibly only achieved by individual lots being bid for. I guess there's that aspect about consistency across set. But does consistency possibly mean a dilution or a poorer quality service in Southend to get that consistency across that space? That has been something we've discussed at length actually as a group around the consistent offer and whether that could lead to dilution. But we felt that it was really important that, especially if someone is at high risk of domestic abuse and they are actually having to flee their home, what we would like to do is be able to prioritise them within Essex. Whether that's from Southend to Chelmsford or vice versa, they would still have the same offer available to them of support that they need and that they had available to them. So we want to ensure there's that consistency there. We don't feel that this is excluding any of our local organisations. If anything it's an opportunity for them to showcase the work that they do and actually make them more attractive to some of the larger organisations potentially for working with them. That was more in demand. But I do feel that there is a lot of opportunity there for them and actually a lot of the work and the guidance that comes through from DLUC and also the work from the updated, or the new actually, Victims and Prisoners Act that came through a couple of weeks ago is focusing on that collaboration when it comes to support for victims of domestic abuse. I'm keen that agencies are working together to deliver that and I think it's actually important to think about the learning that they could also have from those they collaborate with. At the moment there is a consortia across the whole of Essex in terms of the work that's being delivered. They're not delivering it independently themselves. Yes, they are independent organisations but they are also working as part of a consortia at the moment. We're just proposing formalising that and in a different way with the lots and the way that we've set it up. Thank you. Do you think that has been expressed and explained your position on that consortium with potential and in the market event? Are those things coming across and being clear? I appreciate the partnership offer but I guess it's just to lodge that there's a great risk of losing an organisation like Safe Steps from the city if option one played out in a certain way, they would be gone from the city, we would lose that organisation, the skills, the knowledge, this award winning organisation doing incredible work and option one puts that at great risk. The risk knocks on to the resident, the victim of domestic abuse. Are they getting the quality service in this city or is South End just another bolted on part of what's going on across Essex? I guess that would be just the key thing to lodge. We have been very clear in our market engagement events and conversations that we've been having around this work about how valuable we find the work that Safe Steps do and we've been very clear that this is a great opportunity for them and we do think actually there's a lot of options available for all the organisations that are coming together. We have worked really hard to share with them all our appreciation but also the ways that we think this can work so we have been really, really open about that when we've been working with them. I understand the concern around if it goes a certain way, what could potentially happen there and it is something that we have had to consider but I think that there's lots of opportunities there available and there's a lot of options available to them and we've shared all those different options. We can't make the decision as to how they approach this for them and we can't make them do it a certain way. We have to leave it up to them and other potential providers to bid. Thank you for that answer and I understand the position. I guess it's just to make sure that the clarity is in the messaging around commissioning and procurement and for the voluntary sector to understand that there are other points in there about longer contracts that are more appealing to charities and so forth but they're not if there's not inflationary uplifts year to year in them. Other organisations and nationals again, they can soak up that loss of margin, they can move money around and they can cover those increases of salaries. Local, smaller specialist providers, they cannot do that and we see it time and time again. These longer contracts, whilst we welcome longer contracts, making it more or providing more discouragement really for local specialist providers to buy into that. How do they continue, how do they sustain when one of the very questions and constant arcs of the voluntary sector is how do you sustain and what's your sustainability options or plans when actually we're having decrease year on year because inflation's taking away that. So it's just really to lodge all those concerns. Thank you. Thank you. Is that all questions and points? Thank you. Owen, Robert, sorry. Was it? It was you first. Thank you, Chair. Thanks for the report. It's been really good to hear about how voice is being used all through the whole procurement process, which I think is a really good model for the council and other organisations to follow. It's really important that it's actually people who've been through this process, used the services, actually the ones who talk about outcomes and really help professionals such as yourself as a commissioner to design what feeling safe looks like because they're the only ones who really understand that and how that can be evidenced. It's a really positive step. I suppose the question that goes with that is that domestic violence and abuse affects men and women. I just wonder whether you've been able to think about male victims of domestic abuse as well as abuse within same sex relationships and how you could build that into your thoughts about co-production. Because there are going to be obvious sensitivities there about genders coming together in that sort of setting. But just some thoughts about that would be really helpful for us. Thanks. Absolutely. Those are areas as well. We do see lower numbers because people don't tend to report it as much, but it is an area that we are actually looking at in Southend in particular. Going down this route, we don't currently have a male IDFA for Southend, but that is something that we would like to be looking at and making sure we're giving that option available. As part of the co-production work, or as part of the lived experience work at the moment, we do have a male that has come forward that has joined us for that work. Actually, at the moment, everyone's quite happy. They don't mind everyone coming together, but as we move forward, that is something that actually is co-production, so it will be how they want to do it and the best way of moving forward for them in those conversations, I think. So that's something with the Southend specific co-production that I'll be looking at over the coming months. At the moment, the focus is just getting on the feedback for the lived experience, for the specifications. And then as part of that, I'm kind of recruiting them for Southend in a couple of months for me to start working with them on the co-production side of it. I was at a meeting a couple of months ago where I did meet someone who was from Southend Pride as well, and we did have a conversation with them about how we can get them more involved. And we're hoping they'll be able to be involved on our operational group and supporting us with how we can support that community better and make sure that we're getting the message out and supporting them. Thank you. Councillor Falkhard? Thank you, Chair. Southend Hospital was mentioned. Can I declare an interest non-pecuniary? Or can I do it now? I'm an ambassador for the fundraising team at Southend Hospital. Thank you, Chair. Thank you. Councillor McMahon? Thank you, Madam Chair. The question I'm about to ask is predicated upon an example that this council had on the waste contract prior to the waste contract that we're currently involved with. This is where three authorities form an organisation to provide a service to the citizens in our case of our city. Essex County Council, because they were the largest partner, took a position that was diametrically opposed to both the interests of and the will of Southend-upon-Sea councillors and residents. The question is, in the offence of there being a dispute over the activation of a break clause, which is alluded to in the document because it's five years with a two-year break clause, will the largest partner have the ultimate say by virtue of their percentage of funding input into this venture? If not, what is the dispute resolution that you must already have planned and can we have a copy of it, please? No, they don't get to make that final decision. The collaboration agreement is in the process of being finalised, so just from reading the draft earlier today, every single organisation within it has to agree to it. If one organisation does not agree, it does not proceed. The dispute resolution is noted within there as well, the route we have to go down, but I wouldn't be able to tell you what that is off the top of my head, I'm afraid. I think it did involve mediation and then there were further steps for it to take from there. That seems to me, thank you for that response, it seems to me like a bog standard dispute resolution, which didn't actually serve the residents of Southend obviously previously well, so can we have a copy before we make any decisions about the mechanism read by dispute resolution will be negotiated so that we know what we're entering into? Thank you. Just to inform the board that we are not making the decision, we're just having a discussion about it. Thank you Madam Chair, but should it progress to either our colleagues or council, we would need the full facts, hence I asked the question. Does Madam Chair agree to that? We are discussing it, that's fine, yes, thank you. Sorry, so is that an acceptable question? Yes, so I repeat then the request that a copy of the agreement regarding dispute resolution be circulated to all members of this committee, thank you. Thank you Madam Chair, can I just make a point that this is a health and well-being board and not a scrutiny meeting, Councillor McLennan. I think your request should really be channelled through the scrutiny committee because I think it's very specific to scrutiny approach. So I think we were going to have a conversation in a minute about the purpose of the board and I know a lot of you here are new to the board and I think the level of engagement is really treading into what I call scrutiny meetings. I think we just need to divide what is scrutiny to what is collaboration and informing this discussion about the proposal on the table, the process we followed and what is likely to then go and move forward in terms of what will be in terms of the procurement approach. If that is a challenge, that challenge needs to go into scrutiny. Thank you Chair. Thank you very much, unfortunately we don't have any scrutiny committees at the moment. Thank you Krishna but there is the people. Becky. Thank you and so firstly I just wanted to say thank you because I think it was a report that showed that you have actively engaged with people throughout this process. I'm going to caveat what I'm going to say based on the fact that I might be missing something so just bear with me. I think you set out options, what I haven't necessarily seen in this paper is the proposal of the procurement approach and I think that perhaps some of that detail will help to be able to qualify how you are going to keep that localism and manage the risk of providers like Safe Steps in being able to be a strong contender within that. So whether that's within the metrics and the evaluation approach, the weighting within that, I think that would be really helpful. So apologies if that's me not seeing that information but if actually when this goes further, that kind of totality of the picture, I think it would strengthen the case. Thank you, yes that's actually what we're developing at the moment because obviously we've got four different authorities in this. So there's the three local authorities and then also the police, fire and crime commissioner within that. So we are in the process of ironing out the weighting around that and how that will be done but part of that weighting I can confirm will include lived experience participants as well. They will be having the opportunity to put forward the questions and I'll develop those with them because I'm leading on the lived experience and then they'll also have the opportunity to evaluate those responses as well. Also, sorry, just to come back on that, just also the weighting around the onus that you put on that local provider and the social value attached to that. But thank you, completely appreciate that response. I'll just take Michael Marks and then Councillor Broughton and we need to wrap up this discussion, thank you. Sorry, Madam Chair, I have a declaration of interest, I did signal. That's fine, please declare me interested. I'm a personal friend of the police and crime commissioner. Yeah, thanks, I just want to follow on from Krishna's point. So whilst I accept Councillor McMahon that we haven't necessarily got a scrutiny function in place, that doesn't necessarily mean that the health and wellbeing board will then follow up that function. We need to wait to see what the decision is around the scrutiny function within the council and I think as Krishna has indicated, the next item I think will be useful in just clarifying the role and functions of this board. Thank you, Councillor Broughton. I haven't got too many more questions. At 7.2, it mentions that Southend has the highest prevalence of domestic violence across Essex. I just wondered if we're doing any work to try and find out why that is and also, as regards to the other areas, could it be that there's underreporting in the other areas of Essex? Yeah, it's always possible that there's underreporting when it comes to domestic abuse because obviously there's so many different ways that it can be reported and a lot of people obviously don't report as well. In terms of the Southend highest prevalence, that is something that we've been looking at. It's not something that we want and you want to have that. We've been looking at where we have the biggest issues within Southend and one of those is around the generational abuse and people witnessing it as a child or growing up within that environment as a child and then going on to become an adult and either become a victim or a perpetrator themselves. That's one area we've been working at with colleagues. One thing, Public Health have funded the Prince Charming play. I'm not sure if you're aware of that. What play was that? They go into schools and they've been doing that. That's one way of getting into the schools and doing that element of work there. It's an area that we do want to work on. What we've actually recently done, we've recently secured funding from the Department of Work and Pensions around reducing parental conflict. We're viewing that as pre-domestic abuse in a way. That is parental conflict specifically. It's not domestic abuse but it is looking at what sort of work can be done there. We've just got some funding for that for us to be able to train not only our early years staff but also for our health centres and school nurses and those different organisations for them to be able to have that training which we're rolling out this year to help to start to identify where those issues are and start to move forward. Reducing it getting to the point where they are needing that domestic abuse support and services. One area that does need further work to reduce domestic abuse victims, we need to reduce the number of perpetrators and the work needs to improve and increase with perpetrators. We are increasing the amount of funding that is going towards the perpetrator programme this year. At the moment we only have £18,000 that we're putting into that but we are increasing that from next year. That's an area that we really are keen to work on because if we can work on perpetrators we can reduce the number of victims that need support services. Thank you. Can I turn to 7.3 which is about 7 rooms and it just says the last sentence. We would like providers to explore the provision of accommodation for perpetrators so victim survivors can remain in their own homes. That is the concern. I just wondered about safeguarding for the people that are going to remain in their own home and you talked about lived experience. Have you sought the views of survivors of domestic violence to see whether that would be acceptable as a lived experience because if somebody knows where they are then there's a likelihood and we know that there have been deaths because of this. I just want to know what safeguards will be put in place for the survivors because the perpetrator will know where they are and the lived experience, have you spoken to them about that provision? So that is one of the questions for the lived experience participants. I've actually only met with one person so far, I met with them this morning. So I don't have enough feedback at the moment to be able to say yes they're in favour of it, no they're not. However, the feedback that we've had from the work that's been going on for the last few years and a lot of it is why do victims have to move, why can't the perpetrators move? We have a flexible fund in South End at the moment and as part of that what we've been trialling is a service that they will go and take, it's very similar to the sanctuary scheme, are you aware of that? No. So basically this service, what they'll do is they will go and take a look at the property, they'll identify any areas of risk or access so making sure you've got window locks, locking back gates and stuff like that. They can make any recommendations for ways to make your health safer and other recommendations such as video doorbells and that sort of thing as well. Also if people are known perpetrators at least they obviously can put a mark on the address so that if a call is made to that address it's given priority, that is something that can be done. So we're working through this flexible fund and also with partners to be able to look at how we can do that. One thing that is available in a lot of places and it's come out about from the duties that we've had from the Domestic Abuse Act is around sanctuary schemes. So we can, the local authority can set up a sanctuary scheme which is actually something we are looking at doing here where partners, we work with partners for there to be a pot of money and where people need support in securing their home. However that as an example can be used to replace a damaged door but also again safety measures on that property, alarms, video doorbells, cameras, that sort of stuff. People could apply into that for them to be able to then get the funding to cover them for that sort of work to be done. Obviously one of the biggest concerns is the fact that if a perpetrator is moved they still know where the victim is so it's looking at all the safeguards that can be put in place. But a lot of the feedback that comes back is the victims want to stay where they are, they've got their support networks there so it's then looking at the best way for us to make it safe for them around that property. So I do think that when we come to speaking to lived experience participants they might tell us a similar story just based on previous research that I've done and I've read as well. But until I've spoken to them more obviously I don't have all that feedback just yet. As long as there are safeguards in place, I mean there have been other cases there have been safeguards in place and the perpetrator still got there and there have been deaths as a result of that. And it's also the police as well because sometimes they don't act, not saying anything against the police, but they don't act as they should in these cases sometimes. If we're going down that route we need to make sure that the survivors, and the children as well, if the children were older would you seek their views? I don't know. That's definitely something that can be taken into account. The thing with domestic abuse is it's incredibly complex and a lot of the work that you need to do when it comes to people experiencing domestic abuse is about empowering them to make the decisions and take back that power themselves. If they would like to stay in their home, you look at the best way to safeguard them in their home and do everything you possibly can. Unfortunately there have been situations where everything has been done and something does happen, but we can only do everything within our power to support them and make them fully aware of all the options so they can make the right decision for themselves. If it is felt that it really is not safe for them to remain in their home then that is the advice that will be given and they will be strongly encouraged and supported into what the other options are. If they feel really strongly about that then we have to support them to make the right decision for themselves. And I just have one more. It's to do with financial implications. It mentions there is a potential for some savings to the current budget consisting of the pots below, however it does say cuts to domestic abuse service carry risk for the victim survivors. So how will these savings be achieved? So I think that was something we wanted to look at moving forward and whether there is that option for savings and what there is available at the moment. That was in the original report from the 5th of March, obviously things have moved forward since then and we are looking at where we can kind of spend all that money because I would like to put as much money as we possibly can into it. Obviously we are always having to consider cuts to budget so we have to take that into account but we would prefer not to make those cuts if we can but if there is stuff that is needed we can kind of look at where the options are but obviously it will always be done taking into account the impact that is going to have on a victim survivor's safety. So what would you cut then to achieve the savings? I would have to look at the rest of the stuff because we are not putting all the money we have available into that pot, we still have additional... Sorry, I managed to push the button. This discussion now, because we have many items to cover... I have my comments Madam Chair, we haven't had comments. Do we have comments in this board? I don't know whether that happens. It's unlimited questions and also it's only at the council that two questions and a comment will die. So we just have two comments please if that's okay with the board? They're unlimited, you've got to apply standing orders unless we're... Can I just have a comment from Krishna? I misunderstood, carry on councillor, not mine. It's highly unorthodox that the councillors aren't actually invited to comment. Am I being invited to comment Madam Chair? Please make your comment. Thank you. There have been mentions around the table this evening about what is appropriate and not appropriate to be addressed during this meeting. I see around this table a number of councillors and people who have devoted much service to the community. Specifically the role of a councillor is to ensure that the proposals are in the best interests of residents. Whether it be a comment made in this committee or another committee, I think being pedantic about what should be included or not included here is against the best interests of residents. And I think perhaps that councillors whose elected role it is to actually help officers to fulfil the policies that they choose to implement should be honoured. So I do look forward and thank the officer for her presentation and look forward to the percentages that have been promised. There is also a copy of the dispute resolution, but it is that after hearing the presentations made I am very concerned about the proposals in option 1. Because of the contributions that have been made in relation to local services and the impact that if we pursue option 1, smaller services instead of being included will lose the offer that they can make to our residents and our residents have to come first. So I thank you Madam Chair and I look forward to this being discussed in the round with full and adequate time so that all members can consider all of this very important information that is before us in a very brief and detailed manner. Thank you. Thank you Councillor McMahon, I think that is a valid point. Any other comments? Krishna. Thank you Madam Chair. I think just to summarise some of the comments because it is important in the fact that this service is also partly funded by the Public Health Grant. So the comment about making savings is not really something that we are going to be exploring. The efficiencies achieved here are really around the economies of scale that we gain by looking at the service and its offer. I think what the challenge has been for the team and Katrina from Southend is to show whole needs across the whole of the system including Southend around a very restricted envelope, financial envelope and operating that financial envelope. I think certainly what has come out quite clearly today is we have got some gaps in those services and what I am going to offer to do is that we get to meet as partners to talk about some of the gaps that we have and how we get to operate in going forward. While we still try to finalise the current proposal around this service offer and the options being considered currently. I would also like to point out that the issue about the risk associated to losing the local specialism is something that will be explored as part of this approach because there are opportunities to leverage what we want to see. It is easy to use the commissioning and procurement process to ensure that actually we get the best for us locally and we do not lose potential localism where there is specialism in that field as well and I would be quacking to support that view as well. Thank you Madam Chair. Thank you very much Krishna. Yes, I think the decision about whether we agree that we are satisfied with the progress taken to date, we must have input from our partners and where we see there are gaps where they need to be filled but thank you very much for that. If we can move on to the next item which is the alliance plan report from Vicky Jarvis, the alliance director. Thank you. Thank you. Really good to be here. I think it is important to say that this is effectively my first health and wellbeing board so great to meet with you. For those that I don't know around the table I look forward to meeting with you in coming weeks and months. As you said my name is Vicky Jarvis, I am the South East Essex alliance director. Just to reiterate that means that I am employed by the integrated care board and I have responsibility for one of the four alliances that sit as part of that integrated care board and as part of our integrated care system. I am going to just share with you a report around the work that is continuing to develop so this is not in its final form. That is around our delivery plan and we have intentionally looked at the delivery plan for the next two years with a view to really thinking about how we come together as a system, collaborate to improve health and wellbeing outcomes. Obviously that patch in South East Essex includes Castle Point and Rochford but we are absolutely focusing on the identity of places and neighbourhoods and that you will see is a key theme throughout. I will run through the presentation but this has been done in collaboration with South End local authority and absolutely within working alongside the teams to align this delivery plan with Connected South End but I also just want to note that there are partners around the room that are also involved in this and in particular our chair, Anthony from SAVS. So I am sure at some point there will be comments to share and update on what I am going to say. So, am I nodding? Thank you Robert, just to be clear. So as I said this is a two year plan, it has been crafted under the lens of as a system, Mid and South Essex is in financial recovery so we are working actively to look at how do we improve not only the financial position but continue to deliver high quality safe services for our residents. We, in light of that, will have focused and are focusing on the role that we can make locally to contribute to that wider system but actually really really putting the spotlight on how do we use place based working as a lever to change and transform how NHS services in particular are planned, designed and delivered. We have adapted the governance model and we absolutely want to use that governance model as a vehicle to deliver the plan but also provide assurance to our committee, the integrated care system and you as health and wellbeing boards and our wider partners. Excuse my voice as it's gone. I won't go through this in detail but this is really just trying to set out some of the emerging principles and assumptions behind how we have developed this approach. A couple of things I think is probably important to pick on is we have to remain agile, we are working in changing challenging circumstances and actually this is not just about creating a solution, it's about creating the conditions and the environment that enables us to continue to collaborate but most importantly to improve the lives of people living in Southend. And I will really point this out to really think about how we collaborate, to challenge ourselves, to take off our organisational hats and to say actually where is the value of coming together and how can we make the most impact in doing so. Another one I'll pick on using data, that is something I'm absolutely passionate about. We actually as systems need to improve, there's loads of data, it's how we use the data. So actually really thinking about how we use data to unify us collectively and then absolutely show the impact of what we're doing. I think the other part of this and again is really empowering communities. We really want to, this is again, yes I'm going to talk about services but actually we know the financial challenges, the increasing demand, we know we absolutely need to think about how do we work with people so they have choice and control over their own care and can help to self-manage and most importantly be independent in that. This is a just, again within our delivery plan, it's really important and I did a presentation earlier on in another part of South East Essex, Canvey Island and the health system is very confusing as sometimes it's local authorities to be fair, there's lots of acronyms and there's lots of layers. And this is really when we're talking about what we're delivering locally and what our partnership is going to do, this is trying to just show that that middle box is the scope of our delivery. And that's really taking some of the conversation we've just heard, where are there clear need in a area, so this is in Southend and where can we come together to make that most impact. But as part of that, my team and I also have responsibility for some of the ICB core delivery areas and that includes primary care engagement veterans as some of those areas. And then the wider integrated care system, whilst it's not necessarily directly in our scope, it absolutely is dependent on our delivery, so we have to stay close to that and stay connected and make sure everything we do aligns. So as a partnership, our vision is for people in South East Essex to have healthy lives and wellbeing. Our purpose is really to think about how we integrate care and support around a person in connected and thriving communities. So it's really trying to simplify that, but our mission in doing that, and this is the bit that I personally am really passionate about, how in doing that can we transform the longer term view and operating model of NHS services to improve access outcomes and reducing inequalities. And we want to do that by using our data, our collective data and intelligence, gathering insight from our residents, from our councillors who are close and working with those residents to understand what those changes are that we need to make. The next couple of slides, I won't go into a huge amount of detail, but again just reiterating that as South East Essex Alliance, as Southend, as a City Council is as well, we are part of an integrated care system. We are part of, as part of that system, we have an integrated care board that has a number of corporate objectives and an integrated care partnership that have set the healthy domains as part of their strategy around what they're going to do differently. And again, this really just plays back to the Health and Social Care Act that came in two years ago and puts the statutory, these two bodies as statutory platforms, but it also just highlights the need for integration, we can't do it alone. And again, really showing that across all of the different health and wellbeing board and unitary, sorry, sovereign organisational strategies, there's clear alignment. So actually thinking about how we can use that collective resource not to do the same thing across the whole of the South East Essex patch, but tailor it to the needs of the population is really important. So as part of that, we have looked to think about how do we really prove the impact of this place-based partnership? How do we start to really galvanise people around a clear outcome? And that clear outcome we're suggesting is healthy neighbourhoods. So really looking at across South East Essex, but in our neighbourhoods, how do we collectively integrate care around those neighbourhoods and then provide the information, wellbeing and support to ensure the healthy and thriving communities. So as part of that, we also want to focus on those four healthy areas as our key priority areas, and they've been driven by data and insight, but also some of those assumptions that we built around the work and activity that's already happening that we know we need to deliver in the next year and then two years. And again, I won't go into this in huge detail, but collectively as a system, we've been working in my team and with partners to really start to specify what is the activity under those healthy areas that we will deliver. And then the next stage of this is actually showing how we're going to measure it and what the impact would be. So that's the work that's developing and we're hoping to get a final draft, sorry, a final version of that by July that we're going to be taking to our committee. And then this is our roadmap. So really looking at where we're looking to continue to engage, continue to develop and then present a final version. But actually, again, coming back to my point around remain agile, this is not, yes, it's a document, it's something that I want to hold us to account to and myself to account to. So this is really important. We continue to review, we continue to look at that impact and we don't stay stagnant on something on the shelf. This is actually about how we show the difference it's made. I think that's all the slides. Oh, there's another note. No, some of them are appendices just for when it's so close not to go through. Sorry, I forgot myself there. Sorry, I didn't. Yes. So there are some appendices and we can share this. This is an emerging document. But this just is showing our governance, really. So quite simply and again, there will be other layers on this. But the governance that we have, we are accountable to the integrated care board and obviously we also report into the different health and wellbeing boards. But the platform that we have is the South East Essex Alliance Committee and as I said, that's chaired by Anthony from SAVS and there is a whole range of partnerships in that committee. That committee will have the overarching accountability for the delivery of this plan and will include senior decision making officers. And the secondary kind of part of that is we are establishing a healthy neighbours partnership group which will be the strategic leads that will deliver that work. But we also recognise, remaining agile, we will need to set up task and finish groups to keep the momentum of the action and that will happen through that partnership group. And then next steps, not the one before. And then this just starts to build on the next steps. I think that again, a couple of continuing to develop, it's really important, this is not an ICB plan, this is a partnership plan. And actually we need every partner involved to be able to have the right level of sponsorship and operational delivery to enable this to happen. And I would ask that Health and Wellbeing Board continue to work with us and support this so actually we can put some visibility behind what we can do differently at place and what difference that can make. No, that's it. That is it. Thank you very much, Becky. Are there any questions? Alex Kaldi. Thank you, Chair. I just wanted to say I think this is an exceptionally encouraging presentation about the way forward. I think in flying the flag for – sorry, it's Alex Kaldi from the Better Start, South End, by the way. In flying the flag for healthy child development in this context, I think it's vitally important that we have a coherent plan for healthy child development across the Alliance area. And I attended the Growing Well Board earlier today at which the ICB as a whole set out these five areas of priority including Healthy Start. So what you set out, Becky, in a really clear way I think is the seeds of a genuinely collaborative effort to use the data, use the evidence, use the local knowledge to put something together which hasn't existed before. To be slightly negative for a moment, the ICB as a whole hasn't had ever a convincing plan for healthy child development across the system. That is a major miss for Middle and South Essex. And I still think, having made this point to the Growing Well Board earlier today, that the ICB as a whole does need to pick up the pace on this to avoid in an era of scarce resources, not trying to focus on everything and not achieving anything. And so I think you have the tools, Becky, in terms of people and willingness in the Alliance area to develop something that makes sense, meets the needs of local communities and uses that scarce resource really well. Again, I'd be very keen that the organisations I represent participate in that process that you're outlining. I think we have a problem to solve, not in this forum, but in other collaborative forums about the focus on children by the ICB more broadly, getting my acronyms mixed up. But I think if the action can start a bit more locally, I think that's maybe something that we can control and get our hands on a bit more, Chair. Thank you. Thank you very much. Yes, it's so important to have a holistic view of this and also we've seen really good health outcomes with the OBSS work that's been done over the last five years. Any other questions? Thank you, Councillor Broughton. It's about reducing health inequalities. We've been talking about this, I'm sorry to say, for years and years and years, and I don't know really if there has been any improvement. I mean, we really need to tackle this because people in certain areas of the town and elsewhere in the country are dying much earlier than they should. And the pension age keeps going up, but some people, because of health inequalities, won't ever reach that. And as I say, this has been, you know, I've been on the Council a long time and we're always talking about health inequalities. But I'm sorry to say, I can't, you know, in all the time I've been here, I can't see any improvement. So, I mean, we really need to tackle this and to show, can you tell me if there's been any improvement in health inequalities? I don't necessarily, Krishna will come in, I don't necessarily have the data in front of me and I think that, but, you know, I'm sure Krishna will talk to this. There has been improvements in health inequalities for certain groups, certain populations based on some of the activity that's happened. However, and I will say this, the pace of which we need to change, absolutely, you know, we need to go stronger, faster and those health inequalities are still there and the Marmot Review shows that. So there has been work, but I think we shouldn't lose sight of that, yes, we've been talking about it for years, but there is still more work we need to do and hence the point of coming together at place to think about how we do that. Krishna. Yeah, thank you, Chair. I think we, you know, I concur with what Becky has said, you know, we have made significant improvements in some areas. COVID has had a significant negative impact on healthy life expectancy and we expect that won't recover for another year or two. But I think one of the things, the question you're asking is a question we're asking of all of us within this room, is this board is here to help deliver reduction in health inequalities and improvement in making sure we can drive the changes we want to achieve. And I feel, as the data public health in the last six years I've been here, sometimes we've not really kept to that agenda and I'm quite keen given the next item we've got is to talk a bit more about where we want to go in really focusing on these areas collaboratively on the board. Thank you. Casa Porto. Sorry, quick, I don't know if these are quick wins where you're making improvements, but we really need to make improvements in not in the quick wins, in the stubborn figures that don't ever seem to change. Because you say, oh it's a quick win, we've done that, but we haven't done it because, you know, still all these years later there are still so many health inequalities and you know, as Avery said, we really need to tackle this, because it's not right that people are dying earlier than they should be. Any more questions? Oh, sorry. Thank you, Chair. I just wanted to develop the inequalities bit as well. I know Becky and Caroline agree on this. It's not just about outcomes and length of life, it's also about experience and access, so all the stuff that we see from NHS England is talking about those three things. I know we've had this conversation in the Alliance, but it's really important not to forget some of the stuff about experience, how residents experience healthcare, and we've heard that about the domestic abuse stuff. But it's also about access, so how quickly people can be seen, so it's important to try and get the balance right between all three components. I agree. Can I just add something? I mean, one thing which is not our remit is poor housing, which results in a lot of health problems, and that is due to inequalities in society. So that's something we can't address, but we have to mitigate for. Sorry, Anthony, next, and then… Declaration of Interest, Madam Chair, you've alluded to the healthcare and healthcare inequalities. I work for an organisation that manages NHS complaints. I would hope the local authority could impact on housing and make some change around that, something to just reflect back on. I just wanted to echo some of the things around and thank Becky for the presentation, but it really is about the partnership and it's important that it doesn't get buried under health and that we see the diversity of partners around that table giving in to those wider determinants of health and how they impact on people. And what matters to people. I think it's also about our learnings in the last couple of years as chairing the alliance and going on a journey that we actually learned from the past and we understand that we need to do a few things really well instead of a lot of things. So, so, or not really having any accountability around that. And the new governance structure is about narrowing that down to bring accountability with a delivery plan that is realistic, accessible to all and can bring that sort of measure against health inequalities impact that you're talking about, Margaret, and so forth. So I just think it's, it's about bringing the willing along and it's a good time to lay the platform for going forward and delivering some tangible things that people can begin to believe in and see and understand what the difference, what difference the alliance can bring. To the place when we're looking and talking about specialism and localisation, that place-based theme and that place-based knowledge is key to everything and the community voice coming through that. Thank you very much for these contributions. I think we've taken all these different aspects on board and thank you very much Becky for your report. Thank you. So now we have feedback from the informal session from 23rd of January 2024. I asked Krishna about this because I was not at that meeting. I think Councillor Broughton subbed for me, but he might not. The informal health and wellbeing board that was held in January. He will also have the input as well. Do you want to go first Becky? Yeah, just to say, I will have an input, but through Caroline who it will absolutely give an overview working with Krishna. I was there, but it was before I actually formally started. Yeah. Thank you. Thank you for that comment. I think just, I think as a resume of what happened on the day, I've definitely got to need Caroline to remind me. I'm getting closer to retirement. I think I forget these things sometimes. So, just to shape where we are, I think some of the conversation today helps us think about where we need to be in that space as well as certainly Mark as the executive director for adults and communities and health in terms of health intervention. We have a role and responsibility to think about the purpose of the health and wellbeing board. And I think that's the bit of the conversation was really driven by the purpose of the health and wellbeing board in terms of going forward. So, I'll start a public health. I am actually quite sad that we have very, very few people sitting around the table. We've gone from a board where we used to have regularly 30 people to me starting to think whether I should send a deputy as well. So, I think it's about understanding why we are here and why things are changing and what we should be doing differently. The conversation was about understanding the work we do at a locality level, what it means collectively. So, as an organization, as a local organization, as part of the partnership with the NHS and all the work we do. And we're probably one of the few alliances that has got our CBS chair, chief executive leading that as chair. So, I think we made a huge progress in terms of some of the engagement and working in the system. So, we also talk about the potential to think about how the presentation that Becky has given is very much in flavor to what we were talking about on that day. It's about how we don't take a health care approach to what we're doing. Actually, I can tell you the data of the regional team will tell you that this ICS has created a strategy focused on the wider determinants. And truly, when you look at the five healthies that the Integrate Care Partnership Board is taking forward alongside alignment with the four priorities that we have here in the alliance. What we have is actually those wider determinants being reflected in our conversation. So, it's taking that forward is understanding actually what will be the value add of the board in engagement. So, two things that came out of that was we have an informal opportunity to discuss matters that are challenging. Understanding those elements informally what they mean and trying to make sure that we are all on the same page when it comes to actually moving forward and collaborating on those. So, contributing together was important. Collaborating was important in those conversations. And I think one of the things that we agreed, Mark and ourselves, was that as we start looking at developing a new terms of reference, that we look at putting together a formal briefing session in an informal way in some ways with the elected members who sit here. Because the Health Care Board is not about the color of a political group. It's about actually what's the collectivism we want to achieve in working together. And like you, I feel any challenge that is very much scrutiny type challenge, we put them and place them in scrutiny because we've identified those as a challenge at this board. It goes to the right channel. The board needs to be able to really contribute to the conversation that's going on and make sure that the debate is seen in a collaborative spirit. And that is something that we really need to be looking at driving going forward. So, we pose there and see whether Caroline wants to add anything else that my brain is not remembering. Thank you. Thank you, Krishna. So, I think when we got into the aim of the session was all about that integration, that partnership and that collaboration. And how actually we've got a common endeavor. We all want to achieve the same aims, but it was about recognizing that we can't do that alone. So, being in our own lane, being a sovereign organization with our own focus on tasks isn't going to deliver the changes that we need in terms of our support for our population to get the outcomes we need. So, if we come together, we are bigger, we are stronger, we have that breadth of how we can do things differently. So, we really focused on that. We focused on the principles of connected communities and how we can bring communities together and the value in that. How do we embed resilience into communities so that they are active participants in their health and care going forward. And we looked at some of the work that's going on in our neighborhoods. We've got four neighborhoods in South End and we have four neighborhoods in Castle Point in Rochford. So, across the Alliance footprint, we have eight active neighborhoods and we had people from the neighborhoods there talking about what they're doing, what's important to them. Really vibrant explanations of what's working for them and what difference it's making, not only to their residents but also to staff. You know, how it's really supporting them with the feeling, I'm sorry, feeling fulfilled. Retention, you know, giving them a reason to jump out of bed every morning and go to work and do a good job. And finally, we talked about how we could accelerate that progress. You know, how could we get out to the VCSE? How could we pull in our culture and arts? How could we really look at those wider determinants and not just focus on health and care and indeed how the Health and Wellbeing Board could help us champion that and bring that forward. It was a really exciting session, really good vibe in the room and I think it's enabled us to take things forward. And as you've seen from what Becky's presented today, as an alliance, our single mechanism for change is around healthy and integrated neighborhoods. Thank you. Thank you very much, Caroline. I'm just looking at the, you know, the notes for previous to the meeting and it's one of the questions was how do we draw health and social care together for effective joint delivery, which is what you've discussed today. Okay, thank you. Sorry, I've got the wrong thing on. Councillor McMahon. Thank you, Madam Chair. Are we on comments or questions, please? I think at the moment it doesn't really, you know, it's up to you what you want to do because we've had comments already. Okay, thank you. In which case it's comment. I'm very, thank you for the presentation. It's very interesting that looking around the council, the composition of this council identifies that because we're actually grouped into political groupings for the purposes of convenience, each particular group has a different ideology and a different method of achievement. So I think it's very useful to actually have an aspiration to be collaborative and to go forward. However, I think there needs to be the recognition that in this particular board, we either don't have true and open discussion and bring to the table all the expertise that are around the table, which are numerous and experienced. We have to have the method of how we come to a collaborative and cohesive opinion, which has to include challenge. Because ideology, the ideology of idealism just actually puts us into the realms of superficiality. Because if we don't deep dive into what is put before us, then all we're doing is rubber stamping something for the purposes of being ideologically cohesive. I'm actually a participant on a health and social care website, which is not pecuniary interest, just purely out of interest. And every day there is progress made because people contribute different opinions and different expertise. But I do think it's part of this board's role to deep dive into what is put before us. Thank you, Madam Chair. Thank you, Councillor Mcleod. Should Mr. Krishna wish to discuss this further outside of this meeting, I would be content so to do. Krishna, please. Thank you, Madam Chair. I would be more than happy to take you on this offer, Councillor McMahon. I think what you're saying is actually the principle, what you're saying is the right principle. I think it's sometimes how we get across that more effectively. And what we found is when you want to redo the deep dive, the informal sessions, surprisingly enough, we've had more attendance at the informal sessions than anyone. So people come to the meeting to really contribute at a much lower level and get to that bottom ground. So we actually get out of it a more meaningful output that then supports the next phase of the work that's been presented on the day. So I think this is the part where Mark and myself have suggested actually. If we sit down, I have a briefing with all of you about what is it we want to achieve, what's the common purpose in driving this together. First of all, with the Councillors and then maybe utilise another informal session, maybe in July, to draw up terms of reference that we all feel would be the best thing for us to take forward and come back to the meeting in September. And start driving forward what you're basically emphasising is the ability to digest what we are talking about, what are the real gain for that, for the population. And each of you have a contribution to make that actually helps us drive that forward as well. Thank you for that clarification. I have attended these meetings when Councillor Salter was sat in this chair and also with your predecessor over many years when you were working alongside Dr. Andrea Atherton and her predecessor before this board. So there is always additions that can be made, but I'm quite content to discuss this outside of this meeting. Thank you, Madam Chair. Are there any more comments? I think we'll move on now to the report from Better Start, South End, which is actually just, we're just going to be noting the report really. Yes, Chair, although I haven't got anything to bring out of the report, but given the conversations that we've had hitherto, I thought it was perhaps necessary for members who may be unfamiliar with this board to just set out what a Better Start, why a Better Start is reporting to the board. I'm Chris Cowley, I'm the Chair of Better Start, South End, which is a partnership set up. Thank you, Madam Chair. I was one of the founding governors on the board of Better Start, and my apologies for not declaring that initially, and also worked with Better Start over a number of years. Thank you, Madam Chair. Thank you, Councillor McMahon. So, excepting you've got a history with a Better Start and a really good, refined understanding of what it does, just for the benefit of other councillors who may be new to the sort of picture, a Better Start is a partnership formed with the council, our colleagues in the National Health Service and a wide range of other statutory and voluntary providers. Coming around the table, chaired by myself as an independent chair, but funded through the National Lottery to deliver a 10-year programme, which we're sadly coming towards the end of. In terms of reports to the Health and Wellbeing Board, we prepare a report for every meeting of the Health and Wellbeing Board because we're Lottery funded, and because we've got a very unique partnership, we felt it was important, certainly when I took over the chairpersonship, to have a focus for accountability of what we were doing. We moved to a position about five years ago where we said our primary point of accountability will be to this board, and over the years I've attended this meeting and produced a report, very much like the one in front of you at each meeting. And at times we have brought out particular matters that we want to bring to the board's attention. In this circumstance, and given the amount of discussion we've had on other items, I think I don't want to raise anything. I'm fully accompanied by the Director. I'm only the Chair, so she tends to know an awful lot more about what's happening in detail and depth than I do. She can't attend this meeting but would normally attend with me. But if I can answer any questions, either outside of the meeting or directly now, I of course will. But I've nothing, Chair, to raise in particular the reports in front of you, and I'd be grateful if it was noted in the normal way. Thank you. Are there any questions? Krishna, then the Council Board. Thank you, Chair. Just a point in terms of the next step as well. Mindful that maybe not everyone is aware, but obviously the Better Start Programme is coming to an end next year. So there's quite a lot of work going on in terms of exploring the legacy and sustainability of the Programme of Work in place. So my question really to Alex would be, would we expect to see some form of proposal around the end point of the legacy work and sustainability at the next meeting? Thank you, Krishna. I think that's an excellent idea to bring special focus to legacy and sustainability. I mean, in the conversation that we've had about domestic abuse, you've got a little sense of some of the jeopardy that we think exists as a result of the programme coming to an end. As a matter of difficult choices, we're not going to be able to wave a magic wand, neither is the Council nor our NHS colleagues. But I think if you're content having a focus on the legacy and sustainability plans and some understanding of what is a jeopardy next year, I think we'll be surviving in Southend and how things are going to change as needs and commissioning priorities change over time. So I'd be delighted to provide such a presentation through my Director and others if that seemed to be a useful use of the Board's time, either at the next meeting or in the very near future. Can we therefore ask that to be put on the agenda for the next meeting if everyone's agreed? Agreed. Okay, thank you. Councillor Boughton. Could I just ask a question about the overall performance, which is on page 21. It does mention that, where are we, the new beneficiaries have dropped by 312. It does mention, it could be families engaging with your family might play a part. I don't know what a better start are doing to try and engage with your family to find out if the numbers have actually dropped or not. And also, the lowest reach was Westborough, the figure has gone down. Do you do any analysis to try and find out what's happening across the better start areas to find out why it's going down? Two excellent points. I think we probably have a bit more data to add into the April numbers in that graph that you see in front of you, so it may give an impression of lower activity than is indeed the case. But I think in general terms, we reached pre-pandemic and probably just post-pandemic, a sort of level of peak reach in terms of how many families we are reaching in the target wards and in wider south end. And that seems to have leveled out at just over 50%, which, when I came into the role, was an awful lot lower. And we really set ourselves the challenge of reaching through the services that we're providing as many families as possible. And I think we've reached a point of peak that we won't, in the last 10 formal months of the programme, recover at this point. Indeed, as some things start to get switched off, we're likely to see those numbers go down a little bit more. Westborough is a really interesting ward, and I was talking about it with one of the ward councillors quite recently. It unfortunately kind of lacks a depth of and range of community facilities where people would naturally congregate. And so our data on Westborough has been stubbornly lower than most other target areas in south end for that reason. So that isn't a fatalistic point, and indeed quite recently we've been having discussions about how we can improve things in terms of reach in Westborough. And it may be that what we're experiencing, and it's not showing up in our data sometimes, is residents of Westborough consuming a Better Start services in other wards. So the picture might not be as black and white as it's presented in front of you here. But yes, Westborough does lack that group of centres and places within it that would be amenable to families with young children congregating a lot. So I think that's not an excuse, but probably a reason why that data's a bit lower than for elsewhere. Sorry about the interruption. I was going to ask about, not winding it down, but it will wind it down, how are you going to support the families who are using it at the moment? How are you communicating what's going to happen? I'm minded to kind of, I think that's the subject, or at least one of the subjects, what Krishna was proposing in bringing that presentation. There's an awful lot of work going on with families, with our group of parent champions, with our delivery partners, like Safe Steps, as we were talking about earlier. So there's a lot of work going on, rather than try to summarise it unduly, I think that that would be part of the content presented to you at the next meeting. Any more comments or questions? I think then we can move to, sorry. How much better Start has helped all the families in the selected wards, and it can't continue forever, but it's a shame it couldn't because it has had impacts on people and children and their lives. It's sad to see the funding come to an end, but well done for all the work and all the people that you've helped over that time. Thank you, that's lovely to hear, thank you. OK, thank you very much for that, Alex, and yes, we hope to see with the City family that that will be a new aspect of some of the work going into that, but that will be for the next meeting, I think. Yes, and I think with your permission, we'll invite the Chief Executive of the City family to come along alongside a better Start, so some of the future plans can be sort of located in individuals and things that are going on. Thank you. OK, so can we have the report on health from the Director of Public Health, Krishna, please? No, for information, sorry, it's just for information, yes. The Health and Well-being Forward Plan, a verbal report from the Principal Democratic Services Officer. Yes, so very quickly, the intention has been over the last few years to actually have what would, similar to the Cabinet Forward Plan, is to actually have a Forward Plan for the Health and Well-being Board for the forthcoming year. So I will be sending out a, if you like, template form for that to be populated by, obviously, the relevant officers and partners and our community representatives, where it's split up into, obviously, where we need to make items for decision, ones that we need obviously for discussion, so obviously like the ABSS that we've just discussed, and then ones that obviously we wanted to bring forward for boards information for noting only, so I'll be doing that in the next, probably week or so, in between general election work, so that will be coming forward. My plea is obviously for the likes of Health Watch South End, SAVS, the things obviously that we don't necessarily cover the Health and Well-being Board that I know you've mentioned in the past around things like housing, and it's how we get that onto the agenda for you and how we can have that collaborative discussion about it in terms of the wider determinants of health, so I don't propose you've got any questions unless you've got clarity around the process, but that's just for information for now, but I think Owen might have a question. Thank you. Through you, Chair, I guess it would be helpful to have the terms of reference when you send that out, so again, we can refer, if we've got items, we can then think does this fit within the Health and Well-being Board or not. Thank you. Thank you very much, Robert. Do you want to add something, Krishna? Thank you, Chair. I was going to propose in terms of next steps is that we have a couple of sessions, ideally one informal session in July, so we can start reviewing the terms of reference collectively, because we've got a number of items being discussed and raised today that we can actually address, housing being one of those, and it's never really been an item on the agenda despite trying to push this through, so it's a collective approach we need to take here, and I will also talk to Mark in terms of arranging a session to work with our counsellors as well, so we are quite clear what we want to get out of it. I think we can put that on, as noted, that we'll try and have a meeting in July before the next Health and Well-being Board. Are there any other comments or any other business? Looks like that's it, but thank you very much all for coming today and for the reports that will be presented, and the meeting is closed now. Thank you. Thank you. .