Transcript

This meeting is being audio recorded and will be uploaded to the council website. Could I remind people to speak directly to the microphones and switch microphones off after speaking. Could members please indicate if they wish to speak by raising their hands. I am happy to welcome four committee members, Councillor Moss, Councillor Morton, Councillor Snowball and Councillor Vernon who I think certainly Councillor Vernon has served on this committee before. We also got some visiting former members and visiting speakers but I'll introduce those at the time. I'm going to ask our legal representative just for some advice from members bearing in mind during the pre-election period and I believe that Brian Reid is about to help us out with that, thank you. Thank you Madam Chair. Madam Chair we are within the period of pre-election restrictions on publicity given that there's a parliamentary general election on the floor, we're all very mindful of that. Madam Chair I know that members treat such matters with great care and we're always very respectful during periods of pre-election restrictions, in particular the need to ensure Madam Chair that what is said at meetings is not perceived as seeking support for a political party or candidate in the election. So it is important that we mention that to acknowledge it. Of course Madam Chair this does not prevent legitimate debate and challenge on items on the agenda but I'm sure Madam Chair that members will take care in terms of what they say this evening. Thank you Mr Reid, thank you for explaining that to us. If we move to item 1 of the agenda it's apologies for absence, are we any apologies for absence? No apologies Chair. So no apologies for absence, has anybody got any declaration of interest as per items on the agenda? You can't see any hands. So if we move on to the minutes of the previous meeting, has anybody got any queries with the minutes of the previous meeting in terms of accuracy? I can't see any hands, I'm happy to propose those. I'll second all Madam Chair. Councillor Randy seconding, all those in favour? Any against? Any abstentions? For abstentions members were it pleasant at the last meeting. We now have public speaking and former Councillor Ayles is here and I believe she wishes to speak about item 5 so perhaps it's appropriate if Ayles speaks first. I think it rhymes that way. Thank you for having me, I am here. I didn't know you were speaking, I was just reading. I am speaking only in this mental health forum which is a branch from here in Macclesfield for a long time. I came upon it because the chair suddenly passed away and was running to run for a long time and I was just an attendee so I was there and by events I just became the chair which I'm honoured to serve as much as I could. In the first place I wasn't sure of all the things he did because he did it so well and I was the attendee who gave my views where I could and I was thrilled to know me, I have a long history in health and I was thrilled in the health industry. The first thing we had to do was to break together again and find out how he paid for the places and the links that he had and that took some time and so that took a lot of things because we're not sure how he linked, how he managed the links, how much he paid for the rooms, all those we have and the signatures of the banks and we had to go through all that. By the time we managed it we brought that together so so far we've had five meetings when I found the place that we could afford and the bit of money we had in the bank because the previous funders are no longer there and we weren't sure how we could go out funding it. Eilidh, I'm sorry to interrupt you but we have a time limit for public speaking, could you wrap up what you were saying please? Right, so far we've had six meetings and six speakers and one of it is training, have I got two or three minutes? You've got about another 30 seconds. Okay and we are going to get some other signatures because two people died and we have an attendance between eight and eleven at each meeting, thank you. Thank you Eilidh, thank you for coming to speak to us. I'm now going to move on to item five but I want to make members aware that we've got a slight change to the agenda and we are going to take items nine and ten after item five. These are just appointments so can I welcome Sarah Sinkin who is caring for and representing and Maddy Lowry from CWP who's joining by teams, thank you. Maddy are you going to leave the presentation? Oh I can do, I'm very happy to if that would be okay, I had thought Mark or Keith might be doing it. Okay so Mark and Keith are going to do that and members have got the, we are having some difficulties with the presentation because the projector's not working but members have seen the slides beforehand, thank you. Would it help, just interrupting, would it help if I put it on screen on teams? It's because of the size of the television, it's not showing up anyway. Mark are you starting off? Yeah okay, so I'm going to give an overview of the mental health partnership board and an update on some of the progress around the mental health plan. Okay so the mental health partnership board, we have reporting arrangements with the health and wellbeing board and we also do updates on the Cheshire East mental health plan to the adults and health committee and also the children and families committee so these updates are provided upon request. Okay so in terms of the membership, so we've got partners from across a variety of organisations so health, obviously one of the prime partners as well as the local authority but we've also got the police, other voluntary sector groups and we have lots of people now on the board as well with lived experience so carers and people who are members of various local forums. So just to say as well as part of the partnership board we've got a number of organisations who have their own plans and strategies and work streams which have been combined and obviously reflected in the Cheshire East Place Mental Health Plan which went live back in April this year. So in terms of working with other lived experience groups and forums so we've got obviously the Cheshire East Carer and Carer Forum which Sarah is here today. The East Cheshire Mental Health Forum which covers the Macclesfield and Condleton areas, Rick Hayley just gives a little bit of an update on and we've also got the Cheshire East Carers Forum and we've got representatives and children's as well so the children and young people's co-production work stream, we've got some members from that particular group as well. So we've probably noted there is a gap at the moment in terms of the local forums so we are looking to re-establish one which was based in Crewe so some of you might be familiar with the Open Mind Forum. So we're seeking throughout the course of this year to ensure that we have some representation from that forum on the partnership so that that particular part of Cheshire East is represented as well. Okay so in terms of how people with lived experience work with the board, so they've been in place since the inception of the board back in 2019. We have a regular slot on the partnership board agenda as well, each meeting followed with experience groups and carers to provide any updates or raise any issues that are pertinent to their particular area. We also have heavily involved them in the development of the recent Cheshire East-based mental health plan so they were heavily involved in obviously the engagements and consultation activities as well. This was obviously taken forward and included within that plan as well. So we can see obviously there's a heavy involvement from our parents, carers and people with lived experience within the partnership board. So one of the main activities that the board is currently focusing on is the Cheshire East-based mental health plan. So at every meeting, so that's on a bi-monthly basis, we have a specific focus on different priorities within the plan. So we have nominated lead offices who specifically lead on each of them these priority areas, they provide highlight reports to the board as well as verbal updates on progress. So this gives you an opportunity for offices to obtain feedback, ideas for collaboration opportunities and also to escalate any items that perhaps require further support in terms of partnership interventions so that there's opportunities there for people to really collaborate and ensure that we deliver on what is in the plan. So we also have a risk register in place as well which identifies numbers of actions to ensure that we can mitigate some of these as best we can. So just going to move on now with a little bit of an overview of the monitoring for the Cheshire East-based mental health plan. So I'll hand over to Martin. Okay so basically not fully familiar with the plan, there's six key priorities and I'll give an update on the first three of those. The first of those priorities is children, young people's mental health, and emotional well-being. So what we've achieved since the inception of partnership and waiting time for children, young people's initial appointments increased since last November and we've done what's essentially a deep dive, a JSNA, needs an analysis of children, young people's emotional well-being across the border. We've had good feedback from children, young people and teachers and parents about the My Happy Mark programme and there's not really until just now where they've done what the children, young people's co-corruption group and it is it's been fruitful I think you know to get a shared joint view of what our priorities should be. And the finding of workstream successfully reached the deployment of variable to target the support and funders in people. So what's fun next, we're going to roll out the ASH1 platform, our Assistant and Education team, and then answer what we've done. Further implementation of the My Happy Mind programme and the delivery of focus groups for care for children and care leaders in particular. So if you're very used to improvement, children, young people, waiting times for treatment appointments, your developmental assessments have increased and you know just you know getting away from that. But we're looking to see what we can do around waiting while initiatives to support families whilst they are waiting for an assessment and consumer benefits service. Moving on to priority two which is education and employment and training. Being a positive uptake in the senior mental health roles in schools across the country. An individual placement support service is in place to help people with mental health needs access employment in our supported employment team and supported employment strategy is now at the draft stage and that will be brought to committee later in the year when that's been developed. Some isolated and rural schools are struggling through their staff time, to do our you know some of our time with rural schools upon finishing pre-district and some of our more rural areas. And we will need to talk about how we support those schools to access and respect our providing education to support children in their community. Priority three, early intervention and prevention. So we've developed a local suicide action plan. You may be aware we have high incidences of self-harm and suicide compared to our statistical neighbors between the northern borough and just something we really need to and to double down on. We have more to go about strategy around physical health at the draft stage and we're looking at a training approach around making every contact count. What's coming next? The community's team will develop systems post for support and we're going to re-establish a small community just now. Working towards a monitoring of the framework for those that are active including associated with outcomes and the element to which actual physical activity action plan comes to partnership. And at this point I find I'm able to speak. Thank you very much, Martin. As Mark said in the opening remarks, the mental health plan touches on a range of things that come to activity in our partners and I guess building a community support with the function of local health and pylons. So in order to make the mental health plan digestible we've obviously identified certain areas which touch in particular on the mental health work commissioning role you know so by example therefore you know we've been working about a homeless object we're establishing them to be supportive of mental health problems who are homeless and there's a source for them to work with. We've been working very closely with the connected videos services across Cheshire and linking that into the Cheshire suicide prevention plan as well. What we're going to be doing next is a clear show of sale that went through Martin's perhaps later on because support for care has been raised from there of concern seems to have gone a little bit backwards I think in terms of support for care has been there supporting them in their care as well. Issues on stigma and discrimination is something that we work further on in relation to establishing the capital some of the issues in relation to those two elements and also working with other health colleagues to identify funding for domestic youth support especially primary care and the iOS model by the way is a particular model that is fortunate to use with training support and and again touching on housing and development of a new vulnerable and old person's housing staff which is going to be tried nearly for improvement I think is a form of reform and public program. We want to identify constellations of mental health services again concentrating very much on the lower levels support for people mental health issues and we are now moving from making space to providing support for people up to six months to develop a low-level mental health support pathway which relies on an active response housing service from ISL by one of our private libraries. It's always been a bit of a mouthful for me actually as additional goals and inverse from Steve who could afford it the most in after your title for a job. Anyway we think of our ICT colleagues have been defying them across primary care between our individuals and making a sort of prescribing and now we're providing for care for youth. Working time to access adult second care mental health has decreased but remained about four weeks except for three weeks three weeks. The longest rate on adult mental health in the past was 12 weeks. We're getting a little bit of some progress there but we're not there yet but where we want to be and see what the key is now working with all the care communities to consider and deliver the transformation change at the local level and again that's that's jargon I guess we're trying to ensure that the relationship between second and primary care is as close as it possibly can be. I've already mentioned that in terms of what you're doing next if you live a low-level mental health pathway that's not becoming funding it has to be and we're trying to create an alternative for them and they are very successful with the rise of 46 hours of support per week and we've followed your idea of their maximum capacity. We want to engage those that are providing the market with a new service model beginning for people mental health and complex needs. This is actually one of the lower levels of support for mental health, we've got quite a wide range now of support for people with complex, new and shiny mental health issues. What we're finding is now that we have a lot of step time to be able to do more less supported monetary care in order to make sure that the more effective and cost effective way is important going forward and finally we need to do what we want to do in this particular priority is managing localness or focusing on monitoring and supporting people in the path of universal assessment. The way we encourage is that first of July if you look at working list activity, again working list is a big area of consumable cost in the trends. We've already mentioned working list value is an element of support for young people and it's even working agreement I would say that people are gaining from that culture and the bringing is important for adults although a new machine and also some assessment tools, but that's not a good news item and I agree to that in part two. And again there's a very complex list of models working lists that have an increased amount of capacity not to service the industry and finally we need to play out these six places of support. I mean we've had some great improvements in relation to supporting young people with mental health problems and development of a human support team and basically from ANCOA which is a tier four establishment in the province of Chester, California and that can be taking a number of young people coming into second year through 13 admissions in 22, 60 days in 24, so it's a big impact on families in relation to working and it's proved very positive. It will be an evaluation of the of the service in October, contract management in the crisis Fed will move from the ICPP single in two and we are continuing to work with our first food crisis cafe and one of the macro speakers to support people with engaging in mental health crisis and to develop more accessible communities and Mark has already mentioned the need for improving our relationship with some of the schools. Schools have been identified by high referral rates and crisis services and that is a core initiative to do this year and so overall I guess we can say there's been some progress and I think these initiatives have gone in the opposite direction. Areas for corporate attention to, again as I mentioned, support for carers. A new one actually after I've arisen recently I guess is support for women-style prison. There's been a number of locations that have been released in terms of like innovation-style prison and I seem to see a reduction of the services of physical health care for women there and there's also concern about increasing mental health assessments that we do not communicate with people who need some form of hospital bed. and I think that's concluded. Thank you Martin, Keith and Mark. Sarah is there anything you want to add? No, I'm just here to help for any questions, it's fine. Thank you, and Councillor Garner is interested, we should speak to anybody else. Can you put your hand up so we can write them down? We've got Ploughs of Snowball, Ploughs of Warble, Ploughs of Ploughs, anyone else? Right, so can you start with Ploughs of Garner? Thank you chair, so the reason I put my hand up halfway through the process is because I'm somewhat confused. I was under the impression that this report had come from in Cheshire East place part of the ICB and yet the report itself to me has been exclusively presented by many of the Cheshire East staff. I was never in favour of the setting up of the ICB and this is part of the reason because I suspect that Cheshire East is being asked to carry a lot of the work involved in these programs and yet the provision of services quite clearly is from CWP and other primary health providers and I'm somewhat amused as to why we do not have a representative from the ICB here today to answer questions about the development of strategy etc because a lot of what we've been told this afternoon and I am sure that Cheshire East staff are doing excellent work in all of these areas but a lot of the work areas are not Cheshire East staff, we are not the service provider. The service provider is the mental health trust for other parts of the NHS and yet those people need to take responsibility for and ownership for the service delivery or failure thereof. It sounds to me like the failures in all of these services are from NHS providers and not from providers provided by this council and I would like to know why there isn't anything here today and I appreciate the name from CWP that is present but that is not good enough. The ICB when replacing the CCG was supposed to be interacting with us as members as well as with the council at large and that doesn't appear to be happening which was one of the things that I and former Councillor Judah were very keen to see happening and I'd be very sorry for the three gentlemen that have come here this afternoon because they are being held to ask to carry the can for failings of things beyond the walls of this organisation and I think if we are going to get reports like this we need to be able to challenge them and we need to be able to ask questions of those people who are responsible for the delivering services. We cannot just rely on our own good staff to do that and I'd like to register my concerns at this stage in the process. I know that colleagues will be asking the specific questions about the presentation much of which sounds very good but where there are flaws those flaws appear to be within the defined areas of work that don't fall within this council so thank you very much. Councillor Charles and Cmobe do you want to take that? So I'm really sorry Councillor Dartmouth. The report, if it's anybody's mistake it's mine. We were asked to bring the partnership board. The partnership board is largely supported by the local authority with the involvement of staff from across the NHS and so in bringing a paper about the partnership board and the partnership plan this is the report that we have brought. Maddie I know will absolutely be able to answer questions about delivery of services on the ground and I am very happy to go away and ask health colleagues from the ICB if they would be prepared to come and answer questions if that would be helpful but certainly mental health partnership board and similarly at the end of the year when the Loan and Disability partnership board comes it will be it will be a presentation read by local authority for those reasons. In that case I apologise because I miss I clearly misunderstood the reason for the presentation and understand why these three gentlemen are here because I obviously work with them in a different capacity and I also for manager for interested the minutes earlier on when former Councillor Haynes was speaking I forgot to say that I have also sat on that forum that she represents in the past so that should be needed thank you. Thank you Councillor Garland. Councillor Slobel. Thank you chair. A couple of questions related to the last part of the presentation. Overall assessment where it says areas of focused attention including improving support for carers and a deep dive into supported style and Keith gave me a bit of information there. I would like to know a bit more about the nature of the support for carers and the improvement that are planned and also I was at the Cheshire East Hilton World Board meeting the last occasion and staff as was mentioned I'd like to know a bit more about the plans as they've proceeded since then there was talk of a working group at the League bringing in various interested partners and I'm particularly interested in style of prison since I in a former life I've worked with staff at style of prison and with issues of style of prison I'm very interested in what can be done to address exactly the sort of concerns you've heard. Thank you. I understand that to give a really detailed answer might not be possible at this point in time. Give a pre-transfer then give a written answer to the rest of the whole of the committee thank you. Okay so respond to the issues raised by carers because probably not with Sarah that raised those in person at the last one meeting at the Mental Health Partnership Board and Sarah submitted quite a lengthy list of the reasons you can see in relation to amongst all the things the withdrawal of these experiments at Pareco's children and people and there's been some confusion from our commission for either in respect of Pareco's assessments and how those have been conducted we've been working with that commission for either and to address those areas of confusion and exactly what they are commissioned to do and what they should be doing and support caring carers and responding to the other points into writing and say that Sarah can pass those to care for among this. There are still some things that we need to do on that list of areas of concern that Sarah and others have left off and I'm not sure it's worth it and it's already gone. Yeah and in relation to the style of prison the main concern from our perspective from the mental health perspective is that we have scraped what we thought was to us and in respect of women who are going to the Middle East we're in a few days sometimes in a few hours and then notified that the mental presentation is set that it could be eligible for an assessment of the mental health plan and can we go up and assess them. There's a couple of challenges with that first of all you have to arrange a two doctor two medical expert recommendation to be sought from two different doctors and of course a lot of these women amongst all of them are in different areas Flint, Oldham and Creston and it's very difficult to ensure that these individual women are properly assessed and they're properly arranged in the name prior to them having to be released so far everyone has been assessed in a total of four different states arranged for but more or less in German as I'm testing, if you'll be honest with you we had one particular incident involving women in Flint whereby I think it was about three hours before people have three minutes before a dentist came forward in Northland area. Very quick infection on the physical health there I think you might already be aware from reports from the homeless and the nationally voting for the care of women who are pregnant given the you know satisfactory circumstances and whether the administration's medications are problematic as well as general health care and so what we're trying to do is to raise darlings in the open room the prison government is responsible for safe diving there and we are inviting the members of the local safe diving board as well as also the members of the institution of health and poverty, mobility, public protection, death by probation, animal streets, bring them out of the cold it's a closed institution and obviously it isn't but we want to ensure that there are things you look to our whole family and this is the day. Thank you Keith and thank you for those responses to council Wardlaw. I was very interested in your response there and I wasn't really talking about this to ask but what is, I find it difficult to understand why if someone in prison is approaching a release date that those assessments and preparations are not made in a timely manner I'm sure there's been but I can't think why that isn't all organized and you're left with Cheshire's council holding the ball in three or five hours or two days to go. Can you, surely there is a whole system behind the prison service which should, I can see your smile, that should be in place in order that Cheshire East isn't forced to deal with all this at such a last minute, thank you. The NHS does have guidelines for the transfer of prison under the second board date of the Mental Health Act from prison to hospital where they can accept from the mental disorder to show that she's in hospital and the process is capable of 21 and 28 and 92 in the directory it's done in the directory and properly and there are then other entities in the process. The difficulty I think that they say when they're asked a very similar question is that a lot of these members first of all come from different parts of the country, they're there for short sentences so they don't even get to go very well before their time on duty is at their own prominence. A lot of them are drug and alcohol problems so a lot of them already have, in fact probably all of them are drug and alcohol problems in relation to the domestic violence and the victim of exploitation, all sorts of threats and descriptions. So they're already a valuable group anyway, putting aside the fact that prisoners, so I think what is to do with the number of women there, the late presentations sometimes in relation to the mental illness, the fact that they get a lot from their short sentences, six months, three months and by the time they get to know them and then they stand they're released, they've been released to go on to their health of work. And I have asked them a question why they haven't really utilised the courses which are in place and they say it's because of that, that there isn't really that they have yet to understand what they need now before the time is basically lost. Thank you, OK. Councillor Caulker. Thank you for that answer, it's entirely what I expected, in fact it's exactly what you said in your presentation, but can we not challenge that further in, you know, I don't expect you to answer that right now, but it seems quite incongruous that the simple answer is we didn't know that sort of prison services are telling us, there has to be accountability for their care and safeguarding of their prisoners and not just a, you know, a last minute 24 hours, somebody can just be set up to fix this, that's just why I'm putting it for you. The schools programme, I'd like to ask you about, Councillor Woldlock, can we, sorry I have loads of questions, well you gave to answer the answer before. So I'll put the question to the quick, the schools programme, does it involve the academies, the roll out, you know, for the Happy Minds and the other programme, is that, are we rolling that out to the academies as well as our schools and then the adult and older people pathway taking 11 weeks or 12 weeks or so, is that about dementia or is that a combination of other things or multiple mental health issues? Thank you, Chair, thank you very much. OK, can we quickly answer those please? Yes, that's what I thought I would answer for. So the older adult pathway is for, it can be either dementia or an older adult with mental health needs, so we define it as people aged 65 and above accessing either, accessing community mental health services either for dementia or for older adults. So I can get a breakdown after this about what, you know, which numbers are which, but what we're saying basically is it takes about 11 weeks to access is the average wait time. Thank you, so the schools question? The schools question, I'll pick up whether our education's in the following days. So you're going to provide written answer, thank you. Councillor Colco? Yeah, just very quickly, I'm sorry. Yeah, sorry, very quickly, I wasn't taking that much time. Just the priority through the early intervention and prevention. I'm not quite sure, I've read the thing and I listened to your presentation, but I'm not actually sure what you're doing to intervene early and prevent all the problems arising. It seems to rely quite heavily on active Cheshire doing a prescribing, I don't know if it's a social prescribing or, which I'm actually in favour of, but if we intervene very early then we prevent a lot of problems later on. Martin, do you want to answer that? What we can do, probably subsequent to the assist, is include a little bit more detail around talking to AOPs and more, there is additional stuff going on, there's an additional stuff going on. So can you provide, you'll provide that committee in writing, thank you. Councillor Cloud? Thank you, a couple of things. First of all, this is an interesting report, however, it's a bit data-light. Whilst we don't need, you know, every last piece of information, we do need some indication in terms of how many people are improving, how many are not improving, what were the problems indicators that we are judging our plan against, because it's going to importantly achieve what are the areas of improvement, what will we do next. I'm assuming that my recollection of the plan, I know this was last April when we were looking at it, but you know there were indicators, performance indicators, so I would like to see something set against that so we can judge how well we are doing. And it's early days yet, this is a four-year plan, so we're not, or five-year plan, we're not expecting everything to have been done already, but I think we need to see that direction of travel. The second element of it is I'm really disappointed having listened at various bodies, whether that's the CCGs or whether it's partnership boards or whether it's health and wellbeing boards, we have repeatedly had these delays and funding insecurities around neurodiversity, both in our children and young people and in our adults. And we know that these are a vulnerable group, because not only do they have to manage those problems, but the failure to manage them also increases their mental health problems. So I would like to see what the longer-term trajectory is for dealing with that, because I don't want to be in another five years and we've still made no real progress. And I do know that our health partners are ultimately responsible for quite a lot of that element in terms of assessment and the provision of care and support, particularly from that health aspect. So those are things I'm looking for, not so much in this report, but as we move forward, I really would like to hear what's going to happen to addressing that. Thank you for those. I hope that those have been taken on board. We get a bit more data, various ideas about directional travel and also neurodiversity. Will you be able to provide a written answer to that or is it too early yet? Thank you very much. Thank you. So this report is to receive a note, so there's no vote. Is everybody happy to receive a note? Thank you. I'd like to thank Maddie for attending and Sarah for attending and contributing to the questions. We're now going to move on to item 9, which is the Cheshire and Merton side Georgia Health Smith Smith relations protocol. I think Ryan needs to go to his Jesus. Thank you very much for the items to be brought forward, but very grateful to yourself and the vice chair. The item 9 is on page 115 of the report before members this evening and it relates to the Cheshire and Merton side joint health scrutiny protocol. City members will be aware that the council has agreed to the establishment of the integrated care system, the joint health scrutiny committee and of course Madam Chair this comprises nine authorities. They're all listed on page 117 if you wish to have a look at those and the committee has got a protocol Madam Chair and that's been agreed already by all nine authorities and the legislation and we have always this evening if they wish to contribute, but the legislation which underpins the protocol changed in January of this year and the change effectively in the legislation means that the joint committee can no longer refer substantial variations in health service matters direct to the secretary of state for health and Madam Chair you can see a definition on page 116 paragraph 6 if you need to see that definition of substantial variations. Instead Madam Chair the joint committee must request that the secretary of state call in service changes but the legislation notes that these the circumstances must be exceptional. So that's the change in legislation and we can see some information about exceptional circumstances on page 126 paragraph 6.2.2 but the amended protocol Madam Chair or the amendments in it must be approved by all nine authorities of which Cheshire East is born and so the council and chair needs to do that. The recommendations are on page 116. It seeks a recommendation to council so council will be the ultimate determinant of this and Madam Chair we did check with our colleagues and the other nine authorities the vast majority of them have already approved approach to all there are one or two who's signing of committees or the council etc are still awaiting but Madam Chair I'll answer any questions if your committee has any. Are there any questions for Mr Reid? Can't see any hands. It's not a question it's just a reflection. I have to say that my personal view which is not going to be a great deal change in the grand scheme of things is that that removal of that right to forward to the secretary of state our concerns it is unfortunate because we did use it and we used it to good effect in 2018-19 in terms of the rearrangement of mental health services across Cheshire East and indeed some of the the rest of Cheshire in order to make sure that we had that provision within borough for our residents which might not otherwise have been the case. So I see that as a disappointing change but I also understand that you know that cooling aspect is still something that we can match on to even if the bar is going to be considerably higher. Thank you Councillor Cloud, that seems much quite an easy date. I'm happy to propose that we accept this to be recommended to council. So all those in favour. That's ten in favour anybody against. Any abstentions? So that's ten in favour and two abstentions. I think we might just need to redo that. Could you put your hands up again please. Councillor Adams is your chair hand up sorry. So that's 11 for two abstentions. Thank you we now got the right numbers. If we move on to item 10 which is appointments to subcommittees, working groups, panels, boards and joint committee and again Mr Rees presenting this. Madam chair page 133 of the reports back madam chair for members to look at if they wish. This is a regular report by chair for the committee to make its nominations to various boards and partnerships. Each of them madam chair is listed between pages 134 and 136 and important with the terms of reference of each body are set out in the appendices from support between pages 111 and 161. Madam chair the recommendations are on page 134 and ask the committee to agree those nominations. One member each to the health and well-being board and the joint extra health management board. Three nominations to the state of Cheshire's partnership and two to the Cheshire's combatting drugs partnership. Madam chair my colleague was vicious and circulated the conduct of some very helpful discussions with both administrators and leaders so thank you for the cooperation of the group. I believe that there's been an addition to fill and complete the picture of Councillor Place who I believe is the proposed nominee or one of the proposed nominees to the Cheshire East conducting drugs partnership. So that's the open today position madam chair and the recommendations are there in the report. Thank you any questions to Mr Rees. Martin Snowball. Thank you Mr Rees. I just wanted to clarify. I believe that I'm the Cheshire East health and well-being board. I think that I am the representative from the adults committee who are several representatives on the health and well-being board. I think we've got three possibly four representatives. Thank you. I'm happy to propose that we elect these people to represent the council. Anybody willing to second that? All those in favour. That's unanimous I think. Anybody against? Any abstentions? Thank you. Thank you very much you tennis Mr Rees. We're now going to move back to item six the learning disability review. Sorry we're now going to move back to item six the disability respite review and this is going to be introduced by Mark Hughes. Thank you. Right okay so the learning disability respite review has been conducted over the course of 23-24 and we're seeking following the review to develop a learning disability respite service in the borough and we've done a lot of analysis on the current services so we're ensuring that this new service continues to meet the demand and needs offers value for money and also improved outcomes for people with learning disabilities as well and we've conducted a very thorough review with lots of people across the borough including people who access respite services, carers, providers of learning disability services and also conversations with our social work teams who refer into these services as well. Some of the key findings on the services that we've included the benefits of respite so respite is highly valued by by carers to prevent you know ensure care of break and prevent care of breakdown and there's also some some views on actual service itself in terms of providing access to the community and integration with community activities as well and we've also found that occupancy across our current commission services and they've dropped significantly post Covid so we've looked at the occupancy data which has shown that we're perhaps not achieving great value for money in the current model as well and our in-house service which is located over at Wally News it really struggles to meet the needs of people with more complex learning disabilities this is a portion of a lot of the time to the actual layout of the building and also the staffing issues that this service is also had as well to ensure we can support people who require greater support so for example one-to-one support waking night support so in terms of the new model that we're we're seeking to go out to tender for this service we're seeking a more person-centered offer which can meet a variety of needs and also provide more integration with the wider community so for example more opportunities for individuals who are accessing this by to access eating activities to stay up late so that that would be something that we would want to heavily focus on in the service specification we're also looking at an improved accommodation offer as well we did a greater focus on the use of assistive technology which in turn will lead to promoting greater independence we also are seeking as part of the new model to reduce the number of units down from eight to six as well so in terms of the the geographical sweat we're proposing to have four units in the north of the borough this will include one emergency unit and two units within the south of the borough part of this and this redesigned offer will mean that we are seeking to replace the respite provision which is located over at lorry news in macclesfield so we anticipate that through the redesign and the reduction in units that we will achieve some savings as well from this potential intervention and also the need to spot purchase additional respite within the independent sector as well which can come at a high cost okay thank you are there any questions thank you chair um thank you for the report it's uh it's a very interesting report um i'm just a little bit confused and you don't have to bear with me i'm not not just bear with me um in uh in children's services it appears that uh going outside you know commissioning uh children's homes for example has uh has been an extensive option you know it's um we we used to have our own children's homes and um uh we now have commissioner outside so i'm just a little bit confused as to why we can't do this ourselves you know i understand that more it uses is inadequate but we can invest to say if that's um that's been a something that we've done very successfully in other departments um would it be better or would it not be better to um to create our own respite centers and and do it ourselves would that be a why is this a cheaper option that's one question the other question is um this uh we've um we're doing a five plus two so a seven-year contract has been proposed um is that going to be absolutely fixed costs so there's no risk at all or are there going to be instances that they can increase the price um and if so under what circumstances thank you you want to take those two marks yeah yeah so on the first question as to why and we are looking to commission this service externally so there's parts of the um market engagement we we did a lot of analysis on what it would cost obviously from a commission external service compared to our our in-house service and looking at the the model that we wanted to develop which was based on the findings so having a more person-centered offer and having an offer which you know provided better accommodation having an offer which produced better outcomes for people the ability to go out in the community so take taking all that into account and the actual cost of doing that in-house were far greater than what it would be you know to obviously deliver this externally and a lot of it comes down to obviously the cost of delivering services in-house in terms of the salaries and other other costs associated with the local authority but the other thing well as well was that we couldn't actually deliver and the actual service that we wanted to within the Warwick News footprint so that that was that was a significant barrier that and with with the size of Warwick News and and the layout we weren't able to say provide things like um en-suite bathroom facilities you know for everybody there because at the moment that is that's our shared provision within that site so so that that was the reason we wanted to replicate what come through the engagement from people who've been using the services that that model you know just wouldn't be cost effective to deliver as an in-house service so on the second question and in terms of the contract so we are looking at a five plus two year extension so as part of that that contract we want to ensure that there is sustainability you know in this contract for our providers to take this this particular contract on board so and prove our provider engagement that that was what to come back is obviously offering is great to sustainability for the market and so in terms of obviously the the cost surface that we have we are seeking to build into the contract that we will have uh annual uplifts as part of that contract you know to ensure that obviously it's sustainable for providers who are delivering this service and also to ensure that there is a mechanism by which we can you know your award you know any increases so that that will be put into into this the contracts as well for when we commission service yeah thank you mark council clouds yeah thank you um so first of all um we've tested the market and you are confident that there are providers out there that will um set up a first of all good quality of care care that we're looking for um that we can't provide ourselves at more than years anymore um but that similarly um they will be able to do that within a constant growth over that five seven years that is as assured as possible because we we have experience of other adults social care providers who have told us basically over about and um i don't want to be in that position over our elderly respite service um the other element of this is that part of the reason um when we were having earlier consultations at the first consultation um last july was some parents actually identifying that they weren't taking up rest because facilities were not good enough or they were too far away are we assured that if we then are providing a smaller number of beds with a higher quality we're not going to get into a little bit of a problem whereby those are able to access elderly respite are drawn back to the service as indeed you know i would argue they should be because the because the services are then better than they were uh because the one thing we should be doing when the previous item on the agenda today is at the heart of our towns so is that fact related to this going forward um can i um leave that one to the end and that's time we've made time for that one thank you um council gardener um i recognize as um the kept communities represented on the lv board the importance of respite to those who provide care but i'm wondering whether or not we are looking at the full panoply of options here i understand there will be occasions where it will be necessary for the care receiver to be relocated to receive care in order to provide the despite but it's then not an option to allow people to be the care receiver to remain in their normal place of domicile and the care to go to them rather than the care being provided so i'm not suggesting you don't do what's scheduled in this report i'm merely saying that i think there may be something else that we need to look at here which in in which we have a responsibility to those people who provide care to people often long hours with a little support direct support in terms of the day-to-day and provision and if we are going to keep those people doing that job so that playing that such an important role in the lives of those people we need to make sure that they are themselves fit and healthy and sometimes it's not a case of whereas if they if the careful person is in their own home i think there might be more uptake for them to be able to go away for a night somewhere or to go away from the kendall even longer knowing that they're the person that they care for is being looked after in a comfortable place that they know and are comfortable in so um that's just something that perhaps you can look at um thank you um i think jill groomer wants to quite thank you cancel we do provide direct payments for respite as well so individuals can purchase respite different to them but they just keep then going to somewhere else and then can purchase beds coming off their houses we also use shared lives as well for that's fine so we're going to somewhere but uh you know you okay oh i don't know what's happening there thank you you're welcome um council wardlaw okay chair i have experienced through my family who shared lives and i cannot speak highly enough of the facility wonderful people um changed my life and just share it um so thank you to them um i would like to pin you down a little bit please on the page 29 paragraph 12 how is the plan ahead of us going to assist in the reduction of costs on spot purchasing we're having improved facilities um which potentially will attract a wider audience and which will mean perhaps a higher demand which we were able to fulfill um so spot purchasing not clear how we're going to reduce that in this way and also just wanted to ask do we know where we're going yeah i think in terms of uh scott purchasing we are generally speaking about a very small minority and because of uh complex multiple physical and learning disability needs uh with a nursing element to it as well and um as it says on the 40th verification that uh on a contracted basis would be excessive there are some very good providers um in our area in cheshire west actually which i do a great job with that and uh i can't see that necessarily changing quite honestly these are very brave and a very particular e-sport type of care and there's a sort of service that you can hear i guess would have a main region physically but that's more as well not in the same extent as that i think so there's been some really important questions in there um and uh i think that question about uh should we provide ourselves or should we commission um is one that we are grappling with um as you'll be aware um the prevailing view across the country is has been that services should be commissioned for reasons of cost efficiency and effectiveness and that is a an approach that has prevailed for about the last 20 years we're not unusual in having commissioned everything out in fact we're unusual in that we retain provision unlike other local local authorities and clearly things are changing and there now needs to be serious consideration to insourcing services um that uh that has to be worked through very carefully to ensure that we don't end up increasing costs given the pressures we're already experiencing experiencing in adult social care um and there is absolutely something about um the market both in adults and children's having become more um commercialized and commoditized and that driving prices um the bulk of what we spend does not go to the workforce um and that raises some really serious questions so uh as i said the prevailing mood about insourcing and externalization is changing we are exploring that ourselves but there is nothing that we will do that will have a direct impact within the next three years we must do things this year and next year that will bring down costs this year and next year uh we think a five-year contract gives us the best opportunity there won't be anything in there that doesn't stop us um cancelling that contract if we have to um should we decide to have it resourced instead um but we we are at the moment clear that this is a way of uh making savings in the short term i would also say um and we will come on to this uh when we get into the finance papers um that at the moment there is clearly a level of provision around respite and care of support and the challenge has been about whether that is sufficient um the question we are going to have to answer over the next 12 months is whether that is too much um and with all the associated risks that go with that it doesn't alter the fact that we will have to bear down on activity and expenditure across all budget heads which will include carers and restaurants but we'll come on to that uh soon i am sure and tell us about so you can show us about the costs and savings so that's so at the moment this is the uh this is our best assessment of the best way of controlling costs on this service it may change and we are very alive to that but there is nothing we can do to build something that will enable us to deliver respite care in-house more quickly within the next two to three years. Thank you for that um i'm happy to propose the recommendations on page 2930 that we approve the new model and that we could delegate authority toward contracts to providers to the executive director of adults and how it's breaking. Thank you. Does anybody wish to make any comments or a debate? Councillor Gardner. I'm satisfied by the responses i received from uh the officers today um that this is maybe not the ideal option but it's the pragmatic one that we need to take because um we need to ensure that we have got some provision um because otherwise um and i i hear exactly what and mrs charlesworth may say about the pressure on the budget unfortunately the failure to allow these people to have some form of respite will only uh further expense further down the line we must happen to pick up a much bigger problem and i am supported of the proposition. i just can't uh any other comments? Councillor Kirk. Yeah just very briefly um yeah reluctantly i too support it although i think i i hear um the language that mrs charlesworth may used and i feel that in the long term selling off thank you selling off the off the site then using that money to uh to help or put towards our own restaurant care centres elsewhere may be a better option um yeah thank you thank you for your comments um so we've been it's been posed and seconded all those in favour right so we have 12 votes anybody against anybody abstaining one abstention thank you very much that's 12th floor and one abstention thank you everybody if you're patient and we're on to item seven the final part mickey you're going to read this yes thank you chair this report's starting on page 70 at 73 of the path device members with the final outcome the adults in health community services for the financial year 2020 return to school members of the committee being asked to consider the financial performance of these services well in terms of preference the recommendations are still paid 74 and recommendation two is for approval and it's the table one page the final item in position was 11.8 which is an increase from the fr3 full pass position the reasons for this movement are listed in the commentary and it's made up of the various a huge amount of work is going on to try and improve the overall position but not all of the funds and improvements were able to be delivered within the time of sales house things such as mitigations that were in terrain for 2024 and it was hoped that they would start to deliver at the end some unsuccessful negotiations with providers some lifetimes of old and complex of all direct payment we find that and being able to being unable to capitalize some costs and the usage of disabled facilities around alongside these movements the cost of external care have also continued to worry about the anticipated levels quite that we just are not increasing but costs are and so we have more of my customers work is also underway by both services and the finance teams to ensure that we understand as soon as possible the impact of 20 25 and financial forms and point one will be carried out in july using the 8th to june actuals we have any of these issues which would have been identified earlier which would allow us to take actions thank you very much thank you very much is there any questions to the officer that's the gardener and council client council gardner so uh thank you nicky i'm not sure whether it's gonna be you or jill or my arms this um i heard you say we haven't had an increase in the number of clients customers but that we have an increase that the customers do have are becoming increasingly complex and therefore expensive i am aware that for many years we have had an issue with um a provider in the shelter focus um whereby um people were uh placed there um on very high cost packages um which were being paid for by their families and that then circumstances changed and we pressure for moving that i appreciate that we don't have the ability to challenge our responsibilities but i am wondering if there is any way in which we can at that time renegotiate how much we are paying for that service because i suspect that um there may be some issues and i appreciate that um i have touched on this offline so i'm just wondering whether there's anything that could be shared now and i appreciate that it may not be possible and it felt too sensitive sensitive i'm happy to uh receive some form of uh thank you your welcome thank you thanks regardless and providing you with those tips the cost of our fugitive care have increased significantly the cost of pathogen of care for people transitioning from children's services who have some really big enemies are astronomical for example we have 44 people from the age of 65 in residential care at a cost of 6.6 million a year we have 109 people in supported living at constant 8.3 million per year the costs of providing care for each um we are seeing more individuals requiring one-to-one support and six-to-one support for three times 24 hours a day because of their penalty their physical needs their medical needs and the age of them and packages of care of 4 000 times a week thank you for what is a very comprehensive thank you so obviously this is a retrospective look at the budget system and you know thank you for your hand in terms of identifying the levels that we need to deal with but i'm very cognizant of the fact we've got another agenda item to follow and that has its own additional pressures so these pressures will be added concurrently to those that we already have and i welcome the fact that adults are able to actually bring the quarter one review in a july meeting um we're playing a bit of catch-up on some of our other committees but for this committee where the costs are so high i think it's imperative that we do keep that really close on what is happening um in terms of some of these costs i know that you have always been very much involved in um working with some of our national bodies in terms of national care costs working with adas and so on what is their feedback at the moment on this in the light of the fact that you know um inflation rates coming down energy costs have reduced that was what sort of triggered some spiraling costs what is anticipated to be the lag time between those rises gradually coming down or at least us being able to challenge providers on their business cases um against uh the costs that they're currently charging thank you yeah i think that's a really interesting question um so across the so across the north the northwest happens to be an outlier on cost and activity for people with learning disabilities against the national average um so we have just commissioned a piece of work as northwest adas to support all local authorities in the region to look at what is driving those costs um and what uh what interventions you might do in order to bring it down this is a person for this paper but it's also a person for the next paper um an initial assessment uh which is true locally as well as across the region is that um we have a number of uh providers who have a traditional model of delivering service which has um not responded to either the pressures local authorities are experiencing or some of the some of the changing service requirements that we are presenting um so we have some providers where we think there is over provision for people with lower level needs but um perhaps not the right environment for people with high level needs so you have large uh large workforces supporting people um and we also think but we haven't done the analysis to know categorically we also think that we have high numbers of people in the northwest associated with the culture of the old long-scale hospitals and that is still flowing through the system not least because um i am very pleased to say people are looking longer than they have ever lived with a learning disability um so if you look at learning disabilities as a as a group of people generally as i said the northwest is an outlier what i can say is having taught to my colleagues in london etc they are also seeing significant spiking costs for people with additional needs again linked to children coming through the system so we're going to have to develop a new model of care for people with learning disabilities going back to our last question i think there is a case for building and insourcing services but that can't be done without due regard to the business case and we don't have our business case yet so that is the sort of medium-term proposition older people is different so what we're seeing across the country is that those local authorities that have a high lg population which we have and a constrained nhs which we have are seeing a spike in prices beyond that which we're seeing in other places so some of our bordering local voltage structure but down in Cornwall or up in Cumbria seeing similar things and i think that is about price not necessarily about cost price and demand not necessarily about cost and so that takes us to how do we get more transparency around costs and and so you'll know that we're implementing care kit which gives us transparency but the other thing that we need to do and again is pertinent to the next paper is that we will have to be much stricter about price i'm sorry to say that the fair cost of care exercise nationwide 18 months two years ago now gave a head of steam to provide us around prices and trying to pull that back really hard but and again equally hard but absolutely necessary in the circumstances the local authority finds itself in we are going to have to ask for more third-party top-ups so we will have to be much much stricter about our standard price and we will have to be much more direct in requiring the families to make a third-party topper if their accommodation of choice is more expensive than that those are all tricky things to do not things we have done historically but they are absolutely things we're going to have to do now and forever now very quickly just two things so in terms of third-party top-ups i'm assuming sorry council do you need to leave okay i'll put you i'll put you on the list i thought i was doing something very strict i've lost my thread now um yeah third-party top-ups um so we're not just talking there about people coming into the system and perhaps having to make do with a home that is not exactly what they want because of cost but i'm assuming we're also talking about those top-up arrangements that then fail and may enable moving people from where they are to somewhere that satisfies our cost and then i suppose you've summarized what i was trying to say in terms of that head of steam that the fair cost of care raised 18 months ago but that was at the height of inflation and energy costs and everything else so you know my my challenge out there is um that world does not exist at the moment justify that charging um it's not going to be going wanted to pay for food quality care but it's got to be accessible and it's got to be financial systems thank you quite quickly yeah so so i think i made the point that i think prices become disconnected from the cost for older people um certainly top-ups for new people entering the i moving people is much more difficult because of the risks associated with that but we can't always out and i think the um the head of steam you describe is uh is absolutely what we've seen and we're now going to have to bear down on that because we have no opportunities thank you um just looking at the outcome of the commentary i'm just wondering and so uh late unanticipated changes also affected the final position and you did say that you were going to look into what could have been predicted and what couldn't um i'm interested in um the fact that you know this is a new phenomenon year-on-year anticipated savings are frequently not met the targets are not reached and maybe we should become more realistic in in our um statements around what we actually and it would what you know the wish list and the achievable um and and just be more realistic about that but what i'm really specific what i've asked about here is the agency recharges and the agency staffing i find agency figures across chesterly's council difficult to understand are they departmentalized and what agency figures are we speaking about here is it care staff is it um administrative staff what and how is that possible so our agency within adult social care uh 50 percent of the agency's stuff is in care boards where we struggle to recruit um the cost of bringing in agency stuff in careful is actually complete from the council because we don't pay holiday pay and that kind of thing so 50 percent of our agencies and care boards offer six vacancies the rest is in um a pre-mental health professional because we have to maintain a 24-hour seven-day a week statutory mental health service so we have um agency hours because it's difficult to approve we have had um for the past three years significant issues in recruiting occupational therapists we could not get our professional therapists so we have a number of agencies who are now slowly being replaced by uh permanent ones we are managing to recruit and we're also um trying to grow our own through the apprenticeship scheme and then it's social workers so it is careful and then the professional staff social workers yeah thank you chair um i'm going to support the recommendation i'm happy to either propose it or oppose second it but i'm just going to make a few comments in may um for 50 per day something's about to chop me up and shut me up but um i think that it's a personal view probably going to be endorsed by the rest of the committee but adult social care costs need to be a national cost not a local cost as you probably know um our actual budget would increase by an extra two percent five million pounds to actually um go into the adult social care budget i mean what we've got here is a significant drift let's put it this way and and of course we'll get the budget next next night but we've got about another 37 million there and my only worry is that um i accept what's been said in the report i said i'm happy to move the recommendation and what would be the perception now in the outside world i worry about in other words um it's out there and i think we're going to see that we've got a drift of something like 6.8 million and public perception up there isn't going to be very good thank you my question was really just thinking about um in terms of the cost if it's the individual cost the the high needs of people and i was just thinking you know obviously you know it's important that um that that they're prioritized i was thinking that i mean obviously and however we want we need to get back to control of the budget and everything else but was there anything that i know a while ago we talked about this national care service ideas and i've already think that could be funded really i hope that could be funded centrally through central government and i think in an exceptional situation like that if there's nothing that central government can do to support this high level of care i mean presumably it's enough grants that we could additional grants that we could get from additional places when we're on such finite budgets in this crisis situation but the statutory responsibility to these people i just cannot believe that we're not in a civilized society with this situation where we want to have these discussions thank you do you want to answer quickly in a word or where there are grants we have applied for them and i think what you just said is exactly right i cannot believe that in a civilized society this is where we find ourselves and that is applied to very social work in kesha at the moment that we cannot believe that every day we are making decisions between where people would like to spend the remainder of their lives and where we will pay for them to spend the remainder of their lives and that is nothing that any of us came into this this work to do but that's where we find ourselves and that is being stuck between a rock and a hard place when it comes to care because we all want to do what is right for individuals and to make sure that their lives are fulfilled so it is a rock and a hard place for us all thank you right if we can move on to recommendations on patients for which pass them around as proposed we have to consider the factors relating to the adverse net revenue financial output and we have to item three scrutinize the context of annex one which we have done the only thing we have to approve is the supplementary revenue estimate request for allocation of additional grant funding over five hundred thousand to one million in annex one section two ten two that is the only thing that we are we have to approve and i'm happy to second counsel around because we could move to vote all those in favor of approving the secondary grant estimate that's unanimous everybody in favor so if we can now move on to item number nine which is the um sorry even at service budget 24.5 adults and health 45 the adults in house connecting and this is in line with the mtfs it's approved by as well as the first update on progress against each revenue the recommendation has anybody got any questions on the uh budget for 24.5 house of clowns um thank you so um first of all um i'm just going to uh find the rad rated um elements so just looking at um those various items so how are we um mitigating against the new pressures in the year um can i first also add just at this point uh and i've said this at all thank you very much for the graduating against each budget line um and it ties in very closely with more highly classified of all committees uh back in january prior to the mtfs finance meeting so the committee members have a relatively easy immediate visual on how well we are meeting our obligations on each budget line over the course of a financial year so um we've got some new ones there so um you know i think it's referred to another meeting as a grad rating in some cases so well done for that but we do have this investment this this red line element that we need to do to establish the current budget pressure and to recover in terms of so i'd like to have a little bit more about how we're doing that and similarly because obviously in july that is the official one um you know the fact that we are going to be looking at it in july where others are waiting to september um i appreciate that as well so that's what i was referring to um in terms of um so i'll start by saying i think we'll have the opportunity but actually last year broadly speaking we delivered the same as we said what we weren't able to do was control that price pressure that we discussed and the price pressures we're holding all of the risk a moment in that line around the growth which is where we anticipate price pressure now i know i've said this before but it it there's repeating there are only four ways in which you can save money in adult social care fewer people in receipt of a service less service per person reduced unit cost of service or fewer staff those are the only four things you can do anything that you come up with um that you might think about doing as a saving profit under one of those four headings so that is what we are going to have to do in order to bear down on the pressure that we're seeing we know that the front door has held june 23 24. we actually saw fewer people at the end of the period than we did at the beginning of the year but we know that that is coming under extreme pressure and that is being driven by age and complexity in the community and an increased level of activity through the hospitals and children coming through from send um but you know we were we're trying to hold back reducing the amount of service that everybody gets requires us to review people and we're starting to look at how we can target reviews to reduce the amount of service that people receive um that might be respite it might be helpful around the home and clearly it won't be people in care homes because having entered a care home there are people who actually never move down to the care home the unit price is where they're putting a lot of focus and as i've said we've brought a tool to help us deal with that and we are currently setting and rolling out a base price that we wanted over the that is in line with the fair cost of care that we came up with 18 months ago and sort of two things one you know price has risen significantly beyond that but we also know that the things that were driving prices started to come down um and then there is a question about our overall levels of staffing which has always been lost on my list because we've not grown our workforce as activity has grown and although we don't we ended the year sorry we we ended 23 24 with fewer people in receipt of a service the number of people who came to the front door increased hugely and the number of people in receipt of an assessment increased hugely but we found ways of supporting them as well so those are the four things we're doing those are the four things we're focusing on in order to bring down expenditure i set out in the budget report in february this year the things the biggest risks that we were facing they were untunded minimum wage they were not being able to say categorically how many children were coming through the same system and the increase in activity we were seeing through the hospitals one of those things have gone away so i think we just need to recognize that we will start doing things we have never done before that will be difficult for the team but i also anticipate it will be difficult for families and it will be difficult for the councillors who will get the complaints and my only ask of councillors is that in full knowledge of what we're going to have to do nobody lobbies the team about making a more expensive decision than officers have already made i'm going to leave it there if that's okay thank you council gardner just a follow-up on something that's in this childhood they just said the garden would be um not being able to assess the uh sends pressure that you're going to see is this because there are people in the system who are still waiting assessment who are deemed to be children who very shortly will move into um adulthood or is it an issue of there not being enough relationship between the two departments i hope it's a former so there's a really important piece of work to be done to ensure that children have their ehcp status reviewed before they become animals that is the piece of work that children's colleagues are now focusing on doing that will have a huge financial impact on adults because if a child becomes a young adult with an ehcp they cost significantly more than they would otherwise so it has been really difficult to make the judgment about how many children will become adults likely to be eligible for adult social care for that very reason we hope we will have a better handle on that as we go through the next tribe ones can i just come back from that point of clarification so what you're saying is that um this work is being done but because if somebody as a child is in receipt of some form of support because of an ehcp there is no guarantee that we will they become an adult but they will get the same name of care how are we doing that i think it's almost inevitable they won't because um care rats standards are very different thank you so i'm going to try something with the care act we're indifferent to the children but however if that young person has a ehcp at the court have decided this is the care that they require then we found a duty to provide that care for example a youngster who we were paying the weird sense of requiring support totaling 175,000 pounds per year which is coming up for me the ehcp um resulted in the package of care at the residential school being 375,000 per year because yeah sorry can i just clarifying something you just said so what you're saying is because the court determined this person because there was an ehcp that stated residential education then and that was still enforced at the point of moving over to adults the package of care that we suggested you know and i understand thank you very much thank you passing around yeah just very brief brief comment um mickey i've just been looking at the um we've got we've got a red in the um in pain placing i mean i voted for the i voted for the budget so it was in there so etc but i've made this comment at the various committee meetings that in previous years we put five percent in and the the wage claiming came in higher than that so it plays in there probably the question as well for the for the previous item where we'll be i called it you know there must have been some pain placing in there as well but i do find that i've already it's April we get the agreement was open in amis july but as you can see if we don't we don't set up anywhere near three percent we've already already got some problem or anything okay thank you thank you very much um the recommendations are on page 94 but they are to note to know and to review so uh there's no vote required because i assume that most people are quite happy to know the report and to think we have reviewed the various items that are under the budget so we're now moving on i think i'm right to item 11 which is the need to stretch at ease health and well-being group which we just have to um actually uh we see so i just we're all willing to receive the health well-being minutes um yeah i'm noting the attendance and the public use absence and it would be helpful if we could know the rep i mean obviously i know who that is but there are several other people there who's knowing that many escapes but there are people there who i don't know who they are and it would be helpful if we knew which which body they were representing in the minutes that could be passed on because i meant yet again with the exception of louise barry and mark wilkinson and the person who is the final rescue service that we are again heavy and light on that various thank you i want i'm sure you can take that away so we now move on to item 12 which is the work program um has anybody got holland you want to introduce them soon you say we have updated this for a number of reviews and commissions that will come forward during the year i anticipate there will be further reviews that further items to be added as we start to look at the specific things we're going to do around bringing down the forecast overspend um can i just say we did have suggestions uh for uh an update on the one-year contract but that's been done so far informally and we had a request that at september meeting we have some idea of direction and travel for quarter two and that um we'd like some input into how the transformation program will be affecting adult social um so those could be added there's also you can check um a request that we do some briefing on time funding work there's a very normal three that kind of thing so again that would be a briefing on yes okay then i can see council coke has got a standard from council class council coke thank you chair just two very brief items um one is really uh for uh a public health issue um a short while ago we uh as you said you know i'm the chair of uh everybody health and leisure a short while ago we we suffered the tragedy which doesn't even come close to one of our apprentices passing away through a cup undiagnosed completely asymptomatic cardiac arrest um now as a result of that we've had all our staff or they've been offered anyway the opportunity of health screening up to the age of 35 and we we understand that five percent of those are going to be referred for further investigation so i just wonder if is there anything we can do to roll this out across the whole of cheshire east or at least look at um look at doing that because um in a in a in a school of a thousand we're talking about 50 kids who have got on those stats have got serious heart conditions that need further investigation um can be no symptoms they just drop down there uh so that that's one issue if not entirely and the second issue um just very briefly we in in children's uh when i was on the children's screening committee we um we had reg 33 visits of children's homes um and i just wondered whether we could do something similar to our commissioned homes because as counselors we quite often get complaints of sort of and i'm sure you do the same from uh from um families about yeah they're not really very good um and i just wondered whether we could go in there have a look for ourselves make comments bring reports back as counselors to this um to this committee in the same way as children's services did on the reg 33 just two issues to think about thank you obviously what counterparts have you got any suggestions yes um so first of all i think i may have misunderstood i thought we were having a quarter one report in july so in terms of the minutes everything i said about a july meeting just scrub um but um chair the chair has identified that we want to look at course one and quarter two um in terms of the direction of travel in september so apologies for that absolutely um the other thing i just wanted to mention and i think it's worth us thinking of a way that we might want to investigate this um on our work program and that is um jill very kindly helped me with a very complicated case this week uh which i am very grateful um but it was really quite concerning the lack of communication between strategic um and statutory partners so we had safeguarding we had social work we had nhs we had fire we had police we had housing trust we had the rspca and they were not talking to each other and i would like to sort of as a committee bearing in mind that cost partnership working is the core of what we're doing in health and we had reports today mental health reports how important it is could we look at our communication systems um because i i do consider that that case last week demonstrated a gross failure of communication between partners i would like to also say at this point um adult social care came in and they saved the day they haven't been told about all this but they actually um sort it down so thank you very much yes i'm happy to and obviously it's it's extremely saddening to hear about sudden unexplained deaths especially in young people it's an extremely tragic circumstance that has affected members of staff who were working with everybody and who were working closely with the individual must have been affected deeply so i think it's just i just want to know how much of an effect that must have had that it was a very tragic circumstance the instances of sudden cardiac death in younger people are fortunately very rare but when it does occur it can be extremely tragic i think i'll need to come back to you with a written response on elements of this because i i don't think um i'm going to be able to do the topic in justice in a you know brief reply but in general these are extremely unusual and um usually very difficult to detect circumstances where people have got often underlying things which are very difficult to detect and only tend to get found when a whole host of things comes together around that individual that leads to unfortunately a very tragic outcome um quite difficult to detect with random heart traces and things like that so we'll come back to you in a little bit more depth on that thank you very much indeed thank you thank you very much matt council burn so you remind me of that there's something else that comes from also that i wanted to mention i was wondering that there was an opportunity because we've all got lots of different things happening in our boards as counselors and i certainly have around our books and health and i'm supporting different people with my classes and we were i was just thinking was there an opportunity for us to have an informal meeting as counselors where we can share some of the things that are taking place within our ward and i don't know if that's kind of the big thing um to raise here but that was something we could go forward and could be part of the work program going forward i mean i'm sure officers can take that away look at that thank you so anybody else got any points hannah uh council moss thank you it's more important it seemed that it's not on the item um how's the garden did you want to ask a question no mine was to do the work program and it was to thank you and officers re-timing scheduling the item on the lb partnership to facilitate my holiday and thank you thank you um we don't actually have another business slot um so could we just close the meeting and then we'll unsecret your question because it's not yeah um so thank you all for your attendance and uh and a good evening and uh what's like well hopefully you'll start to stay out in the yard and enjoy the weather thank you thank you thank you it was just a question