Transcript

and well-being board. I will warm welcome to everybody attending. My name is Chancellor Argencio and I am the co-chair of the Health and Well-Being Board. This meeting is being webcast. Can I ask Joanne on my right to give us the housekeeping for today?

• Please can I request that mobile telephones and other such equipment to switch to silent mode so as not to disturb the conduct of the meeting. There is no fire test planned for today. If there is an emergency evacuation, please take construction from the council staff present. The assembly point is Tudor Square. The meeting today is open to the public and will be streamed live and to subsequent broadcast by the council's website. You should be aware that the council is data controller under the Data Protection Act. Data collected during this webcast will be retained in accordance with the council's published policy. By entering the meeting room, you are consenting to be filmed and to the possible use of those images and sound recordings for webcasting. If anybody hasn't collected the name card from over there including speakers, if you wouldn't mind doing it, that would be helpful. Thank you.
• Thanks, Joanne. Before asking members to introduce themselves, I'm just going to read something about the pre-election period. I would like to remind everyone attending and speaking today that we are in the pre-election restriction period. This means that the council has to be especially aware of its legal duty not to publish any material that may be seen to favor a candidate or a party in the election. There is also a requirement to ensure government policy is presented in a balanced and even-handed manner. Publicity is given a wide meaning and includes matters said in council hosted meetings. I therefore require everyone speaking today to confine their question and comments to those strictly necessary to conduct the business on the agenda and not to stray into incidental or related matters that might breach the publicity restrictions. Due to these rules, we will not be taking public questions today. So can I ask members of the board to introduce themselves and I will start on my left.
• Thanks, Jett. Greg Fell, Director of Public Health and Integrated Commissioning.
• Alexis Chappell, strategic director for adult care and well-being.
• Good afternoon. Ian Atkinson, deputy place director within the Sheffield Place team of NHS South Yorkshire ICB, here on behalf of Emma Latimer, who gives her apologies to HR. Thank you.
• Dr. Andrew McGinty, GP and clinical leader, Place for South Yorkshire ICB, deputizing for Dr. Zach McMaritady.
• Pat Butler, assistant director for school effectiveness, deputizing for Meredith Teasdale.
• Councillor Dawn Dale, chair of the Education, Children and Families Policy Committee and lead member for children's services.
• Jamie Anderson, district commander, South Yorkshire Police.
• Megan Norrie from SO, which is a community anchor organization in the north of the city and a voluntary sector representative.
• Hi, I'm Helen Sims. I'm the chief executive of Voluntary Action, Sheffield and a voluntary sector representative.
• Hello, Kate Joseph, chief executive of Sheffield City Council.
• Good afternoon, Yvonne Millard, chief nurse, Sheffield Children's.
• Dan Spice, policy support for the board.
• So I will just mention Kate who's taking the minutes and Amir who's doing the technical bits as well, thank you. Apologies for absence, that's item two, item one on the agenda, I believe. We have received apologies for absence from Dr. Zach McMaray, Dr. David Black, Councillor Douglas Johnson, Paul Ferguson, Janet Kerr, Judy Robinson, Lee Sorsby, Rob Sykes, Dr. Tony Schwartz, Meredith Teasdale, Alison Wells and Emma Latimer. Are there any other apologies that we have not been made aware of? Would you like to take a seat in one of the chairs there? Thank you. And then you can introduce yourself properly and maybe one when you get a chance, thank you. Thanks, did you knock down that apology? Thank you very much. And before we proceed, I would like to officially record our thank yous to Dr. David Black for his contribution to the Health and Wellbeing Board as he's been replaced by Mark Tucker from the Sheffield Teaching Hospital. And we now move on to item three, which is the Better Care Fund, and Martin is taking this away for us, thank you. Martin, can I just stop you a second? I forgot to do the declarations of interest. Are there any declarations of interest from board members? Thank you, thanks, Joanne. Good afternoon, everybody, I'm Martin Smith. I'm the Assistant Director of Transformation and Delivery, a joint role between Sheffield Council and South Yorkshire Integrated Care Board, and I look after the program management of the Better Care Fund. And the report today is a summary of the first year of the Better Care Fund and the quarter for return and the updates for the 24/25 refresh as part of the plan. Just for a refresh to members, the Better Care Fund is a mandatory joint plan owned by the Health and Wellbeing Board. It was signed off in September 2023 for two years, and that was what was agreed. This is the, this plan is, you know, this update is what's happened in the first year of the plan and the primary objectives of the Better Care Fund plan are to enable people to stay well, safe, and independent at home, and to provide the right care and the right place and the right time, which is related to discharge and supporting people coming home. So the end of year template has, because of the timeline, has already been agreed. So we've got a proposal in terms of the recommendations, which is to delegate the sign-off, because they don't match, which is a frustration we've tried to manage in terms of the return dates back to NHS England and when the board sits. So we returned the quarter four template on the 23rd of May 2024, having already been signed off by the co-chairs of the board. Just in terms of the summary of the first year of the plan, we met all the national conditions as requested. The one measure we didn't meet was around ambulatory care admissions, which are long-term condition emergency admissions going into hospital for Sheffield residents. We were requested to do a bit of a deep dive onto that measure because we weren't meeting the target for a number of quarters. And in the paper, we've got some graphs and some information around what that is. I'll go through it briefly, but I'm happy to provide more information. And there is, in the paper, stated that we have to do some more validation on the data. We will bring it back in quarter one in '24, '25. But effectively, we have seen a 14% increase on last year in terms of long-term conditions. This has also been seen across South Yorkshire. And mainly, this is related to chronic obstructive pulmonary disease, heart failure, and asthma. And the paper shows pre-COVID 2018 numbers to now. So there was obviously a big drop in the COVID period, and it's sort of returning back. That's what we're seeing, that there was a big drop, and now it's returning back. So although it seems like a significant increase, it's a sort of return to the pre-COVID levels. In the paper, we've referenced a lot of the work that's ongoing, and the support that's been provided. There's a project currently looking at some, why people aren't accessing some of the evidence-based support, like pulmonary rehabilitation for COPD. We also have our community response, our urgent response, and our support through YAS around what we're doing around long-term conditions and management of urgent response. We see that the COPD, cognitive heart failure, and asthma make up about 51% of the admissions. But they're not necessarily the ones where we're seeing the biggest change, and we are seeing variation between general practice. It wasn't included in the report, because we need to do more data quality checks on why that is. And some of those variances are because they're small numbers, and we've got linked data that we want to put in, so our proposal is that the next one will give a more detailed breakdown of what we're doing around that and what's happening in place. But I'm happy to take questions at the end around the work we're doing there. We are on track with all the other metrics in the plan, which is around discharge back to normal place of residence. And in the paper, we've referenced the recent report that went to adults committee around the work around discharge and all the support in that. 98% of people going back home following an episode which is significantly higher than our peers, and a really, really good measure that shows that we are living our method which is around making discharge personal and having the home first ethos. Our residential admissions target was lower than planned as well. Again, we're not putting people into residential care earlier than they need to be, they're being supported in communities, that's what this number's reflecting. And we've looked at that number and put a quite ambitious target for next year around that as well, to be in line with Yorkshire and Humber's average. We're significantly better than core cities on that. The reablement measure in '23, '24 was around people still being at home, we hit our target with that. And again, I've sent a link, or included a link in the paper around an adults committee paper and all the work we're doing around our reablement and enablement services and all the transformation work that supported that number. Again, falls is on track and included. And we went, I think I spoke to the board previously about the presentation that was taken at the Better Care Fund national event around our joint work with YAS and our community services around falls pick up and extending our falls pick up service and it's a best practice model. So we're doing a lot on falls that's to be celebrated. In terms of the finance update, the numbers are in the paper but they've both been agreed by the council and by the ICB and signed off in terms of the Better Care Fund budget for '23, '24, closed down, '24, '25 has also been agreed in terms of inflationary numbers and what's in the schemes. Again, it's included in the paper and I'm happy to take any questions around that. In terms of progress, the template asked, the end of year template asked for, where are you against your measures? We're doing well against most of the measures apart from the ambulatory care, but also asked for progress and highlights. So I've included some of the highlights. There were a lot of schemes in the Better Care Fund. So we selected some that we think were significantly better or we made the real difference in '23, '24 as part of the plan. One of those things around the work we're doing with unpaid carers and the support to unpaid carers, referenced the first carers road show that was held in October. There's around 60,000 unpaid carers in Sheffield and only about 10,000 of those have contact with the carers center. So we really wanted to push out the support that's available to support people in the city around this. Again, carers play such a vital role in health and care and supporting everything we do between the council and the ICP that we wanted to highlight and make sure that people had access to the support available. And in '23, '24 we saw a significant increase to the referrals made to the carers center and from the data from those, 100% of them said they were satisfied or very satisfied with the service. So I think it's something to be celebrated. The other element that I've included in the paper and I've included a case study around this is around our team around the person model, which is developed to individuals with complex needs challenging, where they have to link different organizations together to come up with a support plan for people. Again, that has seen an increase in people going through the service and the approach has been recognized nationally and recognized in terms of a good practice model. Again, I thought it was useful just to bring it to life a bit with a case study in terms of what sort of services we're doing and the offer that's being provided. And finally, in terms of the three top things, I think a discharge model and the work and the progress around discharge, we've got a new joint system role of supporting our discharge model. The adults committee recently received an update on all the work on discharge and the pathways around transfer of care hub and how services are working together to support people going through the right pathway and not decompensating and staying in hospital too long, and again, being supported to be home and then wrapped around. This links to the two measures effectively, the 98% of people going home and the re-ablement support when they do go home to support them. So 23/24 plan has been submitted and agreed. The 24/25 plan was only an Excel template effectively. So when the board saw the Better Care Fund plan, it is a narrative plan that meets the number of key lines of inquiry. That plan is still valid and active effectively. So that plan hasn't changed in terms of what we're doing over the two years. The 24/25 part of this paper is what's new. So the ask from the center was to update our finance figures which we've done and included in the paper, update our targets. There were tools available to us to set the targets. We've also gone through between health and care leads and we've set the targets for each of the measures this year. We refreshed the demand and capacity element which is part of the Better Care Fund plan in this as well. But we haven't changed the ongoing narrative or the core services that are in the plan. So the original plan that was signed off by board is still that plan and we'll still be reporting on that. The quarter one and quarter two reporting timeframes are an attachment to this report as well. And again, they don't match when the board sits. So we're asking as part of this paper today for delegated sign off and for members to note that the 23/24 has been submitted within the timescales and the 24/25 refresh to the numbers and the metrics have also been approved and submitted in the timeframes. Thank you.
• Thank you so much Martin. We've had quite a few meetings haven't we in the previous months and thank you for the narrative. I think it's really, you've kind of ticked all the requests that we made for that. I have Councillor Dale, just put her hand up. Councillor Dale.
• Thank you, Councillor Genzio. Please excuse me if this is not the right time to ask this question, but I'm really interested in the team around the person element of this. And I understand that the target is to discharge, not keep people in hospitals a lot longer than necessary and to encourage and improve quality of life so that people can stay at home for longer. But my fear is that we're driven by those KPIs but we're sending people home from hospital. I have a case today where an elderly member of the family had been hospitalised, was then put into like a six week stay in a residential and then sent home with home care, completely inappropriate. She was housebound, she was bed bound, she couldn't see. She was getting calls four times a day, but quite often between that things could happen and then she'd have nobody coming round. And then the time it took for her to get the assessments to get her into residential was really quite long. So my worry is that we're trying to achieve the outcomes but sometimes missing the fact that the person shouldn't be at home. So my worry, how are we ensuring that people aren't at home that shouldn't be at home, that should actually be in residential? Thank you.
• So Councillor Dale, it's a really good question. And I think what Martin's describing in the report is some of the national direction of travel. So nationally, what across all areas across England look towards ultimately the person be able to live at home, wherever that's possible. And recognising within our pathways that around sort of around 2% of the people, residential care is actually an option. What we have within Sheffield is actually a range of options for people whether it be intermediate care, as which is step down from hospital or equally, and we've got step up. And we've also got, which is another form of that, a support living. We've also got temporary places where people could be assessed while they're being discharged from hospital as well as direct residential care. So we do have a range of options where that's appropriate for the individual. But ultimately the aim is to enable people to live as independently as possible. What we can certainly do is look into that particular case and find out more to learn lessons from that. But certainly the feedback that we've had is that where possible people want to go home and want to live well at home. And our resources and supports are very much being geared towards that. And we also have I statements that we gain from individuals about the impact that we're having. And certainly year upon year upon year, what we are starting to see is our I statements, which are people's impacts, are actually improving year upon year upon year. So I figured I must be doing something right in Sheffield. But I think certainly, I think what we could do is we catch up after this and get more details of the individual case.
• I have Greg and then Megan.
• Thanks, chair. Martin, usual comment on track with all the metrics. Let's not underestimate how complex that is as a whole bunch of machinery that goes into that. So congrats to the team, et cetera. The ambulatory care thing. Yeah, very complex set of stuff. Numbers go up and down. Didn't worry me intently. One thought, is there something more to poke at here with regard to inequity? Healthcare delivery has pretty equalizing effect on unequal need. Is there more that we could do to level the playing field a bit more and further correct inequity by smarter use of resource targeting and the like? Easier said than done. You don't have to come up with their answer now, but they're welcome. A bit of comment on that at some point.
• I think the answer, yes. Yeah, we can definitely do more. I think it would be useful maybe to have a conversation with you or outside the team around how we put some of those models in. We did look at, as a first cut, where we were seeing large increases in long-term conditions change rate from pre-COVID to now. Were they in the most deprived areas? And it was interesting to see that it was a 50/50 split. But that's why we wanted to do the validation on it, because I wasn't sure that that was the case in terms of the numbers coming from affluent areas and more deprived areas seemed to be the same. So that's the bit that I do want to look at, 'cause I really want to understand, is this issue substantially affecting our more deprived wards? So that would be the next part of the report. Thank you.
• Megan.
• Thank you. On a similar vein, actually, I was really interested in the section of the report about the unpaid carers' support. A couple of questions associated with that, really. One was about, obviously, there's a lot of unpaid carers out there who aren't getting any support or that we know of that aren't getting any support or we know of. So I suppose, what's the ask of this board in terms of promoting the carers' support services that are available and the services that we represent? How can we ensure that more carers are getting the support that they need? And the second one was about the diversity of carers. And it sounds like there's a really good event, and just of those 10,000 carers that are accessing the support services available, do we know how many of those are from deprived communities? How many are from ethnic minorities? So yeah, I just was interested to know a little bit more about that.
• I can talk to those two points, but I can send some more information. I can include more information. There is currently a multidisciplinary carers' team support across health and care and the local authority around this. So yes, I think anything the board can do to promote the services available to unpaid carers and to signpost and anything they can do in their own organizations, if I share the information out as part of the board around what's available and how they can access it, that's a really good suggestion, so thank you for that. And in terms of, do we know the breakdown? I don't know off the top of my head, I would say, but I'm pretty sure that group is really well established and really works really closely with the carers' center and has been established for a while. And they were the ones that coordinated that event and all the support that went. And there is a plan, the carers' support has been built into our quality contracts, actually, in terms of through the ICB, in terms of asking those questions. So it is something that is at the forefront of the better care fund and there is an active group trying to make sure we get more people to support and the unpaid carers are recognized and supported. Thank you.
• Thank you.
• I have Alexis, one, two.
• Maybe just to come into support here, we have carers partnership group is in place, which is actually led by our carers and colleagues, and particularly the chief executive of the carers' center, who's a great asset and supporter of our carers in the city. And one of the key, so a couple of key things we've done to promote unpaid carers of all ages, actually, across cities, is number one, we actually had a dedicated session at the Health and Wellbeing Board, and we've done paid carers to actually promote the message and to promote what we're doing. That was the last one, which was really good. And the aim is we'll continue to go in, you'll have these kind of sessions, particularly through the Health and Wellbeing Board and through the policy committees. We've also got a dedicated multi-agency carers' delivery plan in place, which was actually designed with carers, because the views from carers was they didn't want yet another strategy, what they wanted was delivery and actions. And so, what's been really helpful, actually, through the carers to level practices, some tangible things that's happened, is actually the partnership with colleagues in Sheffield Teaching Hospital, we've actually produced a guide and a booklet to support unpaid carers, particularly the support of people coming out of hospital, 'cause that was something that people talked about, it was totally a crucial point in their lives. So that, we talked about that actually just in June, last month, and we could share that with the board. Equally, what we've also done is looked at how we could support carers more informally in networks across local communities, because often, people will not touch base with formal services, and I think that one of the key things for us is actually how do we support carers who are in communities who might not know, so that's a big focus of an area of work, and we've linked in to a range of organizations to go and take that forward, and particularly in the voluntary sector. And our priority this year is to be very much more community-led. That really is, that's our focus. And so I thought it's particularly strengthening the understanding of who is an unpaid carer, 'cause often people don't recognize that they are an unpaid carer, and so whatever big drives and publicity campaigns is actually recognizing that people are unpaid carers, and to support that both as employers across the city, but also in our own support. So lots of work going on, and certainly, we could share all that again with the Health and Wellbeing Board, but also we're gonna have further events in July post-election to go and promote and highlight carers again, 'cause we think that's really important.
• Thank you, can I make a suggestion that maybe if it's possible and feasible, next year when we have the yearly report, maybe we include that data as part of the report, share whatever we've said we would share with the board, but also maybe we can make the data public, if it's something that is doable without creating yet another data, a set of data. But if the data's already there, we may as well publish it, and then people know what's out there. So yes, sorry, I can't see your name from here.
• So it's Pat Patrall. Can I just ask how this links in with support for young carers in our city? I mean, particularly as a hidden group of young carers and the effect that has on their attendance, education, and their outcomes.
• Yeah, please.
• Yeah, absolutely.
• Oh, sorry, sorry, sorry. There's been a partnership group of, actually with children's services, and with colleagues right across children's health services, and also with young carers, actually university. And actually the priority over this year has been to actually going to highlight the role of young carers, and we've been doing it in different ways, is number one, actually with young carers, and a partnership with young carers. But also secondly, and I'm gonna say this from a different head on, from my own head and from adults, is actually often when you've got families where something is hidden, where you've got me grandparents who are also kinship carers and whatnot. So we've also been thinking about the family approach, and certainly universities, academia, have been very good at thinking about how do we really think about research, but also think about how we continue to go and escalate, and particularly a crucial point in a young person's life, how we promote better outcomes for young carers. So absolutely, and we could share all the whole suite of information to the board, and I'm going forward. That's helpful.
• Great, there are a set of recommendations there on page nine of the pack. There are some spare packs here if people need printed copies. The recommendations are, there are three, is note the 23/24 Better Care Fund quarter floor update, note the submission of the 24/25 refresh planning template, and delegate in year oversight to the joint strategic executive meeting, and sign off of the year reporting to the board co-chairs. Are people happy with those recommendations? Brilliant, thank you, Martin, for bringing this to us.
• Thank you.
• And we move now on to item four, which is the joint health and wellbeing strategy, which is on page 89 of the printed pack.
• Whilst Helen and Susan get set up, two thoughts. We're getting to near final here. We've got, we're broadly getting to a place where we're hoping to have this ready for agreement by the board in the September board meeting. You'll all have seen various drafts of the forms of words. The strategy's very heavily based on Marmot principles, and in effect will become the city's health and health and equality strategy, as well as formally being called the health and wellbeing strategy.
• Thanks, Greg. Susan and Helen, do you want to start for us? Thank you.
• Thank you, Chair. So yeah, this is a brief update on the progress of the development of the new health and wellbeing strategy. Remember that Susan brought a longer paper at the last meeting, which detailed a bit more about the whole strategy development journey that had taken place up to that point. Just a few reminders, hopefully this is very familiar. The overall aim and vision of the strategy is to close the unfair gap in length and quality of life by improving the health and wellbeing of those worst off the fastest. The strategy, as you mentioned, Greg, has shaped around eight foundational building blocks, which have been developed from the work of Professor Sir Michael Marmot, and four radical shifts, which are about how yourselves as the health and wellbeing board, as well as everyone else across the city, needs to make changes and work differently. The new strategy is going to be running over a 10-year implementation period, because we all acknowledge that there's no quick way round. This is about a long journey in the same direction. And that 10-year period will be broken up by three yearly reviews of your priorities and commitments, and then supported by yearly board action plans and annual reports and progress. So the first update is about the format of the new strategy and the language that's going to be used. So you can see in the papers that the microsite is currently under development, and we've shared that basic menu structure and the design concept. We're really keen to make sure that the language that's being used makes the content as accessible to as many people as possible and is in line with literacy levels across Sheffield, and avoids jargon. So we're aiming for a reading age of 11, and are proposing to call the health and wellbeing strategy in the microsite, the fair and healthy Sheffield plan, and calling the joint strategic needs assessment the picture of health in Sheffield. Some of the feedback from the public workshop back in January was that people really valued your visibility as board members in the development work. So you were hosting table conversations, you were presenting different aspects of the strategy development to the whole room, and we'd like to encourage you to build on that and enable people to have a greater sense of connection with yourselves as the board by participating in the development of some of the content that's going to be on the microsite. And you can see that there are some suggestions in the paper of the kind of things that might be. It might be a video where you talk about what it's like to be a board member, what it means to you. It might be introducing particular parts of the strategy, as well as contributing to regular blog-style content that can be shared with the public and with partners using the GovDelivery service, which is an opt-in email service that has a large number of subscribers across the city. The next update is about the radical shifts. So many thanks to all of you who were able to participate in the facilitated development workshop on the 23rd of May. I hope you agree that was a really productive session. You were able to develop your collective commitments to the four radical shifts, and there's a summary of the event in one of the papers in appendix two. After the workshop, the editorial team reworked the language of some of the commitments that you've made, again, to make them more accessible. And you can find those in the paper that's appendix three, along with the text that describes what each of the radical shifts are. And that's the text that we're proposing to upload to the microsite if you're happy with it, although it won't actually be published until the whole strategy is agreed. At that workshop on the 23rd of May, each of you who were there also made an individual commitment about how you were going to support the delivery of the four radical shifts. And we'd like to invite anyone who couldn't make that session to do that, to take part and to complete that, so that we can also upload them all together to the microsite. Moving on to the eight building blocks. So these are the foundations of Afera and how the future for all Sheffielders, as we've mentioned, modified from the work of Michael Mum. And you can see the draft descriptions of the blocks in the papers, and you'll note that we've made some modifications to some of the titles to make it more succinct, and that block seven is now very explicit about the importance of fair access to quality NHS and social care services in supporting health and wellbeing. And the editorial team is currently identifying important emerging priorities with each block based on our Sheffield data and insight, what the wider evidence says, and what we've heard throughout the development process from yourselves as board members, but also public and partners. Coming up in the diary on the 19th of July, we've got another facilitated workshop, and that's for the final phase of the strategy development work. And this is where we'll be able to identify where you as the board can add the most value and have the greatest impact on these priorities by integrating your commitments to the radical shifts, and then using that to develop an action plan about how you want to use your time and efforts for the remainder of the municipal year up to the end of April 25. We had originally aimed to complete the strategy development by this meeting today, but we really didn't want to rush that final, crucial part of the work. So the timeline has moved back slightly, which means that over the summer, the microsite will be populated with all the content, and we'll come back to you with a finished product for agreement at the meeting in September. The very last thing I wanted to mention is the approach to measuring and reporting what matters. So one of the collective commitments to the radical shifts that you made was we will ask people in Sheffield to help decide what to measure and report about making Sheffield healthier and fairer. We're really keen to make sure that we're not duplicating other work that's happening in the city, so we're working closely with the City Goals Transition Team to explore opportunities to develop that part of the work alongside or as part of the cornerstone indicators work, which is focused on developing an approach to measuring progress and delivering the city goals. So there are several different options. I think they're in the paper about how we might achieve this but we'll be able to bring more detail to the next meeting. So that's everything that I was gonna share, Chair. I'm happy to take questions or comments. Thank you.
• Greg. (mouse clicks) Are there any questions on the, wow, this is interesting. Okay, I'm gonna say it's because it is so clear and I think because we've seen you like in, and I want to say a huge thank you to the team because the amount of work that's gone into making it happen and making it happen fairly quickly, actually, has been enormous. And the session on the 23rd of May was really, really good. It went by very quickly and we had some really interesting conversations. So, Greg is coming in now.
• I've scratched me back now. One thank you to the team. It has been a genuinely amazing piece of work. Just I want to comment on the delivery plan. Lots of people say, well, where's the delivery plan? There isn't going to be one. It's willfully a strategy. Individual daughter strategy, for want of a better phrase, to feed into it. They will be clearly focused on delivery. But the thing that pulls all of this together would be delivery plan this deep and nobody will write it nor read it. So, I want to be really clear about that one. People will also say the outcome framework is the public health outcomes framework that's published by OHID annually. And our picture of health, aka JSNA, speaks very, very closely to that. And I just ask board members if they possibly can prioritize the 19th of July. It will hopefully be in everybody's diary. Things will happen. Things will go off track for all of us. But please, if you can, try and make it 'cause we're getting to critical time for the next 10 years, health and wellbeing strategy.
• Brilliant, thank you, Greg. And there are, sorry. Sorry, Helen, do you want to come in?
• Yeah, I've just got a question. Just, we're referencing Marmot in this work, aren't we? And really utilizing the health equity research. And I know Michael Marmot's been in town recently, so I just wondered if anyone had been to his first debate session and whether there was any kind of fresh thinking or reflection, really, on where we've got to and what he's saying.
• As one of my members of staff said, he came, we knew what he was gonna say, but it's like hearing your favorite band live for the first time. There's nothing to beat hearing it live. And he was very, very good. But he didn't say anything surprising. And we've cross-referenced all of the stuff that Professor Sir Michael has said pretty much throughout. Nearly verbatim with one or few Sheffieldizations of it. But there'll be a remarkable read across with what Mike Marmot recommends with this is where we eventually get to.
• Yeah, I can confirm it was really good. Maybe we can have a conversation after the election. (audience laughing)
• There are nine asks of the board. They are on page 89 of the pack, and I'll read them out. Note the summary report of the outcome of the strategy workshop on the 10th of May. Approve the wording of the four radical shifts and the board's collective commitment found in appendix three. Number two, develop individual commitments to the radical shifts if they were unable to attend the workshop on the 23rd of May. Number three, note the current descriptions of the eight building blocks found in appendix four and make any relevant comments to support further development. Note the design concept for the new health and wellbeing board microsite, which will host the strategy. Support using language everyone can understand in the microsite content, agree to participate in developing video content for the microsite, and blog style content. Note the time scales for finalizing and publishing the new strategy, participate in further development workshop on the 19th of July. If that is not in your diary, please put it in, and provide any additional steering guidance, including the role of the public and partner organization in development and endorsement of the strategy. Are people happy with those asks? Thank you very much. Thank you, Susan and Helen. And we move on to item five, the growth plan, and I have Diana presenting this for us. I believe you have a presentation. Yes, thank you, I do. I think Greg just wants to do a little bit of an intro, if that's okay. Only by way of framing and narrative. Growth productivity matter enormously to the city, and the city is developing this piece of work. The supplemental paper that went out in the pack after the main agenda, apologies for that, was basically the strategy and resources committee framework, which I think was the March strategy and resources committee, and Diana will talk us through where that got to and where we're at. Brilliant, thank you, everybody. Yes, so I'm Diana Buckley. I'm the director of economy skills and culture. Thank you for inviting me here today to speak about the growth plan, which I'm leading on as behalf of the council and our city partners. So I'm gonna give you a quick overview of the process that we're going through at the moment, and really what I'd like from you today is any initial ideas of where you want content developing, how you want to be involved as a board going forward to kind of influence this document. So I'll just start with why do we need a growth plan? So the council has a council plan now, and as a city we have the city goals, so it really feels like the right time to start to look at how we prioritize growth and prosperity in the city. We've got quite a lot of different strategies and plans, and you as individual organizations will be doing actions that impact on growth, but there is nowhere that brings this together and articulates the common direction of travel, how we want to grow, why are we growing, and that's really what's critical about this growth plan. It's going to bring those narratives together for us into one place, and it will do so hopefully at a time where we're likely to be asked for local growth plans, and when the Merrill Combined Authority is focusing on their plan for good growth, so it'll allow us to respond to any future requests from the Merrill Combined Authority. It will also make us much clearer when we're talking to national government or investors about what the city's here for, what we're trying to achieve, and what we need from them. So in terms of what we've been doing so far, we started by listening. So we engaged with around 70 stakeholders, 65, 70 stakeholders in the city. There was a list of some of them there, but not all of them, and we held focus groups with specific groups as well, so I think some of you might have been involved in some of those focus groups, so thanks very much for supporting that process. In those groups and those one-to-ones, we were asking things like, what do you think the city's key assets are, what are its key challenges, what's important for Sheffield's future, what role do we play in South Yorkshire, nationally and the world, and where are our opportunities as a city and our blockers? And from all of that information, we brought together a strategic framework, and this is what went to our Strategy and Resources Committee in March. It came out with three key themes, one around our economy, global, green, and growing, one around celebrating and growing our vibrant, cultural, and creative Sheffield, and one around growing our neighborhoods together. And it was really good, I think, for us to hear from the city how important having creative and cultural industries was as part of an economic plan, as well as growing our neighborhoods. We probably expected to hear the green growing and global element, but the other two came in through us strongly to make this strategic narrative. The other thing that was really clear is what we need to do to grow, why are we doing it, and how are we going to do it? And these have been summarized in looking at prosperity, people, and planet. So in order to grow, people were really talking about an asset-based approach, looking at where we've got opportunities in the city, where we're strong, and really focusing on those. So things like our world-class assets in the universities, our skills profile, areas where we've already got things to build on, why we're doing it, this was really clear. We need to improve people's lives in the city. It's about tackling inequality and the disparities between our places, and making sure more people in the city have got a better standard of living. And then how we grow. There was a real concern around the planet and sustainability, and ask that the infrastructure that we need is put in place in a sustainable way, so that as we grow, the city can handle that, and it's not causing planetary harm. So there's a bit more detail in the SNR paper that had been circulated, but this went in March this year, and has now been adopted cross-party. But that becomes the basis for the work going forward. But obviously, some time has passed since March, so what we've been doing since then is looking at areas where we're making significant progress on some of the strategic direction that impacts growth. So through our policy committees in the last 18 months, you might have seen things like the transport vision, our destination management plan, our culture strategy, the employment skills strategy, and these are all jigsaw puzzle pieces, which are now being adopted in policy that add up to this picture of growth that we want to paint for Sheffield. So we've got a lot of policy direction and thinking already done that we need to bring together, so it's more coherent. Also in the last few months, the SIMCA Plan for Good Growth has been launched. That's gonna be a core document for us as a city. We need to play our role in South Yorkshire, and make sure that we're supporting growth in South Yorkshire more broadly. And there's some really good areas for action, collective action together in that document, that focuses in on kind of sectors that have a prosperity to, a propensity to export. It focuses in on innovation and our assets, particularly in Sheffield around tech, and creating a really good place to live, and making sure our transport and infrastructure is up to par for kind of future growth. So because cities are complex and interconnected, it might feel a bit fragmented to have all of these different strategies, but you actually need them. What we do need though is also to bring these together, because not one intervention on its own is gonna solve the problems of the city, or reach our growth ambitions. So the growth plan is really to bring all of those ingredients together to look at, where are we strong, where are we weak, are there any areas that contradict, and where can we build together? So we're putting together kind of the critical ingredients for the city's future economic health. Just in terms of the timeline for this, since it was adopted, obviously we haven't stopped working, we're developing the document. So throughout June and July, we'll be continuing that with more analysis, collation of evidence, and drafting some ideas. So do you guys have any evidence or any case studies or information you want to share at this time, to kind of inform some of the first drafts? Then going to go into more of an engagement session, obviously this will be after the summer, so you can get hold of people. We want to do that with specific groups, to target in areas where maybe there's a strength or a weakness or a specific opportunity. So we'll be doing a lot of engagement. We'd like to know from you, how you want to be engaged with that, but are there any groups that you can leverage and bring in that we could talk to about this? And then we're hoping to do some drafting, and a final growth plan will be adopted towards the end of the autumn this year, '24. And we'll go to the Strategy and Resources Committee for a final sign-off. I just want to end with kind of saying how important working in partnership is for these huge strategies. And as you've just been hearing about the health and wellbeing strategy, you'll get this. You know, there's not one lever we can pull, and there's not one of us that can enact change on our own. So collective leadership and that Team Sheffield approach is really important, and that's why I'm here talking to you about economic growth today, 'cause we recognize your organizations and how integral health and wellbeing are from an economic perspective. So how do you want to be involved? How can you get to a point where you or your organizations can stand behind this growth plan? What do you need to do and be involved in to make sure you can go back to your organizations and recommend that? How do we connect as you're developing your health and wellbeing strategy, and we're developing the growth plan to make sure the narrative is really strongly connected within there. We're already working closely with the city goals, which I think gives us all a really good start and a sense of direction, and as they've been engaged and consulted on so much, it's a really firm foundation for both of our documents, so we're already doing that in some respects, pulling together. So yeah, I would like to open up the conversation, really, in terms of any ideas or observations, reflections of things you would like to see in this document and how you might want to, from a process perspective, get involved going forward. Thank you.
• Thank you. Are there any questions or comments? Greg, oh, sorry. Sorry, Helen. Was I first, was the fastest?
• Yeah, really welcome the plan, and really pleased to see neighborhoods are a key kind of foundation of it, and I think the offer from myself, my organization, people that I'm working with is to do the work to understand, well, actually to understand neighborhood, what we mean by neighborhood and what that means to different people, and I think that leads into really understanding where people are at and what they want to see, what good growth looks like to different people, so welcome the sort of invitation to sort of think about different groups. It'd be good to know who you've already connected with in terms of communities, so we can make sure that we're bringing forward perhaps more marginalized groups into that conversation, but yeah, I think we'd like to just see sort of a hyperlocal approach to this, and I think we can probably support in defining some of the principles around how we go about this as a city. For example, taking a local approach to developing neighborhoods, we probably need the expertise that's within those communities, and how do we make sure that things like commissioning deliver that and value that properly, so yeah, really, really keen to work with you on it.
• Any other comments? Greg.
• Thanks for three things, and just to assure members of the board that I'm doing, and Dan knows this, I'm doing some of the connecting between health and well-being strategy and growth plan, as is Helen and our others, and it's tied closely with the city goals. Don't rely on me, so if members of the board have got comments they want to lob in, please do lob them in, 'cause that really, really, really matters, otherwise I'd be way at limiting step. Dan, you made a point on the sort of maximizing the levers that the city has, I hear lots of, oh, there's nothing we can do, it's all inherent in the government, I think there's plenty we can do, and I think we all need to reflect on how we do that, and last point, this sort of nailing the inequality growth trade-off is probably a false trade-off, actually, I think we need to nail that as we go, that's a content thing for further down the line, but you know I care deeply about inequality, as I suspect you do, too.
• Alexis.
• So again, just want to say, great to read, great plan, I think it's great ambition for the city, and particularly that focus on, for me, is tackling inequalities and improving the outcomes for all, as part of this. A couple of key thoughts, I think it'd be helpful to think of as part of this, is the health and social care is a significant part of the economy of the city, and it's actually a priority within the South Yorkshire ICP strategy, is building the economy, and particularly that recognizing the contributions that may be worthwhile to make that link, 'cause I think there's also a wider set of works that's going on that would support this work, so I just wanted to kind of highlight that, get a strategic link, then secondly, I think there's also something about how do we also think about people with a disability, and particularly those who are seldom heard as part of this, the growth strategy, because people in neighborhoods are also people with a disability, and with a learning disability, and those who are non-verbal, and I want to make sure that their voices are actually captured, you know, as part of the growth plan and what we're doing, and particularly for those who need to grow more accommodation and more housing locally, to ensure that these individuals are not having to be placed out of area, so I think that would be a really good way to block us into the growth strategy and growth plan, so thank you.
• Kate.
• Thank you, Chair, obviously I agree with all the points being raised, and I think it's really important that the growth plan has at its heart an ambition and a commitment to good growth and growth that supports our people, all people in the city, to access opportunity. I suppose the one thing I wanted to flag, which we've spoken a lot about those aspects, but I think, thinking about some of the other themes, there are some really important intersections with the work of the Health and Wellbeing Board, so while, you know, in very knowledge-intensive, high productivity jobs in the city will not be for everybody and I think it's really important, as Alexis has said, that we're really paying attention to our foundational economy and the jobs that the vast majority of our communities do, and making sure those are fantastic jobs, which support health and wellbeing, it is also the case, thinking about the other aspect of those knowledge-intensive high productivity jobs that I think as a city, given the assets we have, our universities, our health, wellbeing organizations, our fantastic community organizations, I don't think that we've made as much as we can about the potential for the city to be a real engine room for the sort of research and innovation around wellbeing and health that are both our city, our region, and frankly our country and the world is going to need going forward, so I just want to flag that 'cause I think it's an item where colleagues representing the universities or the teaching hospitals or the children's hospital or others will want to have that in their mind as well, it needs to be an expansive plan and it needs to be a plan that is also about, it's about the twin challenges of tackling inequity and inequality in our economy as well as growing our economy and that comes from deeply productive knowledge-intensive jobs that we can export around the country and the world.
• Thanks Kate. Andrew.
• Thank you, Gia. I think just sort of building on what you've just been thinking and Alexis too, I was thinking of when I was, in my own GP practice when we had a big growth in our local population, suddenly there were more patients who needed care and support from our practice and so although it's very exciting, it's very optimistic to think of growth and I think that's a really important thing, with growth comes stretch and I think whilst it's really important to think of the ambitions of growth, we mustn't forget the potential unintended consequences of stretch as we grow and I think that's what you're alluding to in terms of the kind of inequalities and worsening inequalities and our missingness within our populations as those who are brightest or biggest or fastest grow, disproportionate to those who can grow more slowly, we must be mindful of the unintended consequences along the way.
• Yes, thank you.
• Thank you, Gia. As obviously a really new member of this board, you just really give my commitment that we'll be engaged in my leadership team and I've already got some thoughts around case studies and some of that analysis that we've got access to that might support that commitment from us.
• Brilliant, thank you. Are there any more comments? Can I suggest that if people want to go back to their organization and have more comments or they want to kind of digest things and then come back maybe to get in touch with Diana with Di directly, is that okay, Di? Yeah, of course.
• Yes, please do get in touch if you've got anything further you wanted to add and I just wanted to accept those offers of kind of different groupings of people that we bring together, that's great. Well, if we could work with you to convene those groups, we'll absolutely come and listen and learn from those. There is also a point around neighborhoods and that hyperlocal, that's an area we want to develop over the summer and into the autumn and test, so I think there's a real opportunity there. Thank you all for your support and your efforts of help. Just on two things around sectors and then like the balance between growth and inequality, we are definitely looking at foundational sectors, health and social care, hospitality, construction. They form the basis, the majority of the jobs in the city around kind of 66% I think is what we think. They're really good to connect people into work and create pathways to get good careers but they're also not that high value sometimes and so we also need to bring in, as Kate was talking about, the knowledge economy where we're gonna trade, bring more money into the local economy that can then be spent in hospitality and local sectors. And just in terms of reassuring you around the purpose of this strategy, we absolutely are looking at how we increase growth and productivity and tackle inequality. They have to come together. Critical to that is infrastructure to avoid that stretch on systems and places that can't handle it. So the growth plan will also talk about housing around local infrastructure that's needed in our neighborhoods to make sure that as we grow, we've got the capacity to grow. And then at a city level, infrastructure and transport will be critical, both to connect internally but also to the rest of the UK and internationally. So that absolutely is embedded in our approach of this growth plan. So just wanted to reassure on that. Thank you.
• Brilliant, thank you. We are just asked to note the update and I assume that we'll hear more once it gets back to SNR. Thank you. And we are going to have a 10-minute break now, but I'll be straight with time. So it's on this, okay, it's 15 or two, so 10 minutes and we come back. We are now on item four, sorry, item six on the agenda is changing future. And we have four people presenting for us. I'll let them introduce themselves. Thank you.
• Thank you, chair. Hello, everybody. Yeah, we brought quite a gang today and we haven't all got name badges. So I feel very privileged that I have, but so I'm Sam Martin. I'm one of the heads of commissioning in the council in the integrated commission and public health service. I'm one of the two senior responsible officers in the council for the change of futures program along with my colleague, Suzanne Allen in housing. I'll let everyone else introduce themselves.
• Yeah, hi everyone, I'm Vic Sterling. I'm the head of services, South Yorkshire Housing Association. We were very luckily successful in setting up and managing the co-production services part of changing futures.
• Hi, Justine Adams. I'm the changing futures program manager and strategic commission manager for some housing related support contracts. Louis Cajet, program coordinator for the co-production service at changing futures.
• Okay, so yeah, we're here to talk to you about the changing futures program, which is a program that's working with and trying to change some of our systems and processes around the support that we give to, I guess one of the most highly vulnerable groups of people in the city really, which is adults with severe and multiple disadvantage. I'll tell you a little bit, some slides came out with the pack. I'm not gonna talk those through verbatim. I'll just provide a bit of a summary. Give Louis, Justine and Vic to talk a little bit more about the co-production work, which I think has been one of the real successes and valued aspects of the program. And then we'll just finish off with a little bit of the final slide which are about the future 'cause this is a national program that will end at the end of this year. So for those of you that don't know, so Changing Futures is a national program that we are one of 15 successful areas that were bid for a couple of years ago to run. And the program aims to work with people who've got severe and multiple disadvantage, which is a combination of all of mental illness, substance misuse problems, problems with homelessness and rough sleeping, exploitation, involvement in the criminal justice system. So a whole bunch of stuff that all taken together make people so highly vulnerable. And I guess on the back of the fact that there are a number of services that might work with those people, but actually a lot of those services are about one particular aspect of their life and there isn't really anything that joins all those things together and tries to work with them as a whole person. And that's really where the program is trying to kind of take learning and deliver some lasting change for individual people. So we have 1.2 million pounds a year of grant funding from government to run the program, that ends this year. And what we've been doing with that program is two things really. We've worked directly with over 100 people in the city who are experiencing severe and multiple disadvantage. And we've done that with a kind of key work approach. We've employed some direct key workers to engage and work with people. We've also done a whole load of kind of system change work around the edges of that. So programs and projects, for example, on work around cuckooing, which is a big and growing issue in the city. So bringing organizations together to work out a policy on how we respond to cuckooing 'cause it impacts on lots of different services and impacts on people in different ways. A piece of work around women who've had multiple child removals and sort of impacted the trauma of that and the way that that then impacts on their lives in terms of their psychological wellbeing and implications for them in terms of their chaotic lifestyles. So a whole piece of work on all that. And a whole bunch of other things that are kind of around inclusion health. So one of the aspects of the program that we found was that a number of the people we're working with, or the team I've been working with, are excluded from health services. So they're on a risk register. So it's harder for them to access some health provision because they appear as a sort of dangerous patient and all those kind of things, even though some of the reasons for that might be a long time in the past, the kind of stigma of that sort of stuff and the label sticks with them throughout their life. So a whole load of programs of work there that we could talk about in endless detail but I'll choose not to today. I suppose a couple of things worth saying about the program and how it works is it's a real partnership. So the way that the lives of people are quite complicated, I guess, and interface with lots of different services in health, in the police, in probation, in the council, and with our voluntary sector as well. So we've got some really strong, thriving voluntary sector organizations working in this space like the Archer Project, like Ben's Center, that we've partnered up with who are part of our kind of delivery team. And I guess one organization on its own can't make the whole difference. Now the council has led on the change in futures program in terms of putting the bid in for the money, and Alexis is the chair of our board, but actually it's a genuine partnership. So we've got some of the investment in health services, in mental health, for example. Greg, you know about that. We've got some investment in voluntary sector around positive activities. A whole bunch of stuff going on there. It's not all just about what the council's doing. And that's been a real strength of the delivery and the way we've set the program up, I think. In the slide set, you've got some of the outcomes that we've got so far. So we're doing some evaluation, which is feeding into the national evaluation for the program. And we've had some real successes in terms of the lives of people that we've been working with. So reductions in things like offending behavior, which are measurable. You can look at the cohort of people we've worked with and say, the year before the program, there was this much offending, it's now dropped to this over the course of the couple of years we've been working with them. Things like safeguarding frills. This was a cohort that had huge numbers of safeguarding frills. So agencies referring to adult safeguarding were worried about this person. We don't know what to do. And no one else knows what to do either. So the number of those referrals has dropped significantly because we've got people engaged with those individual people and trying to help them sort their lives out. And so people aren't as worried about them, I guess, and we know what we're doing with them. The other things that have changed, reductions in referrals through to a MARAC, which are multi-agency processes around domestic abuse and exploitation. So again, the group of people that we've been working with, there were huge numbers of referrals through to those processes in the years prior and running up to the program starting and those have significantly dropped off. Some of that's been through direct work we've been doing with perpetrators who are kind of repeat perpetrators and their offending behavior has reduced as a result of that. So there's a whole load of really good stuff in there at an individual level, but we've only worked with just over 100 people. We know when we did the initial start of the program that actually there are probably maybe one or 2,000 people in the city that might meet the criteria for the program. Probably only had the resources through the government money to set up a program to work with just over 100. So we know that there's this kind of level of need out there that is a lot bigger than the program is at the moment. What we've been trying to do is work out some of that sort of cost avoidance stuff. So inherently, we know that doing this good work and reducing the number of AT&T attendances, for example, for a cohort of people, makes a difference to the system. It's often, people will know this, I haven't been involved in these sorts of bits of work before it's really hard to quantify some of that stuff. You know in your bonus that it's making a difference and it means that it's freeing capacity up in other services to do other things than work with the same person again, week after week. But trying to kind of put an amount on that in terms of pounds and pence can be quite difficult. There's lots of ways to do it. All the varying kind of degrees of confidence, I guess, but part of what we're trying to do with the program is illuminate a bit of that and show where that's kind of making an impact. So there's some details about that in the slides which you could look at at your leisure. And some of that's feeding the national evaluation 'cause there is some work going on in government around trying to lobby and say actually look, this makes a difference to the Treasury, it makes a difference to loads of other government departments' budgets if we can do it at scale. So we're obviously trying to support that piece of work as well. We've put some case studies, which I won't talk through, in the slide deck that you got with the papers, but they just give you a bit of a flavor of the individual work that we've done as well as the kind of system change stuff. What I really would want to do though is hand over to these guys to talk a little bit about the co-production work 'cause I think that's been one of the big, it was one of the big successes of the program. We set out initially to say we're gonna really have a go at doing this because as a city we've got pockets where we do this stuff quite well, but we've never really invested a whole load of resources and time and capacity into trying to really make it work. And so we've really done that and I think there's some real successes and some learning that's come out of that that I think is really useful to just help my colleagues talk a little bit about. Shall I hand over to you?
• Yeah, shall I start? I'll just give a bit of an introduction to the co-production service and some of the key things that we're working on at the moment. Like I said before, at South Yorkshire Housing Association we're really lucky to be part of the co-production service. We're working with a really big number of people with lived experience of recovery in the city to be part of the design, delivery, evaluation of services within the systems that they might have experienced in the past to really feel like they're contributing to how services are delivered and improved in the city. There was just four things that I wanted to pick out from the work that we're doing at the moment that I thought it would be really nice to share. The first is last November we launched a pilot of a city-wide co-production training offer. It was co-produced by associates on the programme and it's co-delivered by them as well. We've had 60 people today on the programme so that's across third sector, public, local authority, probation, all types of services that support people with multiple disadvantage in the city. And we've got a waiting list for the future events. We hold them monthly and the popularity I suppose has really grown for those events. We started with an intro-level co-production offer and we're moving to an intermediate one now as the capacity and capability within the city grows. The second was peer audits. So we've been working with co-production associates who want to get involved in auditing services in the city. We worked in partnership with Crazer at Sheffield Hallam University to deliver accredited training to people to be able to go out and evaluate and audit services for people with experience of multiple disadvantage in the city. There's three parts to that offer. The first is light touch, a bit mystery shopping. The second is a face-to-face service visit and the third are qualitative interviews with both staff and service users, including people who maybe haven't really engaged with that service and understanding the reasons why. And again, this is absolutely all part of people being involved in the design and improvement of services in the city. The third is just wider co-production associate involvement in systems and services within the city. So getting involved in housing independence surveys, tenders, temp accommodation strategy, that's something upcoming, getting involved in women's move on housing. So we're really feeling like the co-production associates that offer to them is really developing and there is choice now within the co-production service about which bits they might want to get more involved in, either at a strategic level or getting more involved at various levels, really. And then the last thing I wanted to talk about was we've really thought about approach to recruitment, both for volunteers, but also paid staff. And we've seen some progression that Lewis will talk a bit more about, we have people coming into the services volunteers and moving into paid work, often the first paid role that they have had. And some of the things that we're doing there is advertising in a very different way, offering informal drop-ins, giving people the opportunity to come in and really understand what the service is about and get familiar with people. We have lived experience co-production associates on the panel, so there is that lived experience and the decision making about who comes in. And we're really working in partnership with different organisations, including Sheffield City Council. So we've recently recruited two peer support workers to support people who are leaving prison and to help them to understand housing benefits and all the rest of it. And those roles are starting soon. And I can't go without saying that the team recently won a Gold Award, that was the team, not me, for the lived experience chartership by Career Matters. And it's just been really important to the team to get that recognition for the brilliant work that they've been doing and it's made us all very proud. And I'll hand over to Lewis to talk about a bit more about involvement and progression in the service.
• Thank you, Vic. Yeah, hi everyone. It has and remains a priority of ours to ensure, to the best of our ability, that involvement for people with lived experience is meaningful and most importantly to them. And we do that in a couple of ways. And first is to sort of ensure where we can, that the experiences they share and insights they provide are used to inform better working and thinking practices around supporting people with multiple disadvantage. And the second one is that we have a progression and development opportunity that underpins the entire program. So it's not a common let's take from you, it's a common let us share for you and improve for you. And as part of that, there's training offers, there's different progression offers. We're extremely mindful that it's not for everyone paying employment, it's about making space for them to realize their potential in ways that's meaningful to them. And we do that in ways I mentioned, like the training offers or opportunity offers, or sitting just down with them and listening to them and what would improve their outlook in the future. Yeah.
• Great, I think the only thing I would add is that I think Vic's being quite modest. The over 40 people went for the career matters chartership and we were one of five organizations that achieved gold in that, so yeah, being modest Vic. But yeah, it was great to get that recognition of not only lived experience in terms of co-production, but also recruitment of staff in paid roles that aren't just frontline support roles, but there is a place for anyone with lived experience where if they don't want to do peer support or support work in senior kind of management positions as well, so yeah.
• Thank you, so just in terms of what we've learned, I mean, there's a whole bunch of stuff on the next few slides. I can see that you've kind of moving them on, keeping up with us, which is brilliant. Which I won't reiterate, but I think the big thing for me about the program has been not just learning, but about building trust. I think there's something about the trust that the individual people get from the relationship with the key worker, for example. Building that trust right from the start and maintaining that trust is I suppose ultimately the key factor in anyone's, you know, making a difference to anyone's life, I think. But it's also about building trust between services. So this idea that people bounce around, well, you know, we're a bit too difficult for us, or we can't help you with that bit of your life. You need to go somewhere else. There's something about the program trying to sort of live that value, really, of well, we can help and we can bring people together to try and help with things and we trust each other. When someone says I'm worried about somebody, it's not me trying to kind of pass a problem on to you, it's about us trying to share the answer to that and share the solution. So I think, yeah, trust is the kind of big thing, I think, that I would say is the kind of fundamental learning for me from that program. And how do we kind of engender that in our systems and processes so that they're not just about mechanistic referral processes, but they're about the human at the centre of all that, I think is the kind of key thing. Which isn't easy to do, actually. I guess it's a principle we should all be keeping in mind, I think. Our next steps, though, is the final bit that we just need to sort of put on the table. So we've had a program which has been funded by a grant from government, which has been great. It's done some really good stuff. Everyone's been really proud of that. That funding's gonna end in March next year. We start to do quite a bit of thinking and some conversations about, well, what do we do next? And I think the last couple of slides just sort of explain that what we're thinking about is, we've got the opportunity, really, to say, well, that was a program. Now it's how we do things as a city. And so developing what would be a kind of forward strategy for how we support people with multiple disadvantages, what we're aiming for. We're hoping to sort of bring something back, at least through to the council committee process for kind of approval, at least from the council's perspective in the autumn. And we're hopeful that the kind of partners around the table who have been involved in the program will sort of support that as well. And we're hopeful, obviously, the Health and Wellbeing Board will be supportive of that. Obviously, that would take some of the learning we've got from the program so far. Plus, I think some things like one of the questions we've got is, well, we've worked with 100 people. How do you stop some of the people who are on the edge of being on multiple disadvantages falling into that as well? So how do we think about that slightly wider cohort of people who are very vulnerable, but at this point we haven't been able to engage with? So some of that thinking is quite complicated stuff, but we've done a couple of consultation events with a whole bunch of partners which have been really helpful to sort of feed into what might any strategy look like. There's some stuff in the slides that kind of teases out some of those aspects. And I think some things like the key worker role is really important, the co-production aspects of it, plus some of that kind of community practice learning and development process stuff is really important too. So we will try and pull that into something that's so coherent and bring that back for people to kind of approve in the relevant forums over the next few months. There's also a question about how we might resource that going forward. And we're also involved in some complicated conversations about what do we do when the money runs out? 'Cause obviously various partners, including the council around this table, it's not like we're all awash with cash and the public sector's pretty strapped. So we're doing some thinking about how we might make that work over a longer period of time. And I guess the opportunity we've got there as well is if it's no longer a program funded by government, we can build something that's much more aligned and embedded in the wider work that we do in the city and isn't a standalone piece of work or a standalone service, but it's more integrated as part of a network and a kind of framework of stuff that we do to support vulnerable people in the city. So more work to do on that. And I guess the ask of the board is to, where you can, both as a whole board and as individual operations, be supportive of that. And if we come and ask for a conversation, be receptive to that would be our ask, I think. Thank you, I think that's got us to the end. So thanks for putting up with us over that period of time.
• Thank you for that. I have Kate who wants to come and comment, ask questions.
• Thank you, Chair. I firstly, I just want to say a huge thank you to the team. I think the work that Changing Futures do, particularly the co-production team, is something that I think we as a council in the city should be incredibly proud of and impressed by. It's something I think that is a real example to many, many other services. And I always get a bit twitchy when, I know Sam, you have to say, we have to say that funding is only here until next year for this, but I think it would be, it's really incumbent on us as leaders to be making the case very clearly and in an evidence-based way for the importance of these sorts of approaches and the learning that we've had from this programme. And so as we think about how all of us, wherever we are, whether we're in the NHS bit of the system, the local authority bit of the system, the police, as a kind of, as a system of public servants, that we're making the point that this sort of highly personal, intensive work informed by lived experience makes a huge difference, I think is really important. And it's something we've got to do, thinking about sort of timing over the course of the coming year and anything we can do collectively to provide a bit of kind of comfort to the team that while we do that work, that they're safe to keep working, especially given the fact that we know that the funding we have had from government has only allowed the team to work with a really quite small number of people and there are many, many more people in Sheffield who have incredibly complex needs and for whom this model could really work. So I just want to make that case. And then also, and there's a bit of a segue into the points I'll make around the council plan, reiterate the things Sam said about our recognition as an organisation, we need to get far better at instead of just doing little pockets of these sorts of projects, driven by funding from central government, we need to get better at thinking how do we embody this approach across all of our services while we're working with citizens and customers with complex lives and needs and who need us to be there for them. So that was all I wanted to say really, but it's just to kind of say my personal thanks to the team for all the work you do and how great it is to be able to show you off to people coming to the city. (chuckles)
• I have Yvonne.
• Thank you. Brilliant piece of work. Thank you for doing it. Might seem odd that I'm saying something from the children's hospital, but actually what I need to say is what you're doing will have a huge impact on the lives of children and young people because they either become adults or surrounded by adults or are influenced by those adults around them. So I think what you're doing is gonna make a difference certainly to children and young people. It really resonates what you say about how people bounce from service to service when their problem becomes a bit too wicked for us and we kind of push them along. And what you've done to me really demonstrates the city around the citizen, which is what we should be doing really, all of the services pulling around that one individual. So I think it's a great piece of work. Thank you.
• Greg.
• All that Kate and Yvonne have said. Firstly, folk often say to me, What does prevention actually look like? There you are. So thank you for that. Are we involved in shaping the national evaluation? And there's a question, are we better than other Changing Futures programs? And I don't know that, but I'd be dead interested to hear that. And my other thought was, just to give some thought to what mechanisms we've got for embedding what we've learned, whether or not there is future funding for this or not from any future government. How are we embedding what we've learned into our mainstream service delivery across multiple sectors, multiple spaces and spheres? Because if we fail to do that, then we've clearly missed a massive trick.
• I'll start and are we better than everyone? Maybe that's a good place. Yeah, so I think literally this week I've finished a 57-page evaluation on the individual outcomes of the cohorts. That's of the 79 that we supported for the two years. So no other area has done that so far, so I'd say we're better. But yeah, no, in all seriousness, definitely taking the learning from that. So I was just noting down some of the things from that. 42% decrease in episodes of street homelessness and rough sleeping and sofa surfing and a 51% decrease in the number of days people have been street homeless and sofa surfing. So I think off that alone, you can really start to see some of the positive outcomes of a non-needs-based service that is tracking people throughout their lives and is cropping up intermittently when people are at the worst or at the worst crisis that they're at. So yeah, I think in terms of the wider evaluation, definitely that's going back to DLUC and to MEME, all of that kind of data and information. So yeah, really, like you say, it's about the learning. It's about not just what are we doing within the program, but how are we influencing other sectors in the city, not just from the local authority, but yeah, looking wider than that. So we've actually got a conference that we're gonna schedule in for September to really to share that and give that back to the city. You know, the successes of the program isn't just off the back of us. It's been off the success of the partnership working. We aren't the only person that's been involved in that person's care. So it's really kind of giving that back. So yeah, those things are in process.
• Thank you, Alexis. I just want to say a massive thank you again. The team are absolutely fantastic behind us and have really driven forward the changes and have led and inspired and motivated so many people to take that forward. So just want to reiterate that massive thank you to the team. And a couple of points I just want to draw out here is co-design and I think the key point for me, just want to draw out the side of the road, it's got to be absolutely meaningful from the point of view of the person. And that's what really changing the futures has done. It's made it meaningful 'cause people often talk about co-design and co-production, but actually it's got to be meaningful. And that's what has been, I think, a big learning in how we shape and take that forward. And that's something we can reshape for the whole city. I think the second bit for me is that equity. What's been a success to change our futures is equity. It's been an equal partnership. It's not been about hierarchies or any of these things. It's actually very big people working together to get the best outcomes for people in the city. And that's something I think, but also I think we need to draw it 'cause that learning then takes form right across the whole city as well and how we do our business basically. And the third thing is the reason why we're so keen to draw, to not just focus on tackling inequalities, but to that move of focus on a multiple disadvantage is when you think about it, this is the area in which multiple services across the council, across the city, across partners are often involved in. And this is a way in which actually if we could work as a united team together, not only do we improve outcomes for people, what we also do is actually receive incredible cost benefits across the city. And this is why it's really important that we take this and we draw this out and we think about how we make this sustainable 'cause this is what works. So if it works, let's continue to go and grow and expand and actually make this something that as a city, we can say that we're really proud of that actually, that we are not only tackling inequalities, but we're actually getting to the root cause of multiple disadvantage and actually addressing that and improving people's lives.
• Thanks, and Andrew.
• Thank you, chair. Just to kind of echo everybody else's appreciation and value for this. I'm glad I thought I was going to steal Craig's thunder for a moment. There's some really good research from Scotland that shows people with severe mental illness who have long-term conditions, the concept called missing this. So it's not that they're hard to reach, it's that they find services that are possible to access. And you only have to miss two GP appointments over the course of three years. And you have an eight-fold increase in all-cause mortality. So you're eight times more likely to die of anything. So work like this that brings these people back and helps them connect to services, fantastic. And if this could become the way we do things in Sheffield, then we will save lives.
• Thank you. So we are asked just to note the update and I'm sure we're gonna hear back from you in the next year to see how we progress and how we move on in the future. So thank you so much for the presentation. We are, yes please. We are now on to item seven, which is the council plan, which is going to be presented by Kate. Sorry Kate, I made you move. I think it's better for the camera, if you're there.
• Thanks everybody. So I'm really pleased this morning, this morning, it's this afternoon to be presenting the council plan to the Health and Wellbeing Board. This is a really important milestone for the council. It sets out for our staff, our partners, and most importantly, the people of Sheffield, who we are, what we stand for, and the outcomes that we're committed to achieving over the next four years. People, keen-eyed watchers of the council may be aware that the council hasn't had a plan for some time, a medium term plan. And so this has been a really important development for us. The priorities and outcomes that are set out in the plan are aligned with our medium term financial strategy. And as everyone will be aware, as a council, we faced incredibly challenging financial times over the last period, with our core budget effectively halved since 2010. So that's no mean feat to be delivering over 800 services within that constraint, but that doesn't mean that we're not ambitious, and hopefully that plan sets this out. It also is designed to marry with and influence the way we set our budgets and the way we prioritize, and making sure those are intrinsically linked. It is a demonstration of our development as an organization. We've been really open and upfront about the fact that we are on a journey of improvement as a council. There was a specific recommendation in our LGA peer challenge in 2022, and this responds very clearly to that. It also enables us to align as an organization of 8,000 people working with and commissioning services across the city, all of our high level ambitions with key strategies, such as the growth plan that we've heard about earlier, directorate plans, and the contributions that our staff make to communities and the city every day. It's also really important, again, and we've had a lovely thread throughout today, back to the city goals, which I think should be our sort of bellwether for almost all of these strategic conversations as a city. So whether it's the health and wellbeing strategy, the growth plan, or indeed our council plan, that thread, that golden thread back to our city goals is really, really important. And that collective statement of ambition and vision for the city's future that has come from our communities and partners is something we want to make sure that we are being faithful to as a council. And so in setting out what we're gonna do over the next four years, we believe this sets out a contribution we make to those goals. The plan's built around three critical policy drivers, people, prosperity, and planet. It's a bit of a tongue twister. Just to expand on those, that means we're committing to put people at the heart of what we do, enabling our amazing people across the city to achieve their potential, tackling inequality and discrimination in particular. It means that we will take the long-term decisions which are needed to drive the city's long-term prosperity, and it means that we will protect and respect the environment and our ecology to create a sustainable future for our city. It's worth being clear that these three drivers, people, prosperity, and planet, are fused together. One isn't more important than the other. The idea is that they become a triple lock which shapes the way we work and make decisions as a council. The plan also sets out five strategic outcomes, which I won't rehearse, but hopefully will speak to many of you in the room, and they help us build our organisation and focus the work we do. So they'll run through everything, they become the focus for our budgets, our performance and outcome frameworks and our plans, and hopefully also ensure that we can demonstrate to citizens and to you as our partners that we're delivering the priorities that matter to you and to them. Just in terms of consultation, the plan was published in draft in December 2023, and we had lots of feedback from citizens, partners, our own staff and elected members to make sure that we got this right. We know through that consultation that there's really significant support for those policy drivers I mentioned, and also recognition and welcoming of the level of ambition that we're setting for the organisation and for our role in the city. We also heard that citizens and partners wanted to know more and understand how we're going to deliver. Obviously, a plan is just a plan, a strategy is just a strategy, unless it influences action on the ground, and that links through to the points I've made about how this drives the choices we make about our budget, how we develop our key strategies and how we thread that through into staff and service planning. It's very ambitious, and we make no apology for that. We are ambitious for our city, and we're ambitious for our council. We believe as a council that we can be one of the best councils in the country, and our goal is to do that by 2028. That means that we need to be relentlessly committed to the quality and consistency of the experience citizens get when they interact with the council and connect with us. So great service delivery is a real foundation in here in terms of the how we're going to deliver. There will be some areas of the council where that is gonna be a harder and longer journey, and we make no apologies for that. We're on with it. I think also, as we've just heard, exemplified in the work of the Fantastic Changing Futures team, there are some really amazing bright spots across the council where we've got teams doing wonderful work that really connects with our communities, that challenge us to behave differently, to do things differently, and we want to really draw on that energy and inspiration. It's also a really clear statement about the fact we want to work as one council. Many of you, as partners, will perhaps have experienced, and will have referred back to me, that sometimes it can feel like you're interacting with lots of different organizations. That's inevitably a challenge in a huge organization working across a complex city, and it's probably almost an unattainable ask, but it is something that we know learning from other highly successful organizations we can aspire to and we can drive towards. So really thinking about how we empower our brilliant, passionate, skilled employees to get things done, to use their experience and their abilities, but to see themselves as part of a bigger whole. And hopefully that will really be something that you increasingly notice in the behaviors and the culture and the mentality and the delivery of what we do as an organization. So I think all we're really asking today is for you to note the council plan, the content, the framing, the direction of travel we're on. I'd be really interested in any feedback you have, and particularly whether areas that you think, as partners or as organizations championing particular communities in the city that you think we could do more of or you're particularly interested to support on. Thank you.
• Got off lightly, Kate. So there are some questions for the Health and Wellbeing Board. Although they're not framed as questions, so I'll say some reflections for you. So as individual members of the board and as a whole, consider the best opportunity for becoming further involved in this where appropriate, collaborating across the organization and sector to increase impact and providing feedback to the council as we continue a transformation process. And the Health and Wellbeing Board is asked to note the content and framing of the council plan and a strong cross-reference of this to the city goals and with refreshed joint health and wellbeing strategy. Are members happy to go with that? Brilliant. Thank you, Kate. And we're going now on to the last item on the agenda, which is approving the minutes of the last meeting. So this was the meeting of the 28th of March, 2024. I will just ask members whether they are a correct record and then I'll go page by page to see if there are any matters arising. So are members happy that the minutes are a true record of the meeting on the 28th of March? Happy? Brilliant. And minutes start on page 147. So that's the first one I'm looking at, 148. 149, there you are. Somewhere between 148 and 149, the conversation we had about vaccination of various types of flavours, just to do very brief matters arising. So we, in reverse order, had very helpful debrief, structured debrief on the measles outbreak we had. We learned a lot and various agencies are busy internalising that learning at the moment, including all of the NHS organisations, council and beyond. We did write to NHS England on school-age vaccination to over-characterise, well maybe to correctly characterise the response, didn't cover all the questions we asked. So we'll keep on that one. We need to get a letter off to NHS England on quaff and childhood vaccinations. Ian, a specific ask, that's with Abby. Is it okay to send? So just drop Abby Tebbs a brief note. An off-note, I think it was Lee Soresby that mentioned the additional work that the ICB plays team have put into place to improve coverage of childhood vaccinations, Vaccine-Saved Lives, et cetera. I heard the detail on that this morning. I was really, really, really impressed. I did ask Abby whether or not we know the results and she said, Way too soon. But it was a really, really good example of good commissioning practice to address a well-known problem. I think the ICB deserves a lot of credit for it. So we'll pass on, thanks to Abby.
• Thanks, Greg. Will we kind of update next time? Please, put that down. So I'm on page 149, 150, 151, 152. Okay, so that concludes the meeting for today. The date of the next meeting is the 26th of September, 2024 at two p.m. in the chamber. Thank you, everybody.