Transcript

We've started to start to start to start to start to start to start to start to start to start to start to start to work. So many of them are sounding now. They don't have us. Better. Yes. Yeah. Okay, good evening everyone this meeting is also being live streamed on YouTube so welcome to everyone viewing on that channel. Any member of the board who is unable to join the meeting in person is able to join remotely. However, they will not be able to move or second emotional vote. With regards to the meeting etiquette, please can I ask that you indicate that you wish to speak by raising your physical hand. The chat function will not be monitored during the meeting. Please also know that we we've moved around the agenda slightly to accommodate some members that need to leave early. Therefore we've changed the order. So there's a revised order with eight and seven, which was on the new equity. We will then move back to the item six, which is a new update. So basically, to make everything clear the new agenda reads and I'll start with obviously apologies for absence in a minute. My name, by the way, is Councilor Neil Wilson, and the first item that we have on the new agenda will be appointment of a vice chair, and that is the first item and then I think I'll go on to this detail about different agendas. So, over to the clock. So we need to obviously agree that nominee for vice chair. Happy to nominate Councillor Wilson. Is there a second to that? And I'll agree. So shall we make progress with that? In accordance with the terms of reference that was three, four that the board has to appoint annually this first meeting of the new municipal year. So we've done that bit, but just, I was a bit confusing everybody, especially those online if they haven't got a piece of paper in front of them while they're trying to follow this live meeting as well. We're doing next, apologies for absence, then declaration of interest, minutes, and then we're going straight into the Northeast London ICS strategic approaches to meeting new population need which is a standing item. Then the health watch item, which is again a standing item, then action on diet. We've moved things around. Well it is that, but then I've got your chair lead there where it says how we're moving it around. Okay, so therefore items 8 and 7, health equity programme and 7, action on diet is going after item 5. Is that correct? Yes. Okay, so it's now in the order 12345786. If you look on the chair brief it'll have it. I hope everybody's not confused as I have at that. I'm sorry, the officers wanted to go so we've needed to know. The important thing is that we've made discussion and everybody's got journeys and all the rest of it. I hope that's agreed, and apologies for absence. The carcass regime apologies for absence from the following members of the board. Sam and Ashton who's the chief executive of Newham University Hospital, you're welcome Tom online. Hope you can still hear me Tom, in place, we've had difficult meetings. Just to note, this version of zoom doesn't seem to have an ability on my screen anyway to put your hand up. So, just to note that. Do it the old fashioned way. Yeah, wave at us and I'll try and, you know, Jason and others will tell me, or Roxana should be right. So, apologies also for Marie, the director of delivery at Newham health and care partnership. Do we have anybody else in the Newham health and care partnership? Thank you. Apologies, I will have to leave it, because I wasn't expecting to go so I'll have to leave about 10 to seven. She needs to leave at 10 to seven, but her items first. And Lorraine, the chief executive of East London, board members not present, appearing online. If I got this right, Jasmine can you hear me from help box? Yeah, I can hear you just fine. Oh, hi, thank you very much for joining us, Tom, I've already introduced you to Joe. Are there any other apologies, perhaps, I did give the apology, I don't know if we actually had just written Councillor Sarah Ruiz. A full member of the board representing children services. Roxana, do you want to take over for declaration of interest? Do you want to point the vice chairperson? You've done that. Congratulations. No, I'm okay. We can see everyone. Okay, so colleagues, do you find you just note the statement on declarations of interest on pages nine to 12, and note in the agenda items that are going to be coming up this evening, are there any declarations of disposable, pecuniary and non-precuniary interests for any member of the board on a matter being considered this evening? I cannot hear anything. And then we are going to be just going on to minutes of the last meeting, pages 13 to 20, I'm going to assume that everyone's with them. Just going to request, are there any inaccuracies that need to be noted? I can't see any notes. So can we just move to approve the minutes as an after a record proceedings of meeting on the 4th of April 2024, is that agreed? Okay. And now we're moving on to the substantial agenda items. So we're going to start with the North East London ICS approach is to meet the names of operation boards and this is a standing item, and it's part of our role as a healthy board given our statutory nature to hold our various partners to account that help us mobilise in response to health needs in our board. So he's going to come on. I can, yes. Thank you. And I think it's important though to stress that obviously the ICS isn't just the ICB, it's a system approach. So sometimes that is occasionally forgotten. But, so I think most everyone will know that we have completed the exercise where we had PA Consulting come in to support us in understanding the pressures that we face around population growth. And what we're doing now is, is sort of cracking on with some of the actions that were in that report. There were a number of key interventions that we need to look at how we implement. Some of them are supported by neighbourhood working and the development of integrated neighbourhood teams, so we are pulling together across system working group to start designing in detail what that can look like and how we deliver that. We've had good conversations with primary care, and currently have Stratford PCN looking to be involved but we're hoping that we'll get some other PCNs involved as well in terms of how we take this forward, which is great. I think it's been really good now to see that actually this has put us in a really good position to start understanding what we need to do next. The Health and Care Partnership Board has a workshop on the 21st of August off the top of my head, where we'll come together and look at ways of working and start to really flesh out these plans. The proposal is to sort of focus it a bit around scenarios that help us as we approach winter, which I think is sensible, but obviously, because a lot of what we need to do will help us with winter but are just also the things we need to do so. Yeah, I think we've done a lot of work, we're in a good place. The final report isn't quite ready, we are still just reviewing that but as soon as that's available it can get circulated far and wide to everyone. And Reema, I don't know if you've got anything you wanted to add? No, I mean, I can add about the neighbourhood working and we've certainly got a couple of PCNs that have put themselves forward to try and pilot some of that modeling from peer consultancy. So, yeah, there's an obvious keenness there and we just now need to kind of move it at pace. And I think the peer consultancy work has been good and I think that workshop that we'll have in a few weeks time will be to start with the outputs of that. I did just want to also raise a comment about kind of the infrastructure part of things, I know we're not looking at it specifically at the partnership, we've got the infrastructure for a day. And yesterday, I want to just mention yesterday, we had our CAD meeting which is the Clinical Advisory Group and Heather who is a mental and mental team, and she came and spoke about a strategy that they were looking at, looking at fighting Mary Wolf, and obviously, I mean, we all kind of fed back thinking that's not going to meet our population needs. And I have fed back to her that it's really important that she links up with place, as that's certainly not something that our population is going to need. It's not going to be feasible because even travelling there is massive in itself. So, I just want to make sure that that sort of NEL strategic stuff is linked in with place and Joe, if you're having kind of any catch ups with Charlotte, if we just make sure that we're feeding that back, that would be helpful. For what kind of site was, what kind of site are they looking for? I mean, it's just to look at health, and I think they're just floating that idea. Obviously, there's very limited capital, very limited revenue as well, so it's, I think it's more actually capital free, so I think that's why they're looking at that particular area. But I think we really pushed back yesterday, so you really need to look at population needs and whether that is going to meet the needs. It's just for us in Europe, it's just not feasible. Sorry, I've got a question. What does it mean by capital free in terms of their innovation of a site? Is it because it's going to be costly for them? It might be less than expanding in Boris. It's a bit stupid, isn't it? Yeah, right, okay. Well, we discussed on Tuesday, all the important reasons, you're running into one, exclusionary with the item around, you know, population growth. That's right, exclusionary, it's got a lot of views to conflate the two. It's right that this is a different sort of meeting. Population growth, PA consulting brought in, get all of that. Two pilots, and I'm sure I was told this, but just the basic really, Joe, Boris, you know, how long is a pilot going to last for? The obvious one. And this health and care partnership is a place, in other words, borough level. I still don't know why we can't say borough level, but place level. Where is the accountability to that in terms of us as, you know, the mayor who's chair of this board and why is our cabinet representative, in terms of decisions? Because you mentioned the infrastructure, and it's one of my, I keep saying, possibly we may get movement from the new government, but it's very early days, that NHS estates is less remote. And we've got primary care networks, which are not necessarily geographically in the air border that the council would perceive them. Get all of that. But the infrastructure, we've also got health and care spaces, there's a relationship with, you know, health. So I'm just worried about all of these interplays of this. Meanwhile, the residents are, you know, somewhat distressed about the availability, and they see population growth, or they see primary care, not necessarily as, you know, on their radar, this interpolated missile telephone. Yes. I'm going to just take a break. If I may, Joe, can I just take a moment of you comment first, and then we can... So, thanks, Joe. So, I think, you know, Joe's spoken about the work of neighbourhoods, and Rema's talked about that as well, and I think it's worth remembering back to when we had our kind of away day conversation, looked at the PA work, that what that work showed is that more effective, integrated working will definitely have a positive impact for our residents, but a small positive, a modest, you know, with existing resources, a modest. And I think it's worth, and we had a long chat about this excreting as well, and it's really difficult, that work. It's not reason we shouldn't do it, we should absolutely do it, it's the best thing for our residents, but it's not on its own going to, it's not on its own going to turn the corner and help us be able to meet the need, and without significant, and what the PA work showed is, without significant investment in primary care and prevention, that's what we really need to make real, real gains. So, I think there's a question for this board, and particularly in the context, in the light of a new government, of, you know, what, you know, it's got a health mission, a real commitment, stated commitment on a health mission. You know, what are the things we can do as a board really to advocate for new one, to have the resources needed maybe to be, you know, at the forefront of trying to deliver some of those health mission goals. So I just wanted to put that out there for us to be thinking about what's our role in this, you know, we can, we can hold, one of them is, as Roxana said, to hold our system, which is us, to collective accounts. But that's on the stuff that's within our domain of control. The other bit is how can we advocate for, for, for newer on actually getting the resources that we need to turn, turn the corner on us. Yes, I can answer the neighbourhood question, because you mentioned about the pilots, there are no seats on the pilot, such with an end date. This is start the work and it's to continue and it's, you know, looking at that integrated approach. We have, again, opened it all up to all network, primary care networks, to get on board. It's just that two came forward earlier on. It's not about having one or two, it's about, you know, even if all of them came forward and we want to, you know, start doing this, then we're absolutely open to that. But it's actually, it's convincing sort of primary care to get that. I think they are on board with it, you know, they're seeing some of the benefits on the already, the really good integrated work that's happening. And it's not just primary care, it's sort of everyone. We want some of the sweetest organisations and, you know, not only financially, but with people as well at workforce. But I think if we try, we're in the presenters in the right way. I think Jo, are you able to answer the accountability question? Yes, we're accountable to each other, you know, we're not accountable to our residents, to be honest with you. Yes, and thank you for answering that other part because that's what I was going to say. And it's also helpful. We learned a lot having Michael, who was the lead in Greater Manchester and Cambridge here in Peterborough, and he was telling us that actually Greater Manchester, who've been looking at their neighbourhoods for four years, have only just started now looking at PCM boundaries and do their line with neighbourhoods. So it definitely doesn't need to be a barrier to us starting. We have also, so I sit on the Health and Care Space Newham board, and we are having a number of conversations to just ensure that we all understand current governance, we're all really clear where decisions are made. And also, we're much clearer as a partnership so there'll be a paper coming to the Health and Care Partnership board in September, that kind of resets our relationship and how we work with Health and Care Space Newham and how we make sure that the model of care is better fed into that work. But the work we start on neighbourhoods will help that. So, ultimately, the Health and Care Partnership board hold responsibility for this and then yourselves. Obviously, we are more than happy to bring regular reports. To Jason's point as well, I just want to say, so the work that we've been doing with PA is already being used to help advocate for Newhams, so Zeen Etheridge, who's the Chief Executive Officer, I don't think that's a proper job title but mine's gone blank, for the ICB, has taken some of the outputs to NHS England. We've also are doing a similar piece of work in Barking and obviously we all know the cross boundary issues, particularly with the hospital so we're looking forward to when that work with Barking has finished, to holding a sort of wider stakeholder event across Barking and Newham so we can really make sure we're all coordinated on those outcomes. I'm actually talking at an NHS population health session tomorrow sharing some of our learning so it is already being used in that way we would want to see to say actually this isn't just about neighbourhoods, this is about more significant issues and funding issues. Are there any other comments? Is that it, just in terms of the update from North East London, ICS? Yeah, I think so. Okay, may I ask Jo, just for purposes of future meetings, and just making sure that we've got everything properly documented, but even if it's a one pager, can we have a written update over a verbal, just it helps us digest it in advance and follow some of the verbal additions, and it's just good practice. I mean, I know we're going to be capturing things in minutes, but it's useful to have it in writing. So, have we resolved the, so this, what's going to happen with this building that they're identifying in? It was just the first time it was mentioned last night, so I think it's more of a let's float the idea rather it being more like just want to make sure is our local infrastructure is sort of linked up with that, you know, because it feels like the nail on the strategy around it is so detached to what we're discussing our plans. I think we can go away, you and I, and we can go away and find out about that. I think it's more important to say that even if the building seems like a good value, the real cost is the people that go in it and the services that go in it. So, this huge opportunity cost from just chasing what might seem like a nice building and a cheap room to work from. It's not the way we want to strategically plan. So we'll follow that one up. So I guess just in terms of follow up on that one, it's basically making it really clear that we don't think it's, well, in fact, it's not a good idea, so don't do it. I just wanted to also say that's great to hear that Zeena is already advocating for Newham and I just wonder if we want to think about going forward about how we amplify that as a Health and Wellbeing Board and I don't want to speak for Roxana and Neil, but as political leadership how we might want to work to amplify that advocacy collectively. Just do it. I mean, yeah, I mean, we will just do whatever it needs to be done, I guess. I didn't want to do it. Yeah, we can have that conversation. Yeah, we'll take that away. And will that mean for the purposes of the next meeting we'll have presented to us the game plan, and by that point we'll already have been issued for a bit of letters to the Secretary of State or government ministers and the whole crew. And just on that, I mean, rest assured, I was at the ICS leaders meeting with you this afternoon and we keep saying the same thing that, you know, we need, we haven't just got the new government we've also got early days indications or certain things. So there will be a campaign around making certain population growth, it's not just the technology but the resource and within that, the old chestnut of in and out and under funding and all those sort of issues. So, you know, it is the metric treatment is where how do we coordinate that for this new that whole wider thing and now. Yeah. Okay, cool. Well, I think we move things around on the, if you look at the chair. Because there was the officers that have to leave. So he said, which office needs to be done it so if you if you just put your chair brief story. Oh, it's a health equity program. The reason why I'm reluctant to move it and follow the agenda is because I said from the outset that Health Watch needs to be given the priority that they deserve because they're there as our advocates for our residents so we need to get them from us. Okay, no, no, no, it's okay. Who's the colleague on the health equity program that needs to leave set you stop, Tom, by online Tom, what time do you need to leave. It was news to me that I need to leave. Well, first, I invite Jasmine to introduce the report, but Jasmine Could you kindly assume that you want to read it so if you could just focus on top lines, and he issues that you want to provoke us into thinking about. Yeah, of course. So, and we recently published our annual report from last year. And so we just wanted to kind of bring a few things that kind of highlight the work we've done throughout the year so I assume everyone has had an opportunity to have a look at it so a couple of the kind of standout. bits if you will. And so one of the big pieces that we did was around kind of improving the experience of send diagnosis processes so we worked really closely with an impact care forum which I'm sure you're all aware of, and to kind of run or gather kind of feedback servers essentially around what their experiences were and we've done this across the whole of an impact care form so this has been an ongoing piece of work and will continue into this year. So we kind of were finding out about 60% percent, sorry 60% of the people who were kind of involved in the parent care forum, and we're feeling kind of inadequately supported both mentally and physically through or from service providers. So what we kind of wanted to do with that information, alongside some of the other information we gathered was that we were kind of working alongside new in place partnerships to identify some improvements across services and just kind of figure out ways that we can deliver those services a bit more consistently. And we used some of those findings to develop kind of next phases of projects and again working closely with our partners and the MPF about ways that we can work across the board to kind of collaboratively support the services and identify ways in which services can improve. And we had some really great engagement from those focus groups and then working with NHS England on the recommendations around this kind of critical issues for various patients. So, and that is kind of all. So we've kind of fed those findings into the All Age Autism Strategy across the borough. Another kind of big piece that we did was around continuing health care so we looked at diabetes services was one of the kind of specific areas. So, we, we kind of found out from a series of focus groups that, generally speaking, the overall experience was quite a holistic approach, and there was a good ratio of kind of staff that were available in diabetes clinics. And, and actually there was a really high, so actually 100% of people that we spoke to said that they were, they understood the information that was being given to them and they understood what their treatment was and what their condition meant to them. And actually the services were providing a really successful kind of service for the people that were using it, which is not something that we generally discuss other services that we, we have kind of spoken to. And so it was a really successful piece of work and the report is for that is available on our website as well. But a couple of other big things that we did was around kind of health care council services so we ran a series of focus groups that looked at dentistry and freedom passes, and the process of applying for a blue badge application. But with slightly less positive kind of feedback in terms of the process so this was looking at people that were aged 55 and over, and were black, African, Caribbean, Asian and Polish backgrounds. So, 90% of the people that we spoke to said they can access any dental care, they've been waiting 12 months to kind of speak with anyone, there were long waiting lists, there was limited communication about the next steps and what they can expect and all that sort of stuff. When it came to freedom passes, there were 70% of people that had applied for them. And I said that the process was reasonably straightforward but then the criteria and the requirements for applying that changed and there was little communication around that and it made it quite complicated. And then in terms of the kind of blue badge application stuff, again, there was some concerns around kind of complications or complicated processes to apply for that so we kind of gathered that information and we were able to feed that back to relevant kind of authorities, although this is something that due to kind of staffing, lots of staffing changes in the health and wellness team over the past kind of year, we weren't, we haven't had the opportunity to kind of fully follow up with those service providers yet so it's something we definitely would like to continue on with. In terms of one of our kind of biggest pieces of work that we offer that really helps us to hear from our residents is our NHS campaigns advocacy service and that's been a really successful program that we've been running. We have actually managed to kind of utilise some of the feedback and create a report and share it with the university hospital to kind of help to give them an understanding of some of the commonalities we're seeing and the feedback that we're getting back. And that was a really productive kind of conversation around that. And we have managed to reach a huge amount of people across the borough for complaints advocacy but what we, again, so it's subcontracted to mind and they've recently undergone some changes, which has meant there's been a little bit of dip in activity in that kind of last quarter from the last financial year in relation to kind of how much networking they're doing, how much going out and about, and support they're being able to provide. That is now kind of studied out a little bit so we're hoping that kind of following through this year that will start to pick up again but it was a really successful program for us last year. And the other thing that we pushed really hard on last year was improving or increasing our volunteer capacity. We found that actually we were able to take on, and this is something we're really pushing this year, but we're able to take on significantly more work when we are using our volunteers in the most productive way so we initially started out just using them to support us on entering review programs. So they were going into the various kind of health facilities across Newham, but actually we realized that if we kind of bring them in on report writing, or they were supporting to run focus groups or even to facilitate things like coffee mornings, we were able to kind of host a lot more activity so we've just started kind of reaching out to various other communities, kind of the Congolese community at the moment has been massively supported by our volunteers. So we really pushed that recruitment in the last kind of six months, four to six months of last year, and we've now got six kind of active volunteers that are really supporting the program. So, I'm going to pause you there, thank you very much for that overview around headlines. I'm going to open up to questions. I've got a couple of thoughts to impact and system change contribution that it's all the interventions and surveys and reports that you've done is actually tangibly having, and how that is being evaluated. That's my question, but are there any other comments or points. I've got Councillor Neil Wilson, I can't see any hands up on there on. Yes, sorry I didn't, I've only just been over access to report for various reasons. You mentioned, and it may be a figure that is in there and I apologize but as I've just got it. This NHS advocacy complaint service and working very closely with our residents, invading into the university hospital. I presume this complaint service is just directed at acute care, rather than across the whole system. And you did say it was a huge amount of what's on the know me well enough to know that huge couldn't be any number so are there any figures on that. And finally, and that is I know so contrary that through to other partners, volunteer capacity. Another one that we, you know, the mayor will not be surprised that we have various volunteers, all across our communities, but we're still not able to necessarily put our hands up as a local authority and I think this is true of other partners, given the diversity of population there are still huge groups. I'm looking to segue into another item in a sense chair in terms of equity program, but how we can make certain that we communicate with this. Why is this, I think, primarily we were in a discussion about these Europeans and smoking rates or something, it could be black African populations with HIV issues I mean there's a whole realm, that we, it's not just about complaints that Health Watch can assist us with, and it's about how our volunteers, or people can work with Health Watch in a more coordinated way. In the back to that, you know how did we make that contribution so we're not asking the same people, too many questions, and not leaving other people not to even know about, for instance, you know the NHS advocacy complaint service. How do people know about it? No, no question, sorry. There's two key things. Yeah, so, just in terms of kind of the NHS complaints advocacy service so last year we had the number off the top of my head I can't remember specifically but it was 6000 people and kind of rolling through the year so not all of them required. Full investigation, some of them was signposting to kind of services that can provide a more accurate support service for them. But it was around 6000 people that that our advocate was able to kind of support to some degree. And in terms of kind of making people aware of that so the service itself as I said runs through mine so they do quite a lot of promotionary stuff through that kind of organisation. Alongside, so we obviously promote it through Healthwatcher whenever we kind of do any outreach or when we receive direct kind of feedback or complaints through our website for example or when people phone us, quite often the signposting for them is to go through the NHS complaint service because a lot of the feedback we receive is around NHS services, and that is obviously hospitals, but it also stretches out to kind of any NHS primary care facility across the borough. We do get feedback from other boroughs but we tend to kind of signpost obviously to the relevant people for that one. And in terms of kind of promoting that. Yeah, it's been through kind of running those attending various events throughout the year, and both Healthwatch but also MIND individually as well do attend staff and promoting it on our website so there's a whole section dedicated to the NHS and what we realised this year that was coming into this year or kind of writing the report from last year was that we wanted to kind of promote a little bit more accessibly so sharing information kind of out in the community in a physical format while rather than relying on people to always have access to an internet version so putting up those leaflets and posters and things in the libraries and churches and things like that. But our advocate is in person, she is kind of doing that face to face work, so that it's not everyone just relying to kind of discuss with her over a phone call for example. And so that is our NHS stuff in terms of the volunteers. Yeah, it was a massive dip for us last year and we didn't have many kind of at the start of last year, many active volunteers so we have a lot of volunteers signed up to work with Healthwatch, although they're not particularly active in actually delivering the healthwatch work. So that was something we wanted to work quite strongly on towards the end of last year, and to do that we kind of had to put in some parameters around what we were expecting from our volunteers in terms of the kind of work that we would expect them to do, delivery timeframes, the kind of hours we'd like them to commit to Healthwatch work, and that kind of allowed us in the nicest way possible to kind of weed out the ones that were very passionate about delivering the Healthwatch work. One of the things we found is, a couple of months ago a volunteer networking event that was put on by LVM, which has actually had us see another 12 volunteers sign up to join Healthwatch on top of the five active ones we had at the end of last year. So, it's not quite where we need it to be in terms of having volunteers but actually it's a huge step up and we're seeing a huge step up in our volunteer community essentially for the Healthwatch side of things. I can't remember what the other questions, I'm afraid. So, I've read the various sections of the annual report that talked about the scale of resident involvement that you've been able to initiate in order to generate insights that you then pass on to various bodies within the local health system, and you can produce six reports. I'm quite interested in understanding what that can be led to in terms of changes to system-wide practice in those areas identified. So, you know, you've noted how you've made a difference on page 10 of the pack that I'm looking at, and you've worked with the ICB. You've talked to over a thousand residents about what they look for, but have they gone, you know, what's happened since spring, have they actually begun to make changes to their practice model or organisational operations, etc, etc. So, is this tangible output based on this work? Yeah, so I'll do my best to answer this. This is a question probably best answered by Julie because she does a lot of the kind of, she sits on a lot of the boards and she does a lot of the kind of influencing stuff, I suppose. But from kind of our side of it as the Healthwatch team. So, we work very closely with obviously partners across the board, so we host our Healthwatch Advisory Board, for example, where we're able to take a lot of these reports and kind of discuss them with our partners on the board, but then kind of look at ways that we can implement changes. So, I'm trying to think of an example off the top of my head. So, for example, we're recruiting for a deaf outreach worker post. This is something that we had hoped to have filled by the end of last year but unfortunately due to various reasons we weren't able to. But this has kind of come off the back of so working this kind of an instructor by the ICB and together identifying that that was a huge lapse in kind of a community of people that we weren't accessing. And so, kind of off the back of that we're recruiting to have a deaf outreach worker in our team, who is primarily there to kind of really engage with those communities and kind of find ways that we can get their voice and represent that in these sorts of examples. For example, and as I said, for various reasons the recruitment of that has been a bit more of a challenge than we were expecting. But it is a post that we're all very excited to kind of get moving forward and we think it will kind of really contribute hugely to the kind of information gathering that we're doing at Healthwatch. So in terms of kind of. So, for example, I know, Tom, Alice we sat down with you to kind of discuss some of the feedback that we were getting based on NHS complaints. So that was we wrote a report and shared that with Tom to kind of gather some information around the strategy for the following year for them. So things like that is a couple of examples that I can think of, as I said, Judy's probably best place to kind of give a more in depth response to that. Thank you. Are there any other questions? I know I'm probably asking for a bit more detail in terms of breakdown of who did that from the beginning, blah, you know, just to get an idea of, you know, when you talk about community, who do you really mean? Sorry, can you say that again, I can't quite hear you. Sorry. So you've reached out to 1000 people in terms of getting feedback. Yeah, I just wanted to know who those thousand people are. And when you talk about community, what community are you really talking to? So we're trying our best across all kind of pieces of work that we do to get kind of representative samples so we don't want to just hear from one particular community and actually our community listening is project is has been a really helpful way for us to reach out to groups that you don't often hear from so it's very easy for us to gather information feedback from from groups of people that are loud, and we'll kind of shout louder than everybody else but they're the ones that will have to be back to generally directly to the service provider. And what we want to do is hear from people who are, you know, less confident or, or less sure about feeding back to those services so our community listening is project has helped us kind of reach out to all sorts of kind of seldom heard groups across the borough, and it's something that kind of at the start of last year, dipped a little bit in terms of we weren't running those community listening as events very often. And it's picked up towards the end of last year and this year is something that we've gotten our work plan to prioritize. And because actually, we realized it's not very helpful for us to come to these sorts of things and feedback about all the things you already know, we want to be representing very diverse barra with very diverse experiences, and to do that we need to kind of reach out to a whole host network so. And one way that that's been that has been really helpful for us to do that is through our advisory board connection so we're growing our advisory board members. We're getting significantly more representation across from across the whole barra and still obviously space to grow, but that has been really helpful in time and linking up with people and then putting you in touch with the relevant kind of organizations or groups or even events and you know great people to come up to this because that's one way in which you can kind of link up with people so it's an ongoing process to keep reaching out, but it has kind of stepped out through that project quite a lot. Okay, I've got Jason stories as well. Just a quick one, thanks for the report and it's really interesting to see, they can be really helpful the board if possible, as an action to share the work plan for the year ahead, so we can really see kind of prospectively how we can really positively engage with that. Yeah, absolutely. I can distribute that afterwards. Yeah, I'm just sorry. Yeah, cool. Sorry, go on. No, sorry. My, my hand up function isn't working so I'm going to have to. It was just say, we're trying to build the relationship with health watch. We've reached in in terms of their work plan for this year to understand where and how it impacts on the hospital where the hospital is an element of it to try and provide be proactive about trying to address the issues in it so there's ones around oral hygiene cancer weights around breast cancer and personal care in hospital so we're trying to work with with them proactively to take those on and not wait for health watch to come to us but us to go to health watch and say how can we help you to actually deliver your function because I think it's part of the addressing the democratic deficit sometimes that exists in the NHS. Okay, I'm going to bring in. Do you have comments. I think that Tom's, the example of being proactive is a really good one I'm looking to be looking to do something similar around the equity program health watch sits on our diverse communities group which is one of our two work streams are also really keen to see the forward plan and also see where those points for alignment and influence that we're not doing pieces of community inside working silos but that we are, you know, we have limited resources so to have a comprehensive more comprehensive joined up plan. There's a lot of insight work that needs to be done in a lot of spaces around some of those core pathways, but in, you know, not necessarily about services but in some of the prevention spaces around some of the primary care spaces so just to join the report has helped watch have done a piece of our continuing to support, one of our exemplar deep dives in the equity program around with the safeguarding adults for looking at the representation of safeguarding referrals and understanding around and holding quite a lot of the insight gathering and also design work in the space. Okay, I'm just very briefly share my way you say in the report, these covering points I can now see key points organized public meetings community neighborhood events with residents and stakeholders. Clearly stakeholders in that sense I hope would include those of us who are community elected representatives. That's a better way of saying the counselors because we are, you know, sometimes asking the questions that officers can ask and residents come with casework or whatever, and they could be both virtual and face to face get all of that. To ensure that accessibility about work and give residents an opportunity. If I know people can go into my public library and a lot of it is tributes above a healthy but scrolling on screens and it's even here in the telephone. So, you know, that's great, but it would be helpful if we joined in a bit because it links in I think we want long term concern about then saying what you said earlier about the communities represented by trying to get as many people in the discussion. Jessica comes like really, and if I may just wrap up, because I'm just assuming that Jasmine will know all of those comments. On the board plan of health watch, just a provocation, straight forward, given the orientation of this health and well being, which will have as a golden thread. Our collective challenge around addressing health inequity, how will health watch align to that and help us really surface issues around health inequity in a way that builds on their work that they do as part of a normative practice, but it shifts in the same way that and then hooking up on that as a polar point to avoid the duplication that you're referencing, and also with an eye to value in health watch mirror as a really important partner and help them build their capacity, how much of that insight generating can be done by health watch through a commissioning or contractual arrangement. You know, the health team doing itself. We do commission, we do, we do, that's ready. But to do these things, we could do, yeah, there's always an option and additionally yes, yeah. You have a resource that you've allocated for the purposes of health inequity, insight generation, or you're calibrating your budget or you're going to be. We have a very small amount of insight money, but there's sort of different pockets dotted about the system. It's a bit about how you use the resources we have, so health watch each unit will set the work, we will work with them to develop a work plan and give them focus points. The insight team that works with Ade will have focus points, but we also have a wide commissioning group in adults and children and we've tasked them. So you try and crack your null in several different ways, same with the ICBT. We don't try and duplicate, we try and coordinate how we invest our resources. Sorry, you know the insight team that works in, what do they actually do? Sorry, I mean, I don't mean that in a, sorry, the insight team, are they, what? So I think for public health, we have an intelligence function, and so they are, in part, we also as a team generate our own qualitative insights and there have been some specific projects funded by Energetic Inquality's money that have generated some insights. We're mindful that thinking around, every time we do something new, or recommission something, or think about an innovation, or look to address a gap, that we need to effectively do an assessment which is, in part, involves some insight generation, it's a mixture of quantum and quantum gap analysis. So, when I think about insight gathering, I'm thinking in the round. Since you asked, what we're planning with public health over the next couple of months is kind of like an insight dump, we've been working on it for a while, we've done lots of different projects, we have learned a lot, what we don't or often necessarily do is all come together and share that insight in a structured way across the teams. So that's our plan is to think about within our team and within commissioning and bringing in help, where we can share what we have learned, so that we don't accidentally duplicate, but we will be sighted on what we already know. There's a fool, I'm just looking behind my shoulder to see and make sure there's no hands up. Right, so, citizen science, and the benefit of residents that are already being engaged for their opinion and views, in order to generate insights for practitioners, or people that work with practitioners to help inform their thinking, and system design. How much is the citizen science methodology, part of the system thinking around how you work with a voluntary cohort that has been mobilised by Healthwatch. It's one of the things that struck me about this annual report, actually that's quite a lot of residents locally that are being fought with about their views of health, and why can't we empower them to be system changers of health, as opposed to empower arguably passive articulators of how the system isn't working for them. If I may, I like that, I think, I can't quantify how much we have citizen science, we have a small team of peer researchers that was set up with a little bit of exploration money to particularly look at diabetes and diabetes. There is a bit going in from the policy performance team around another citizen science project to create more of a network, and there's been a couple of meetings. There's been actually quite a few bits of organisation meetings between officers from different parts of the council to look at how we think about co-production and co-design, and with Henrietta thinking about co-design standards and having a more coherent co-production network or co-design network. I think the idea that we have volunteers and emerging citizen scientists and emerging activists already in community to be able to support and develop those seems very sensible, so I'll connect. There is a network of citizen scientists that are being mobilised by the citizen, data citizen science network that is led by a chap called Bernard Hu in Forestgate, and he hates everything about the council because he thinks that we're really kind of hierarchical and boring and not sufficiently disruptive. No, but he's really good and really interesting. Anyway, so I'm just going to be shut off. I'm coming back to this, it's not going to go away, is it? No. One other thing, just finally to throw into the mix of this as you're working and discussing with Health Watch Newham about its programme plan for the coming year, and this leads to some instances that we've had in Newham over recent weeks. How we helped elevate a community-led response to a public community-based format as a consequence of some serious instances, be it fire or fatalities, so I wanted to just leave that out there and I will encourage colleagues to talk about that. I think, you know, we drew a trauma response to staff, and lately we've been reaching out to other staff and other directorates after a serious incident, street cleans, street cleaners, people in an orchard, etc. But, you know, it's how we can potentially reach out to communities and also partner agencies who are actually experiencing that form to a particular practice model. Yeah, all right, fine. I'm going to suggest that we move on. Jasmine, is that okay? Thank you very much for all the hard work, and can you please pass on to the whole Health Watch Newham team that it's been amazing what we've all done, and with very much family contribution that you make. We're now going to be moving on to our FEND improvement updates. Action on diet for better health outcomes, and I do know of the big sugar inducing... All the sugar on the table! All right, so we've got action on diet for better health outcomes. Who would like to kick this off? Okay, I'm going to chop a couple of slides up, and hopefully that'll keep me on point, and further to the discussion of my weigh day and a focus for the board on more work around, or on our work in the borough on action on diet for better health outcomes. We're going to look tonight at four specific pieces of work, just four examples, and if I'm able to somehow manoeuvre this better, we will have it easy to see over this slideshow, which will help me as well. And the theme running through all these, there's going to be an answer to the board, as always, to think about how the work we're looking at tonight can be scaled with support from the board, and the sort of other networks and opportunities that we plug into to the board that may be able to help with. It's a great evening, although it's a very hot evening to be looking at this work, because one of the themes of a lot of the work we look at on food and health is the way it all joins up. We're new to pioneering work on a just transition. A couple of colleagues in the climate thing, I thought you weren't able to be with us tonight, but will be certainly joining us at a future session, I'm sure. And something that runs through our work when we look at the five A's of health and security, and the five A's of food, health, security and equity, is actually when we look at this work, often there's a really clear link back to our work for a just transition, and opportunities, because obviously we know that there are tons of money and funding there. The four bits of work we're going to look at tonight are highlighted, just the four examples, and probably because there is some relevant stuff happening in each of these spaces at the moment, and actually the longer list of examples, some of which we've talked about before this board, or will definitely be coming back to in the future, but again, things are, this board has the potential to help us manage the mind and connect it into. So, first the four bits of work we're going to look at. Newham is a founding partner in the creation of the London Circular Food Procurement Commitment, part of a big programme that we funded as a council with all other London councils to create solutions that are council-wide across London. We were one of four original signatures and have obviously been very active in supporting the members of this work, because as a council we recognise that we need to understand our food, how what we do impacts around our carbon emissions, but also with these tools, looking at the impacts of that food, and how we can make systems level enormous scale change that has impacts on health. So, we have put these tools to work, our Caterpillar Juniper that does over 4 million meals a year has helped us in the process that begins with benchmarking and finding out where you are in terms of the carbon emissions of your food, which also tells you exactly what you're buying. We know from big techs that we've talked about this more before, that the Eat, Lancer report tells us that if we achieve our carbon, our just transition targets on food, we would achieve our transition needs on health as well, which we've own goals. And also there's tools that enable you to monitor waste and measure your food procurement and it's been very interesting to the council to see that when we apply these tools, we're already significantly ahead of sector averages on carbon per plate in our food. And also it tells us actually the food we're delivering in our schools for example, most of those 4 million meals are things the council does in schools. We are really a long way down the road at delivering the meals that we need for a just transition on health, on climate, because of the way we are set up. So thinking bigger, thinking at the board, where are we? Well right now we have these incredible tools and we are using them in the buttering, we don't have to use them, we've seen that we can go out and get that benchmark done and set ourselves on that journey to reduce our per plate carbon emissions and bring with it improvements in the food we serve everywhere we have catering for health. But where could we be? We could be applying these tools way beyond the council and way beyond schools and way beyond that partnership with Juniper our caterer and some of the private caterers that we've brought along. There is an opportunity to take these tools everywhere. We have catering, we have food, we have assets, and to use that expertise in a cross-cutting way as a borough and be supportive for those who have already done this work inside the council everywhere that we've got those health partnerships. If that makes sense. Then the big barrier is obviously just building that greater awareness of the commitment and making sure that we've done the mapping and we've got awareness of everywhere we have catering across all of the buildings, estate, wards, things that we cover in this room as organisations. And there is a real journey here where we could be factoring the terms of this commitment into contracts, procurement, leases, our own internal work wherever we have work in catering and using it to drive change towards 2030 that is at scale and is significant. I'm going to move on to something different. I hope we come back to the discussion if it's OK with the chair. I saw four things at the end. We do a lot of work to drive up fruit and veg consumption in this borough, particularly amongst residents where we know that financial factors impact the food they buy in a negative way. We know from the New Food Alliance the focus of the food we move to some of our most vulnerable residents, so depending on food clubs, food banks, £2 million of that surplus every year is fruit and veg. We run school marketplaces that again could spread fruit and veg in the hands of students in schools and their families. We have dedicated team on Healthy Start uptake with those vouchers, again, targeting some of our most vulnerable residents, those who are pregnant with young children and getting them access to brief room veg. And we have one of the biggest uptakes of that scheme in terms of the total number of users and Healthy Start boroughs anywhere in London. We're in about the top three on the last set of data that I saw. But as a percentage it's a massive piece of work constantly keeping that percentage high because of the barriers to the scheme and conversations we've had elsewhere about how that scheme isn't necessarily best set up to meet the needs of new residents, which is why it's such a challenge and why we have a team home. And we've talked before in other forums about our shop healthy work targeting retailers and food deserts to increase our output, to increase their floor space of healthy food and fruit and veg. And we'll come back to all of those, but the thing I wanted to just bring to the board's attention tonight is about fruit and veg on prescription. So we've been talking about this for a while, it was in the National Food Strategy as a best practice piece of work. And obviously we've come back to this after COVID and cost of living, and we are currently in the process of developing a scheme that's particularly focused on targeting households where there is diabetes or risk of diabetes. And we talked previously about the incredible success of the remission diet in making a difference on diabetes in a new way. Now this is a very similar idea, putting a pilot initially out to work that will enable us to put fruit and veg on prescription in the hands of a particularly vulnerable cohort, where it can make a significant difference. Now, we're reasonably far along here, we know how to do this, we've got the tools, the partnerships, the ability to make the scheme work and happen. We've got some secure funding in very, very challenging financial times. But the way we could be is a much bigger partnership, perhaps if we can provide support work with other partners in this room. And as a result of that much bigger partnership, we could be stimulating even more good food retail and using it as a lever to talk to our retailers, talk to our retailers and markets, and using this as another example of a joined up piece of work or as well as directly targeting a cohort of residents, it becomes as with a scheme like Shop Healthy, an opportunity to talk to retailers and drive change on the ground, create a lever. Our big barrier we've discussed is we're not quite where we need to be with the biggest possible pot of money. And also there is an opportunity for NHS partners to support us with practical measures to help us define the cohort and evaluate the impact. Something very different, something that costs nothing, but when implemented or cost nothing now that we have things in place, but when implemented makes a huge difference to the way our residents see the boroughs, they move around literally. We introduced in 2024, a healthy food advertising policy to the council. After about two years of doing very similar work with a set of what might be called mandatory guidelines, we turned that into a policy along with a new procurement on our advertising estate. The healthier advertising policy prohibits the advertising of foods high in fat, sources sugar on our estate. It's all about keeping unhealthy food off council advertising estate. It's extremely effective. The data shows that people who see less junk food advertising experience 1000 calorie decrease around healthy purchases across a week, which is an incredible number. If you look at that work in more detail, it's a remarkably small decrease in what you see, that's needed to make a huge impact, showing perhaps how effective advertising is and why some money is spent on it. We know that this is a huge expedition, because of course you're much more likely to come square in the face of large advertising, depending on where you live, and what you're able to restrict, from what you live. And it's a very, very robust piece of work based on a really significant piece of work that we were in on the ground floor talking to Transport for London about when they did the first healthy food advertising policy. So we know it's something from now we're taking anywhere, and the way that we've done as a council can be applied robustly to a big commercial asset where they exist. We've implemented this across the council estate at the same time we're really scaling up our digital advertising footprint and a really interesting and modernising piece of work that we're doing. And we've taken our policy as far as we can in terms of not just high fat signature food, but work on breast milk substitutes, work on alcohol, work on gambling, work on vaping, work on cosmetic surgery. Now, where can we get to where there's no reason to limit this to the council estate? Any anchor partner that has advertising estate could be working with us, we have the tools, we have the expertise. You know, there's tremendous synergies in replicating what we currently do inside the council with any partner that wants to do this in the borough, that is anchored in the borough and has estate. So any organisation across this room that have advertising estate of any sort, from things inside the building to things that really make a huge statement outside, we have the ability to support them and work in a cross-country way again on that estate. There's an interesting bringing us back to climate on this evening, apply that into this. The food that is high in fat, sweet and sugar also is associated with enormous climate impacts. So there's a real opportunity there as a barrier or a next step to look at mapping the estate that collectively perhaps we have in this room as organisations that come together in this board and getting procurement colleagues on board about the opportunity because this costs nothing. It's evidence in Newham and elsewhere to see revenues not decrease but continue. And then the last thing that we've done a huge amount of work on in the last year. And again, taking advantage of the current financial circumstances where there is money for intervention or a just transition. Newham is in the process of really leading the way on a great, great, great revolution where we demonstrate the power to take pots of money that are targeted particularly at looking at sustainable urban drainage. Solutions where we work to reduce the amount that is underwater when we experience very, very heavy rainfall and to pivot that work to complete technical and engineering objectives, but also producing food growing spaces in the borough. The borough will always be a significantly urban place in terms of its architecture and design, but we've demonstrated with just under £625,000 worth of investment that we can produce a tremendous number of small growing spaces. Now we know these spaces are important not just because of how they impact people's relationship with food, when they use and engage with, but because of the impacts on mental health, impacts on exercise, movement and new opportunities created. So we've done a huge amount of work in schools, but we've also demonstrated you can do it in many practices in GP surgeries. Now, where are we? We've got a huge portfolio and we have all of this expertise in the borough. It's available to partner with anybody that's looking to move this work forward. Some tremendous work with Catherine Gaynor at the tile gate who lots of you will know from her climate leading work. But we have the ability to produce more of this work, potentially targeting more money that is already being spent and just spending it clever. There's a real opportunity here. Where we could get to, well we're already on the way to this, but we could be a leading, perhaps the leading example of how you achieve health, climate and economic benefits of food growing in an urban environment. Activating spend that's already out there on climate mitigation and just traditional work. We've got a vast portfolio already of different types of work, including one really beautiful rooftop garden that we've done work on. But the expertise in the borough is such to show the space we can do this. The barriers are we need access to more spaces, and again that awareness that we have the capability to track record now doing this in Newham. And then the second barrier or next step, can we unlock more access to funding, because those pots of money are out there, and it's not a case of taking new money. It's a case of taking the same money and in effect spending twice to hopefully achieve the same outcomes. So to bring those four things back to the board. And we think about how to scale those further the opportunities, and what are the networks and opportunities we're missing to take some of that forward. Okay, thank you. Yeah, mine is not so much a question but I observed you know we're at this time of year, people can't necessarily absorb all that and there's a tremendous amount there and I want that, with you Roxana's chair's permission to circulate that. Because otherwise we look at this whole area, we've had this discussion before. I mean, you know, I've been on this from the journey of being vice chair to London Food Board. We've had the discussion about the real obvious ones about the diet, that health care, particularly you said in your introduction about diabetes type two. There's a load of information there which I think we need to convey to our partners, not just on the health and wellbeing of Roxana but across the system. Yeah, because it's otherwise it's seen in the narrow focus of free school meals, rightly so. It's so hot, and the lives are horribly stressed. It's just really terrible. We need to circulate it wisely, and we need to make sure it's not just seen through the narrow lens, and what we're doing is what's important in our communities. It is about, and I love to think about, a great degree of reference to the aging world strategy a lot of the time, but you know I'm being silly human. But it's more important than not just a council in its various directorates, let's say there's one council, but with partners. And I do agree with you, it was the same argument years ago at TLA level, that there are pots of money that not necessarily are labeled food, but we can sanitize it. It's not a fancy word, you know, we could be more creatively used, but it's all on the same wavelength. If you don't want to circulate it, we'll come back to it. Really good piece of work. I just wanted to ask in terms of our marketing material, could we use food that is identified by, you know, different communities, so that you know children looking at food will now worry, I know this food, I should be, why am I eating it? Because it's good within it. So, when we do our marketing and comp, we bring in lots of fruits from different communities and lots of vegetables from different communities. Absolutely really critical in terms of something like food growing, that is a tremendous opportunity isn't it, both to talk about our cultural food as they are now, but also as we transition into borough, our cultural food as it will become. We sit here with the wedge of Kent and Essex, but we come with roots that run all over the world, you can go around this room, I know that. We scratch all across the inspiration and things that we do here are broader and different to other places because of that unique influence isn't it. I just wanted to respond to that because I think that's a really good idea and I think different services and organisations learn from each other. So some schools who are, you know, way ahead in terms of growing their own food, checking sheds, just everything. And that's what, and actually, children are learning about business, alongside that, parents buying little raffle tickets, it's not real, you know, money, but huge kind of greenhouses at school, all growing, all different types of fruit and veg and herbs. And actually, if young children saw that throughout all the schools, you know, what would that teach them about healthy eating. Very briefly. Thanks Andy, that was great. Andy and I have been working a bit closely on some of the fringe overlap areas, so thinking about fruit and veg on prescription, but also some other issues around how we think about the whole landscape of everything to do with diet related diseases. This is in the kind of the market determinants side of things but we think about how we, how we share messaging with our residents and so that's culturally competent as well as affordable so the five day structure is really helpful there. So there's more work will be done in this space but different, different parts of that prevention pathway and also the NHS colleagues. There is something that, and Andy mentioned the remission diet, but some parts of the additional new thinking, it's not, so climate is the big overarching threat, but also for our borough population, the risk that our borough residents have of becoming overweight, and of developing diabetes at lower levels of overweight and developing heart diseases at lower levels of overweight is can be mitigated to an extent by how much we're able to switch the default diets. So, having and being able to clearly communicate to really cut down the other processes. But where we have levers and controls around the food that we supply and the food we recommend in those systems where we're providing it, where we're funding it, or where we're supporting it, that we can work to be much clearer about what we mean by healthy and as Andy said, plant based, dropping some of the refined carbohydrates, dropping the ultra processed components, so it's not just plant based vegetables and pulses particularly, and how we socialise those in ways that are culturally competent, all the lovely options for the dals and beans, etc. But there's something about us being able to support our residents to have that affordable diet that will be health promoting, rather than the diet that they actually can afford which is health farming. And this is really good work to be able to shift the diet and support the leaders that we have, and the big leaders as hard as we can. Thank you. Thanks, Andy. It's really exciting things going on. So, two points. One is, I guess it follows on from Laura's, which is, I mean, not just about the stuff you spoke about today, but the wealth of stuff that's going on around healthy food in schools. And how having that ambition that the default experience of a newer child through primary secondary school is this kind of healthy food, whole healthy food experience, and really setting that as an ambition that we work with our school communities around and really elevating all the brilliant work that's increasing going on in multiple schools. And yeah, setting that kind of as an ambition how we can work with that school community around that. And the other thing you kind of alluded to was just, I guess it's a broader thought, which is how we, on the stuff that you spoke about and other issues we cover as a board, how we engage a broader central bank of partners in the work of the Health and Wellbeing Board. Big players like UEL and others who've got potentially really big influence in the spaces that we're talking about and how we can bring some wider anchor partners into some of these conversations for greater influence. I was actually pointing to Jason, but I'm happy to chip in quickly and just go back to that marketing piece, like Word of Man is our best marketing tool. Just thinking through some of the stuff we're doing with Nutrition Kitchen, where we're connecting people into the food options that we're creating. Also providing the skills to train their friends and family and making it fun and tasty. We talk about culturally competent and all these things, it's all really important in my experience, people want to have fun when they do these things and have fun learning to cook healthier food and make sure it's tasty. It's really great work and I think from an NHS perspective we're not even visible, because work sometimes isn't even visible, so I just wonder how are we kind of communicating that all out. Certainly when I sit down with patients I think a lot of their eating habits are very much bad eating habits and very much around what they're having at home. It's a school actually that's educating these children as to what's healthy and what's not, because they're not getting that in their home environment. So some of those projects don't know whether they work because of the whole family needs rather than just the children in the school. They've already got their diseases, so they're really kind of further down, but yeah it's a balance between that prevention of gaining that knowledge and again you know cultural backgrounds, how they maintain their cultural backgrounds and what type of foods, but in a healthy way it's really important. I'm just going to quickly ask if there's anyone online, colleagues wise that would like to contribute, because I can't see hands up, but I'm just going to do a follow up. No? Okay. Yeah, just because it does tie up with this, you know, we had a GP open day at Custom House where local councils were there and nutrition clinics were there, and I want to support what Simon said because when I had a food policy hand user just before, people in our political group said it was very way trophy and it was too middle class, and I personally think we don't get across the message that eating can be fun. It needs to be somehow less sort of paternalistic in some of the approaches. Try all things, so I'm going to put on record, you know, whether it's total day when it was sent to all customers, you know, I think there's a great chance for us to move away from, you know, the sort of top down approach. But it does have, I don't know, I'm not scientifically qualified, but I mean, in terms of, you know, there is a clear causal relationship between the current diet and type 2 diabetes and cardiovascular. So it's about more preventative work to save more upstream and to have a one council approach, but we do need to work with partners. If we talk about social prescribing, I love this great Greek revolution, I think we all have to sign up for that. Sorry, I've just got one more point about children with special educational needs who they call, you know, things called the fussy eating thing, they call the picky, I mean, I think we, you know, that terminology needs to get in line with the way, you know what I mean? And how do we maybe tailor some of this for people with disabilities, learning disabilities, autism, as well as culture, you know, how do we consider disability as well? So this is a really good example of synergies and opportunities, so actually it's in some of our special educational needs schools, where we've made some of the biggest investments in food growing, recognising that a lot, as well as the impact on health, the impact on some of those needs that we've talked about there is enormous. This is a massive area where the synergies have always been underplayed. And I think if I, if I could ask, we'll take away one thing tonight, I knew it was beginning to the vanguard of this work for 15 years, we just celebrated 15 years of equal freedom in the country's original universal meal schemes. And five years ago, it became the country's original universal meals and a whole school of roaches, it's been. We have a long history in this world of joined up work, we have significant expertise and stakeholders and partners who are attracted to you. You know, it's a huge thing, the academic space where people ring us up. So, have you worked with us on this? I think if, I think we have a lot of expertise and energy in this space in the room. There's no reason why, for example, expertise in the council should be limited to that space, the food strategy team are there to work with our partners and support, develop and grow this and areas like that, synergies are just marked. And we're already really pushing to cash in on them. There's a hand on mine. Yeah, thanks. Yeah, I just wanted to go back to the point Laura you made about children with special needs and additional needs and certainly, I think there's a, some of the purpose of the board, the thinking about some of the partnership work. So, ELFT and Children's Specialised Services often, clinicians there often talk about the children that they are on their waiting lists for diagnosis and very often very restrictive diets, you know, and this kind of, you know, slight concept of restrictive eating, sort of fussy eating and we know they're children who are likely to have, you know, real adverse consequences in future so I think it's just like a bit of a plea for some of the, the kind of partnership role of the board here, and how ELFT, you know, is a sort of a key part of how we might address these children's needs and just kind of thinking about yeah the role for ELFT within this partnership within that, and the, you know, the insight they bring to those children's needs. Thanks. Thank you very much. Is there anyone else online? Very briefly, and I feel like I'm kind of, people not in the room, I had a really good conversation with ELFT colleagues this morning and I know that they've been doing lots of work in their dietitian team around thinking about how they support people with learning difficulties and learning disabilities. I'm not sure that how far it extends to children but they are starting to think in that space very proactively and there's a lot of programs like that. I don't agree, there's a lot to be done, there's a lot to be done everywhere. Okay, just some final comments from me. I know that we talk a lot about culture in the context of ethnic groups that exist in the borough, and how that's a wonderful opportunity to be seized in really igniting love of growing and cooking. I think also culturally, we're having to contend with a generation of young people who are millennials, and generation, what do they call it now? Class foundation? And you know, the emerging generation of, on TikTok, there is a global craze that's derived from a Korean word about eating, and it's called wong bang, where people have eaten in competitions. And over the last four years, it's exploded and you can see over the period of 12 months, someone young, and there's one probably causing controversy on TikTok called Jelly Bean, who's gone from hair to hair in 12 months, and gets normalised to eat him to the world. And kids are popular. So when we're talking about a systems-based approach to eating, and it's about primarily how we impact the eating habits and lifestyles of the younger generation, in part influencing their parents, but their parents and we are up against cultural power moves online. How do you contend with that? And I think that goes back to the marketing thing. How do you make this as exciting as watching someone stuffing their face day in day out with fast food and wanting to emulate that as well? Because that is where all that's happened. And that's a critical public health issue for us in children's services and in the wider health system. And then I think the grey estate matter that needs to be drawn into this green magnification and using assets to promote all of this. There's going to need to be some quite hard-nosed negotiations and a percentage of that grey asset needed to be used for promotional stuff and elevating. The importance of healthy eating as a place-based approach. And actually, if they're not serious about it, you shouldn't be a part of an health-based auction, that's the point. I think it's going to have to be that hard-nosed. And maybe there's a percentage extraction of grey estate for advertising purposes. But can I please let you know that if you are going to be doing advertising, please do it wrong. But this primarily wasn't about stopping bad advertising rather than us. We don't have the resources to be doing big marketing campaigns. This is about stopping bad advertising rather than us doing our own advertising. That's a commercial aspect of our estate. I wouldn't get anything about the local farm shop. So I don't know what we do about that. But there is that culture where the first thing that I would see is this leaflet. We're swimming against the top tide. But also, you know, I think part of what informs what we perceive to be, well, they are bad actors. They need to call the stuff that you're having to deal with on the front line. Parents are trying poor because they're needing to survive. And it's easy to make pasta with a little bit of already made sauce. I mean, some of the gross things I see on TikTok, it's... You're on this too, but that's a secondary thing. I know. Nobody's useful. Exactly. Right. I'm going to suggest we move on because we've got two funky items to get through and we've got to finish everything off. I'm going to suggest that we move on to the Da Da New Impa'u'lekte programme, which is really important, over to Adeola. Thank you. Can I do a preamble? Yes, please. Basically, everyone is going to be part of the FBI team that's going to ensure that health equity is taken seriously and is a golden thread in everything that we do. And we're going to monitor through the health and well-being board. So this is great. And this is this is just a very gentle intro so that we're not doing anything terribly new. What we do have is we're going to showcase Tom and his work with the route map. We're thinking of ourselves as a programme. I've got four slides that just recap what you already know, but I'm going to keep them in as our North Stars. Our programme is specifically focusing on services and organisations. And creating a context for prompting, nudging and pushing tuition work to support those organisations to become more better in their outcomes. And the main lever for that is doing deep dives and understanding pathways. There are other elements of it and supporting that with tools to make it easier and simpler to do that work. Here are nine activity areas. Deep dive, so if we say deep dive is also a QI project for those people in the NHS. We have created a four step process, which is a universal process. It doesn't matter whether you call it group dive, interested in inquiry or QI. It's the same four steps so that we can measure where people are progressing and getting stuck. We've got all the commissioners in Newham Council have within their PDP plans a mandatory equity objective, and within the 50 step strategy, all 50 steps have some equity element with a KPI and actions, all of which is a process to support them to progress. We have our learning community and our programme board leadership group, which are there to share the learning and keep things going. B, we have our tools and tonight I'm going to focus on the route map. It's got a bit more detail and use that as a jumping off point for the ask of the board, which is to consider where your organisation or the team that you're involved with is in this process on a couple of key areas, foundational areas. You have the art framework, which helps organisations think about their challenges, their service uptake, their outcome challenges from more from the perspective of the service user who's not getting the benefits at the moment, and in a way that's less othering than the current frameworks that are out there. Does it look like Newham? And again, we'll continue to socialise these things, simple piece of public health observed versus expected, but a quick tool to help you see if your service looks like the borough, and we'll be reworking that with a neighbourhood footprint to help with the neighbourhood work and then more complex pieces if there is a skew in the thing that we're looking at, for example, smoking. And we started work as a team to accelerate on what we're calling mini needs assessment. It's basically community care needs assessment so that we can have a snapshot of our various communities and their health needs as a community. We've got some advisory roles, we've advised on how to spend our NHS inequalities funding on, we're thinking and looking a bit more about protecting characters, state recalling and putting together a piece of work on that. And we've now stood down the else provided QI coaching and training. Right, so we're going to spotlight on the roadmap. It has three elements of it, or three iterations. One is aimed at organisations or another is aimed at teams and one is aimed at individuals thinking how we look at what we know already about the drivers of inequality and the two big key drivers of inequality health outcomes are poverty and deprivation and structural racism, and there's a big intersection between the two of them. And then that with taking that lens of protective characteristics there are other barriers around access, which are seen around cognitive abilities health literacy, and other issues which prevent people from having confidence or trust in service. So it's either with looking at the art framework, things to do with accessibility things to do with relevance, I don't think it's for me, I don't understand what it's for, and things about trust I don't think people are going to treat me well when I get that. This particular roadmap was requested by our stakeholders in our one of our foundational workshops, and is intended as a maturity matrix and an accountability tool, but it's also a support tool for organisations that pick it up. And that's what we're going to hit on in a minute, to be able to look at their own strategy and their own approach and see how they're doing. The purpose of the tool is bearing a green box at the bottom, how do we get to good to an organisation, and also for us as a system, and are we there yet. It's practical, it conveniently maps quite closely to the LGA 2021 quality framework which is a guide for councils to become equitable. That has four modules, counts that we've taken through those modules on the side of workbooks. Ours has six domains, which map and cover the same areas and the same important areas of activity. So for example workforce is always an important area of activity, thinking about leadership and organisational commitment, understanding the challenges through data and insights and understanding our communities, and working more closely with our communities to hopefully pursue things. And then in the LGA framework number three is responsive services and customer care, which is largely about increasing and providing. That's workstreamed for the TRID programme in our tackling racism, inequality and disproportionality programme that this equity programme reports into that board within the council, and they're shared for their joint and parallel pieces of work, mutually supported pieces of work, there's a timeline. Right, I'm going to hand over to Tom to look at the NUH route map spotlight. Thank you, Adi. Next page please. So, this is something that everyone in the room is going to be very aware of, but this is just an extract actually from 50 steps version one, and we used it as a tool internally to both educate ourselves but also educate the wider group executive board about some of the particular challenges that we faced in Newham. And I think the reason I put it in there is just to, I suppose this is this is one of the things that made me when I joined Newham and through me and others at the hospital who've driven this programme over the last 18 months or so, understand how important it is that we get this right, and we start by acknowledging that we don't yet have this right, and are not necessarily close to having it right. And it's such a big topic, and it reaches into everything a hospital does that I think one of the challenges for any organisation is knowing where to start. Next page please. And we found that the route map, we found the route map and I'll come on to some detail in a minute, we found the route map, a really, really useful tool to enable us to break down, to chunk down a really potentially overwhelming topic for people to get their heads around into a series of questions with a series of criteria that enabled us as an organisation to take an objective look at ourselves. And this is how we scored ourselves and we actually, in the route map it's fundamental, intermediate and advanced are the three categories that you can give yourself, but we actually felt when we were doing it that it didn't really reflect some of the nuances about where we were. So we actually did a subset and part of that is because there wasn't really an option within the route map as presented that says you're not actually meeting the fundamental position. So, we erred on the side of caution, I think we were harsh with ourselves but we agreed that was the right thing to do so if we weren't sure we went low, not high, in terms of our scoring. So, and I think it was really important, this was a conversation we had with ourselves as a board, hospital exec board, to say there's no point starting this with a lie, there's no point lying to ourselves about where we think we honestly are. Because if we start from that position clearly the outputs and the process are not going to move you forward in the directions you need to go. Next slide please. Now, I think Adi has been asked to talk a little bit about data so I've pulled out the summary page from our process, our review outputs. And this is one where we rated, I think it was the only one where we rated ourselves strong, fundamental, because we're not bad on data, in turn, in fact, UM Hospital is the best in the group but collecting ethnic data, generally. So we felt looking at the fundamental standards and this is where we found the three columns here with fundamental, intermediate and advanced. A really useful way to judge ourselves and we also felt, and one of the reasons why we signed up to ourselves is, again, the opportunity for all organizations in Newham to utilize the same tool to analyze themselves means that hopefully you get a common language, common currency in discussions about equity. So, this is a summary of our observations. We found that across all of the domains we had a set of discussions, we scored ourselves, we took the whole thing through our hospital exec board to say this is where we are, do you approve it? And everyone, no one demurred on our self scoring position. Next slide please. Actually, if you move on because that's one of the ones quantitative and this one's qualitative. So we then took the each domain, and we use the, the newer methodology, the Barts Health methodology of driver diagrams to chunk up each of these questions into primary drivers and then some of the secondary drivers, and therefore set of change ideas. And it's the change ideas which have gone to inform the program that we've got. And we're very, we're very comfortable with the fact that this is not going to, there are, whilst they're quick wins to be had. This isn't a quick win program. This is a, this is a bit of a fourth bridge program that you will, you're never going to, we're never going to, and we acknowledge we're never going to get to the end of this process, and that's okay. So that's informed, that's a sort of snapshot of where, of just one domain set of change ideas and actions which have been allocated to individuals. Next page please. And this is just to show in a way that the arc from agree you know signing up to the process and going through the the route map as a tool to to drive our understanding of where we are to the first line in this particular so we obviously produce a hospital plan every year. The first line in the equity state patient equity page is NUH health equity plan to make material progress against the actions allocated in the new hospital health equity plan. And this will be put there for delivery 50% and partial delivery of 25% of the actions allocated for 24, 25. So that's quite a tough ask given that there's always an awful lot going on in a hospital. So, we take it seriously, we think we've had some pretty reasonable wins out of the process over the last sort of 18 months, just a few of them, and I wouldn't, I wouldn't. We set up a proper equity governance in the hospital, and that might sound quite managerial but actually without trying to embed it within the hospital overall governance you're at risk of it consistently being sidelined as an issue. We've currently now got no differences in waiting times for elective care for based on ethnicity, gender deprivation, and we've made massive progress in reducing waiting times for learning difficulties patients so that now there's no difference there either. I would just note that this is tends to be a quite a macro level. So I'm happy to acknowledge if challenged that there will be areas or sub cohorts of populations where there will be differences but a macro level with making decent progress. So overall, we found it as a hospital we've found it a really useful framework and a really easy framework and I think one of the things I would say to partners and I'm happy to talk to any organization that's considering using it but isn't sure whether they want to that we actually found it a really easy framework to use as a hospital. The as an issue, you know, equity so big that the framework gives us a tool and the guide, and that's what it is. It's a guide to enable us to start to work out how we as an organization, which has no hundreds of thousands of interactions with patients over the course of the how we move the oil tanker slowly but surely in an equity angle. I think I probably say that progress has been slightly slower than we would like. And that's, that's, I think for a variety of reasons. But I think the point is that even when progress is slower. The framework the roadmap gives us the going to go back to so that we keep on the road and we don't allow ourselves to be blown off course over the long term. And the other overlay and new overlay and it's the second line on here is around health literacy and beginning to understand what we're doing quite a lot of work internally around trying to understand health literacy, some of the models out there. And we're clearly going to align with the 50 steps and are aligning with the 50 steps, step around health literacy and I saw that working group because I think there's something about making sure both organizations align on this as we go because we're both in, I think, with both sort of baby steps, pointing the process so we should work together to help each other, make sure to make a success of it, and understanding it and we're going to have a health workshop, health equity workshop. And for both the hospital exec board but also wider in terms of staff and we're really aiming this at frontline staff in October to just try and get people to think more holistically about equity and how the role and their function and their everyday actions act on equity and to try and diffuse and I think this is one of the challenges, diffuse ownership of the equity issue away from individuals into a more business as usual mindset when people are developing or delivering services. And I'll stop at that point and I'm happy to take questions or hand over back to Addy. So I had some questions for what I'm really happy to just have that Tom have some questions. Because I think that he and I have helmed a really thorough and interesting process and it's great that something that we collectively created has been so useful. And I think it'd be useful if there are questions for Tom to share with more about the process if partners are interested. Okay, I'm going to take a bunch of time. Anyone else? Just very briefly, I mean, it's, it's, you know, you mentioned in your introduction, Addy, and I know it's not a question to Tom, but it's about half there's a knock in the room, but there's a feeling at this time of year that we need to just, and it's not going to go away. It's, I mean, it's, it's level one and two on how portfolios go from the mayor, you know, this whole idea of equity. When I say, maybe I won't say that's political. It's very important, I think, that I know that Tom's two comments have really struck home, so thanks for that Tom. No point starting with a lie. In other words, we've all done this and we're getting bored with this or it's all okay. Or the next one, we move away from individuals so that it should be business as usual. It's like the whole of the protected characteristic thing, it shouldn't be that we should label an LGBTQIA community over here or a Black African community there. It should be just part of our business as usual thing. And whether it's frontline service delivery, but also be as strategic board, build on that stuff from health to, you know, because I was nine years on, the quality improvement programme is about not just influence in the workforce. So you don't have stereotypical views of the over-representation of Black African currently in men within the mental health service provision, or the over-reliance on, we've always done it like this. So when it's about that stuff, I'm too old, possibly, but we had this, what was it, circle of low expectations, low expectations within education, and we've moved a long way of hope from that. But it's stereotyping individuals before they get into even secondary education or whatever. And I think if we own it together, then it should be business as usual. But that was a really good example of how we just keep the workforce also in our communities informed of how we all see this as important. Just really quickly, I think it's a great start. I think this is the first piece of work I've seen from Newham Hospital in terms of even addressing any of this, considering the population that Newham Hospital served and the amount of patients coming in and out of the hospital is incredible. Just on that health literacy point, what I find so surprising sometimes is consultations are done with translators, but the communication that's sent out to patients of what the appointment was about is not in their language, and also letters that go out with appointments. So I'm part of something else I'm doing is meeting with Barts to look at their clinical activities and more about what the content is and for us in primary care to see the actions. Because one of the things that keeps coming up is what is that communication that's being sent out to patients, because they are then visiting the practice saying, well, I didn't know that, I didn't understand that. And it's just such a big thing that can be fixed probably quite easily. One project that we were involved with the hospital through our Well Newham Challenge, which is all about how you get in terms of health into clinical pathways, was the hospital translating prescription labels. And I think you've had a really positive impact from that, Tom, and I think there is learning to be spread from that piece of work. Yeah, that's I think a massively important starting point that that Bangladeshi pharmacy project, label project. But we know we've got a long way to go, not just on embedding that but then expanding it out. Okay. I'll come to you, Councillor, I'll come to your offence. I guess it's a broader point, we've all got pressures coming through out through the door every day, and we can look at equity from our perspective. What I'm quite excited about over the next 12 months is as a partnership, looking at that neighbourhood footprint. When we start looking at neighbourhoods, we start looking at shared pathways and shared communities that are kind of using our services, or not at the moment. That's where I think we can really kind of turbocharge the equity work by looking and talking and working with those communities. This is just what I want to leave the partnership with, we don't have to answer it now, we can come back to it. So we'll be here every month, we'll go through some of the domains of the group map and I think one of the things we wanted to cover early was data. One of the things is like, understanding your issue, and how we as organisations and systems record our protected capital, particularly and specifically how we record ethnicity, and there's a level of granularity that Newham requires that five high level groups are not sufficient to tell us what to do about any discrepancy, disparity, disproportionality we find. So, I'm just asking these questions, what's your approach to Age and Insight, collective ethnicity, gender, deprecation and poverty, and where are you in that group map foundational level, where's your organisation, where's your team, and I'll send it round and you can have a look and see what we've got. Care experience. It fell off the agenda when our current government was asked in power and we were trying to advocate socio economic status, because we thought that would get through better than class, but deprecation and poverty are a really important issue. And of course Silas has been talking about this informally, about, you know, if I'm navigating around the system with my skin colour and my educational background, and having difficulties, I just wonder where some of that goes, it's not just about holding everything to it. It's the trickiest one to capture though isn't it, a lot of these are mostly self-explanatory. We've got hundreds of people, very important also. So I'm thinking about inclusion, how people are the most severe challenges, but this is our majority population for the most part, 50% of the population are women, 72% of the population are global majority, so that's your takeaway thing and I'll stop sharing. Thank you very much, we'll have something else for you next time. We've got one more item, before I jump onto that, and we will do that quickly, albeit give it the ideally quality time it deserves. There's a series of recommendations I just wanted to ask everyone to note because we've got to just read them and I'm sure everyone is going to support it quickly. I'm just reading them. Right, we've got North East London Sexual and Reproductive Health Scratching. That's the item we're about to have, that's the one we just about, that's the recommendations for the item we're about to consider. No, no, no, no, I'm going to just do that now, so we're going to just consider all the other recommendations and all the other reports, can we just note them forward in the end? Great, that's that. And then now, it's North East London sexual and reproductive health strategy, and there's a lot of pages from 25 to 126, and Simon, you need to talk about this. Yeah, thank you for inviting us to the healthy North Korean board, we speak from yoga, really enjoy it. So we're not going to present the slide pack and we're definitely not presenting the strategies, we'll just talk you through some elements, given the time and such. But I guess this speaks to two of your priority areas. One, equity, like sexual health, where you can think of it in many ways, but like it impacts, just like Adi said, half of the population who is over a reproductive age needs to access contraception. So on the one side, it's a particular characteristic and a large number of people, and it goes down to very specific communities, very vulnerable communities, so people trafficked, certain sexuality groups and such like, so a very broad number of people, we see roughly about 30,000 new residents here, but also very specifically, we will see kind of groups around trans and various different things like that. So that's one thing to make. The other point just made before I could bring Kieran in is that the strategy is new, but the work isn't. The partnership, and it's really about kind of, we've tried in recent years to move away from a commissioner provider split, it's about us working closely with the specialists and Barts in primary care to develop pathways that work for people. So we've got equity and we've got systems sustainability. And how do you do those things? Well, you don't hide behind contracts and then blame each other's KPIs on the living. Really work with your communities to understand them and what their needs are and how to benefit them. Three examples, when kind of the new and more recent Barts contract came into place, since then in 2018, we've seen a 40% increase in long-acting reversible contraception. We've seen that in primary care and in the specialist side, and that's really about talking and working with women from various different backgrounds to understand what their motivations are and kind of progress from there. Another one is PrEP. If you think back just a handful of years to the HIV epidemic and the challenges for certain communities and in doing that is a broad split between kind of gay and bisexual men, or men who have sex with men, and kind of the black African community. We have come so far in a certain number of years. And again, Barts through co-design, and we were talking about kind of scientists earlier, it's that whole process of working with people from the start. What's the issue? How do we address that issue to where we are now? We've seen a three-fold increase in the number of people who are accessing that service locally. So again, really good success. And then kind of psychosex, something that splits very much between the NHS and ourselves and the kind of various needs of various communities. We are about to start one of the few trans services in the country, largely because we have particular communities in Newham and neighbouring that kind of need those particular services. So I just want to flag that this is both about equity, but systems sustainability. And I guess maybe just to point out, like a number of the sexual health functions sit between the council and the NHS. It's fragmented by design. The strategy is aimed to kind of take us that next step further to bring these things together and go, great, we've done a lot of work over the last five years. What's next? And how do we do that together? And how do we ignore the legislation that splits us and brings us together? Kieran, do you want to kind of highlight a couple of the bits and the co-designs that you've done? Yeah. Yeah. So the slides, I won't go into the strategy, but the slides kind of pick out just a few elements of this work that have gone on already. So one of the things that we're really proud of, working in partnership with the voluntary sector as well as with VARTS, is a project called Women for Women. So this is about just trying to basically train up community ambassadors for women in the Black-African community in Newham to be able to be aware of threat, talk about threat. And HIV more broadly and just try to break down some of those barriers that we think that that sort of quality engagement told us was one of the factors why you're not seeing uptake and prepping in some of these at-risk communities, Black-African community. And they've trained up to 30 people, 30 women, and over the course of the past year or so, year and a half, I think there's, I forget the actual number of sessions that have been delivered and how many people that have reached, but it's decent. And we're starting to see increases, as Simon said already, in the number of people accessing for HIV in particular for Black-African communities. Still a way to go there, as we've kind of alluded to, you know, if you're an at-risk community, for HIV, for example, getting bisexual men, bisexual men, loads more are switched on to sexual health services, getting tested and getting screened. So there's still that discrepancy, it's going to be there for a while, but it's starting to make headway. And some good work's been done on LARC as well. So we see, we've got lots of women on LARC, we do quite a lot of LARC in Newham, but relatively you see it's a bit more likely to be used by women, by white British women really, other than women of colour, or Eastern European women. And so there's been some focus scripting work done there, and then sort of translated into comms and GP surgeries, staff training and things like that. I think that's got a way to go, I think that's a really complex issue, I mean they're all complex issues, but we're starting to see some, starting to see some positive results coming in on that as well. So yeah, there's some good stuff there next year that's already happened, and then really over the next year or so it's about trying to keep that going, build on it, keep talking to people and understanding more, because I think there's still plenty of capture there, not understanding, but getting there slowly. Thanks Kieran. I guess, just to sum up, we run a shared service in Newham that covers all of North East London. And so whilst this is a strategy for North East London, it's very much been led by Kieran and his team, so thanks for that, it's hard to do collaboration, it's hard to do a multi-borough collaboration, and with health partners, so to keep that kind of shape of flow, it takes quite a lot of patience and various things like that. And just something on the detail of the strategy, it's got broad aims that we're looking to achieve over five years, but we all know how much can change in five years, just look at the last five years. So it's based on an annual action plan, and those actions can be delivered at now, they could be delivered at a Barts footprint level, or they can be delivered at a borough level. So we can be really specific about some of our very specific needs in Newham, whilst also complementing that wider NELP piece. So we're trying something new, I don't believe there is a version of this in North East London at the moment, hopefully it works, but it tries to bring together partnership, whilst also recognising that in some areas we're quite unique. Okay, so I have Rima and then Neil, is that your hand up? Is there anyone online that would like to ask a question as well? No? Okay. Just a few comments, just want to second the really good kind of feedback that I see about the interaction with larcs and the outpatient clinics, I think a lot of patients have really good experiences from those clinics. On the larc issue, I think one of the things we probably still need to look at is access to it. I know there are really quite long waits for women to get that, especially in sites like them or East, I think it's up to kind of two or three, you know, they might call and those like two or three months wait for larc, and we're still getting that kind of feedback. So it's just something to take away. I don't know whether it's similar to other boroughs. And the other thing that's coming our way is the women's hubs. So I don't know if you've had to get experience, it's just started with Tar Hamlets, they've set one up in City and Hackney, and I think it's really important to kind of make sure that that's all kind of integrated within that sort of sexual health side as well. Because there probably still will be women wanting to kind of access contraception at those sites, once we kind of decide how many sites we have in the borough and what's appropriate for our population. So there is that coming. And then I think it's really great about kind of the trans, in terms of is it like a hub or a clinic or do you know what? We have an exception within the police. So with that, those that have sort of already established, because obviously there's only one kind of main clinic in the whole of London that kind of look at like every gender, I don't see clinics. You'll be looking at sexual health through the eyes or through the service perspective of someone who is trans. Yeah, and so any changes and things, it'll be a bit of a feedback as to what's working well, what's not. I don't know. It will just be a place to come in and talk about any specific sexual health related issues. Yeah, yeah. Just on the last look, I'll take that back. There are issues across the London as a whole. Locally, we've not seen anything too negative, but we can take you back. Sorry, may I ask, so what is the concern? So obviously, yeah, could you just unpack that for me so I understand it better. So you're saying there's one trans community. For an actual gender identity clinic, there's only one in London, which I can get you out to the US Minister, and they many, in terms of prescribing hormones, they may initiate treatment. They may have the experience to continue that prescribing and across the boroughs, we haven't yet established those kind of prescribing guidelines across now. So, but there are other parts of London that are. So, you know, it is an equity issue. Yeah, because why should they be totally understandable what they are able to get in other areas. Why? I'm just trying to kind of preempt that this may be something that may come up, I know now I'm looking in terms of medical optimisation team into those kind of guidelines and seeing if we can try and have some special, special communities with special interests in each borough to then start being prescribed. Right. And yeah, from a sexual health perspective, obviously trans people will use their service, it's about developing a more sensitive offer, and having co-designed it with people with experience and socialite, they felt like a specific clinical session would be the best way to do that. So like, it steers away from like that kind of broader discussion too very much of an act, sexually active, trans from there. Yeah. Yeah. Any other, I've got Neil, and then Jason Sturdex. Yeah, I mean some of these issues around in terms of HIV, black, African, serous, gordon infection rates were known 20 or years ago, and it was still reflecting some of that, and I mean the report is really good to say that, you know, we need, for instance, continued funding for, you know, GP HIV champions. There's still stigma, which is clearly within communities, with some racially and religiously, as a morality. But it's important that the service provision is at the most accessible points, and people don't have to necessarily because of their sensitivities around this, go to a newer clinic or whatever, it's about all of that, you know, people being confident where they're getting HIV advice or STIs or whatever, you know, and I think it's important that we recognize, and I said this in an earlier meeting for the ICS shares that, you know, this is a good example of where we were already leading across boroughs. Unless you say so, to me, you know, this has not been an easy place of work, and there's still a long way to go, there's still a lot of inequality within the system, whether it's about black, you know, take up rates of prayer, or the e-service which is still not recovery among black communities to pre-COVID levels, you know, and all of that, and I think it's important that we don't make certain it's not talked about, because that's just rubbish in one minute, but we talk about things like the trans issues and where people are within our community and they've got the highest census figures, and some of these issues in terms of STIs, for instance, we had a dip and they're now up again, you know, just keep them up, you know, so I want to pay tribute to the Office of Roxanne on this little thing, it's a really good piece of work that we've showed models of good practice across, from Newark being the lead agency to now, the now footprint. I think just to echo that, and I think just for yourselves as the politicians to say that this creates a great framework and then over the next period of time there will be actually specific decisions from a council perspective, coming through cabinet for around procuring different aspects of how we deliver this strategy. Great work. Leave you with a challenge, I suppose, and I think you've kind of partially touched on it, Councillor, this is a fragmented system, things like HIV are coming back to the ICB. We've designed the strategy so we can evolve over time, but we would really like to kind of design that offer, well, open that offer to the ICB to co-design with us various pathways. In some parts of North East London they have better measure of pregnancy provision that leads to a reduction in repeat pregnancy. We don't because we don't have that particular relationship where we are co-designing or even commissioning on each other's behalf, so I'd really like over the next year to accelerate that integrated work because at the moment it does feel a little too fragmented. This is a start, but it's only words on a paper, isn't it? I can't underestimate the challenge around the practice enhancement and some of the testimonies that I've heard directly from our trans and even white LGBT communities when they're going through important transition moments, sorry, forgive the pun in terms of age as well. There's still quite a lot of unconscious prejudice and bias that we're going to have to contend with. Yeah, unconscious bias. Yeah, and also, you know, just the appropriateness of how you, how can we develop a practitioner base from that community itself? I think within this community, within this work environment, we tend to see quite a lot of practitioners from that background and active people, they're particularly passionate. I've worked in and around this, I remember one of the first things you did there was Open All East when you became the mayor. These are services often driven by people passionate through their own experience. It's just that it's about consistency, consistency of protocols, primary care, someone care, excellent kind of, but you can talk about that sexual health, you can talk about that a lot of different conditions. I think it's about the equity work, consistency, continuing to push where we can. I think also, if I may, just in the context of some of the minoritised communities within what would be defined as mainstream trans community, such a thing exists. You have hierarchies also existing within these communities and how do you address issues of disproportionality and how do you ensure that whatever division is being served in this regard, in terms of sexual health. Undoubtedly, some of the sexual health strategy issues that you're going to need to contend with amongst the trans community and wider LGBT community from the black and ethnic diaspora community will be as a consequence of abuse. I've heard some pretty harrowing stories that are now only beginning to surface from a maturing LGBTQ+ community from the South Asian diaspora and they've had to hold lots of things back, including instances of rape and sexual abuse by family members to stop them from being. So how do you make sure it's a torn, informed response and also, or practice, as well as practice informed by issues of systemic racism and inequality. And these are live conversations that some of the support networks are having. Yeah, me and Rojek went to the ML conference last month, was it earlier this month? It's really important and if you just take care of sexual health. We have contracts with people like Stonewall who provide accommodation for people who have gone through difficult scenarios in a young age, but in a broad sense, I think it's a really good challenge. You often see with sexual health an awful lot of investment around the openly gay population, because historically, that's where a lot of the issues have been. We need to make sure, unusually, that we're more balanced to make sure we hit all of our protected groups, because sometimes you take away from a group that you think should get investment to make sure that the right people do get the right offer. Okay. Do we, can we not approve Bonharto's meeting with Paul and the recommendations and can we also only note where people actually do things at the banks, our appreciation to the team for putting this together. Yes. Well done. Okay, next meeting will be circulated, look forward to seeing you, hopefully it won't be so hot. We're trying to do a bit to Stratford to make it easier for people to get to over East Ham, so reach out to the instructors. And thank you for your patience online. Take care, bye. Bye.