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Thank you, Councillor Bath. Just before we start the meeting and we officially hand over to Councillor Bath as chair of the Health and Wellbeing Board, just want to advise members that Councillor Bath was selected as chair by the -- at the annual Borough Council meeting on the 28th of May, and we have agreed that a vice chair will also be selected as part of the Health and Wellbeing Board and that we will defer a decision pending some discussions about who will be the vice chair for the next meeting in October. Thank you, Councillor. Thank you, Kelly. I forgot to mention the bit about the vice chair. Okay. So, can I welcome everybody again and can we start off with introduction? So, I'll start with myself, the cabinet member for Adult Social Care, Health, Public Health and Integration, and I'll be chairing the Health and Wellbeing Board. Moving to my right here. So, I'm Stephen Forbes and I'm the executive director for Children's and Adult Services here at the council. Hello, I'm Chas Falsander. I'm here from Democratic Services. My name is Chris Hilton. I am the chief operating officer for West London Trust here, representing mental health and community services. Good afternoon. Martin Wellington, director of commissioning and the borough director for Northwest London ICB for Hounsler. Good afternoon. Sukhjit Gill, JS&A program delivery manager. Hello, Dr. Hamid Gupta, Hounsler borough medical director and primary care representative. Hi, I'm Samrin Nohsin. I'm the senior project officer for Health Watch Hounsler. Hi, everybody. I'm Astha Bindrajka. I am the operations and research manager from Health Watch Hounsler. Good afternoon, Councillor Samir Chadri, cabinet member for Education, Children's Skills and Employment. And Kelly O'Neill, director of public health for the borough. Okay, lovely. Thank you, everybody. Can I also ask anybody if they've got any declarations of interest that they want to declare at this present moment? No? Okay. All right. In that case, we'll move on to our first item, which is the minutes of the last meeting. So this is really for us to agree the minutes' accuracy and any matters arising. I won't be going through them. So if you're all happy with accuracy from last, I'll sign those off if that's okay. Yep, cool. We have one matter arising, which was from the last meeting. And the action was that Dominic Conlin and Christopher and Dr. Gupta were going to present on A&E high-intensity users. But that has been deferred until the next meeting in October, if that's okay. Is that -- yep. Okay. All right. Thank you very much. Can I then move on to the next item, the agenda, which is going to be a verbal update from, sorry, Dr. Christopher Hilton. I only met you the other day, so I apologize for that. And you're going to give us an update on the actual transfer details and how it's been going so far. So over to you. It's a verbal update. Sorry, before you start, I realize I hadn't welcomed anybody who might be joining us online. Okay. Welcome. Thank you. Thank you very much. And thanks for the opportunity to provide an update to the Board. I, first of all, wanted to say how pleased I am to be able to let you know about the transfer of the Hounslow Community Healthcare Services from Hounslow Richmond Community Healthcare Trust into West London Trust on the 1st of July. But I recognize that this Board may not have been fully aware of the full circumstances behind that. I am the provider in this circumstance, and there are commissioning decisions involved, but I'll do my best to outline a little of the context, as well as importantly what local residents can expect and should not experience as a result of the changes that have taken place. I also ought to acknowledge, I believe this is a matter that the Council will scrutinize in the autumn, by which time there'll be more information, and we'd be very happy to come back at any time to this committee or to any of the other scrutiny meetings to provide further information when it's available to us. So just to cover a few areas, you'll be aware that Hounslow Richmond Community Healthcare has been the provider of community health services in this borough for a long time, and since the trust was created when primary care trusts were dissolved over a decade ago. For the same period of time, my own organization, West London Trust, previously known as West London Mental Health NHS Trust, has been the local provider of comprehensive mental health services for the borough of Hounslow. During the last 10 years, West London Trust has been on a significant journey, and we have not only been formally, legally renamed through, secondly, legislation, we have taken on a greater number of community health services across the area that we serve. So for those individuals who are less familiar with West London Trust, we cover the three boroughs of Ealing, Hounslow and Hammersmith & Fulham. We have a range of specialist services, including forensic mental health. And for the last 10 years, we've effectively had a division providing community health care services, initially in the intermediate care space, providing services for individuals with frailty, but also since 2019, we have been the provider of almost all community health care services in the London borough of Ealing, branded as Ealing Community Partners. We also have some community health services in Hammersmith & Fulham. And since last year, we took on a respiratory contract in Hounslow from a private provider commissioned by the Integrated Care Board. In the last couple of years, there has been a strategic discussion around Hounslow and Richmond community health care and its long-term strategic viability and partnership arrangements, including working increasingly closely with Kingston Hospital. And whilst this is outside my decision-making, a decision was made that a strategic outline case would be developed for a merger of Hounslow and Richmond Community Health Care with Kingston Hospital and for residents of Richmond and for the South West London integrated care system. That makes a lot of sense, making sure that the services within that South West London organised part of the London health and care economy is hosted together. However, in parallel, I think North West London wanted to ensure that the services for residents of Hounslow, and that includes both the Integrated Care Board, the old CCG-commissioned services, and the services commissioned by the local authority through the public health team, were able to be provided by a provider that is part of the North West London system, part of the North West London Community Provider Collaborative, and really importantly, part of the Hounslow Borough-based Partnership, and a Hounslow partner that was and is able to maintain relationships with the local authority, with our primary care colleagues, with the acute hospital here, voluntary sector partners, etc., in this place. Therefore, as part of that decision-making, an agreement was reached between Hounslow and Richmond Community Health Care and the relevant commissioners that effectively mutual notice would be given on the services and a tendering exercise would take place this year using a piece of legislation known as the provider selection regime. So, West London enthusiastically participated in that commissioning process with both the local authority and with the Integrated Care Board. That was a slightly accelerated process and we were notified at the end of April, beginning of May, that we had been selected as the preferred provider for those services. As is usual, a period of standstill followed and subsequent to that, we've been working really intensively with the commissioners, including the local authority and the ICB, including through Martin, and with HRCH and Kingston to mobilise the services with an extremely ambitious mobilisation start date of the 1st of July. The reason for that speedy transfer was because, I think, a lot of people in the system had been aware that this was coming and it was an immediate and urgent priority for us to provide confidence to not only the commissioners and our residents and patients and carers, but also really particularly to the workforce that they knew where they would be landing and to manage that transfer as safely as possible. So, just to let you know what's been happening over the last, just about three months, a joint steering group in West London Trust, comprising executives and senior representatives from all of the relevant departments, finance, digital, clinical services, workforce leads, communications leads and our estates and facilities colleagues, as well as regular meetings with commissioners have been taking place. This has been an accelerated process. So, at all stages, we've tried our best to be completely open book with any risks that we've identified and also the mitigations that we've put in place to minimise the impact of those risks. And we had a go/no-go decision at the end of June, collaboratively with the council, the ICB and both providers, that confirmed that whilst an accelerated mobilisation had taken place, we had sufficient confidence that we were able to go ahead with the transfer. And we, therefore, did, and the paperwork and contracts were put in place and staff from Houser and Richmond Community Health Care transferred into West London Trust as NHS employees on the 1st of July. Just to give you a sense of the services that are involved in this, it is the majority of the community health services within the borough within the local authority contract, we have a number of services commissioned through the Public Health Directorate for Universal Children's Health Care, that's the 0-19 service, Health Visiting, School Nursing, the Family Nurse Partnership, and a number of additional services that support prevention in the community. Through the ICB contract, we have the range of community services that people may be familiar with, including in a planned care space, district nursing, and all of the associated specialist nursing, a lot of therapies, including the Musculoskeletal Physiotherapy Service and a number of our other therapy contracts, a number of children's services, including children's therapies and the Child Development and Paediatric team. The other additional element of the contract includes the hosting arrangement that the Trust now has, that we've inherited from HRCH, which is the unique partnership between the GP consortium in the borough and the Community Trust as a host, but also as the employer of a lot of those additional roles that are supporting primary care in the Integrated Neighbourhood team, so staff including a small army of community pharmacists, among others. All of these staff transferred on the 1st of July. We held 10 in total induction and welcome events for those staff. They all had to choose just one, just to be fair. Each was half a day. And in those events, we believe we managed to meet nearly 700 of the 756 staff that transferred into the organisation and provided them with an opportunity to reflect on the things that they were excited about moving into a larger organisation than HRCH had been, but also the things they may be apprehensive about, including the messages they told us about their excitement of the opportunity of working in an integrated way with some of our other teams. So for our children's services, for instance, I was really pleased to hear about the school nurses' interactions with our mental health support workers in schools, the opportunities for our health visiting colleagues to interact with our perinatal psychiatry services in the borough. And there was a real appetite for the opportunities that that might bring. Their anxieties, particularly in some of the most small services, were about losing their friends from the Richmond border. And of course, we have both HRCH in Kingston and West London have said you may no longer work for the same organisation, but you can still share best practice. And there are a small number of services, a handful, that we have, by a contractual agreement between the two trusts, agreed to continue to operate on a two borough basis whilst we try to unpick and make sure that we've got a safe long-term solution. I'll give you an example of that at the moment. The referral hub for the services is exactly unchanged and remains a Hounslow and Richmond referral hub whilst we work through all of the pathways to make sure that if and when we choose to unpick it, we do so with as little disruption to refer as possible. But we're doing our best to make sure that there is no inconvenience. The key areas that I just may draw your attention to that may be of interest to the board, we are absolutely clear within West London Trust that we want to continue to operate Hounslow Community Healthcare as a ring-fenced resource within our organisation. So there is a new, what we call, service line that has been set up within the trust, working alongside the Ealing service line but not integrated with the Ealing service line. So all of the resources that are given to us, and I include principally financial resources that are given to us to provide care to Hounslow, remains ring-fenced for Hounslow. We are making sure that we've got an ability to report absolutely clearly the workforce implications, the productivity implications, the performance reports for the Hounslow borough. Obviously, we're going to compare them to Ealing and we will also compare them to the wider boroughs in the north-west London system through our partnership with CNWL and CLCH. But it's really important to us that we are able to see, in an unaggregated way, the work of the teams that we've inherited, the great work of the teams we've inherited in many cases, because they are fantastic in the teams that we have met. And they are enthusiastic about continuing to innovate and transform, including through the health and care integration work that we're doing in the borough-based partnership. A couple of other things just to draw your attention to, and I am very happy to then stop and take questions. Just for the record, the approximate value of the contracts coming into the trust are of the region of £50 million. So that's a significant resource within the trust. That brings the trust, my trust's overall annual turnover to just over half a billion. And as a contract or pair of contracts of that size, this does not quite meet a materiality threshold in terms of the financial risk of bringing in a contract of this size. We have some estates issues to work through. Interestingly, within Hounslow, many of the properties that are occupied by Hounslow Richmond Community Health Care, now Hounslow Community Health Care within West London Trust, were already occupied by us, the biggest of which across the road at Hart of Hounslow Health Centre, which we have both occupied for some time. Most of the other premises from which the services were delivered are, of course, patients' homes and nursing homes and schools. But there are a number of other health centres, almost all of which are leasehold properties, and we've made transfer arrangements for those to come across. One of them, West London Trust, is the freeholder, and anyone who has visited Lakeside Mental Health Unit will know that the Hounslow Therapy Centre is part of the old buildings on the site. We are... I've talked a lot about workforce already, but just to give you an indication of some of the other work we've done, apart from analysing the workforce, making sure that everyone gets paid in a week's time, which is the final hurdle to make sure that we don't... that the mobilisation has gone well. We've also examined the vacancy factor within the transferring services. So we inherited from Hounslow a vacancy factor of about 13.5%. That's a headcount of about 180 staff. And it compares... It's slightly higher than West London Trust's overall average. We are now at 10.8% as an organisation. So we are already recruiting to those vacancies through West London Trust and obviously using temporary staff where appropriate. We are also interested in the cultural alignment between the Hounslow services and West London Trust services. And just one measure of that has been a comparison of the NHS National Staff Survey that looks at what the NHS calls its People Promise domains. And I'm pleased to say that HRCH has traditionally done very well in the NHS Staff Survey. West London compares very similarly across all of the domains. And the focus of the welcome events that we've had was very much on cultural alignment and bringing the best of both organisations together to provide good care. We have not, I'm pleased to say, identified any significant, or indeed, in most cases, any performance challenges as a result of the transfer or any quality or safety matters resulting from the transfer. We are able to continue to report incidents, complaints, etc. now through West London systems. And we've continued to work with Hounslow and Richmond Community Healthcare and Kingston to make sure that there is a safe programme for replacement of all of the digital equipment that staff use so they can continue to do their work uninterrupted. The final thing I would say is that we've tried to lift and shift all of the patient-facing materials from the HRCH website, their leaflets, their posters, etc. onto the West London website. We'll obviously be working with the team members themselves over the next few weeks and months to refresh and rebrand all of those materials. But any members of the public, carers and families that want to find out about the services, going to either the HRCH website or the West London website will redirect you to the place to get the information about the services and also where to raise any comments, concerns or complaints so that we can hear any feedback that comes to us. I might pause, if I may, Councillor Bath, and I'm happy to take any questions from the board. Thank you, Christopher. That's very helpful, actually. You've given us a good sort of overview of the transfer. And just before I take questions and comments from the board, is it complete? And I'm sort of reassured from what you're saying. There isn't any loss of any particular services as such and loss of money as such or staff. But obviously, it's early days, isn't it? So, if we just to get... So, to be absolutely clear, the process that both commissioners and both trusts were applying was a lift and shift of the Hounslow services into a new host organisation. So, there's no change in the nature of the services, the size of the services, the funding for the services. A small number of services within HRCH spanned both boroughs. So, during the nature of the staff transfer, we, or rather HRCH Kingston, had to consult with staff to work out which way they would land, would it be on the Hounslow side or the Richmond side? And there has therefore been a small number of individuals who are still in their jobs, but we've lost them to the Richmond side. But likewise, Richmond has lost some to us, and we're making sure that we fill any vacancies. So, yeah, we will be monitoring the impact and very happy to report it, certainly by the time we come through to scrutiny in the autumn. Thank you. And so, as far as the residents are concerned, there's no difference to them in terms of the services that they get? Absolutely, there should be no difference. We're hoping over time that the staff will continue to transform and develop their services. And one of the bits of learning I had from when we absorbed the E-Link community services, we took on, having run the numbers, we took over about 25,000 or 30,000 episodes of care overnight when we took on the E-Link services. I ran them through the trust's database, and we already knew 40% of the individuals that were receiving care because individuals with frailty were known to our dementia services, children and young people were known to our cams and mental health services for young people, et cetera. I'd be surprised if it was any different in this borough, and I think that does offer a really good opportunity for us to provide more joined-up care. So, I'm hoping we may be able to improve the services over time, but obviously that will be a co-production piece of work. Thank you very much. I'm happy to take any comments or questions from the board now. Yeah, Martin. Thank you, Chair. I think firstly it would be really important to thank Chris and his team because this was a very speedy transfer and they did excellent. I think it's really important to thank Ann Stratton and the HRCH team because they were fantastic as well. Personally, I'd also like to thank Ann because she has been a member of this health and wellbeing board for many years and a great servant to the people of Hounslow. She's transferred over to Richmond, so I think this board should be noted our thanks to her for this work, but generally all of her work. I'd like to thank Kelly and her team because they were public health contracts and Ann in the audience today and Davina were really instrumental in making sure the council services were transferred well and Jane Wheeler and the ICB worked really well on the health contracts. We don't celebrate good things always and I think this went really well and smoothly and for the timeframe was a very successful transfer. So thanks to all. I guess then my question to Chris is what will be the benefits for the residents of Hounslow? So those numbers are really interesting, that 40%, but over the coming months what do you think will be the benefits for the residents of Hounslow? So I certainly think there is a benefit to local residents of having their services hosted within the Northwest London system or within the Hounslow Borough-based partnership. I think that we will be continuing the work that we're doing, including through the Borough-based partnership around health and care integration and seeing whether there are opportunities for us to simplify the care that's provided across the local authority, across the trusts, across primary care in order to make people's experience of what is a complicated series of services in the community more straightforward. I want to just be really clear, as a trust we don't have an already set out plan for how that is going to look and it's going to have to continue to be a piece of partnership work across the Borough-based partnership and really importantly with the staff that are delivering those services and the service users that use them. I think there are some things that we have already identified that will help us including some work to improve the environments in the Hounslow for patients. I'll give you an example. I was visiting the therapy service in Oblock which has of course been our neighbour on the Lakeside site for a long time and it's clear that there is a need for investment in the patient environment there as part of our negotiations with the integrated care board. We have successfully secured an increase in the amount of capital we are permitted to spend this year specifically to deal with some of the estates and facilities that we have in the Borough of Hounslow. So that's just one example of a concrete action that might help improve patient experience and staff experience of course. So congratulations to Christopher again. I just wanted to provide assurance that the primary care experience of the handover has been very smooth, operationally on the ground. I've had no reports of any friction or problems and I also wanted to thank Christopher because on the journey it was a very personal move. He engaged with everyone that he needed to engage with proactively and he was always very sensitive to the staff who were facing this change. So I commend him for that. And I look forward to numerous schemes of integrated neighbourhood team working which I'm sure that we'll do together. So thank you. Thank you, that's reassuring to hear. I've got Kelly and then Stephen. I just want to reiterate a well done and a thanks really and particularly to the staff as well who have been really supportive because I think going through that programme of transition and also maintaining the quality standards that the service has provided and as you've outlined there haven't been any performance issues that you've inherited and that's a legacy of HRCH. So I just want to congratulate you. And the other thing is just to really reinforce that point that you made Chris about integration. One of the principal foundations that the Health and Wellbeing Board exists on is how do we integrate the health agenda at place. And I think that this has provided an opportunity whether it was by design or the infrastructure changes that led to it to allow us to do that. And that 40% that you're talking about is a really good example of what are the opportunities that now exist going forward to really think about providing a more holistic way of working that perhaps having two organisations may have been a bit more difficult. So congratulations. Yeah, I mean I just think to friends lost, to reflect what Martin said, a loss to us is the loss of Anne Stratton. She was a close colleague for us in terms of her work here in Hounslow and is missed in this. So I think our sadness on that but actually thanks to her over the years for the contribution. However, I have this week from start to finish, I think got six meetings where ex-HRCH colleagues are part of that. And I think credit to the staff themselves. They have gone through this in good faith and are continuing to do the work. So I'll credit them and credit to Chris and colleagues in West London Trust. Transfers, as we know, can go one or two ways. They can go really, really well or they can go really, really badly. And this one I think has, in this first 17 days, gone exceptionally well from all aspects. So all credit to colleagues from HRCH. Hounslow Community Services now as part of West London Trust. This has gone relatively smooth and I see no difference in difficulties for us at the moment. Praise all around to you, Christopher and everyone. May I come back, Councillor Barbour? Part of the question that you asked was what happens next. And I just want to say thank you to everyone for their observations and also to echo the thanks to Anne personally for the work that she's done and has been a friend and colleague in the borough for a long time. We, as you've just observed, are three weeks in. We have promised the staff. We will do our best to be responsive to any issues that come up. There will be some, I have no doubt. This is not going to be completely perfect because these things are complicated. We have set ourselves a deadline of the 31st of October to resolve a whole range of residual matters. A lot of them are bureaucratic rather than patient-related in terms of contracts and lease transfers and recharges between our organisations. And we've got a clear contractual relationship with HRCH to manage all of that. Some of them are logistical, including making sure that we can acquire enough 750 new laptops or to reprogram 750 laptops so that staff no longer have to use the workarounds we have built to make sure they've got access to all of our systems. So that is the next stage. And we will, certainly as we get to month-end, be able to comment confidently on the financial position, the workforce position and the quality and performance reports. And a couple of months in will coincide with the council's request to scrutinise what has gone on. So I've been more than happy to provide that data here as well as to the other committees. Okay, lovely. Thank you very much. So an excellent start. I know big changes, but obviously going incredibly well. So thank you very much. And we will basically note on the minutes, I think, a thanks to everybody who's been involved on this. And of course, we'll have you back again, Christopher, at some stage to sort of report back to us. But thank you very much. That was very, very, very easy to understand. It sounds like a very complex situation and change, but you've described that very well. Thank you very much. So if everybody's okay, we're going to note that item and we'll move on to the next item on the agenda, which is an update on our joint strategic needs assessment. And I think we're going to have Sir Gill presenting that verbal update from you here. Thank you. Thank you, Councillor. So I'm going to be providing an update of the work that the Policy and Insight team have produced to support the projects and activity in the different areas of the health and wellbeing strategy. So start well, live well, age well, and healthy places. Most of what I'm going to be talking about in terms of the work that we've done is or will be being, will be published to the Hounso Data Hub, which is essentially Hounso's JSNA. And I'll start off with start well. So we've created a flu vaccination dashboard that analyzes flu vaccine uptake by GP practice and population groups. Unfortunately, due to the sensitivity of the data, we haven't been able to publish this on the Hounso Data Hub. However, it is being used to support the work that the public health team are doing. The next piece, we've got an oral insight report, which is being produced. And again, that will be published onto the Data Hub once it's been quality assured. We're also working on an infant mortality insight report, which will be published onto the Data Hub. That's being worked on conjunction with the public health team. We've produced an infants and young children insight report, which looks at a range of areas such as newborn screenings and uptake of the healthy start scheme. That's available on the Data Hub at the minute. We've also produced a childhood vaccines snapshot, which is published on the Data Hub. Again, provides an overview of vaccination rates in Hounso. And we've also made to accompany that, there's a dashboard for local authority level vaccination rates, which is available. But we've also created a more detailed dashboard, which is at GP practice level. So this information is publicly available and can be published. That's why it's available in the Data Hub. There's a children's mental snapshot, which looks at prevalence rates, et cetera. That's available on the Data Hub again. We're working on a pregnancy risk factors report, so that will be quality assured. We'll be liaising with our colleagues in public health about this report. But hopefully once it's all OK, it will be published and available in the Data Hub. And there's also a piece on underweighting children, which again, same, which will be quality assured and will be assured, quality assured with the public health team. And the final piece under start well is a school readiness and attainment report, which will again be published on the Data Hub. And that's coming. So there's a number of reports, as you can see, which are being quality assured. They have been produced. We had a slight delay because of the pre-election period. So there was a slight delay in publishing reports. But now that election period is over, we will start publishing these reports. So the next section is under live well. So there's a sexual health dashboard which has been created. So it provides information on testing rates among different population groups. Again, unfortunately, due to the sensitivity of the data, we're not able to publish this on the Data Hub. However, it is being used with the public health team to support the work that they are doing. We're creating a smoking and vaping snapshot, which is due to be on the Data Hub soon. It's again being quality assured. So as with most reports that I've mentioned, they have been worked on. They just need to be quality assured to make sure that the data is accurate, the information is correct. We obviously don't want to publish anything with any mistakes. So that's the nature of the work. We're also working on a smoking cessation insight report, which stems from some analysis we've provided to the public health team. So that insight report is being quality assured. It's been shared with public health colleagues, and it will be on the Data Hub soon. So it will be available to anybody who's interested to read about that topic. So as with anything that's on the Data Hub, it's publicly available. So anybody who has an interest in a specific topic or an area, they can actually just go on, log on, and just view this information. And the final piece in Live Well, we've produced some analysis about heat awareness in Hounslow. So this work identifies areas of the borough where residents are most likely to be at risk from hot weather. And we're working to put a report together, which will be on the Data Hub about this. So it just provides some further analysis and information to support work around the council, to support residents during the heat. So that's under Live Well. Under Age Well, we've created a Hounslow Connect. So we have the Hounslow Connect platform. And we've created a Hounslow Connect VCSC interactive dashboard. So it allows you to look at all the VCSCs recorded on Hounslow Connect in the borough. So if you wanted to find out your local or nearest VCSC and what they do, it allows you to do that, which is quite helpful. So that residents can actually use that stuff as well. So again, anybody who wants to look at the Hounslow Data Hub. And the final update under the Healthy Places. So we're working to support the work in relation to net-zero neighbourhoods. We've done this in an analytical capacity at the moment. But hopefully as work progresses, we'll aim to have a report which we can publish onto the Data Hub. But it's still in early stages and we're working closely with the teams. We've published a Flood Risk and Resilience Insight Report which assesses flood risk in the borough. That report is available on the Data Hub now. But we've been working with colleagues more recently. And we're looking at potentially updating the report, adding something in in regards to an interactive map, which hopefully might identify the top 10 LSAs who are at most risk of flooding in terms of the most vulnerable residents in those areas and how it could affect them. And the last thing I'd just like to update is that we've, there's been some newly published Ethnicity Group Deprivation Index data, which it provides a more nuanced understanding of deprivation in Hounslow. So it covers disparities based on ethnicity. So whereas before we had, we have IMD, which is this index of multiple deprivation. And it looks at different scales or indexes. This new public published information focuses on ethnicity and it provides some really interesting insight. So we've created a report which will be published on the Data Hub, which will provide some further insight so people can access that information and use it accordingly. That's my update in terms of the work that the team has done. Sorry, there was a lot of information there. But as I mentioned, a lot of it will be available on the Hounslow Data Hub. There are a few reports that I mentioned are unfortunately not on the Data Hub due to the sensitivity of the data. So that's my update and I'm happy to take any questions. Thank you, Sirk. So it's quite a lot of detailed information, but it is on our Hounslow Data Hub. Just before I ask any questions from the board, there's a lot of reports there, presumably, a lot of analysis and a lot of insights, etc. And I haven't been on it recently, but what I've seen is really quite rich, isn't it, in terms of the data. But does it lead to any kind of recommendations anywhere and does that lead to any change in services or improvements? Have we got any examples? Because obviously we can analyse, analyse, analyse, but what difference does it make? That's what I'm trying to get at, if you understand what I'm saying. Yeah, of course. So in terms of examples, I can't actually give you one off the top of my head right now. However, we can bring an update back to... Yeah, sorry. So, just to remind you, Sirk, there are three different products that have been set up by the JSNA team and what I would say is that the JSNA work we've done over the last two years is way beyond what a traditional JSNA does. And not only that, it is up to date, we're using contemporaneous data, it's coming in, it's being updated. And that's very, very different to the time of a three-year JSNA that we've previously had and many other areas have had. So we've used that kind of technology to really improve things. And part of that is to use the team with subject matter experts, which is why Sirk is saying about quality assuring, quality assuring, because you can interpret data in many ways, it's like 200% of nothing. But actually, by bringing in the subject matter expert, it allows that clear narrative to be accurate in the context of that specialist area. And that's why we've set it up. So there are three different types of products. One's a deep dive and that's used for particularly around things like health need assessment or when we're commissioning big pieces of work where there is a real need for really solid, robust and in-depth evidence to allow us to make recommendations about what the service needs to look like and what's the need in the borrower and going back to our health and well-being board principles, how do we improve access, experience and outcomes from the resource that we're allocating to that new contract. Then there is an insight report, which is less of a deep dive, but allows us to have a really good picture of an area of health need or social determinant need or wider determinants because, as I said, it covers quite a broad remit. And then there is the snapshot. The snapshot is here is some headline information that allows colleagues to look at information about the borrower, so on a day-to-day basis, they can self-service themselves. So all of these things that Sirk have presented are about business need but also encompass the traditional scope of the JS&A. But actually, the level to which the work is carried out is really determined on that kind of resource allocation decisions and proportionately. So if we're investing a lot of money into a service, we need to have all the information to allow us to demonstrate that we're using data in a really informed way to come up with a product that will match the health need and also tackle that sort of one-size-doesn't-fit-all. How do we deal with underserved communities and support them and make better use of our resources that helps those who are most vulnerable and have traditionally been less likely to attend for services which could support them? So that's why I think it's different uses and some of it, as Sirk has pointed out, is particularly around sexual health data, we use that for contract management. We use that with the provider just to make sure that there is no emerging risks and there's nothing that we need to tackle that's different and outside of what our current contract says. But it allows us to be really clear that we've got a repository of information that allows us to monitor trends and horizon scan for the future. I hope you don't mind me jumping in there. Thank you, Kelly. I don't know, did you want to add to that or no? Okay. That's quite okay. Brilliant. Thank you. Dr Gupta? Yes, thanks. I just wanted to ask, in terms of your voluntary sector tool that gives the interactive map of services available, have you got data off the back of that to show whether the trend of the use of that tool is going up or down? And we probably can't have insights of who's using it because if it's just on a website, but we could probably just get some insights on utilization. So we do have stats on usage of the Hansa Data Hub and the different pages. For example, the dashboard that we've created with the Hansa Connect VCSE dashboard. So we can look at numbers in terms of, since we've put that dashboard up, how many people have visited that particular area of the site and to see if, however many weeks or months, whether accessing that particular page on the site has been increasing. So I can bring that back to the next board if that's of interest. I guess my spirit of my comment was I just wanted to know that people were going there and using it and that utilization was going up, which was the root of my comment. One of the struggles we have is letting people know of the services that are out there and connecting people to the right services. That's a struggle, I think, for everyone. So if you're getting it right, let's learn from it and see the numbers going up. That was the spirit of the comment. So I'd be happy just to see that the numbers are going up. But other board members might want more details, but I don't want to create a job out of nothing. I can't actually comment myself because as much as we do have access to that, it's not something we're focusing on in terms of tracking to make sure that that particular, for example, that particular page of the data hub is having X amount of hits or is increasing in terms of how many people visit that particular page. As I was saying, it's something that I could bring back if that's of interest. If you'd like to know if that is the case, that's something that it would just be a one-liner I could bring to the next board to say yes. Yeah, I think that's a fair comment. It would be really interesting to see what usage is. Yeah, thank you. Thank you for that. No problem. Any further questions or comments from anybody? In that case, thank you very much and I think we'll move on to the next item, which is Martin and you're going to be updating us on the Better Care Fund. There's a huge amount of papers here which everybody's read. Yes, I thought I'd do a short test on how well you have read it. You're going to test us. No, thank you very much, Chair. The Better Care Fund is a pooled budget between the council and the health system, the ICB. Now it started with the CCG. It started in 2015 and every year, the Health and Wellbeing Board is asked to approve the planning submission for the following year and approve the spend for the previous year. So that is what we're asked to do today. The submission actually had to be done completely on the 7th of June, so we got the chair's approval outside of this meeting. So we're seeking formal approval of the board today. I'm not going to talk you through all 120 pages, but just to confirm the key purpose of the planning submission is to confirm the status of continued compliance against the requirements of the BCF and to confirm the income and expenditure for 2024/25 and just to make people aware, the total expenditure or income for next year is 43,149,000 pounds. So it is quite a considerable amount. Stephen and I, Chair and Executive Board, have oversight of that spend. We meet regularly to ensure that you spend sensibly within Hounslow. So I think Stephen and I will be happy to assure the board that we are happy with that planning submission. And then, again, the end of year report for last year is confirming the spend for the previous year, which was 40 million pounds. And, again, Stephen and I and the team have been working to ensure that will be spent in a sensible way across Hounslow. So I welcome any questions on the paperwork. Thank you, Martin. Before I take any questions, Stephen, did you want to come in at this point or after questions now? I always feel obliged to have a comment about the Better Care Fund. Primarily because the Better Care Fund seems to eat up an increasing amount of my time in terms of the administration, as much as the output, not reading the papers, no creating the papers behind the scenes, Councillor Butler. I think, you know, in reflection, you know, as Martin says, the Better Care Fund has been in existence since 2015. There are a set of national conditions that have changed over that nine and a half, ten year period. Fundamentally, some haven't disappeared. So certainly the implementation of the Care Act, there was money passported to the Better Care Fund in terms of new burdens to the local authorities and implementing Care Act duties. There were elements of the Better Care Fund that wrapped up predecessor arrangements. So we used to have what were called old section 256 arrangements that money flowed through the NHS to the local authority for mainly local authority duties, which were to encourage the partners to collaborate. All of that got sucked up. There are elements that we have to, from our own revenue budget, submit into the BCF. So things like the DFG, Disabled Facilities Grant, which is money that comes direct to the local authority, goes into the BCF again to encourage the NHS and the local authorities to collaborate. And in this year, in this planning year, we've had what's now called the Adult Social Care Discharge Fund, which has now been attached to the BCF as an additional pot of money that flows through the ICB, which is to enable collaboration between the local authority and the NHS, predominantly around, as the hint is, about discharging people from hospitals to improve patient flow. I dare have to say, on a slight negative, last year's planning submission was better than the year before. We agreed to roll over existing schemes across north-west London, London without change. On the basis we agreed a north-west London focused review of the BCF for next year. So we are currently in the process of conducting that review between the eight local authorities and the ICB. The previous year, which was 22, 23, 23, 24, we did have some difficulties agreeing the plan because of the late timing of some requests and challenge from the ICB about the structure of the NHS contribution. We managed to get through that process. But fundamentally, I think for us coming into this coming financial year, i.e. next financial year for the BCF, is the outcome of this review. And at its best title to say we are seeking, I think, from an ICB perspective, Martin may want to comment on behalf of the ICB because I'm only giving a local authority perspective of what I think the ICB seeks to achieve here, which is consistency across the patch from its perspective. But we are setting off with eight plans that were very much developed with a local focus. So we have overall 298 scheme lines across north-west London. And that doesn't talk about consistency, that talks about variability and localism. So there is a bit of a tension at the moment in trying to resolve that review in terms of coming to a conclusion for next year's BCFs about where we get to in terms of the schemes that are adopted in. So we were due to complete the review for next year by the end of June. Not unsurprising, we didn't. We've extended that deadline until September, but those of us in the local authorities now have been fairly clear on that because of our budget setting processes. We need clarity by no later than October in terms of taking future planning on our own revenue budgets to yourselves and cabinet by no later than January, February next year. So there is a bit of a pressure if we seek to make adjustments to the BCF for next year that we have to conclude the review no later than October this year. But I won't say any more on it unless Martin wants to comment from an ICB perspective. No, no. Anybody got any comments or questions? Councillor Choudry. Thank you so much. My previous one, I'd just like to say thank you very much. There has been some difficult conversations as well, but hats off to our team. They did brilliant. Thank you. Thank you, Councillor Choudry. So if there's no further questions, then the board, are you reassured that we signed these off? Yeah. OK. Excellent. All right, then that's confirmed then. Thank you. So if we move then on to the next item of the agenda, which is you, Martin, again, because you're giving us an update on the ICB and the Borough-based partnership. Yeah. Yes, thank you. So last year, October, the ICB was, or probably April last year, we were asked to make an approximate 30% staff saving on staff within the ICB. The ICB not just being Hounslow, but the eight boroughs, which was a considerable reduction in staffing in the system. Luckily for Hounslow, we had quite a small team already. So the impact on Hounslow wasn't as large as it was in other places across north-west London. But as a system, we have been going through a restructure. Staff have been going through interviews in May, June, July. So we're coming to the end. And I'm pleased to say that the majority of Hounslow staff have got Hounslow jobs. And in total, we have only had, we've lost three jobs. In total, we've got 13 remaining within Hounslow. So it is very positive in the sense that we keep a strong team. It is a reduced team, but it is a reduced ICB. It has, again, I think we need to thank staff because it has been very stressful for them all. It took much longer and there's a lot of lessons to learn, but I think we should really thank staff for their time and support during it. And I think the challenge for Hounslow Health and Wellbeing Board is making sure, and it sort of touches on the Better Care Fund, that we work with the ICB to make its governance better, to make its decision-making better, to make it a system that we engage and work well with to get better outcomes for our residents. And I do think it being a more streamlined organisation with less staff does mean it has to become, it has to improve in its governance and its decision-making to make the system work better. So I do hope there will be some positives, but I would encourage the Hounslow Health and Wellbeing Board and the local teams to work with the ICB to ensure that we get improvement through the changes. Thank you, Martin. Can I just follow on? So do you feel confident that with the restructuring and the change and obviously more streamlined board that you feel that we could deliver? I think in reality, with less staff, you can do less. So Councillor, in your role, you will be part of the ICB board. We need to make sure that you're well equipped to attend that board and to make sure it supports Hounslow and what we require going forward. So I think we just all need to be smarter in the way we work so the team we have are as productive as possible. Sorry, Martin, just another follow-up question. Are there any other future restructures or is this, because 30% is quite a lot, isn't it, really? I'm not one to speculate. I think we, in the health service, there are regular restructures, many more than in local governments, so I wouldn't in a public meeting like to say no. But I would hope that this is given time to settle in and deliver what is needed. Thank you for that, Martin. Any questions from anybody or comments? No? Okay, that case, thank you, noted. Okay. Then moving on, we have now got Health Watch, who are going to present us with, you actually have a presentation, don't you, with slides and everything, which is great. Thank you very much. So I'm not sure how you're going, are you going to share a presentation between, yeah, it's all up there. Okay, lovely. All right, I'll just pass over to you then that you get on. Thank you very much. Hi, everyone, thank you. So I'll be presenting on behalf of ASDA because this is my first ever board meeting. So thank you so much. So I want to introduce myself and this is for my own personal growth as well. So we'd be presenting our quarter for patient experience report. So as you know, the patient experience program is one of our major work streams that we do as part of Health Watch Hanselow. So every quarter we get 1200 feedbacks from the local residents. And we visit all GP practices, pharmacies, dentistry, hospitals, and we have a diverse team of patient experience programs. So we have got one patient experience officers and we send our volunteers to different areas of the boroughs. So just to, I will not deep dive in the statistics, I will give you a brief summary and snapshot what we do. So this is the quarter four, which happens from January to March 2024, where we have collected 15, 962 reviews. Sorry for my eyesight, it's quite small for me. And we've conducted 54 visits. And the fact that we have 74% positive reviews for GP practices is quite, quite brilliant for this, this quarter. Because compared to other quarters before, this is quite a significant improvement in terms of GP practices. And then there are other ones that we've collected from the hospitals and pharmacies. Just to reiterate what people have told us in regarding, because we collect their qualitative feedback as well. So in terms of the positive feedbacks, there have been compliments in regarding doctors' behaviors and nurses' behaviors, treatment and quality of care. And one very positive aspect that we've noticed is that the messaging system has been very helpful. So in terms of booking appointments, appointment availability has quite increased in terms of online engagement and getting to people and the patients in terms of digital aspect. And the negative aspect that we would like to highlight is patients have often complained about one problem, one consultation. And that has been going on across the year so far. And we know that there will be always problems. We cannot please everybody in terms of giving them appointments. So that has been another problem that has been consistent throughout the year. So for this quarter, we have collected 656 overall reviews from the patients, whereas 74% have been very positive and just a minor bit, which is 6% that is negative. And you can see we ask people quite a lot of questions around how they find getting an appointment, what do they think about online consultations, quality of telephone consultations, the attitudes of staff, the quality of treatment, how would they rate it. So cumulatively, we ask a lot of questions and then we sort of analyze based on their feedback. This is a breakdown of the data that we have in regard to access and quality questions. So most of them have been very positive for this quarter, whether it was getting an appointment, whether it was getting through someone to the GP practice. This is a comparison between the other quarters of this particular year. There is nothing much to highlight in here, apart from the fact that this has been quite positive. As part of the primary care networks, we have mostly visited Heart of Hounslow, Brentford and Isilworth and Felton. We have got a massive numbers or a significant amount of reviews from these particular GP practices. And to say what's working well and what's not working well, again, the quality of treatment has been great. Staff attitude has been great. We have most comments around appointment availability for this quarter, whereas mostly it was positive. But we cannot neglect the fact that people still struggle to get appointments and there is a lot of waiting time around there. But apart from that, one negative aspect that I might highlight is the quality. Sorry. There is a significant drop down compared to quarter two in terms of the waiting time. So maybe we need to compare what can be more improved if people are waiting over the phone, mostly because it's regarding telephone consultations. We maybe need to look into what can we do more to improve that particular period to help out patients. And this is an overall comparison where you can see quarter four has quite an improvement in regards to quarter one. There's quite a jump from 64% to 74, almost like a 10% jump. So I think I would like to reiterate that this quarter has been very positive in terms of GP practices. Yeah, that's about it. And this report is very detailed in our website and it's been published in our Health Watch Hanslo website. So if anybody's interested to read further, you can take a look there. Thank you so much. Thank you very much. Can I just ask what happens with the recommendations? What happens when you do a report in terms of how do you take them? Where do you take them next? So if I can comment, Councillor Barthe. So Health Watch published their reports. All of those reports go to all of the significant primary care partners. As soon as they're published, access is a constant line of discussion within primary care. This is a good opportunity for me to comment towards that, you know, London did have a same day access program for general practice. It was bold, it was ambitious. The timeline was a bit too fast. The ambition was for it to go into the Northwest London single offer and our partners asked us to slow down. They wanted more time to engage with patients to get the design right. So that's the sort of methodology that's going to be done. I'd actually hope to bring back a more granular, well, granular report on how that will be done. Feedback from Health Watch should feed into that. Data from our 111 utilisation should feed into that. And our attendances from urgent and emergency care services should all be feeding into that access program to make sure that patients can get the right appointments and when they need them. I think it's really positive that the positive feedback is increasing. As Christopher mentioned earlier, the biggest expansion of staff has been the R staff. His service is hosting an army of R staff and we've seen significant numbers of appointments increasing within primary care. That can only be a positive thing. Now also as part of a national program for modernising general practice, there will be work done on the telephone waiting system so that people are aware of where they are in the queue. Maybe there'll be callback functions and equality of whether you're doing phone access or online access from the practice website. So there is a programme of work and funding behind that as well. So hopefully those two pieces of work done in tandem will further improve the access experience. So access remains an active topic within primary care and we aim to keep on improving it. Thank you. Thank you. Just remind me again, for my knowledge, do all GP practices have the ability to book online appointments? Yes. So part of the IT development was that all practices were to have an online booking function. I think initially there was a certain percentage of appointments that had to be bookable online. But I think since then that's been sort of pivoted and it's meant to be more data driven than just a blanket number per thousand patients. It's meant to be more intelligence based than that now. Thank you very much for presenting that report. That's very good to see the positive change. Kelly? Oh, no. Christopher? Thank you, Chair. I just want to say thanks to Samreen for the presentation. I'm conscious, and this is true every time I hear the Health Watch summaries in the three boroughs that we serve, that often the feedback we have from mental health service users is quite small in number, compared with the feedback from some of the other sectors, the hospital and primary care. And I just wanted to make an open offer of anything that we can do collectively to help you, help us to get feedback from our patients would be really pleased to do that. And also in the context of the presentation about the change in community services, I'd be really keen to hear anything that you detect about any positive or negative changes that patients feedback. And I'm really happy to have a conversation about how we might do that. Yeah, that sounds absolutely fine by me. So I've been going through sort of qualitative comments all on my own for this quarter, just because the community services has transferred to West London Trust. So we do information and signposting, and lately I've been receiving a lot of queries about, you know, the false prevention services and all. And because we have done a piece of work and passed on false prevention services. So we have worked very closely with Anne and the team on the false prevention. And I'm talking specifically about false prevention because a part of that project, we have made some awareness campaign. So I'm very happy to give you like we do this with a lot of providers. I'm very happy to talk to you separately or we can meet out of the board and we can discuss about this. And I'm very happy if I accept this, that we receive sort of very lesser comments about the mental health projects. But you must have met Carlene, who is the Ealing and H&F's manager from Health Watch. She does a lot of work around mental health. If you want, I can get the data out for you because she gets some sort of feedbacks for the mental health enhanced law. So I can get that to you. Thanks. Thanks for that. Just to come back from my chair. West London Trust, I think, commissions Health Watch to do the work that Carlene's doing. The Health and Wellbeing Board may be interested in us jointly presenting some of it here as part of the patient feedback experience. We're really happy to do that jointly with you or Carlene. If you want, I can bring you the data for the next board meeting. That would be good to see. I'm happy for this integrated partnership work to take place between you both. Absolutely. But I take the point about low engagement with mental health. That is really important because, obviously, I accept that it's sometimes going to be difficult to engage because of the type of person that your services are engaging with. But it's really important to get that. Thank you. Councillor Choudry. Thank you. I think, yeah, it would be really nice if we can see the combined data for the mental health as well, maybe for the next meeting. Thank you. Thank you. It's just as well I have Kelly here. Yes. Okay. So all I was really saying was thank you very much for the presentation and look forward to your next project that you present at the board. Okay, so I'm going to be moving on now to agenda item nine, and I will be inviting Kelly, who's the director of public health and she's going to be presenting an update on the health and wellbeing strategy report, and actually there is some paperwork to this towards the end of the agenda. Is that correct? Yeah. Yeah, that's, that's lovely. Thank you. And first, just by thanking many of the board members who have been responsible for their various delivery groups for putting the information together. I know that we have struggled over the last, certainly the prior to this particular strategy to bring this information together, and we keep trying to put iterations of how we report this to the board. Not sure we're still there before Mr. Forbes jumps in and gives them recommendations, but I think we've moved to a better place and the reams of information and massive A3 documents that we've had before. So I'll start by saying that the current context and process and governance around the health and wellbeing strategy is the same as that to which we've reported many times. Sook has already flagged that all of this work is supported by pretty robust data triangulation, including sort of insight engagement work and quality and quantity of data that really informs many of these areas. And what we tried really hard to do is to really align the work of the policy and insight team to make sure that we're driving forward a very evidence based way of doing this piece of work. So what I will, this particular report presents all four thematic areas, and it's relative to 22-23, 23-24, quarter four performance. And again, I don't think we've quite got the RAG rating absolutely nailed, but Green is indicative of that the lead officers who are responsible for this work are saying that the project's on track. And remember, this is year two of the health and wellbeing strategy, so in many respects the data, some of the data and its public health data can often lag a little bit. So often we don't demonstrate possibly until quite a significant period into the strategy the outcome is being achieved. So they may be actually RAG rating on are they doing the work that they said they were going to do that's in the project plan that delivers against that priority. The AMBA is a delay in progress being achieved, well a delay in the progress that is being achieved against what was expected and RAG is significant under delivery. And my recommendation is that as we move forward, we start using, we're looking at these red areas and asking the officers responsible to come and speak to us about what are they doing to get this information back on, this project back on track so that we can be a little bit more assured that by the end of the three years we can demonstrate the progress that we stated from the outset was going to be delivered. So starting with Startwell, all the children's areas are RAGD either AMBA or Green and the key points in the document do flag to the board where, particularly where there's AMBA, where there is perceived to be a slight delay or a lack of progress that would have provided a green RAG rating. Suks talked about the fact that work's been going on with infant mortality, this is an area that is continually lagging really. Essentially we're quite reliant on the child death overview process and the information that comes on the back of that. We've done lots of engagement in that area ourselves, but actually I think some of that is translating into a bit more action. We've got a lot of action that's around the kind of children's health area, but there's still quite a little bit more to do. So David and his team in public health are leading that particular work. Other sort of really notable features, and it's a green feature, is that we're in the process of retendering the 0-19 service. Chris will be very aware of that. It's been directly awarded under the new procurement rules to Hounsow Community Trust under West London Trust, and it's been a really positive piece of work in terms of modelling a new way of working, particularly being able to pick up the recognised needs that we've focused on and have presented to the board in the past. The other areas are there for the board to look at. In terms of one of the areas that we continuously have a challenge with, it's child overweight and obesity. What I can say in terms of the data is that there's a positive move in terms of one of our two milestones. The year R data looks positive, and the level of overweight and obesity looks to be plateauing and actually demonstrating a trend to reduce. Unfortunately, it's completely the opposite on our year six data, which is like everywhere else, is still going up. Our ambition here was to plateau that, at least plateau the year six data. We've rated it amber. It could be rated red based on that. What we've done is we've started a children's focus piece of work to try and look at how do we tackle obesity as a kind of collective across our base partnership organisations, on top of the other work that's already been going on in terms of whole system approach, and the new service that was procured last year. That allows other partners to give some objective oversight and to be able to start thinking about what could wider services be doing to support that piece of work, rather than come from a traditional public health perspective. Other areas that the board have been aware of is that we still have a big challenge and an uphill target for children's oral health and reducing visible dental cavities. This is an area that we've still got a lot of focus on. I'm leading the North West London work through the Integrated Care Partnership to try and tackle this across all eight boroughs and try and look at where's the best practice and how do we, as eight boroughs, including, tackle this issue and try and get some additional funding on top of that, particularly through some of the funding streams that tackle disparities, because this is very much a disparities issue, and try and consider different ways of doing this work. Unfortunately, at this moment in time, again, we've got some data lag, but I can absolutely assure you that the amount of work that's going into this piece of work, on top of the new dental strategy, dental access strategy, is really being pursued in a real partnership way between public health, children's paediatric services, and with the ICB. And then, just a really positive one, which is number seven, is a real positive description I'd like to draw the board members to in terms of increasing the number of children aged 16 to 17 who are engaged in education, employment and training outcomes. I won't go through the detail, but there's some really good narrative that demonstrates we're doing a lot of work in that area that's really positive. When we move on to live well, the more adults, the main concern that I'd like to draw your attention to, and we've kind of, and Sukh again is doing some work in this area, is our smoking prevalence. We have one of the highest smoking prevalence in London, and that hasn't shifted. We've got a revised action plan, we've got a significant increase in our investment as part of the new smoking prevention Stop the Start, which obviously was mentioned in the King's speech today. And we've also got quite significant investment in vaping, so that people can shift in terms of a harm reduction way from smoking to vaping. Again, the clear messaging about when to use vaping and when not to use vaping is really important, and part of the work that we're doing with this Stop the Start is to address that issue of children vaping. There's a lot of work to do, and we're really making that an absolute priority in public health. And when I look back a few years ago, well 10 years ago, that and MRSA were the big targets for public health and public health within the NHS. And I think that it's had a lesser priority, but actually this is, we've got past the low hanging fruit, we've got past the people who have found it easier to give up, but now we've got an entrenched group, a population group, that is quite significant in Hounsworth, where smoking is really, really affecting health, and it's driving demand in health services. And despite the fact that we've got the Stop the Start being implemented as part of the new government, we've still got a significant amount of older young people, older young people, teenagers who are beyond that particular age, and adults who, if we don't tackle that, will be lifelong smokers. Other key areas, I think, to point out, most of those areas, most of the areas in that particular age well are green in amber. As I said, I'll point out that smoking is a really big concern for us. And then I think the other thing is, just to flag, is number 11, and this is an area that Stephen has become increasingly leading on. This is about the issue of problematic drug and alcohol use. Stephen chairs the Partnership Board, which was a requirement under the New Harm to Hope Strategy, of which we're in Year 3 of Year 10. This has been really instrumental in really driving forward a kind of a collective and partnership approach to tackle some longstanding issues of drug and alcohol services being slightly isolated away from what is a kind of, a cross-system working that needs to happen in order to move that forward. And alongside that, public health are re-tendering drug and alcohol services that have begun that process with a plan that the new service will go live next year. But I will say, though, that CNW will deliver that service. We do have, usually it's either the first or second top-performing service in London, and they deliver an absolutely fantastic piece of work. We want to maintain that service in its current way of working, because it also provides quite a lot of inclusion health work, which is slightly outside of traditional drug and alcohol services, but really supports those people who have quite chaotic lifestyles, stabilises them in order to more effectively be able to respond to the treatment options that AHRQ provide for them. Moving on to the next area, this is ageing well, which has led to the Frailty Board. And really some key areas here is that falls prevention, which our colleagues in Health Watch have done a huge amount of work. And actually we've done a lot of work in public health with colleagues to try and sort of look at and horizon scan and plan for what is our frail population and those who are likely to fall. That's been a really, so far the data is demonstrating a really positive impact. I think in the early stages we weren't really seeing the progress that's now being demonstrated, so that trajectory looks good, but we're keeping on to it just to make sure that ongoing improvement is maintained. The other area that we also spoke about today at the Frailty Board actually is Area 2 of this, which is about ensuring people are supported to express preferences about end-of-life care. And I think one of the things that we spoke about today is about preferred location of where people want to receive their sort of palliative and end-of-life care. And while we are improving, we kind of recognize this and we've spoken about this at the board, there is still a long way to go to really achieve that in terms of making that preference real. And then lastly, moving on to our healthy places, this is an area where I think we've always had less focus, and I think that there's a little bit of work that we need to do, well certainly I need to do, to make sure that this is really part of, this is being seen as a priority in the health and wellbeing strategy. I think that changes in staffing within the kind of senior leadership team meant that the person that was doing the work previously, that that's changed. So I think for, this is the area where there is most reds, so I think particularly around some of the sort of net zero work and carbon neutral neighborhoods, as a local authority, we've been very proactive on. I think there is a little bit of a deep dive to understand really the nature of what is driving that red, because the narrative does seem to suggest that it's a little bit more positive than the red would suggest. So I think at the next meeting with your agreement, Chair, we'll have a little bit of a deep dive into that area, and a deep dive into stop smoking, although we did speak about smoking before, have a sort of a real focus on those red areas, and bring those officers that are responsible for living this, to come and have a conversation with us and answer some questions. And I'm happy to take any questions on this, even to include any improvements in the reporting that may be flagged. It's better than any three piece of paper. No, thank you Kelly, I actually think the reporting is quite clear, it's really good, because I have been a Councillor for quite a while, and I've seen lots of different styles of reporting, but I like this. Just, it's good to see the improvements, just obviously to flag up some of the red areas, and I was going to ask you, why really? Is that because we're not doing enough, or we're not doing the right thing, but I guess you've addressed that really, because if we're going to look into it, we need to give it a little bit more attention, don't we? So, I presume we'll be bringing it back to a future meeting here, yeah? Yes, I mean, in terms of the Stop Smoking, I think it's fair to say that we commission a really solid service with sufficient capacity. What we're not achieving is the access to it, and we know that with our current provider. And this kind of additional investment, we're really clear, it's not going to go the same way as the, you know, we need to do something different, we need to improve the access, and because all of those people that haven't changed or haven't stopped smoking in the past, there's a lot of behavioural work that needs to go on, a lot of conversations that need to be had, in order to really understand why, because this is not only about health, it's about wealth generation as well. Thank you. Questions from Martin? Kelly, thanks very much for this, and you know, I think Stephen gave the board a good challenge some time ago, and I think it's made great progress. I do still think, so, some of them have amber progress, some of them have got comments by them, some haven't, and the ones that you've highlighted are red, haven't got the comments, but, so I think it'd be helpful for the board that we have all the comments, so if we're inviting people here, we understand the issue, so I think this is progress, but there is still work to make sure that we're really clear, because I think traffic lighting things are fine, but you've really got to understand, and why is it that, and are we confident that that is the right colour? So just a bit more assurance around that, but I think we do need to do that as a team. And Councillor Choudry? Thank you, thank you so much Kelly, I think it was really, really good to see you, and for bringing this back in when Stephen said to us a couple of years back, but only one thing, when we talk about the, I know the challenges we have with the smoking and other, when we talk about the children's one, with the obesity, this report, it's written there about three schools, where we're already working towards, and we're going to see what happens in future, but what else do you think we can do? Anything in mind, or have we started to do something? Because I think this was the only one where you said we could have had in red, but it's already in amber. There is so much that we can do, which I wouldn't say is traditional kind of clinical public health work. I mean, the things that we've spoken about is, and you only have to go outside and look, and the advertisements for unhealthy food are just very, very obvious. We've got children that drink lots and lots of sugar drinks, and again, that was mentioned in the King's speech today. You know, the food, the quality of food and the drinking of sugary drinks in schools, there's a lot of education that needs to happen, and a lot of partners that need to get behind this if they're going to change this. And I think that one of the key things is making the healthiest option the easiest option. So things like children walking to school, making active travel the easiest thing, getting children physically active involved in sports, getting them to eat a healthier diet, without the kind of, well, you know, chicken and chips are an easy option. And the truth is, is that for some families, it's about time and the energy to actually do this after a very busy day. But in order to get a future generation healthier, we really almost need to go back to basics of how do we make people move more, eat less, but eat the right things? Because all of that is all linked as well to dental health. So, you know, dental health, the level of breastfeeding uptake, how active our children can become, how informed parents are about the nature of the food that children are eating. And when children get choices, you know, children in the UK aren't saying that broccoli is their go-to. Yeah, but actually, how do we, in a kind of practical way, because we know that that's not going to change, just get young people to understand the importance of what it means to be healthier and how that they can make some choices that are a healthier option. Thank you. So I can see you've got three schools listed. So that's mean in future there will be more work from public health team with other schools as well. The schools listed are three super zone schools, so they've been funded to run some pilot programs that it's not just about obesity and physical activity, there is about sort of health quality and lots of other things. Yeah, but that's a sort of a London piece of work that we've got three schools in the borough that have been targeted to be able to demonstrate whether that work makes a significant difference. And they're very engaged. Those schools are all very engaged. But we'll roll that out as and when that project comes to an end. Once it's been evaluated and to determine what works, we'll roll out what works in a more informed way. Thank you. Thank you very much. A topic that we've discussed many times, haven't we? Many, many times. And we will continue to. Yeah, okay. Thank you, Councillor Chaudry. I don't think I have any. Oh, Stephen, Mr. Forbes. I'm almost tempted not to want to make a comment because Kelly drew a line in the sand for me, but I can't resist it. So I think just to backtrack onto that comment, I think Kelly's absolutely right. It is about education. We need to make the shift away from service intervention will solve all the problems. They won't. So, you know, it is about when we're talking about that early years, that healthy lifestyles. It isn't people like Amet and GP practices, other than advice and guidance to families. It will solve that. There isn't a pill to solve that. There isn't a service intervention for children's social care and NHS to solve that. It is about, as Kelly says, about education, low level stuff in communities with people to encourage that change. So we do need to, I think, look at the interventions through our family hubs, our children's centres, primary care. They're all, in essence, saying the same thing to families. They keep reinforcing that actually there are healthy choices to be made. There are things you can do. You know, I think as we've had the conversation, we will have the conversation. You know, our 50 things to do before you're five is there for a reason. It's not because it's nice to do. It helps children achieve good global development and prepares them to be ready to learn. And actually, none of those things are delivered by a service. They're delivered by families, mums and dads, grannies and granddas, extended family, doing those things with children that prepare them. And that's broadly the similar as we've had the conversation about healthy lifestyles and improving your child's health and making the choice that, you know, I've got a bag of Haribo at home, which I've had now for a week and a half. Yeah, I bought it for election night, and I didn't, I didn't crack into it at election night, and I haven't cracked into it this week so far. You know, and I am making the healthy choices when I go home in the evening time to eat broccoli, whatever. So that's the kind of stuff we need to be promoting. It isn't a service intervention by Amit as a GP that will change a child's future in terms of good and healthy eating and good and healthy lifestyles. It's a device he can give along with the rest of us. I do think then moving on to where I was, the line was drawn, which I do think this is a vast improvement. And I think it was about us being really holding our own feet to the fire as a health and well-being board, saying we did set out a health and well-being strategy that had some really big, ambitious statements in it. We need to absolutely make sure we're delivering it. I think we have about a year and a bit left before we get to the end of the current one. It looks like we're making good progress. I go with Martin. I think there is a little bit more fine detail on where it isn't moving or it looks like it's slowed. We need the lead officer to be able to tell us very quickly what is being done. I do think, however, a conversation for us as a health and well-being board in the next nine months is, given that we've got about a year left to achieve what we said we'd achieve, do we put a little bit more focus on the ones that are not achieving and be absolutely assured in the remaining nine months of the last year that they do deliver? Because then we'll be into the roundabout what happens for the next three years. And then I do think, as Kelly said, again, it's about shifting the focus of the health and well-being strategy a little, whilst much of this deals with health deficit in terms of things like smoking and children having good health. That latter bit, which links to the new government agenda and our own agenda about growth and improvement of our environment, needs to be almost the first priority and not the latter part of the health and well-being strategy. So I think probably for our own conversation is how do we make that a little bit more real? Because I think there is a bit of a challenge that, to be honest, the health and well-being strategies seem to be that of public health, that of the NHS and that of social care, less so the rest of the public sector, including parts of the authority and partners. So we do need to think about when we come to do the 2026, the 2030 strategy or thereabouts, how that bit gets a little bit more emphasis, along with our business case from growth, opportunity hounds law and other bits that are driving improvement in the overall borough, not just health deficits. That was when I was challenged not to make a comment. No, absolutely right. Yeah, yeah. I couldn't have articulated it any better. Any further comments or questions? Obviously, we've got work to do around this. We've got challenges. We know that we've seen improvements and we will obviously continue bringing this back to the board for the future as well. OK, I don't see anybody with any other comments in that case. Thank you very much. I will move on. I will now ask members, I think we've got to be any other business off the agenda. Anybody got any other business they want to bring up? No, I'm not being notified of anything. OK. And in that case, I can advise you that the next meeting is going to be held on the 23rd of October. And I'd like to actually thank everybody for attending today. Thank you for your patience. I think this is our first online meeting. So apologies where I've switched off my mic. I'll be excited. And yeah. And thank you to any members of the public who might be watching. Thank you very much. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. [ Silence ]