Transcript

Transcript

to start off we are going to go through apologies and check membership so most of you think it's no longer a month. I drop myself is the apologies for through account and account thank you and account. agenda point two minutes. Do you have any comments or. Do we have any decorations or interest. So now we go on to the election of vice chairman do any. Thank you chair. I'll not nominate. With your indulgence. We're going through such a major audit of the organization at present urging the resources between hospitals and a total restructuring. But we trust the issue of these new structures. Times does not serve. If the standards have been allowed to rise within the house they will ask where was scrutiny. Did they not see what was happening. Did they not know. Why did they miss something that the grants a big they did what is the point of scrutiny valid questions service ideal that the practice is far from a deal as indeed as in many political systems. I have no relevant qualifications but nevertheless one difference. Some may have little experience or may not or may not be aware of their shortcomings in anything. Some by the nature of the job may overestimate. As such we could be seen by health professionals as interfering in the sales. You perhaps have been forced by the trend. We still have an important function to perform as the last bastion of public accountability of question and reason. The analysis of our own composition may be a divergence for these standards it is from this background that I express concern in the current direction of the health services. The lack of integration being demonstrated in regard to inclusion of local authorities in the integrated care board partnership which perhaps follows principles of equality more akin to those in animal far. The focus on acute care rather than prevention the voice of public health been sidelined as ever. The lack of accessibility particularly in our own Hampshire and either white I see be who's undergoing yet another cost cutting reorganization renders its offices uncontactable. In practical terms and the decision makers unreachable in the faceless lofty heights of Nebulosa. A seasoned observer of humanity and structures that we build said two things that are of relevance here that as humans we can build our dreams by mastering a dream is a great challenge because humans so easily become slaves to their dreams. The other was that an organization form to serve an external purpose in the beginning is focused on the delivery of its service. But as it matures it develops as it develops its focus can turn to its own survival and benefit to the extent of the original purpose of its being may be diminished pre to for all intents and purposes as an inconvenience. Those who've been around for a while and seen organizations come and go wax and rain will recognize this straight and share my concern. And if we do nothing else in scrutiny we must raise awareness of such risks questioning behaviors and in doing so. Help keep our service on track. Members partners by calling your consciences your awareness and integrity to be vigilant and proactive in the safeguarding of the direction and implementation. The service ideal that we aspire to. To practice inclusivity. Openness review what we are delivering to the best effect that we can. Thank you. Thank you. Shall we proceed to a vote. So those who would like to vote for the council john christen. Yep. We're going to agenda point number five which public question time and I believe we have a Mr Richard Knowles in the audience. So what I'm going to do Mr Knowles I'm going to read your written question and the response and then give you an opportunity to ask a supplementary question if you'd like. Okay, so the question that Mr Knowles put to the committee. Since the last meeting and the committee chairs acknowledgement that the current situation regarding availability of sharp spins and their fitness for purpose is unacceptable. Please describe the process undertaken and progress made since the last meeting to resolve the situation. We received a response from I believe the director of community services and the responses as follows. The council contacted Mr Knowles last week to provide assurances that work is being progressed to find a suitable solution to the issues he and others have highlighted. Unfortunately, due to staff vacancies in a small council team, a solution to these issues has taken much longer than would be expected. The number of actions are now being progressed, including a review of the current pharmacy take back scheme, including contacting pharmacies through the island community pharmacy coordinator to determine which of them are still able to participate in the sharps take back scheme and can provide replacement bins. This includes ensuring those pharmacies participating can store the requisite number of larger 5 or 7 litre bins, a revised list of participating pharmacies, identifying those with the facility to accept 5 litre and 7 litre boxes will be drawn up and provided for information on the council website. The relevant information is being obtained to determine what if any gaps there are likely to be in service provision for those who are not able to access the revised list of pharmacies. This information will be used to draw a business case for proposed additional door to door collection service that sits alongside the take back scheme, but would be in addition to the current collection service for clinical waste. Such a service may attract a charge for users to cover the additional costs of sharp bins collection and the provision of replacement bins. This coincides with a review of the current contractual arrangements made to a third party via the council's waste and recycling contractor. Mr Knowles, do you have a supplementary question? [BLANKAUDIO] [BLANKAUDIO] [BLANKAUDIO] [BLANKAUDIO] [BLANKAUDIO] [BLANKAUDIO] [BLANKAUDIO] [BLANKAUDIO] [BLANKAUDIO] [BLANKAUDIO] [BLANKAUDIO] [BLANKAUDIO] [BLANKAUDIO] [BLANKAUDIO] Is that a summary of the question? [BLANK_AUDIO] Thank you, thank you. So for your question, we'll have to go back to ways to provide a written response to you later. We can get that done for you. Anyone else on the committee have anything they want to add to that point? Yes, Mr. Chairman, this is a wholly unacceptable situation because we highlighted this committee highlighted this. I think it was a couple of years ago when a resident contacted me with exactly the same problems and we then went down for several months. So it's their fault. Then we've clearly established, I think, two meetings ago that responsibility. Thank you, thanks to Dr. Legg. Firmly sits with the Isle of Wight Council, waste department. So I really can't see apart from finding the costs and we know the council is strapped for cash. But this is not an acceptable situation. It is potentially hazardous and we should be facing up to it and responsibly dealing with it by offering the service. Michelle? Hello, can you hear me all right? Yeah, go ahead. Fantastic. I won't mention the person that I've been liaising with in the council because I'm not quite sure whether that's appropriate or not. But I have had lots of meetings with said person and we were moving it forward quite well. I think that she is off sick now, which is why I didn't want to mention her name. But we have done just to reassure people. We have done quite a lot of work in the background. Yes, it is definitely Isle of Wight Council's responsibility for waste disposal. And then the question is, is how we store the larger bins, which people are requiring now because of the change in how people monitor their diabetes. They need much more equipment and they need to dispose of that. So we need five litre bins and we need to make sure that the pharmacist can store those safely and then get them collected. I do think there's something about there has been quite a lot of work done. I'm not quite sure where it is at the moment because I do think somebody's off sick, as I've said. So I didn't want people to not to think that things hadn't been done with the council and health partners. Thank you, Michelle. Yes, I noticed the word pharmacy came out there and I'll talk from personal experience just in the last week, although it's been a recurring theme. I've been with sharps buckets to local pharmacies in the West White, and they all inform me all inform me that they no longer take sharps buckets. We therefore went to the hospital and we went to the pharmacy in the hospital just inside the main door on the left hand side. So I noticed that they no longer take sharps buckets either as of about a month ago. They referred us to pals. We went to pals at the front desk. The pals people knew nothing about this at all. So clearly there's a communications issue going on here. The pals people referred us back to the pharmacy. Luckily the pharmacy lady was very helpful. So the bottom line is that we were told eventually the place, the only place we can take them is to the department at the hospital. So we tripped up to the department, and then we treat and they sent us up to the, I don't know what's called the special care unit. And we went up there and eventually we found somebody who has a one off favor, and then made it very clear to us that it was a one off favor. They would take the sharps bucket that we had and take it away from us. So clearly this is a systemic problem that is not limited to pharmacists who don't really know what to do except decline them. The hospital pharmacy which is told to decline them and are declining them pals who haven't got a clue what to do. A&E another hospital units who also don't know what to do, but are trying their best to help when they can. So it seems to me there's a major communications issue. I don't know who is in charge of this within the health environment, but whoever it is needs to get that right together to sort it out and to make sure that all of those people I've named all of the people involved in this know what to do. And it should not be left to patients with sharp buckets driving around this island desperately trying to find somebody to take them. I couldn't agree with you more that is not appropriate, but just to restate the collection of sharps lies completely with the council. But the work that we've done would be looking at a making sure that pharmacists are commissioned appropriately for the service, and this hasn't happened previously, because otherwise they will have to store sharps in appropriate space. Whilst waiting for the collection, and if the collection is undertaken by the council, but there has been work done on this, and I just think we need to liaise with the person that has been leading on that when she's back at work. Thank you. Oh, my James and then I'll bring in. Yeah, just, just to pick up from Michelle's point, I'm responsible for the commission and community pharmacy so I'll take it upon myself to come back with a view as to why community pharmacy, and no longer the drop off point for sharps in that in that circumstance I'll strive in that so I'll come back with a view from the community pharmacy perspective. So James, before you do that, perhaps liaison because we've already we've already gone down that route and explored that. Okay, and then I can I can fill you out why there are issues in its space, because these have to be ensured and from a health and safety point of view, the space has to be appropriately sorted. And if you have 20 people giving off five litre, seven litre bins, that's quite a lot of space. And so, but but we'll contact each other outside this meeting and I can update you. So just as an action on that then we'll get a response from Michelle and James to the committee that can be circulated later. And I think it's probably appropriate to get a response from the person that has been dealing with that within the Council, and I can outside this meeting, let you know the name so you can liaise directly. Okay, thank you. Council. Yeah, thank you. Can we just make sure that the answer to the gentleman in the gallery doesn't come back from this council that I'm afraid you'll have to hang on to your shots for a bit longer because one employee might happen to be ill. I think that's frankly ridiculous for an organisation in the size of our white council. So, can we try and make sure that's not the response because I don't, I simply don't think that's credible. I had Councilor German and then I appreciate us handing out actions on various people and delay because people are off sick. And I agree with what Council Robinson just said that we should not be beholden of one person being temporarily absent for the system to fall down and have no answer. The question was well made from the public gallery. And I feel I need to echo that. At the moment today, this evening, what is the process with people with full sharp buckets. What is the interim measure, the temporary measure, whatever you want to call it. What do they do with their sharp buckets now. Well, all the various organisations, the council et al debate and wait for people to return and decide what to do about it. We need an interim answer that we can put out on the public domain right now about what people do. It is not tolerable that people are left in doubt about what to do with dangerous materials. Thank you, Laura. Thank you, Chairman. I'm very conscious and echo, Councillor German and Councillor Robertson's views. I sit here as one of the directors within the local authority, and would like to volunteer a bit outside of my own remit to take forward an action on behalf of the committee to liaise with the director of community and neighbourhoods tomorrow to ensure that an answer is provided to the committee within the next seven days to the questions that the gentleman has raised. Those questions, as I understand it and forgive me, the published question and response is not the question and response you read out. So I'm a bit in the dark here. But the questions, as I understand it is, what is the interim arrangement for sharp bins in terms of storage and collection, but also what is the arrangement for people who have a, I'll use the word stockpile because I'm at a loss as to what else we could call it. There are a lot of sharps within their own home out in the community for them to surrender those sharps for safe disposal. I will take forward on behalf of the committee, both those questions, if Chairman, that meets with your satisfaction. I think that sounds like a really good idea. Yes, thank you, Laura. One further point, people who have full buckets also need to know where to get now new buckets. That is a continuing problem and people who've got overstuffed buckets is not helpful, and simply stack as I saw the other day, somebody stacking up used those very long pens. I don't know what they're called the extra long ones and six inch ones, self delivery ones, stacking up those on top of full bins is not a healthy issue to find in our community. So can we at the same time urgently identify and put out as a press release, whoever does that Laura or or someone somebody, what people should do to obtain new bins, where they have a stockpile to use your word law of a full bins already. Thank you. So summarise action alongside that is to also issue a press release. Can we add that as an action as well. Do we have any other comments. 10.6 progress update pages 11 to 12. So we have two actions in progress. I believe on the access accessibility standards, there was a response circulated from Natasha Taplin. I presume the committee have all seen that response. Are there any comments on that. Yes, Captain. Chairman, the response is meaningless because it's just carrying on. I have a, I have a patient who regularly brings me up, and who regularly gets a small print, despite it being on his files, despite repeated requests from Portsmouth and some berries. I think this is just a totally unacceptable situation as as I commented at the last scrutiny meeting. What faith can we have in the integrated care board or the health services if they can't resolve a simple issue like this. Any other comments on that. The other actions that have been completed is the mental wealth, which I believe we've got an update from Council Michael Lilly and Joe Anna on their visit to. Thank you. Thank you, Chair, and congratulations on your first day. In my role as a previous chair, it was arranged by the new Hampshire and Isle of Wight community and mental health trust, which is now taken over seven acres. As you know, it was previously a department of some Mary's. It's now under the under the new trust. And this committee had been looking at the issue of particularly. Awards regarding dementia for patients with dementia that would also be under section. Previously of the Shackleton wall, and that was. Posed down some years ago, and the update of the Afton ward into a wall that included patients with dementia, but also patients are sorry, elderly dementia and elderly with other mental health issues. I'm Joe Anna visited it and were shown around. We were, I think it'd have to put into context that this is this ward is completely unique in the whole of the UK, because you would normally just have a dementia ward or you would have a ward for elderly that had. Mental health issues. But because of the size of the islands and limitations, they have adapted to have one ward. For us, but you have to put it in the context. This is unusual. We were quite I was impressed. That was a huge improvement from. Previous, the. Staff team were extremely good and extremely sensitive to the needs of patients. And we had a good talk with the. Senior members of the team that are now under the new trust trust. I think one of the things that they. Very much urged us was that this committee. Does very much and I call to account. The new trust and make sure that the. Very much the island of white and the needs of either white residents are very much taken into consideration. And that they're not lost in the. In this now. Huge trust. There's a difference with that because obviously there is a difference for needs of. Island residents compared to. Those on the mainland is that it's a different. Yeah, scenario. There is a. Difference with the water surrounding us and the issues that has. It is likely that some patients will end up on the mainland. Because the facility will not. Be suitable for certain patients. But they did for you that that would they would try to keep that very much to a minimum. I'll leave it over to Joe to add to that. Thank you. Yes, the visit was really positive and it was a really good opportunity to see the ward in action. And. To see that people can be careful on the island, which is really what people want. Given the challenges faced when they have to travel to the mainland for the care they need. And just to mention that there's been a lot of work generally around dementia care, both within. The new trust and within the council as well. And I can't not mention the Parklands hub in cows, which is a wonderful resource for people across the islands for people with dementia. So a lot of work's gone on the past two years to provide more support for people with dementia. Yes, so we just need to make sure that. We remain heading in the right direction and that people, people voices are heard. So that the correct services can be provided. There's just one thing I'd like to add, I'm sure. The summaries with the split that one of the things we identified was. You had a friends of St Mary's. Which was an old solo was a Samaria's charitable. Trust. Those structures have actually gone to. Samaria's and the Portsmouth Hospital trust. And actually. Seven acres and mental health services are not left. At all with such structures. And I did raise the question that we didn't do know that there was money that was specifically for mental health. Patients, residents, service users to actually make sure that that money isn't lost because that was money specifically for. Island residents with mental health issues and also the need to actually. Have a friends of seven acres and mental health service is very important. So just highlighting that, if that could be minuteed to ask that there was something that. Staff hadn't realized had actually been lost in the transfer. And it's extremely important. Thank you. Thank you, Councilor Lee, and thank you, Joanna. The last point on that is the mount mount button hospice. The committee wrote to the chief executive of the integrated care board regarding. Mount button seeking an uplift with inflation and the cost of delivering services, but unfortunately have received no response. Are there any other comments or questions on the progress report. Yeah, I just say that just a follow up from being. Chair, that's very disappointing that we haven't received a response. And there is serious consequences to this because the presentation that I think with my last meeting from Nigel Hartley. Was that that would go. Two things would happen. One, they'd have to actually ask more charitable giving or donations from the population. Which will have a spin off effect to smaller charities because there's only so much money in the pockets of generous residents. And the other is certain services could be cut. And the services that the hospital give are extremely important and extremely embedded in the community. So I think we really do need. I suggest, you know, that to the committee as a past chair that there needs to be some kind of resolution to call for action that that's totally unacceptable. And we'll have huge effects. Yeah, can we ask for a response because I think if this committee accepts being ignored, it's going to get worse and we'll be ignored again. Yeah, I think that's a good idea. And I think it should not be a closed. I completed and go back on to open. Are there any other last comments on that point move on. Okay, we're going to move on to agenda point seven pages 13 to 24. We have an update report. So I believe that the committee has all received a copy of the update paper. So I would like to invite James and Scott to give a summary of that and any other points that you want to point out to the committee. So the dental papers, this, this item, so I'm responsible for dentistry is part of my role as director of primary care for the ICB. I'll take the early part of the paper is read because what it does is it starts to outline how the national contract works, some of the complexities in terms of that private market, and how we work with a range of different providers. And some of the circumstances relating to the national contract and how we can influence it. I think the key point to make is that with the dental recovery and reform plan nationally. There's lots of opportunities for us from a commission in perspective. We will work within that framework and we have to make the best of it. But I think hopefully some of my examples in the second will demonstrate. There's absolutely a need to build relationships with local providers and local contractors. We can develop a more dynamic provider model. As you go through the paper, there are some statistics and I think there's some good news and I say good news in a guarded where I don't suggest, you know, everything's been sold, but certainly from another white perspective. We are seeing a number of units of dental activity increase in comparison with other parts of Hampshire and the other white clearly there's a lot to do, but it is going in the right direction. I think that reflects both the volume of need on the island. So one shouldn't underestimate the challenge we face in terms of meeting that need. But I think what it also reflects is the flexibility providers on the island to work differently, to cooperate differently in relation to contracts and increase and increase their capacity to meet the man moving forward. I think that's a, that's a really positive message. In terms of access, you'll see in the paper that we have seen an increase in the number of children seen in the last six months compared to the previous period. But we have seen us like decrease in the number of adults seen from a unit number perspective. But I think the point I'd like to raise there is that actually the average UDA delivery has increased over time. So we are. We are looking at more UDA's despite that decrease the number of adults being seen. I think what that does it reflects that we are starting to identify where there are particular pockets of complexity, where there is more urgent dental need and we put it in place services to address that. And I think that's a really important point. So, while from an adults perspective, numbers appear to be stagnating or going backwards, we are dealing with more complexity and we are being more proactive in dealing with some of those oral health issues. Moving forward. We know there are challenges with workforce and we know there are issues with recruitment and retention. We do have the opportunity within the contract to look at where we can sort of support with recruitment that could be golden halos that could be support with training and education. That could be through the provision of expenses for traveling and relocation. That's all good, that's practical, that's technical, but I think what we've got to do from an ICB perspective is we've got to create a better environment for our dentist where they can see a progressive system. They can see one that is focused on transformation. They can see a commissioner that has a commitment in them as professionals and wants to see them develop as professionals. I think that's really what we're trying to be in this is ensure that we use all of the levers that the National contract gives us in terms of payments golden halos support for new entrants, but equally look at how we can develop the next line of dental professionals. We've got the dental academy opportunity. I think it's really important we establish a strong link with the island in that regard. And there's some of our conversations with Denby House have demonstrated and we're lucky to have Edward and Helen here today. There are opportunities to do things differently, innovatively as a way of recruiting and retaining and keeping people in role. So I think that's our biggest opportunity, but it's also our biggest challenge moving forward. In terms of what we're doing, we've got a very clear dental implementation plan. We've identified areas for target and support and there is benefit in a number of practices on the island wide. So we have, we have seen an increase in a number of UDA's being commissioned. We have dispersed contracts that were underperforming in certain parts of the island to those practices to have an ability to service that demand and develop high levels of performance. And again, we've had conversations with practices like Denby House in terms of how can we build on the existing contract and increase a number of UDA's in year to meet that demand moving forward. Absolutely a commitment to commission flexibly, but working partnership with providers to understand their needs and make sure that we're meeting those needs in a more proactive way. You'll be aware of the mobile dental units. And I think that's an example of where we are targeting health care inequality and source. We are being flexible in terms of service provision. And in some instances, I think the island's slightly ahead of the game in terms of the way the dental bus has worked and how we've used it to sort of meet that need moving forward. So within our sort of investment strategy for this year we are looking to increase a number of mobile dental units as a sort of an extension of our service capacity. But equally we've got to look at how we can we can commission more static sites as well. So in addition to the dental bus. If we know there's a particular area of need or inequality. How do we develop a more sort of proactive service to meet that meet those needs moving forward. I think the other thing we are, we are looking at the opportunities to pilot so obviously with Edward and Helen in the room we had a successful visit to to Demby house in April. And we looked at where we could do things differently in terms of recognizing the inequalities that the practices are facing in terms of their upfront demand recognizing that actually can we be slightly more proactive rather than reactive. And I think you made the point earlier in terms of health promotion and addressing need earlier on in the pathway. And there's clearly an opportunity I think for oral health promotion and that particular practice issue and appetite to do that. And that feels like an obvious place that we can work in partnership with the with the Council and Simon Brian's obviously aware as well from a public health perspective. So that feels like an opportunity that will will bear fruit over time. I think the other thing we're looking at is how we can ensure the practices are able to access the Golden Hallows and the supported expense support for new entrance. And I think looking at existing business models and where can we legitimately support as expansion. So it might be where particular dental surgeries are looking to increase the size of their base. They're looking to invest in capital. They're looking to increase a number of consulting rooms. Again, I think there's a good example in ride where actually the NHS can work proactively with the town council and look at local solutions to sort of meet that need moving forward. And I think, again, I just finished with a final point in terms of if you look at activity February last year to February this year we have seen a slightly increased overall of 6%. That's sort of but national trend and it's the first time we've sort of seen an increase year on year so a lot to do, but lots of practical actions and the way but also willingness to work differently work inevitably. Questions forward. Thank you James and thank you for producing this update report is very detailed and lots to read through which I found really useful. I'd like to bring in Edward day and Helen if you would like to make a comment on that. Helen, if you press the little button on the front and flat ones. There we go. Thank you. Yeah, as you say, we, we do what we can to recruit by taking them straight out of dental school and through the dean reeds and the education system to try and mentor. Dental dentists through their first year, and then once we find they're actually on the island. It's a lovely place. So they want to stay. It's getting these people over here in the first place. And as you say, the finances golden Hello's are important. It's really and even getting into the schools to encourage people to to apply for dentistry go off to their training and come back. I know it's a long time in the in the process, but we're starting to to see that come through now. So it's a yeah, as you say, working with the ICB hopefully we can start some of these projects to gradually improve the system. Thank you very much. Hello, everyone. And it was just to work just to add to that that I started working with Helen back in February, took over them. One of the things I wasn't aware of until about that time was that them be is still the worst currently the only fully NHS practice on the island. And the big issue with that is that all of the funding that comes in is through the NHS contract. Most of the practices on the island and nationally that hold NHS contracts kind of use them as a lost leader. They're corporate owned and these things lost leaders. So they get patients through the door and obviously that works very well functions. But then once they've been seen initially, the only opportunity they've got to receive dentistry will quite often is the case they have to then pay privately. Whereas a then be that's not the case so obviously for patients it's fantastic. But for us, it's a bit of a negative because we are very much strange to the funding abilities we've got, which is why we welcome so greatly the, you know, the support from the ICB with the with the latest ideas and things that we're trying to work towards. So, yeah, some really good benefits done in the pipeline, hopefully. That's really positive here. Thank you. I'll open up to the committee for any comments. Yes. It seems to me that dentistry has been a great problem for many years. I'll do. Very puzzled as to why it hasn't been addressed before. We know that the dentist. Their contracts, they didn't get paid so much money. And that's not the point that was patient care. And the other thing about it is it's not trying to shut the door after the horse is bolting. What I'm sort of trying to say as well is that dentistry. The lack of it impacts on other areas of people's health. So it's just as important as other aspects of medical care. Thank you. James. Yeah, just on that point in terms of the health care needs, the poor access to dentistry generates we are a lot better now than the standing. The unintended consequences and whether self care inequalities are. So that allows us to be more targeted in terms of intervention. The only point I'll make it about historically is historically this service was commissioned by NHS England nationally and regionally. Since 22 the ICB have been able to get local commission and responsibility for this. So hopefully it means we can react a bit more in a more informed and dynamic way to some of that local needs. So I'm not suggesting that's an excuse, but the reality is it was commissioned differently before. I think we've got an opportunity to change that moving forward. In response to Councillor downer, it's that you're, you're right, why don't people come and it's closing the door after the horses bolted because my husband and I were recruited to this island 21 years ago. And we were given grant money to help set the practice up, which we have then done for 21 years since that time, 21 years ago, I can't see that anyone else has been recruited with some grant money to put in surgeries. And so it's all very well paying people, but if you haven't got the money to start out a practice or start putting new surgeries in, you're never going to get there. And as you say, that the last time I know it happened was 21 years ago. Councilor john man, let me start off by thanking Helen and network for their frankness. This committee first dealt with this issue during this four year term of the council at a meeting on the 3rd of September 21. And I look back at some of the records for that and some of the details of what happened to that meeting. And today seems like a very close rerun of many of the issues that were raised then, and the undertakings that were given. But back in 21, I, in particular, and I, I'm sure I wasn't the only one on the island, find myself inundated with local residents, unable to access NHS dental care, simply unable. I took up a number of those cases on every half, and Simon Brian will recall many of the emails we've had exchanged on this topic and with others. And that resulted in a referral that people who needed help should call 111. We tried that many times. It was completely and absolutely ineffective. Absolutely ineffective. There was nowhere that 111 could do other than to tell you to call a local dentist. If you would give you a list of dentists, you could ring them up. They would say, we have no availability. We have no availability. We were going on and on and on with this trying for local people to get them access to dentistry. And finally, on the 21st of September 22, that's one year into that process. There was a formal referral to NHS England as to what we should do to resolve this matter. And noting the ineffectiveness of 111 in providing any help whatsoever. And that bounced around NHS England for quite some time with a very extensive and very long thread of emails, finally coming out in the spring of 23, or a number of urgent referrals were made through them seeking help with local people. Those included, at that time, some Ukrainians who had very urgent dental need. For a month of bouncing it around with those people on antibiotics and painkillers. The final recourse, again, as Simon will know, was that they booked flights from Gatwick to Warsaw were put on trains from Warsaw back into a war region near Carkeve to a dentist to have treatment in the Ukraine because they could not be treated on the island. And then to come back, an absolute shame and putting those people's lives at risk in requiring them to do that journey. Later in June 23 NHS England asked us to refer the matter to pals at St Mary's Hospital. We referred it to pals with the support of internal resources at the council. And that finally came back with another message here at which stage, when do Pereira started to get involved as well, with more referrals and more requests for help as the system was changing. Four more requests for a plan to reinstate universal NHS care for island residents was made in September 23. Her emails went completely unanswered, even to our chief executive. She referred again in March 24. On the 27th of March sent a follow up message to Natasha Taplin urgently asking what is the plan for restoring you at universal NHS treatment for island residents. That email went unanswered. She followed up with that again on the 24th of April this year. And currently that email has also gone unanswered. So we are being completely ignored here as a council even representations from our chief executive officer asking what is the plan for restoring urgently full universal NHS coverage dentistry for island residents. And I still don't know what that plan is or when it will be enabled. Please can we have a plan. Thank you. James. Yeah, I'm not following up. That correspondence are full of that I've been turning the video and I'll pick up with Natasha and make sure we get back to you on that issue. I think there is a plan. There is an investment plan where investments are clearly itemized in the actual sort of activity that generate is clear. I will get back to you on that point. I've been 17 requests. Yeah. First I've heard of it. So I'll make sure I pick it up and come back to this committee with a full response. Is it just me or is this the sharps business all over again. I'm very interested in in in what was today might say it just seems to me that when you said that. Other dentists use the NHS contractors are loss leader. So implying that there's no money to be made out of it. So you can't sustain your business, but you're managing to sustain your business purely on NHS. How do you find that possible for another stone. I think it's it's quite different animal at Demby house only because we don't have all the massive overheads of area managers procurement managers or those sorts of things with the corporate system. The other thing that is obviously it's like negative. I'm sure I could spend hours telling you all about the sort of business model and issues we've got. But we have actually. We're facing some quite hard issues currently which is why we're sort of in talks with the with the ICP. In fact, it all started off with when I first got there, looking at things and thinking, well, how are we actually going to, how are we going to survive, what are we going to do because we've got two dentists. We've got three dentists that can meet from mainland. One has done for 18 years. We've got another who's done it for eight years, and the short number is with the expense of the commute in financial terms, but also in time. It adds two hours on to their day either end. They're now looking and saying, well, actually, I'm not going to continue doing that. So, I'm going to give you a rough idea. Through from the last figures that were sent out, it's somewhere in the region. For all of the NHS. UDA's that we've seen on the island in the previous term 12 months. Roughly 50% of those were seen at Denby house. So if you look at proportionately, the amounts of UDA is covered by one, you know, provider under one contract is quite. Enormous for just a poor surgery practice. The issues we face are funding, basically, that's what it all comes down to. However you look at it. So the big, the big struggle is. Yes, we do get by a lot of it is we've got some very passionate, you know, dentists and staff that come in for good, you know, the sake of a good will of patients. And they're very passionate about their patients, but there's only so far that passion can be stretched. And, you know, walking in and then sort of being faced with this barrage of unhappy dentists people looking at leaving and looking at alternatives. So we've got dental nurses looking to leave to go and work another, not our practice, luckily, but there are many dental nurses that have left in profession and now work in shops around the island. And it's these skill sets that disappear because they're not rewarded highly enough. So one of the big things we do struggle with massively is funding. And that's why we're working so closely currently with the, with the ICP to look at what alternatives we can find for funding, because the actual cost of just existing is going up exponentially. And yet our income is, you know, not changing greatly. And that's, that's one of the biggest issues we've got. So that's why we're looking at do we just, you know, do what the others have done and hand back our contract or clothes or go private like everyone else has, but actually that would be a massive detriment to the island. And it's not what anyone wants to do. It's, but we'd have to do that in order to survive through gaining roughly to most surgeries that have a split, most of their income usually about two thirds comes from the private sector of their income strain. And this is the fundamental point that the NHS contract, then just can't make a living out of it can't make it work. So, so the reality is, there is no prospect to increase NHS dentistry on the island. And that's that's the reality is I see it. Is that right James. It is a challenge. I think that's why the work with them be houses so important because I think it creates a framework by which we can look at similar models elsewhere across the island. We do have flexibility in terms of commissioning. We do have funding that we need to allocate to increase in access. And I think it's an opportunity with them be house given the uniqueness of their delivery model. So look, not just in terms of what we're paying for unit of activity. But how can we support the business to develop? How can we help recruitment and retention of staff? How can we help them be innovative? So I think there's an opportunity with them be house to consider another way of doing things using the levers we've got. And I think that's why that relationship and that connection is so important because we can't exist as we are. We have to do things differently in terms of how we contract. So I understand your pessimism, but I'm more positive in terms of how we can use as an example to roll out. Council John. Again, let me congratulate Mr Day on his frankness. From what he said, I would, I would myself with respect, Mr Roach, I hesitate to hold them up as a good example if they were dental nurses are relieving three dentists traveling over from the mainland, all of whom seem to be on the verge of not continuing with that simply because of the logistics of doing so. That doesn't seem to be a short term solution, let alone a tactical plan. It seems to be something which is on a knife edge, and potentially something which could present imminent difficulty for them. He has to continue with a level of resourcing it's done. The example that he uses is very true. I happen to sit in a dentist waiting to see a dentist on Friday. So I'll declare an interest here personal interest. I listened to the receptionist during that session. While I waited. There were several callows the first one was somebody calling him with a broken tooth. When's the next appointment available I broke my tooth I could hear it very clearly. We have no appointments available. You want to try the dentists, but we can offer you a private appointment. What have you got privately we've got four o'clock this afternoon or ten o'clock tomorrow morning. Now, I sat there and I listened to that, and I was absolutely appalled to hear that. I understand the financial reality that people are under, but to have appointments available, and a patient in need with a broken tooth in pain. Being told to call around other dentists does not seem to be a good solution. The other two callers rapidly afterwards were also told there were no NHS appointments available, and we're also offered private appointments in the next few days. So clearly there's a pattern here and Helen's nodding at me a great deal from behind because she knows exactly what I'm talking about and I suspect every dentist on the island does. We cannot rely on a system, particularly for those in our community who are less able to pray those private fees and they are substantial. We can't rely on a system where they have to continually call around other dentists effectively pleading their case of pain and misery trying to get treatment. We need rapidly a solution to it, and it is not a dental bus provided by dentate as an independent charity. This requires us to provide urgent dent history or whatever cost it is on the island for islanders, and to bring people over put them up in hotels, and whatever we need to do to start cracking through the appalling backlog we've got and stop people who don't have the means of to do it, potentially going into debt, but being forced to go private because of the level of pain they have to sustain, not acceptable. Thank you. Thank you, Councilor German. I think that is a story that will resonate with a lot of people's personal experiences. I know from my personal experience with staff, my business. We've had lots of staff have to take significant time off work because their oral health got so bad they ended up having to go to hospital. And I repeatedly have staff come and tell me that they aren't able to get treatment and they aren't able to get any relief for the pain they're in. And then I have my family members who go to a practice for the first time in many years and finally come out with a bill that's almost a thousand pounds. It's insane. I'll pass over to James. Thank you, thank you, Councilor German. I think some of the practical actions you listed are possible within our commission and responsibilities, but it's a reminder committee as well that we are at the behest of the national contract. We have to operate within the national contract and there's the paper highlights that contract will need reform. It's not due to be reformed until January 25. I mean, we're not obviously can't speak about that in detail, given the current political landscape, but there's a much needed need for reform of the national contract. And until that plays through, there'll be certain things we have. We've got to deal with the hand we've been dealt if you like so that national contract is very challenging and does need national renewal and national reforms. I think it's important the committee are aware of that in terms of context. Thank you, James. I did know in the paper that I found quite interesting that under the terms of the contract, if a patient needs a filling correction root canal treatment and a crown under the treatment plan. The dentist will be paid for the crown only as this is the highest level of activity running a business where you're only paid for one part of the work seem seems quite shopping. I'll bring in Councilor Lily had a question and then Councilor John. I just wanted to say that I was grateful for the ICB and then be house to have a meeting. As in my role then as chair to actually bring Paul because I think it's important to note here, 10 be house in 2023 was viewed as one of the best dentists in the whole of the UK. And I think at the previous meeting, I raised the issue why, why did we have the best dentist in the UK. It's a award winning, and we have this issues huge issue which is very eloquently outlined by Councillor Jarmon. I think that the positiveness of that meeting was at least their dialogue has actually started, which hadn't been fully going previously without practice. So it started. There was a very strong dialogue about the needs of children, because I have children in my ward, who I've never seen a dentist right within that and that's ever appalling teeth. And we'll go into adulthood with that. So at least there's been an hour dialogue, which is involved the children services, education and public health with the ICB and then be house to actually look at sort of solutions of that. So that's sort of positive but it doesn't get over the bigger fact that unless we dentists, like, don't be house get an increase in the UVA. They will not be able to compete with their private counterparts. And we're approaching them be house dentists and offering them 20,000 panel handshakes to actually join them. I mean, how can you compete for that. So I think we really need to thank then be house for keeping to their principles. They're a wonderful group of dentists to their principles to actually get a service to all because that's what the NHS is about. Because there's a lot of people now the cost of living Christ things we cannot afford, even the, you know, the kind of payments that private plan involves. And so we do need to champion, then be house and I think they're a particular point that they're doing 50%. So, one practice is doing 50% of the NHS on the island. Well, we do really need to be investigating this first and really working on that. I think there's a bigger questions but I'm going to the politics or, but we do need to get increased UVA's. Otherwise, the reality is a practice like them would will with a diet we cannot on this island allow that to happen. Thank you, Councillor Lee, I'll go into Council. I think this might also be another example of why an island deal that respects the differences of an island is so important. And I'm sure in your discussions you'll take that forwards. We have to have a couple of respective candidates here. I'm sure they won't be immune to that topic of debate either. But eventually we do need to get to the situation where this island has a way forward. And, you know, although I respect James what you said today, which is useful and we'll look forward to the replies to that. I think we could also invite the two dentists who we've got sitting at the back and at the front, in terms of them actually suggesting what would it take, what can we do as an island, what can be done on this island to improve the situation. I don't want to put you both on the spot, but there is an opportunity, if you can contribute to this debate afterwards, to let us know your thoughts. What can we do as an island in a short term to improve this situation. You're at the core face here. You see what's going on every day. You nod when I talk about the issues we face and which, you know, the chair is echoed as well. So the problems we've got, what we don't seem to have is an imminent solution. And perhaps your perspective can be very valuable in that exercise. I'll leave that with you without it being formal question chair. I mean, I think it would be remiss of this committee if we didn't pass a resolution on this and taking Councillor Jarmon's comments on on seeing a plan. I think the reality of this situation is not very right. I think that this committee, I'd like to propose, if you don't mind, Chris, that we asked for a plan to that is realistically going to improve NHS, dental services, given the constraints that we've discussed. And if we could have that perhaps for the next meeting three months, is that on the use number. So that's the proposal. We've got a second. Yeah. Yeah, please Chris. A member to that. Could we ask for it to be in two months? So there's one month ahead of the next meeting. So we've got time to debate it before the meeting and resolve any issues with it. So if we can have that within eight weeks, that would be very useful. I'm sure if there is a plan and the echo I got earlier was that there is a plan. We just don't know it yet. So perhaps if we could receive that without any addendums you want to make a maybe taking on board the contributions as well that would come in from the dentist who are in the room in eight weeks and then bring it forward and make an agenda item again for next time. Yeah, I should accept that. Indeed. Yeah. And in response, there's a local plan with local actions within the sphere or local responsibility. Obviously the caveat to that will be the NHS England element as well, which are signal and we just need to be clear in terms of where they are around dental reform.