Transcript

OK, good morning everybody. I think we're ready to start. So a very warm welcome to the first meeting, combined meeting of the Health and Wellbeing Board and Surrey Heartland's Integrated Care Partnership. So I think most of you have hopefully been along that journey in terms of creating what I think we will call the Health and Wellbeing Day. So we have the three meetings, the Health and Wellbeing Board, the Integrated Care Partnership and then this afternoon the Integrated Care Board, all meeting on the same day. And we'll talk a little bit about why we've done that, but it is intended to streamline our approach. I think those of you that sat on one or more of those boards will have named or seen that there are many items. There were the same items going to all three boards, which was inefficient. So this way hopefully we'll have all of the key decision makers in the building on the same day. Right, so I better just deal with the formalities. So we're not expecting a file alarm, but if it does go off, then please exit through that door and meet up in the car park. This reminds you that this meeting is being streamed live for public viewing and it is open to the press and, of course, minutes will be published subsequently. For those of you that are not familiar with the sound system here, if you wish to speak and I encourage you all to do so, then I think you normally would push the button on the right-hand side and you'll see a red light come on and perhaps when you finish speaking you might turn it off as well, that would be helpful. Thank you. Mobile phones, if you could just put those to silent, please. I'm very happy that you use social media to join the meeting, obviously provided it doesn't interfere with the smooth running. And then, so just to welcome a few people, I think I'm not going to go around the room for all of you to introduce, but when you do speak could you perhaps just say who you are and where you're from, so don't get all your medals out, but just explain who you are, that would be helpful. I think most people will know each other, but can I welcome in particular Aruna Mehta, Terrence Herbert, so Aruna is the Chair of Soaring Borders Partnership, Terrence Herbert, the new Chief Executive of Surrey County Council, Sarah Kershaw, your title is now Strategic Director Transformation, Dr. Julie Llewellyn from Community Foundation for Surrey, Michelle Blundsen, who's actually given apologies, but is one of the three nominees from the BCSC Alliance, Richard Biggs, who's not here, he's given apologies, he's the leader of Ryegaden Bannister Borough Council, Alastair Burdenshaw, who is Chief Executive of the Watts Gallery, and Lucy Gate, who, there's Lucy, yes, and what's your official title now? Co-Chair of the Benefaction Board. Yeah, Co-Chair of the Benefaction Board. Excellent, thank you, so I think hopefully everybody else, I haven't missed anybody off from that list. Right, so can I just make an observation that having been the previous Chair of the Health and Wellbeing Board, I think some of the agendas sort of got bogged down a little bit in detail, and in particular I think what I would ask is that, and I'm sure you do anyway, but you read the papers in advance rather than during the meeting, in that there will be, so when we do the sort of update on the three priority areas, the idea is it's more for questions, having read the updates, rather than having, you know, asking those to present a lengthy update. So I think we're going to try and make these boards more discursive, but ideally, kind of, on the assumption that you have had the opportunity to read all this stuff, and really it's just a question of clarification or particular questions. Right, so, and we'll pick up some of those themes as we go through the agenda. So apologies for absence, just to confirm, Michelle Bronson, Maria Mills is substituting, thank you Maria, Fiona Edwards and Nicola Airy, there you go Nicola, thank you, substituting for Fiona from the ICS, and then Lucy is substituting for Helen Rostal, and Richard Biggs, apologies for apologies as well. Is there anybody else, any other apologies on this? No, just two members are absent that I've got down, Anne-Marie Barker and Siobhan Kennedy. Thank you. Right, item two then, minutes of the previous meeting, there were two meetings, one of the Health and Wellbeing Board on the 19th of June, 2024, and the Surrey Heartlands Integrated Care Partnership on the 24th of July, 2024. Those of you that were present at that meeting, if you've read the minutes, are they, can I take them, those are agreed? Thank you very much. Item three then, declarations of interest, does any member have a declaration of interest in respect of any item on this particular agenda? No, thank you. Item four then, standard standing item of questions and petitions, there are in fact no member questions and there are no public questions and indeed there are no petitions for us to consider. So that takes us to item five then, which is updating us in terms of where we're at around combining the Health and Wellbeing Board and the Integrated Care Partnership. I think just from my perspective, the kind of the way I see this is that, yeah, we have a health and wellbeing strategy for the whole of the county, and that is with a 10-year strategy, and we're some years into that, I can't remember how many, but it is constantly being refreshed, although the three main priority areas have remained the same. And the Health and Wellbeing Board at this part of the meeting is really to discharge the statute of responsibilities that we have, and that is in particular having an overarching strategy. It owns the Joint Strategic Needs Assessment and so on, it also administers the Better Care Fund, so it's the board, this part of the meeting will be largely focused on those statutory elements. And then you have the Integrated Care Partnership, which I see primarily responsible for the delivery of that strategy or those elements of the health, the wider determinants of health, i.e. the kind of 80 percent of things that aren't directly attributable to the NHS or to clinical interventions. And then the ICB, which certainly owns all of the clinical aspects and beyond that. So it's sort of, it's three sort of separate areas, sort of elements to the work we're doing. But I'm going to hand over to Phil Austin-Reed, who's going to take us through just some of the technicalities and the formal governance issues and aspects that we will need to sign off. Phil, thank you. Thank you very much, and in the spirit of what you said, I'll be brief to provide the opportunity for any kind of discussion. So recognizing that practically we've moved forward in terms of that we are all sitting around the table together, so this is just picking up on how we kind of bring the terms of reference and the other elements in line. And also provide the opportunity to make sure that we're not missing any other opportunities that we can take by taking this step as well in terms of kind of building those relationships across different partners. So just very briefly, the ambition throughout this work, as the Chair has already outlined, is to provide that collective oversight and assurance of delivery of the strategy, Health and Well-being Strategy being ambition one of the integrated care strategy for the ICS in Surrey Heartlands. So we've already got that alignment built in, enabling more collaboration, strategic direction setting, and decision making by way of the fact that we're sitting around the table at the same time on the same occasion. Aligning the-- and streamlining the governance, we've got the one membership that's been formed, and when we are coming together in that one place, we're getting the best value out of discussions and the time being spent. On a practical level, it's about having that conversation once, and I think the agenda that we've got today is a really good example of that. There's probably items that would have gone to the ICP and to the Health Well-being Board either separately or would have been duplicated. Today, we're having that discussion once. So I think that's very-- on a practical note, a good step forward that we're taking. So in terms of-- the paper provides a lot more detail, but just so that we're all on the same page in terms of how we're going to run this going forwards. So each quarter, we've got a bit of a cycle that we'll move through in terms of public formal meeting, which is what we're having today. Kind of the next stage in that or following that each month will be the deep dive walkabout, which is something that's evolved through the ICP and has proved to be very valuable. So we're kind of bringing that in and building that into the ways of working for this combined meeting, this combined partnership of the two board and partnership. That is then followed by a private informal meeting which will have less agenda items and more opportunity to get into detail, but importantly have an opportunity to reflect on what came out of that deep dive and walkabout so that it's not just an opportunity to act on what's heard from that going out into one of our key neighborhoods or look at one of those parts of populations. Pitting down exactly what that will focus on so that will be shared in monthly. So alongside that lens, so that's what it's going to look like practically. We've got alignment and the discussion with various colleagues that have been very supportive in this process. We have shared a memorandum of understanding, which we'll see does include both terms of references. That's because we need to formally have an ICP and a Health and Wellbeing Board, but what the MOU does, that first section really pulls out what the commonality is between the two and what the common responsibilities are, what the common expectation is of each of us as members. So as I say, the terms of reference remain. They've been updated particularly on the membership sections because as we've seen, we've had some movement around that so that we've clearly got the same membership. One slight addition though is that we've introduced a second Vice Chair. So there'll be two Vice Chairs going forward and that will come through in the December meeting. So look out for contact around kind of appointing those two Vice Chairs. And then the last point there is around the procedures which is kind of how the meeting operates. That's largely being drawn from the Health and Wellbeing Board because that was already kind of constituted. So that hasn't significantly changed in any way. So the kind of questions there is, you know, either now or subsequently ideally by the end of October to come back to either them services or myself and the Health and Wellbeing team with any further reflections that you've got on the terms of reference, the MOU, ensuring it reflects the shared deliverables of this partnership approach. What opportunities or different ways could we include or adopt so that, you know, it's a good opportunity to stop and reflect to see if there's anything else that we could be picking up in terms of ways of working to make sure that we're maximizing the opportunities. And then last point there, just an ask around, we're continuing to have the forward planning meetings well in advance so that we've got the op papers go out so you can see what's on there currently. If there's things that you know are coming up of, you know, significance that would benefit from the plan in advance. Thank you, Chair. Thank you very much, Phil. Any questions on the review sort of that they've been involved as we move through that [inaudible] Paul? Yeah, thank you. I just wanted to pick up on one point. The terms of reference look very clear in terms of what's happening within Surrey Heartlands, but I wonder whether it sits with this body to think about the strategic relationships with other ICSs in a sort of regional context given that a number of services run across boundaries and some are commissioned across different boundaries, and whether that should be a bit more explicit, you know. Okay, so obviously we have firmly ICS as part of this board, but not the others. But, yeah, does anybody want to pick that up? More of an issue of those wider ICSs that sit outside from it. Yeah, I mean, they're obviously at a kind of national level, there's the NHS Comm Fed ICS network and the ICP network which we're all involved in. But, yeah, I think, Ian, you have a specific conversation on how we can formalize that a bit more. Okay, in that case, there are two recommendations. The first is the Health and Wellbeing Board of ICP members review the draft shared memorandum of understanding and respect in terms of reference in detail and feedback to the authors as to fill any amendments, questions and concerns. And then secondly, a final version of the memorandum of understanding for the combined meeting of the Health and Wellbeing Board and Intuitive Care Partnership and respective terms of reference, be brought back to the next formal combined meeting of the Health and Wellbeing Board and ICP for final approval, including clear route to approval for any required governance changes in SCCS, sorry, County Council, and/or Sally Hartman to ensure alignment of processes. And that will be at the December meeting. Are those recommendations agreed? I can see some nods. Good, thank you very much. Right, so item five, so item six then, so some years ago, we combined the Community Safety Board with the Health and Wellbeing Board, and as part of the general review of the operation of these boards, we are also looking at how best to take forward community safety. So I think the Chief Constable, Tim, or maybe Sarah Allison, I'm not sure who's actually going to introduce the item, but can I just hand over to you? Good morning, everybody. I'm Sarah Graham. I'm the Assistant Chief Constable for Surrey Police. I'll just outline what's within the paper before turning to the Chief and Chief Executive of the OPCC to add their comments. So thank you, Chair. As introduced, in 2020, the Health and Wellbeing Board was combined with the Community Safety Board, and we acknowledge that that decision has brought some really good connections, and it's managed to deliver on some of the community safety work streams. But the time that could be dedicated to that has been limited, given the breadth of the agenda that sits at this board. So this paper makes two key recommendations. So it asks the board to agree that the responsibility for community safety oversight is reviewed and that we consider a separate arrangement, but that also alongside that, the appropriate continued interface with the Health and Wellbeing Board is considered, because we fully acknowledge that the wider determinants of health impact on community safety. So you'll see that there is more detail within that paper, and again, the current arrangement has brought positive collaboration, but subject to approval at this board, we propose to take forward a shared steering group to look at how the future arrangements can be. Because since 2020, when the two boards were merged, the landscape has changed, and we've seen many additional boards and areas of focus within Surrey. So the Community Safety Assembly's been set up. We have the Serious Violence Reduction Partnership and the Domestic Abuse Executive all currently formed, and we would propose this review would look quite widely at the governance arrangements for those to make the most of everyone's time and focus at boards. So I'll just pass to the Chief Constable now for his comments. Thank you. So I understand entirely the logic behind the position that community safety could be managed under the auspices of health and wellbeing, and obviously to be safe is to be healthy. And we are rightly implored to take a public health approach to tackling crimes such as violence. It's been great success without elsewhere in the country. And indeed, if we look at comorbidities of things like drug and alcohol exposure, family breakdown, they do cluster to predict violence. But the activities necessary to address community safety are I think somewhat distinct and arguably require dedicated senior attention and focus. The new government has set out its intention to have serious violence, knife crime, and violence against women and girls, not to mention addressing antisocial behavior, all of which obviously have profound implications for health, for the economy, and public confidence in our services. And I expect we'll see some very keen measurement of actual progress in respect of these areas of community safety and public confidence, trust, and perception in relation to that progress. So to that end, I think it would be sensible at least seriously to consider constituting a community safety board under whose auspices such work could progress. And I do think there is an extraordinary opportunity here. It would be wonderful if we might aspire to be the safest county in the country. We're certainly not far off as it stands. And if one looks for example at data sharing, if we were able better to share data in respect of those comorbidities I've mentioned of exclusion, family breakdown, violence exposure, drug alcohol exposure, and so on, we would much more efficiently be able to direct our limited resources in respect of people who are at risk of becoming violent or having violence directed towards them. So I think those opportunities and the new regime of accountability we can expect would justify a good look at creating a dedicated community safety board. Thank you, Chair. My time. Good morning, everybody. I'm Alison Bolton. I'm the Chief Executive of the Police and Crime Commissioner's Office in Surrey. Just to add to what the Chief and Assistant Chief has said from the Commissioner's perspective, I know she is very keen to have a strategic level forum where she can engage with partners on community safety matters which just hasn't been possible under the current arrangements. And just to add, I think really that if we get the role and remit and purpose of the revised community safety board right, which is what the steering group is aiming to do, then that will then allow us to look at the plethora, a lot of duplication of efforts at the moment. But importantly, I think we can then be more effective in tackling some of these key issues like anti-social behavior, like serious violence as a county. Thank you. Thank you very much. And I know that having spoken with the chairs of the Children's Safeguarding Board and Adults Safeguarding Board, they're also very supportive of that. I think they will find to go into a more structured board. Anybody have any views or comments? Yep, Kate. Thank you, Chair. I'm Kate Squibbins. I'm Chief Executive of Loomis, which runs the Health Watch Surrey service, which is the voice of people who are using both NHS and social care services. And we have a function on this board of bringing the voice of people who use services to the table, the voice of people with lived experience. I would just be interested to hear in the formulation of the new governance and the new board that you are proposing, do you envisage that the voice of the public and people who use services or are affected by violence, et cetera, will be represented in some way in your structure? Because obviously by splitting the two, we lose that sort of statutory responsibility to have the voice of people with lived experience in the structure. Thank you. Thank you, Chair. Yes, absolutely. So I think what we're seeking to achieve is to keep the really good practice that we've got. And clearly the voice that you're talking about there is really good practice, but then just develop and enhance the structure that we've got to give a bit more focus. So I think it will probably give more voice. So yeah, an absolutely pivotal part for us. Thank you. Yep, Sinead. Thank you, Chair. And thank you all for your cover of this really important issue. And I support the principle as well of what you're seeking to achieve. The only point I wanted to raise as part of your review, given the priority within which community safety falls in terms of the work that we all do collectively around this table, could you consider in your review a kind of dotted line as to how we can still be kept updated on some of your kind of key work and principles that you're focusing on? Yes, absolutely. Excellent. Any other thoughts or comments? So I think, again, it's in the spirit of streamlining things and just making it more transparent and visible. It seems to be a very sensible way forward. So there are two recommendations which I'll read out for those, benefit of those online. The first one is that we agree the responsibility for strategic oversight of community safety is reviewed to enable stronger and clearer leadership of community safety across Surrey with a view to considering what a separate arrangement could be to take this forward. And then the second recommendation is that as part of the above support appropriate continued interface with the Health and Well-being Board and Prevention and wider determinants of Health Delivery Board to continue to recognize the impact that community safety has on well-being. Those both agree? Good. Thank you very much. Item 7, then, are the highlight reports on the three sort of key areas. And we will start with Mary Roberts-Woods. Mary, thank you. Thank you, Chair. For those who don't know me, my name is Mary Roberts-Woods. I'm the, by day, Managing Director of Rygerton-Ballistead Borough Council. And for these purposes, I'm the Chair of the Prevention and Wider Determinants of Health Board. And my role here this morning, hopefully very efficiently, Chair, is to summarize the really broad work that the Board is doing and it falls into three priorities. I will strangely take one and three as I lead on those and then I'll hand to Lucy who is lead on priority two. In terms of priority one, hopefully you've had an opportunity to read the information in front of you and understand the breadth of the work. What we try to do is do a specific spotlight. And on priority one this time, we have focusing on active Surrey and in collaboration with local partners, they've initiated a new place partnership in the key neighborhood of Stanwell in Spelthorne, which is in the top 10 nationally for its inactivity level. So you can appreciate why a particular focus and success is wanted there. Also, more than 50% of children and young people across Surrey are not meeting the Chief Medical Officer guidelines for physical activity. And there is an activity club four. It's the holiday activity and food program for Surrey. And this summer, it offers over 39,000 places for holiday activity and food programs for children on free school meals. So a real focus on trying to assist those areas in particular need. In terms of opportunities around priority one, the Surrey Cancer Inequalities Program in partnership with stakeholders and communities will address knowledge gaps in prevention, screening, early diagnosis, access to treatment, and patient experience. And the program's intention is to really shine a spotlight on invisible inequalities that are experienced by priority groups. And Surrey's work in this area has been given national best practice recognition by Macmillan Cancer. In terms of challenges for priority one, the JSNA chapter on multiple disadvantage identifies a conservative 3,000-plus adults experiencing multiple disadvantage in Surrey. Changing futures bridges the gap. Prevention service shows a return on investment of 1.4, 1 to 4. But unfortunately, funding, as is often the case, is indecided. And in principle, by early autumn this year, it will be decommissioned from 12 local VCSE community providers. Active Surrey is awaiting confirmation from central government that funding for club four will continue on December 24. So as many conversations we've had in this room, ongoing activity is linked to resource demands. I'll move quickly to priority three. Surrey Council made a successful funding bid to Southern Gas Network for just over £900,000. And this will be available to Surrey's Fuel Poverty Program to deliver general support to vulnerable residents. And they will do this in partnership with Citizens Advice Bureau, Surrey Coalition of Disabled People Fire Rescue, and I Choose Freedom Domestic Abuse Charity. Opportunities in this particular priority, the new Surrey Against Domestic Abuse Strategy 24 to 29, published in collaboration with a number of domestic abuse charity partners, provides an opportunity for strong local leadership to transform the way domestic abuse is tackled. And in particular, the Expert by Experience Network will play a key role in doing that. So those who've been in those services, as we've seen in these meetings before, is so critical. Finally, the challenges for priority three, we have funding for some local area coordinators in key strategic neighborhoods due to finish at the end of March, currently to be decided in terms of whether that will continue. Obviously, we've had a welcome extension of the Household Support Fund until April. But of course, we will see what happens after that. And the Serious Violence Duty funding is due to come to an end in March next year, with no clarity as yet for the future funding. Chair, would you like to take questions on one and three, or shall we go straight to Lucy for two? I think we'll do one and three first. Okay, no problem. And also it's just worth noting that the funding, the judicial funding for domestic abuse also runs out next March. So we do need to lobby in government to keep that going. Any reflections? Yes, Mark. Thank you, Chair, and thank you for that. So on behalf of Active Surrey, I'm a board member just supporting the good work that they do. They're Surrey County Council host, Active Surrey, and they're in the process of renegotiating that at the moment. So by way of a shout out for Active Surrey, I'm sure we will continue that arrangement going forward. They do amazing work to get kids active, but they're also now working very hard to actually expand into the adults realm, because it's so, so important to be fit and active. We were at the, and I know the Chair was with me, at the Active Surrey School Sports Day in the summer at Guildford, where they invite all the kids to come and enjoy sports, learn new sports and just integrate and talk to each other. It was a fantastic day, wasn't it? And there was one very important bit of information we learned there, which I'm going to ask you all to join with me in doing in a moment, and that is to stand up and then sit down again. And by doing that, you will use a hundred muscles, believe it or not. So if you do that a few times during the day, you'll get some exercise. So if you'd like to all stand up and sit down again and give yourselves a round of applause. You just used a hundred muscles. So well done. But if you do see Active Surrey around the county, they do some fantastic work. They are constantly looking for sponsors. They get a huge amount of grant funding coming in out of their hard work, but do support their initiatives when you see it around the county in schools. And if you can open doors to them, the results are absolutely fantastic and they get results very quickly. I don't think there's any question now. I think it was a pitch for Active Surrey, wasn't it? I just wondered from our public health colleagues, I was at a meeting recently which said actually for adults, if we do have limited resources, perhaps the area we need to focus is in really inactive people, rather encouraging those who do some activities to do more. And I wonder if that's a question for us as a board, if we've got to give some focus, whether that is being considered. Thank you, Nicola. Ruth Hutchinson, Director of Public Health. That's absolutely fundamental. Evidence base is really, really, really strong on this. If someone who's doing has no activity whatsoever, they just even do a really, really small amount. It makes a significant difference to health. So of course, this is where we apply the public health principle of proportional help, universal proportionism. Thank you ever so much in that, of course, it's important that everyone takes part in the chief medical officer guidelines of physical activity. But we really, really need to focus. So I think that's where, I'm going to talk later about the scorecard, where we've got examples and we can drill it down to geography on those areas where we do have that evidence. And the Stanwell is a really good example of, let's target our efforts there. Active Surrey is a key partner. They continue to work in that way. They're a finite resource, so they have to focus. So absolutely, as a board on physical activity, that's what we want to do. So there's key populations of geography and key communities that we need to focus. Thank you. Thank you, Ruth. Thank you. I'm sorry, Charlotte. Sorry, lots of keynotes. Charlotte, kind of joint chief medical officer for Surrey Heartlands. Just to sort of carry on on that point and to have a little pitch for the soon to be approved this afternoon, Surrey Heartlands clinical strategy, the whole of our prevention focus is about how we target our preventative action to our populations that are experiencing the worst outcomes and the worst health. And I think, as a board, absolutely, Nicola, that our activity and attention, just picking out some areas, thinking about active health in particular, one part of our strategy I'm referring to, we have a whole area on dementia prevention. And interestingly, actually keeping people active through their life is probably one of the most important things to prevent dementia, which is a significant issue and developing and growing issue for these citizens of Surrey. So I think this is absolutely focusing on the right things. Thanks, Charlotte. Jonathan. Thank you. Jonathan, these motion decks are of good company. And I just wanted to come on to point three, just to say, I think it's really positive. Obviously, we talked about raising the 900,000 on the ground. And I think that's really impressive. I think for us as an organization working in Exeter, Mule Valley, like in Banstead, we realized that most people work with being energy poverty are roughly at least a thousand pounds in debt. And I think all the challenge I'd like to say is that if there's any way of developing a consistent preventative work around energy supporting people moving forward, obviously, we use the HSF, it's really difficult when you know it's about to stop, you're planning everything to stop and then something rolls forward. I know we can't roll that for many years, but there was a way of developing a strategy that was working with people in energy poverty that actually changed their situation, as opposed to just topped up, gave them a little bit of breathing space and preventative work, then we feel that'd be really good. And that's kind of what we've been trying to do around some of the trading, supporting people to get air fryers, heated rails that are going to reduce their consumption. So long term, we can see reduction in this thousand pound debt, which is an average. Some of them is horrific and scares me every time I listen to it. This one. I can, I was surprised you didn't come to read through the prevention framework. So yes, so it's something that we've been working on collectively together. And I think not to be too motherhood and apple pie about it. What we are giving fair consideration to is the way in which we focus all of our work in not just the primary prevention space that we would expect public health to occupy, but how we can start to really identify pockets of work that are in the proactive and responsive space. So where we know that there are pockets of our communities that are either communities of interest or geographic communities. And as Charlotte said, very often they are the individuals or the families that have less than favorable outcomes that we, or they're living in circumstances which are hugely challenging. What can we do to target those groups and individuals in partnership with the community and voluntary sector or whoever is best placed to undertake that work and really start to think about, you know, how we identify them, how we can think about self-help, how we can think about referral, how we can think about advice, but in that really proactive and responsive space. So that we try to reduce the number of, if I was talking from a health perspective, we would say acute episodes, but how do we reduce crisis? How do we reduce emergency? And how do we really start to think about our pre-planned approach and support that people can access? So I tried to make that practical. Was that acceptable? Very practical. And we'll pick up on that prevention theme when we talk about the Better Care Fund later on in the agenda. Terrence. Thank you, Chair. Terrence Herbert. I'm the new Chief Executive of the County Council. As we know, I'm relatively new to Surrey, but I do wonder in the context in which we're working, were there a number of funding streams which were coming to an end, what the government's arrangements, et cetera, are for discussions around what we prioritize and how we best utilize the funding that we have, and whether we work as a partnership, given that almost the entire public sector seems to be in this room, as to whether we write to government, whether we lobby, how we do that as a partnership, and where the discussions take place about how we use whatever limited financial resources we have for what are a number of incredibly worthy outcomes that we're trying to achieve. Yes, and so we do need to do that lobbying for that question. Any of you have Samari? Yes. Sue. Both Sues. Okay. Sue Tressman, do you want to go first then? Thank you. There are upwards of 100,000, maybe 200,000 carers. I represent those as Sue Tressman, independent carer lead for Surrey, who may be inactive and thinking about how we promote activity and access to activity for those carers who are really busy looking after somebody else and they may not be able, therefore, to access those sort of preventative after the person they love and pivotal for us as a system. So thinking about how we work with our partners who deliver carer support services, this would be a good opportunity. I was going to raise a similar point in terms of strategy around people that are in work, but low paid. And particularly in Surrey, the challenges of people working very long hours, and I certainly know care staff within our organization are often working long hours. And when we look at health and wellbeing of our own staff, some of the challenges there to support people to live well. So as part of those strategies, I think it is important that all organizations are thinking about health and wellbeing of their staff. But I think the strategy can connect some of those challenges around those in low paid work in Surrey that are particularly struggling in terms of some issues, and what sorts of things we can put in place to support accessible access to facilities and support considered as part of the strategy as well. Yeah, thank you, Maria. And we'll probably touch a bit on that when we come and talk about the poverty pledge, actually, and some of the things that we are doing or need to do. But I think it's getting the right prioritization, isn't it? That's going to be the challenge in a constrained environment. Mark, and then we'll move on. Just very quickly, I wanted to pick up on Sue's point with the carers. We're just about starting some work with a company called Mobilize, who Sue will probably know anyway, in and around that carer demographic. So I think what we'll do, Sue, is I'll have a chat with you, and maybe we'll put that on the agenda as well, the activity and how we can help promote [inaudible] quickly, don't you? Really quickly. I do feel, Chair, that the areas identified in the second recommendation feel very right. And particularly, the changing futures bridge a gap. I'm really pleased to see that there in the second bullet point, because that service is working with the most vulnerable residents who fall off outer services, fall off into the gap, off the ledge, whatever you want to say. And they are having really successful outcomes by doing this intensive work with these people, and they're not coming to the statutory services. And they can evidence this in some of their outcomes. So I feel that the various we've identified are really important. It would be good to hear what... Yeah. Well, I think, you know, from a local government perspective, at least, there's going to be some fairly intense discussions with governments around the proposed fair funding review. And I imagine NHS England also going to be in discussion. So I think we just need to just all come together when it's a bit clearer, kind of, where that's going. What we do know is that there won't be any more money, unlikely to be any more money coming into Surrey. So we're going to have to make sure that we use public pound, you know, as effectively as possible. Okay. I think that's... Thank you, Mari. That's very good. So we'll go to Lucy then. Thank you, on mental health. Thank you. Good morning. I'm Lucy Gates, Public Health Principal at Surrey County Council. And for the purpose of this meeting, I'm Co-Chair of the Mental Health Prevention Board. To update on the priority two, which is the mental health priority and health wellbeing strategy, the key opportunities within this is the voluntary care sector, community sector. The investment remaining on the mental health investment fund is 1.7 million through them and with the opportunity, obviously, for the matched funding. The first round is open. So this is a request for members of the board to cascade focused with a priority of suicide prevention around young adults. The definition of young adults is up to 30 years because of the evidence base that we have and the prioritization recommendations for the mental health investment funds remaining fund was led by a round table discussion of system leaders and wider VCSE partners. And the first round will be 500,000 match fund. Dissemination of that would be very welcome. In the spotlight, this time we've put forward the loneliness and isolation joint strategic needs assessment. Excitingness was published yesterday, so this is available for everybody now. The real unique JSNA, it's not been done before in this way, and it has a plethora of evidence-based nationally and internationally alongside experiences from over 2,000 practitioners and residents. We know that loneliness and isolation, it does cause worse physical health, mental health, emotional and well-being outcomes right across the life course. And the relationship with employment is significant, 2.5 billion a year of sickness absence. This is significant, but obviously also significant for the decline that those people then experience following that loss of employment. So there's 10 key recommendations. Key ones I wanted to just flag with you now was for system partners to really recognize that chronic loneliness is a structural, that there's a shared plan at system level and at place of to how the recommendations from this chapter can be adopted at the scale that's required to address this real population level need. Social connection is recognized by the health and well-being board as exactly as I've just said, as a structure in equality, and the efforts are made to reduce stigma around loneliness and isolation to enable those conversations to happen and for the support to be received. And the Surrey health and care professionals, that there's capacity built around loneliness and isolation and knowledge are there to have those conversations within everyday practice. So what happens next on this? An action plan is being developed at the end of 2024 through the mental health prevention board and obviously be developed in partnership with the system. To move on to the suicide prevention work, many of you, I hope, have now seen the amended suicide prevention strategy. There's been extensive consultation. Multi-agency partnership ownership of this strategy is what is absolutely significant and being considered and amendments will be made for that final publication. As we say, the key aim of that strategy is to reduce the suicide rate over the next five years with an initial reduction within the next two and a half years. That's the outcome aim. And within that partnership, as I have outlined, the system partnership, we've had many recent discussions with Surrey Police and alongside the outstanding role that Surrey Police play on delivering our suicide prevention strategy work and their response to deaths by suicidal serious attempts. This has been in place for the last three years and quite clearly been high of receipt of information on death. The Surrey Police have noted that with the stop of NHSE funding for the suicide prevention post, that if monies are not sourced across the partnership, there is a reality to the minimum expectations outlined in the national strategy. So it's a recommendation of index. Thank you, Lucy. So as I highlighted earlier in my response to the question, just wanted to give the combined board an update on the health and wellbeing index. This has been to the health and wellbeing board a couple of times now, but it's very much live and accessible for all the board and all our residents to see and measure that progress against all our high level outcomes, because that's the real quantitative indicators to see where our challenges are and where we're doing well that complements the quarterly highlight reports that show the delivery. So we've got delivering highlight reports and the outcome data is in our index. And as per the last health and wellbeing board, we've now got an annual scorecard that sits on top of the index that gives that summary. So that's also accessible to all and links are provided in the paper that you have in front of you. Just what I wanted to really emphasize now is how that's being used. And we've had a couple of examples already, especially around challenges. So for example, the challenge where we, it's been indicated by Mari about levels of physical activity in children and young people that is now picked up, all those challenges are now picked up by our two sub boards, the prevention wide health support and our mental health prevention board. And then turned into action plans so that we can really ensure our delivery is against our challenges and then that will be reported up as a highlight. But just to also flag us has just been flagged by the example of loneliness, the detail of each of those particular areas is in the relevant JSNA chapters and there's clear governance for each of those chapters. So just wanted to highlight our tools. We've got the highlight reports, quarterly delivery highlight reports. We've got our index that's measuring the outcomes, annual scorecard summary and of course our JSNA. The first good best place to look is the highlight reports because that's signed posts and it shows how we're continuing to measure our success or challenges. Thank you. Thank you very much Ruth and just actually just for clarification, the Surrey County Council Health System and Community Foundation for Surrey the original fund for mental health was in excess of 11 million and so the 1.7 that Lucy's referred to is the balance of that fund which is now being coordinated by Community Foundation and NASH funded. So right are there any comments, any questions to Lucy or to Ruth? No? Yes, Charlotte? Just that I think that was a really helpful explanation of how we're measuring and capturing outcomes and making sure we continue to show delivery against our areas and I guess highlight where we're not doing as well as we'd like to. As a health and wellbeing board is it worth in our forward plan looking at how we could have a sort of dashboard that gives those of us who can't get down into that detail a sort of highlight. I'm thinking red amber green here that's sort of simple of where we should be putting our time effort and pressure in terms of because I suspect there are lots of areas where we don't need to spend lots of time and there are some areas where we should be focusing more time. Exactly that and that's what the aim with the scorecard is. Index is ongoing, the scorecard will be annual. We can bring that we've got on our forward plan to show, celebrate where we're doing well but actually where we need to concentrate our efforts was similar to Nicola's question. You can't do everything so actually this is a real highlight. Just wanted to reassure the board that as well as those points in time as the board, the sub boards continue to look at those details and challenge what's happening, matching it against the recommendations in the relevant JS&A. So thank you that's going to be key. Thank you Tim and for me it's just that isolation, social isolation and loneliness and the importance of working in partnership with the boroughs and districts who have lots of skills for tackling loneliness and social isolation and I think it's really important because I think we're realising more and more the massive impact it can have on people's health. So I'm really pleased this is being highlighted and hope that as districts and boroughs we can do even more to help solve the problem and the biggest cure for loneliness is friendships. So we must do everything we can to do that. So thanks Tim. Thanks very much Richard and I know slightly related to your point there's a piece of work being undertaken looking at the single teams around communities so looking at the resource that the district and boroughs have and the county council has and indeed the health system again to just find a way of making sure that we're optimising that resource. So I think at the moment there's a feeling there's a bit of an overlap in terms of what some of those roles are whether it's the community link officers, the local area coordinators, the town coordinators, I mean those are acronyms anyway. So that will probably be bringing I would imagine to to the board in December as well for sort of a to kind of talk that through Mark. Right okay in that case thank you. Oh no sorry Annemarie. Thank you Tim. Yeah Councillor Annemarie Barker I'm the representative of the leaders of solely districts and boroughs here and thank you for the update and clearly some really great work going on there. It's good to hear about progress. I'm just concerned about the funding piece so obviously the amount of money in the pot is reduced dramatically. What work's being done to ensure the funding is there in future to carry on this great work? That I think is what they call the elephant in the room. So I think that is exactly why where these I mean we don't know at the moment what's what the government's going to do around funding generally. I mean there's you know one of their first issues they're going to have to deal with is the continued funding of adult social care. There was an extra two billion put into social care in the last couple of years. Is that going to continue? So but I mean the fair funding review is going to be longer term. I think we'll get a bit of a steer at the end of October at the budget in terms of we won't have the local government finance settlement but we'll have a bit of an indication of where that's going. But I think that the point that's being made earlier you know we cannot assume that all of these funding streams will continue which is why you know we now need to take that opportunity to look at the prioritization because I'm afraid I think inevitably some things we will not be able to continue to do. And you know and I think the you know looking at the you know recommendation talking about the unmet needs I think that you know a lot a lot has been done to through the JSMA and through the work in the towns and villages to understand you know who are the most vulnerable people in those communities that need the support and what sort of support they need. But all of that will will need will need funding so you know that that that that is why whether it's this board or you know there needs to be those those collective conversations. But it is it is of concern because you know we're we're struggling to fund the things that we want to fund now let alone things that you know we know we need to address that we're we're not able to do so. But so anyway I think I think you know and and you know Ruth has sort of set out there the sort of for for tools that help yeah targets make sure that we're targeting the right people with the right level of support but that that will be a a very active conversation over the coming months. Sorry Julie. Yeah thank you Julie Llewellyn vice president of the community foundation and that needs very neatly onto the fact that we're going to have to look for alternative sources of funding and some of that will come from the philanthropic sector. When you look at loneliness a lot of that work is done by voluntary and community organizations and I think what we might need to do is think about more of what you're doing with the mental health scale-up fund you're taking public funds and you are doubling it with alternative sources and then delivery goes a lot further. Could I also make a request that when you are developing further the loneliness strategy and work that the VCSE is at the table whilst it's being developed because they are going to be delivering a lot of that work and it's very difficult to measure the impact of that so it's extremely important to that they are there at the very beginning as the strategy is developed but that is clearly going to be more of a way forward doubling money doubling public money with private money and there are individuals who are enormously keen to do that. There's a good track record of things like that with the community foundation and I'm hoping that the VCSE aligns as that becomes more mature will be that sort of point of entry to have that voice and input at an early stage. Yes, sorry Alistair. Thank you Tim. Just to come back to the point about social isolation and loneliness. So I'm director of What's Gallery but I'm here representing arts and cultural organizations across the county both through the sorry cultural partnership but also I chair the sorry cultural leaders network of 17 chief executives and just to say really that obviously please do bear in mind the arts and cultural sector when you're thinking about social isolation but also all of the work around active young people and active adults I think there's a real opportunity right away through the cultural sector in sorry really representing the whole of the county there's a lot of grassroots work that's happening some of it's funded as Julie mentions through philanthropy but also through other programs and also just to highlight that the new 10-year cultural strategy for the county surprising sorry also has a real focus on these outcomes so I think just aligning with Arthur and if I can be a useful conduit then please don't hesitate to reach out. Thank you. Thank you very much Alistair. Okay good. Thank you very much Lucy. So we will move on to item eight then which is oh yes I guess yes the recommendations excited so the first recommendation is to use the highlight reports to increase awareness of delivery against health well-being health and well-being board strategy and recently published upcoming JSNA chapters through their organizations and then the second recommendation is to respond to significant challenges which include the following and there's a there's not an exhaustive list but there's some areas where we know there are challenges and not least of all around continued funding those two recommendations agreed thank you very much so the next item is about our approach to poverty and the request that we endorse a poverty pledge so Mark I think you're going to introduce and then move to Tom yeah thanks Tim there's a bit of a team effort here this beginning was written last week when the temperatures dropped and it starts on about winter and of course now we're coming into our Indian summer and the temperatures are going up again as the schools have gone back and everyone's back to work but I think what it does do is now we're coming into October November winter highlights the the need for support in our community we know that there are a certain amount of people out there who are going to struggle more government and some of their decisions and I think that's going to impact as well as generally speaking the current economic climate that we see ourselves in but this is a year-round problem it's not just winter and the health and well-being board recognized this back in July when we were fortunate enough to invite Jonathan company and we signed the end poverty pledge so I'm bringing that back to the table today some of you will know this some of you won't be aware of this but now with the joint board we're asking you to adopt that recommendation that we support the poverty pledge later in the month or next month we'll be taking this to full Surrey County Council and proposing that they adopt on through boroughs and districts into our communities and that we can all get behind this I mean we we know that poverty is a key determinant in health and working and if we can help mitigate that to a much healthier and a better way of life so I hope you all get behind this I'm going to pass over to Ruth who's going to tell you a bit more about how we are going to fulfill our commitment to the pledge and I think Jonathan's going to tell you a bit more about the good company and what the pledge is thank you Mark just on the previous slide before I go to this slide this slide there was some examples of how we're using the health and well-being index for a certain subject and those examples in the paper on this slide were actually how can we monitor something such as fundamental as poverty which of course is incredibly difficult to measure but I'm just showing those as a highlight but in in order to respond to Mark's point about okay we signed the chair of the previous health and well-being board chair signed the pledge at the last informal meeting what does that mean for action well the last informal meeting based on all the work of the good company and the evidence based around that what does that mean for us as a board well there's three key areas of how we can act collectively in order to enact the pledge and start to tackle and reduce the levels of poverty and they're outlined here the small detail there's two actions under each of those themes is in appendix one of your paper but just to flag some of these so for example under leadership and it was agreed at the last board this is about strategic targeting of those at risk we've already had lots of conversations about our targeting of poverty of course as a board we target certain populations in our priority populations and our key neighborhoods and but that is constantly live just a flag we're just about to publish early next month our jsna chapter on the economy which really demonstrates some of the disparity in social economic status across our county that's just an example and i've already flagged about the index we've spoken about potential lobbying and there's a system we wrote to go the government around the extension to household support fund previously mentioned there's been that extension so that's how we're continued to demonstrate that leadership as a system the second theme in the second column there agreed at the last board was around culture and this is about challenging each other to embed the strategies principle for working with communities engaging on a continual basis those with lived experience in this instance um those who have experience of poverty the hard data and quantitative data is key but of course we've absolutely essential we've had lots of examples of this how we triangulate that and with personal insights jonathan's going to talk a lot more about the experience of good company and how we can continue to build on what is a lot of good work around our system but as a system to make sure we continue to challenge ourselves to do that and the third area in the third column is around accountability and we agreed at the last board this is about continuing to explore again we've had this theme today funding sources but also sharing good practice and helping to monitor the progress so as a result of the signing of the pledge last in july other strategic groups have been briefed on this and we're starting to increase that whole system awareness and examples of good practice so we've already got traction but there's something about really building those key themes into our ways of working as a system particularly around those three areas i'm going to hand over to jonathan who's the managing director at good company welcome jonathan thank you thank you thank you for a few minutes just to speak i'm very excited um not because i've never been here before but because this is a bit of a holy grail for us in the fact that um i started the food bank 12 years ago and it's grown beyond i can ever imagine and i genuinely thought after a couple years we'd fizzle out and wouldn't be needed anymore we for a long time wanted to close the food bank and so what we've developed is a number of projects around supporting people in poverty to do what we feel to develop that emotional and physical and financial resilience within them so they don't need to rely on an organization like us we want to do ourselves our business we don't want to exist and this uh any poverty pledge is something we started probably about 18 months ago and it was a bit of an aspiration i'd be great we've got 300 volunteers get them to sign up get their friends to sign up can we build a bit of a movement to actually say can we come together to address poverty and over the last six months it's really sort of picked up and that's why you know coming here is a bit like wow if we can get and obviously what we're asking is all organizations to sign up to end poverty place and as individuals to sign up as well then we believe that is a significant step we know it's not going to solve poverty poverty is incredibly complex as anybody will tell you it doesn't hold any barriers it will take you from moments that you thought you were secure it will keep you trapped and you'll forever be stuck and what we need to do is to come together to work with the support we've got to break it down um good company as the charity it came into being about three years ago now we came out of another project we've got so big but our name is about everything we do we want it to be good and company is the french slash latin word to bring people together to break isolation we've talked about isolation being one of the you know the biggest killers in society it pulls people apart it pulls the fabric of society and what we've realized is many of our projects we've just started a pantry and like getting banned so we have one in episode people that go to our pantry projects they don't want to leave not because of the food but because of the companionship they've developed in that space we've now moved on to try and develop things that don't have food in them advice cafes one in epsom new one in mole valley one in by getting bandstead the areas of cover bringing people together ways of connecting them with support with agencies but also hey let's just have a cup of tea and they will say to you you're the only person i've spoke to this week and that is so chronically sad in a society like sewing where there's so much wealth there's so much support and there is a lot of support but how can we connect it together so the pledge um we're encouraging you to sign we'd love you to take it away we're happy to come and chat about it in your place if you want um but what we've done around it is develop a couple of resources as well so this is a little flyer you've watched them float around there's some it's on it but we've created a guide to participation we've had a few references to using people with lived experience and actually sometimes it feels more complex to do that and we realize this is a really simple guide but we will be giving these out to people that want them and it talks about it and it talks about the level of engagement listening to their views but actually then responding to their views and actually the ultimate place being where we can bring people to interact here debate work out the best way forward alongside that for those that sign the pledge and we also got a short video that we'd like to work within your teams your staff teams and at the end of this you're going to get a really short snippet of it apologies most of this little bit is me but genuinely the video is not about me so you can watch that and it's just about that participation of bringing people into a space and then there's also an online assessment tool i often say to people what do you do that keeps them in poverty and people go oh i don't think i do anything but a very simple level i use illustration if you have your windows clean by window cleaner and often he puts a card through the door and at some point you go online and you pay him now he's done that job or she's done that job at that moment but how long do you leave it before you pay them any other service you pay straight away and we know that for small businesses cash is the biggest cure and we have so many people that come into us that we're running a small business and it's just crumpled because of people not making those payments so the challenge really is what do you do to keep somebody in poverty and how can you help somebody out of it so the pledge is a first statement about saying yes together we can begin to make a difference and here's a quote from uh assistant vice in mole valley we're committed to working with partners to end poverty and suffering we have signed the pledge because we believe together we can make a difference and that's why i'm excited because i just think wow all of us on the same page going in the same direction then we really can begin to make a difference and that is fantastic and i think i've covered all my notes everything i should say final thing is we're in the process of doing our second poverty truth commission which is where we've brought 15 people in poverty together with business strategic and statutory sector leaders together and they travel for about 18 months not answering the questions but creating a space where we can begin to explore why somebody's ended up in that particular place and often it's not about the policy it's about the culture of the organization and the question is how can we begin to challenge the culture that we function in so we're doing a final celebration pcc event in november and we'd love you all to come to it you'll get an invite especially if you sign up to the place so the resources and everything to detail down there video participation guide self-assessment invite to the ptc we're happy to work with people we know poverty is a bit of a marmite word but we believe that by keeping it full and front we can begin to address some of these issues and move it forward and i hope you enjoy the video so the film is about saying can you think about what you could do differently how could you help people at our core in poverty and it doesn't matter if you're business if you're an agency if you're a statutory sector whatever you are working together we believe we can make a difference and address poverty so we're going to go on to show you some footage from some of our team izzy harris morine farah and alan and they're going to talk about some of the good things and some of the bad things that happen to them as they've begun their journey to rebuild their lives get themselves back up and going again make some of those choices that we take for granted not have to rely on the food bank or the services that we offer in this community and that we think is really good so as you watch the film and listen to their stories they're positive and they're negative can you stop look at the questions that come up think about how what they've said relate to you and your organization too often we do things because we've just always done it we often don't think about the impact the action has we've talked before about changing policies we actually think of changing a policy is really just a moment in time we want to change the culture how do you deal with somebody that is struggling how do you interact with somebody that quite clearly doesn't have enough to survive and needs your help we want you to treat that person with the same amount of utmost respect as somebody that walks in that quite clearly isn't struggling it's the little things we do that make a lot of difference and that's why for us clear it's the statement that we want to pursue see us for communication be clear in what you offer and follow it through l is for listening take time to understand my situation ask questions and don't make assumptions ease for empathy treat me the way you would like to be treated i am a human being not a problem a is for agency find out what support i need and help me to get it building on my strengths r is for respect do not judge me not patronize me i just want to be treated like everyone else thank you very much and don't um start with suit your passion comes through so see murphy our services are particularly very quickly we don't have any plans at the moment it's hard enough to do more recovery um but what we are doing is we do work extensively with the other eight trust all food banks that cover across all the survey so we are working with them talking with them about ideas and we know i think between the nine of us it's 60 65 percent of sorry which is really um positive around data guidance what's going on sharing ideas and good practices so there would be opportunity for conversation so would i need to look to see what areas the trust trust no i mean if you just email us you can talk about what areas you want to look at then we could have conversation and we could follow it up so we have those relationships i'm maria mel's from active prospects and part of the bcse alliance um i want to do this part of kind of the thinking you know some areas have gone towards things like a sorry living wage initiative and particularly the challenges of sorry being so close to london um that has um made um an impact and i guess kind of from some of the earlier conversations as well um and in terms of looking at some of the indices around um health and well-being in other areas access to stable accommodation is a key indicator in lots of well-being issues and i just wonder you know we we you know whether there is a fresh opportunity to to really kind of look at some of the housing strategies that we have in sorry um you know there's lots of different aspects um to that the supported housing there's there's wider social housing there's um how the private renters sector works in sorry how um affordable home ownership works in sorry but i think there's a real opportunity to maybe look at that afresh because it's such an important part of people's well-being shanae do you want to just give a brief overview of the sorry housing strategy yes thank you chair so um maria i'm sure you know this and i'm sure you've seen it we did a county-wide housing strategy um here in sorry and really um the uh kind of main reason or rationale for doing that initially was uh to um acknowledge the housing crisis i mean i know it's a national housing crisis but here in sorry uh a significant crisis linked very much to the points that you've raised and it was a robust piece of work i'll have to say those of us that led on it had to be tenacious but we had good discussion and debate as to the role really of the county in that area and ended creating a very comprehensive housing strategy and it's really taken off nationally we've been asked to speak housing related forums to talk about you know the reason why we did this piece of work and what the next steps are and the kind of golden threads within it are very much around housing for of most vulnerable residents across the county but also looking at those services that work to support those people and whether we can do anything in the essential worker housing arena as well there's lots to do several of us have discussions about this on a very regular basis but i'm grateful you raised it maria because i think housing is such high profile for all of you and really reinforce the next steps and there was a piece of work that the government last government commission from julienne mayor on particularly on a combination for the elderly sort of extra care facilities and so on and i don't know if that report was she was due to report in the end of this summer actually but we contributed to that and we have a quite an extensive program of building extra care facilities and so on i mean i think it's it's you know the challenge is that the district and boroughs are the housing authority you know whereas the county council focuses on the sort of specialist housing whether that's for children or or adults and so on but but i think that the that strategy was intended to bring brings all in the same room without treading on each other's toes we'll see where the the end the national planning something the nppf yeah where that goes and and whether this government actually moves forward with on a more sort of strategic planning basis and so on but you're absolutely right i mean it's it's it's it's probably the single biggest issue for us in terms of recruitment and retention of uh skills skilled people into into this county there is no easy answer because the the cost of property is here and you know building more houses may may bring the housing prices down a little bit but unlikely i suspect but uh yeah so we have to be we have to look at that in an innovative way charlotte i i want to come back specifically around the poverty point but just to extend the housing conversation a little bit further um and forgive my naivety around the politics of districts and boroughs versus the county council but is that not something that we as a health and well-being board could put on a forward plan about how we come together with our districts and boroughs and the unitary and the county council and all of our partners to look at the outcomes of your strategy and make the desired changes that need to happen because i'm also the executive lead for adult mental health and if we want to talk about crisis the the lack of being able to discharge people who are very well fit for discharge from a mental health institution because of inadequate housing is a key key problem for those citizens and also for for the access of other citizens who are very unwell waiting for the beds that these these people are in so i would really like to understand how we can move that along in the right way without stepping on people's toes and responsibilities of course um but just to come back to jonathan and thank you for that really really passionate piece i'm a gp in spell form so i get poverty and i see it daily in the presentations of my ability in poverty thinking what can i do as a gp actually your appendix three is brilliant and i want to draw everybody's attention to it as individuals as well as people who run bigger organizations about how we could go through some of those self-assessment questions with our leadership teams with our receptionists and our workers and ask the right questions of each other you know we're just designing a new appointment system in the practice big sigh but actually how do how do we respond to people who are having to get a bus or walk potentially 30 minutes to get to our practice to book an appointment versus those who drive their four by four into our very busy car park you know we have we thought about that i don't think we have so there is something in here for everybody down to you know very small businesses and personal and i would like on behalf of the icb i think that an in the chair if you would come and do your presentation to us as an organization you'd reach the 600 sorry residents which most of them are so i'd like to invite you good my chair's agreed so that's great thank you john yeah just say thank you for that um love to come and talk to my team and share some of the things there is quite a lot of dependencies and actually you can look at them obviously i didn't go into it in detail um and it is about the opportunity for you to do that i suppose within your organization as an individual to explore what you can do um there's we've had stories of people where yeah the health service has potentially moved so they've had to get a bus because they can only walk and they can't afford the bus so therefore they go into poverty so it is like what do i do go in debt which i'm never going to get out of or suffer let my health suffer it's a really die tough dilemma a choice that they shouldn't be making so thanks for your comments carol marie do you want to come back on the housing thank you chair and just to pick up on the housing um item this is the biggest challenge for districts and boroughs you know this this one area in the next probably couple of years is going to be the item that pushes well-run fiscally prudent districts and borough councils into bankruptcy quite frankly and you know we've got i'm sure the way i would say you know we've got colleagues down the road in crawley who are in particular um because of their circumstances and in particular crisis you know my own authority you know we overspend on this budget by millions of pounds and um you know we're very open to discussing how we improve that the reality is this is around lobbying to government this is around what is the ask what is the solution because it's something we've been trying to crack for a very long time and we are in a perfect storm that is the reality um uh part of the the district council's network which which i'm involved in you know we are taking a blueprint to the local government association conference in october to articulate what the ask is in terms of these are the these are the things that you can be doing to actually help us with this problem because you know i would love to say the answers are in in this room i'm not sure they are the will and desire is but the reality is this problem is is is going to need to come with some solutions from government so you know please don't get me wrong i'm not trying to be negative i am so up for sorting this out um but the reality is we are going to have to take it up the chain and if we can do that collectively again like other comments that's how we're going to have that impact i'm going to let karen say something about the poverty pledge yeah it was so neat to come back jonathan i know you're going around individual local authorities and talking but if um because i know for example we're talking on friday but if you need any help or assistance in terms of talking to others please just ask and we'll um and if necessary we can put it on the agenda for the um chief example thank you so what yeah we'll we'll pick up on the housing point and how we can but you're absolutely right i mean like like all these things whether it's around scnd you know reform home to school transport which are the two biggest pressures for this council uh we're going to need the help and support from the government so it's quite a long list of lobbying things which i'm sadly rolled over from the last government okay um jonathan thank you very much um uh as as mark says uh this will come to sorry council for council on the 8th or something of october um so hopefully we'll have a good debate there and and and you know the key purpose is to get the word out there isn't it and get everybody kind of thinking about it and doing something so thank you very much there are six recommendations which i'm not going to read out the first three were all previously agreed by the health and well-being board the fourth is um to uh ask basically uh organizations to advocate uh for the signing of the pledge um and and the members of this board uh to to spread the word across their networks there's things that all of us in whatever capacity could do and that's really the request are all those six recommendations then agreed good thank you very much um so uh item nine then is the better care fund um and uh i think jonathan already knows that the the you know that this this is this is the pot of money um that i think we should be using wherever possible to focus on preventative activity and an early intervention i know there's some statutory guidelines as to what the money must be useful but i don't think that uh contradicts that um for those of us that were involved with the hewitt patricia hewitt review last year there was recommendation from her that the one percent i think of the nhs budget be ring fence for prevention um i don't know whether that's that's going to find favor it's difficult to to do that i imagine but at the end of the day as we've discussed here uh you know the the only way quite frankly that um we are all going to survive in all of our organizations is if we somehow contain the demand for our services so that is about getting in early providing that support and hoping that people don't then sort of deteriorate or move into chronic condition so so i don't think there's any question that it's in everybody's interest that we find ways in which we can uh you know up our our preventative activity which is why you know we started to build up the framework but specifically on the better care fund uh john you're just going to give us a few thoughts thank you thank you chair um yeah it's a fairly short and focused paper so i'll just pull out a few things that i think are important that build on the chair's open remarks um what the paper covers is the key next steps that we need to be focused on between now and december and those steps are very much informed by previous work that we've been doing including workshop back in february um a lot of the discussion of those workshops are well aligned with the uh the chair's comments um and uh it sets out the steps that we could go through to actually work um that into future plans and the paper importantly i think reminds um people of the national criteria and focus for bcf two key things to kind of pick out in that the focus on independence and well-being and keeping people at home for longer but importantly that people receive care in the right place so that aligns well with some of the discharge related activity and you see that within the paper in terms of the summary of kind of the contributions uh so picking up um other elements key relationship with our district and borough colleagues around things like disabled facilities grant discharge work and additional money that over the years has flowed flowed into the bcf and of course the focus from the early years of bcf around protection of adult social care and as the board will be very familiar with in terms of sign-off process for the two-year plan and annual reporting we often get guidance relatively late in the day we are in a position at the moment where we don't have any clear direction and guidance from the government although i think it's fair to say there are some indicators if you look at the darsey review gives a sense of some of the points of focus some of which may well build on the huett review that the chair mentioned so i think what i'd conclude with is points within the report that really emphasize the need to kind of focus on outcomes we need to really strengthen our evidence base in terms of decision making around what we do and don't invest in from within the better care fund and that the next steps within the report linked to the kind of two question it poses around whether the four areas are still the right things to be focusing on that is work that we can work through over the coming months through to december with a view to agreeing a system plan for 25 26 and beyond should there be a longer funding time frame when we end government thank you john any comments thoughts no oh yes are you invited to the table please yeah absolutely we can certainly make sure you are key stakeholders that are involved in the planning conversations and of course yeah thank you chair and john we always appreciate in the carers support world your strong support for carers i would encourage us to have that recommended communication that i see there in the paper that still needs to happen that will be vitally important in terms of looking at the support for carers from the vcf fund going forwards and i'm just reminded in so many of the items we've had already joe cogswell i'm the exec director of strategy and transformation at the integrated care board i just wanted to speak in support of the challenge that you sort of quietly articulated there tim i thought it might be stronger i think that we could do more and we could do better with a better care fund and i think we really should challenge ourselves in terms of how we approach the next phase of this i think the prevention agenda is key and we need to do more than just keep saying the prevention agenda is key we need to challenge ourselves in terms of the way in which we structure our programs of work and the funding that follows those i don't think for a moment it's easy but the workshop that we had in this room earlier on in the year generated a huge amount of support and enthusiasm for different ways of working and i would just really like to speak in support of not just me and the team that comes with me but us as an organization in terms of our commitment to working together to really give fair considerations for what we might do differently moving forward and absolutely maximize the use of this absolutely thank you okay i can't see any more hands i'm saying there we go john there's a few stairs hints for you thank you chair and follow those up thanks very much so three recommendations to confirm and endorse the four areas for development from the february 24 health well-being board better care fund events secondly to agree the direction of travel especially in relation to ongoing demands upon social care and the nhs as well as the ambition to develop further our preventative approach and i think we said that is that preventative approach is really key to this and then the third is to note the contribution of the bcf in protecting adult social care health and the voluntary sector services and its importance in facilitating integrated working i think those are agreed good thank you very much then the last substantive item is an update on the library of experiences library experiences was effectively pulling together when the icp was allowed on tour sort of capturing those experiences and ideally producing a sort of a not a blueprint but actually a kind of a a guide to what you how you you what you might find in a town but how you go about building that sort of supportive infrastructure which is absolutely key to the rollout of the towns and villages initiative so i think dan sherlock you're going to just give us that update thank you yep thanks chair dan sherlock strategically for thriving communities in public health and community surrey county council as the chair's introduced there this was about having a slightly more deliberate method i suppose behind how we draw learning out of really great examples of work in surrey a common refrain is we've got pockets of good practice how do we spread those how do we make the most of the really great examples we've got and we've had a number of them today um so just a few really quick updates on this three things i would highlight one firstly thanks to colleagues in the boroughs local nhs and other colleagues in hawley and north leatherhead because they were two of the site visits the icp previously did and they've helped to draw out it's in the detail in the paperwork but draw out some of the really key lessons they've resonated today to be honest in this conversation as well so i think that's helpfully reinforcing and it's good to have also the practical side of this captured for people working at a local area how do we go about engaging with our community how do we do this co-design with people with lived experience jonathan please you mentioned the guide you've got as well so how are we making it easier for people to work in the ways we describe and set out in our strategies and secondly in in aid of that there's a new sort of sharepoint digital site this is something we were developing in the county council anyway to improve our work around consultation but we've taken the opportunity to broaden that and make it a site we can use as partners and there's a couple of key things that i'll do one is give our colleagues in different agencies and voluntary sector access to some of this learning and these examples but also start to make it easier to find out information about some of our specific places we know the great local work that happens at district at town at neighborhood level and but it can be deceptively difficult sometimes to find the information about what's already been understood about the community there what we already know who the key people are on the ground so we just want to bring that together in a way that makes it easier for staff to navigate and collaborate with communities the third point really quickly is we will also do a real push on this with communications colleagues but also at the surrey expo the surrey heartlands expo later in october so just a really quick update i think this as a sort of way of working goes alongside those earlier slides that phil shared around the sort of cycle of diving into specific local places and work where things are happening on the ground but making sure we're drawing out the best of that and kind of spreading that across the what is a pretty large county with her colleagues working in it so that's all to say today thank you chair thank you joe did you want to go i did yes please i'm going to try and match jonathan's energy from before um so i'm really excited about this you know how many times in our work do we go somewhere and you hear about something that someone or a local group are doing you think oh gosh how did they do that how did they get that off the ground how did they find the right people what might i learn from them and dan's done a great job of of capturing uh the work that's been done over the course of the last uh few months to try to say well how can we get something together and you know we've really struggled with the name and i know that some people think that library of experiences sounds a little whimsical but i personally really like it um because how do you try and make it demonstrate a level of energy and if you think about a modern library yes there are books there but it's a meeting place it's a talking place it's an opportunity for you to kind of share that experience to create a community of practice and so that's really what we're trying to do so um although the things might appear quite flat on the slide at the moment um hopefully the expo will be a real opportunity for us to demonstrate the energy that there is and the passion and commitment that there are um from the people that really want to share their lived experience um you know some of it quite challenging actually but how do we recreate how do we learn from one another and sincerely how do we really draw on those local networks in our communities so that we continue can continue to uh to work with them for our local communities to really advance um some of the key pieces of work that are fundamental to our ambitions in the health and well-being strategy and the integrated care strategy and also as we've touched on many times today some of those things that are just absolutely the right thing for us to do as organizations to work together um in our communities so um not maybe not quite as energetic as Jonathan but i would really encourage you to kind of embrace this and think about how we can really take it further because it's very exciting thank you so i think you only came up with the name livelihood experiences with visionary um yes thank you and um for whatever it was i think library expenses is fantastic and it's a great idea personally um i just want to ask a little bit more because i think that at the moment you've got a thing which is both feels as i read it very focused around the workforce around what's happening within the icb and sorry and a sort of bit of process around the the vcse and some connections there and you think about the expo which is a set event which a relatively small group of people to be at but there are hundreds of often very micro examples of really good practice um and i guess i want to challenge you to be a bit more ambitious about how you reach out into those very sometimes small little street groups that do something very powerful in their community and whether there's a way to to you know work with but also through the networks of organizations that you would normally link with which tend to be the sort of bigger infrastructure organizations or the bigger charities into but through the schools networks because that we've been they'll tap into things that little pca groups are doing are into some of the things that might be the informal networks of carers that do stuff because they're the richness of that stuff is really strong but there's a risk that somehow this doesn't seem to be for them um this is big organization big um just sort of feels very disconnected and very sort of up here whereas there's something very powerful you can find maybe maybe it's a media partner you need to go and find or something that actually just reaches out into we want this to be right from the bottom up we want people to bring their stuff to us rather than the moment it relies on you going and finding it in a sense there's a sort of conversation about we want to go explore well let's just you know let's get a tsunami of stuff coming at you that actually starts to think about how you encourage people and value what comes at you i don't know if my colleagues are holding their heads in their hands but i'm i because um i'm just the right person for challenge on that because i share your ambition so come join us is what i would say so uh you know if anybody has any other ideas um for how we might um take this forward we would want we really want to hear it so what you've described is exactly what we don't want to be we don't want to this to be uh either actually or the perception that there is that this is just about the statutory organizations and how we can share good practices it should be much more than that so maybe we do need a media partner so if anyone has any ideas we'd love to hear it um jess julie uh i don't think you need a media partner um but you can but you know you've got already all the north starry voluntary action you've got all the small community small umbrella groups of the tiny groups that you are sponsoring they come together from time to time in fact communicate community foundation is having a meeting of all of them in a month's time or so and if you publish this to them they'll be all over you like a rash so um the solution is already there i'm like and that is absolutely been the the ambition is to to get down to the to the street level the sort of granular level you know taking roofs jsna data testing that um but then you know i mean if you when we went to north leatherheads uh the last time and there was some fantastical challenges you know we went to the food bank and everything else you know but they they weren't particularly well connected any of them then that is a challenge i mean there is allegedly over 16 000 uh charity charitable voluntary organizations uh you know and and it's impossible to kind of connect with all of those so but it is what we're trying to do is to set up uh some sort of support infrastructure within each of those 29 communities you know in the hope that that will kind of attract in all of those those organizations that want to want to engage but so it is still fairly early days but that's that is the ambition i mean just i think that there are lots of mechanisms but there's so much more outside that that we can absolutely go through the roots and the connections we have and there'll be lots of good stuff there but so many other as you say thousands of thousands of bits going on that we just don't get line of sight operating and that's where the that's where the riches alice thank you chair um just to say um from a cultural perspective um i found this really exciting when it came to the icp initially um through joe and um i think we'd be really keen to support i think there are loads and loads of connections into the arts and cultural sector um just as an example sorry cultural partnership board has over 300 community stakeholders on its database and i think you know there are loads and loads as has just been said there are loads of great examples that are happening at a grassroots level there is a challenge of this has just been mentioned of getting sight of those and we'd certainly be very keen to be a conduit for lots of that great activity that's happening around the county but i think this will be a super useful resource so thank you for all the effort that's gone into it and i would just add that we're hoping that the voluntary vcse alliance will also help you know us getting get find those voices and help coordinators as well so it's it's definitely where we want to get to i can't see any other hands up so um so to the recommendations so first is to endorse the further development of the library of experience method with all partners committing to share examples and apply the lessons in practice secondly to confirm that positive examples be showcased at the sari heartless expo event which on 21st october 2024 it's an epsom race course i think yeah and be included in follow-up internal and external communication campaigns thereafter as appropriate and thirdly to agree to actively consider the key lessons emerging through this approach when reviewing relevant future health well-being board integrated care partnership items and recommendations that agreed great thank you very much um the last item then is the icb agenda which is for information i don't know whether ian or nicola wants to highlight anything in particular the independent investigation into the nhs the daazi review so just checking that everyone has seen or have got access to it but i think just to headline i think as an nhs organization there were no surprises in that report it was everything we were familiar with although it's a diagnostic i think the next step is no for nhs to work through what the plan is in order to deliver again okay i don't know if anybody else wanted raising on the those agendas if not you will have i'm sure seen that we move smooth seamlessly between the agendas of health well-being board and integrated care partnership and for that can i thank in particular um phil austin reed and lucy clements who've done all of the heavy lifting to get us to this point uh we'll we'll formalize everything at the next meeting um but uh i think it's it's it's worked in terms of bringing together those separate agendas and the next the next public meeting will be on the 11th of december 2024 but there will be private meetings uh in between those times for the integrated care partnership uh the plan is to go to um gobbling that's right joe i'm missing the meeting at which the alliance is discussing where this to host you so i will update as soon as i hear the outcome well or somewhere near golden good okay i think that brings us to the end of the meeting so thank you all very much for uh joining us and um catch up with you all soon thank you [BLANK_AUDIO]