Transcript

Thank you. I'll see you guys. Council. So, I'll just come out. So, I'll apologize. Council, Corey, and also have a family, but we have. Sir, and. Thank you. Thank you. Thank you. Thank you. No further. Five years. Council will. He's reading a bit late. Yeah, she will be. Yeah, she will be here. She's building. I think she's got my releasing. Um, item two, a declaration of interest, and the council got a declaration of interest. They wish to be cleared. Seeing. So, thank you for that. So, item three, which is announcements by, uh, any of the executive or the directors. Absolute David. And as members will know, we've been dealing with a substantial puzzle from national grid for pilots down the entire substations, and both you and I have made significant comments about those. We've now received two further applications. One for the two further cable routes with associated infrastructure giant substations, which will impact enormously. And offered the footprint on the substations is actually bigger than the town, which is quite devastating. Last week, we were briefed on a new project called, which is for a further cable route connected to. Um, it's coming to I've looked at this and bearing in mind, this works with. Both the Viking then, Lincoln, to properly integrate into the landscape by underground. And we have a policy that is supportive of underground. It's quite clear that these three new cases are so significant infrastructure involved, but if they were taken as a one application by a planning inspector, they would be refused. So this piece will, one at a time to try and get the planning system isn't going to work for us. So I believe to change the position, the formerly object to all cable routes, and insist that the powers that take it away and work towards an offshore integrated grid. And the only use, I can go to where it is needed. Obviously located on that, and we should make sure that not only do listen to residents who are upset if you can, but it's our duty, I think, that we champion Lincoln share and that we fight for the tapes and the people of the entire eastern part of the county. Let's see by these proposals. I'm also going to propose that I like to leave readers of the East area. So we have a complete set of clarified objections for the entire eastern side of the day. We all know the part of any of these things into the grid, but it's supportive of Lincoln she supported the landscape to reach out and the toilet sectors that are critically important to us. I think we're going to make a lot of noise, so we're going to have to stand up for Lincoln shirt. And it's not right that the south of England does not have solar farm, bringing farms on the beautiful south down. Because those people to drive on and I was live to look at beautiful countryside, but the people of Lincoln share to have the same. Really, I don't need like one county. So that's my view. Yes, very good thing sport you're in your bus. And there is, I think just with, but also with all infrastructure, there's a lot going on, all sorts of wind farms and. I've lines, which I'm reservoir. So I think it is becoming an increasing issue for us as custodians of the countryside, if you like. So we know this stuff's got to happen, but it's got to happen in a suitable way. Thank you, I like, I think it ultimately for all of us. We're here to serve the people of Lincoln. We also need to make sure that what we hand on when we finish is as it's better than we inherited. And it's quite clear that these proposals and more ones you just mentioned are going to be difficult. For ever. What Lincoln sure is. So we are going to have to be. Yeah, thank you very much, leader. So just to confirm that the consultation period has been completed. Obviously, there's a decision in March for council. This council is at two ounces across greater Lincoln share to support right into the secretary of state. We've subsequently written to the sector estate to ask him to consider laying the statutory instruments to set up a barrel combined authority. I'm expecting an announcement in the next two or three weeks from them as to whether the secretary of state will grant the statute. Certainly, it appears to be all systems that go that we wait five minutes. Thank you. Any further announcements by the. Okay, thank you very much for that. So we don't want to item four, which are the minutes of meeting how. Is it your wish I signed these through an accurate record. So agreed, no dissent. Okay, that's a great thing. Okay, thank you for that. So let me move on to the first. So an importance of time is the people's leisure center. Obviously, if the building is owned by the council, but he's on it. It was close some time ago now by some district council a lot of. See that the leisure center is saved for the community. If it can be saved. So the proposal today is for us to indeed look to do that. There are quite a few of those. This is to a hand over the building to the local community group with a diary to make sure to match what the district house. So desperation, but. Second had a very positive meeting locally local players didn't reach out, really positive. So I gave us a lot more confidence. These proposals will actually fly on. And certainly if we make a decision today to support financially. So we're not to the end of the story yet, but hopefully we're in a much better place. I should be trying. Which was supported and supported in proposal of up to $150,000. Given to the CIC for the deep things. We were just looking to. To get the support today and we're from from the executive. So as council of health has stated, there are a number of who still let go through. So I think Jane will probably go into them in more detail. But it's positive so far. I think it's a long way to go with approvals from the DFE. And obviously all the conditions to meet as well. So, so we're on the right track, but I think that'd be the still long way to go. David's changed the details. Yeah, I think you just said, I think in terms of the bid that's that's come in. I think the bid shows an incredibly strong desire for the group to open the letter center for the benefit of the wide community. But as council of Detroit has just said, there are a number of gaps that still exist in terms of making the business case viable and sustainable. The gaps are set out in the report, but just to give you a bit of an all of you. And that's really important because in the event that the legislature said, it does become a viable and it's necessary for the building to be actually demolished. But it's important that any, any group that that looking after the leisure center cover the full cost of demolition and clearance. So costs don't fall for the county council, nor to the school as well. So that is a big gap in terms of the exit strategy. We will need to make sure that any other sort of major funding contributions are covered off as well. Within the business case, there were a number of funding contributions that were set out at the moment, they're not all secured. So that is, that is a gap at the moment. We have asked that any big to the community ownership ownership for just being approved as well. Again, a lot of the bid was predicated on that. And of course, it's really important that any plan moving forward has been, you know, agreed and reached with the school. The deep things like a center sits in the heart of the school site. Therefore, it's really important that that the school agree any sort of operating plan with that as well. I think last but not least, it's really important that an experience provider comes forward in order to manage and operate the letter center moving forward. And we would like to see, we would like to see that in terms of any, any sort of future proposal moving forward. Thank you. Thank you. I just don't want to. Sorry, please. Remember. The script. The script needs to just want to summarize comments and also any personal comments as well. Thank you. Yeah, please do report. On the 25th of April, the overview and scrutiny management board recorded unanimous support for the recommendations that are before you today. The board expressed it's a broad support for the proposed approach. And I as local member, emphasize the importance of achieving a best interest approach value for money approach and protecting the interests of the county and all the other parties. As well as the need for collaborating amongst the partners to overcome the challenges that you've mentioned. The report and recommendations were welcomed and the potential benefits, such as the potential reopening of the letter center and getting swimming again. And that deepings enjoyed for nearly 50 years and achieving a cost effective solution for the county council were highlighted. There was clarification was received on a concern that was raised by members of the board. And that was concerned about the risk of a judicial review regarding the proposed action under the subsidy control act. And inquiries about the potential cost of the county council in defending itself against such a scenario. It was explained to the board that the advice had been to classify the financial assistance given as proposed by the county as a service of public economic assistance, which is permitted under the subsidy control act. Officers clarified that the fulfillment of the subsidy control act principles were not necessary to pursue this route. Therefore, the risk of a judicial review challenging the lawfulness of this route was deemed to be particularly low. May I just add as a member, and say, I'm particularly welcome your common sense approach and particularly from council of Detroit and the chief executive. And I know you could be been several times too, David, and it is most welcome. And I would pay tribute, obviously to the community who have just shown absolutely determination to see if it is possible. If it is possible to get swimming and the measure center reopened and add a value for money approach, then it is really sort of welcomed by our community. Thank you. Thank you very much. Okay, questions comments. Anybody. I'm sorry, I was cutting some analysis, just on the slide. If you would apply. You would spawn a common means that works subsidy expert and until the end of the arrangement, which will be end of the graph agreement. Yeah, so that's, that's further information. I think as we, as we work through the process, council, we're not quite at that point. So, obviously, we have, if we hand the building. So, it's there, it's a legacy. About certain laws. It's double check. I would think if we handed it over, then that would, that would be the end of the monitoring. It's in the monitoring for the, for the eight hundred and fifty thousand. So we've monitored that and see how that's done, wouldn't we? I was in charge of it. It was a vegetable. Yeah. I'm with you with you. So if it wasn't, I'm sure it would be what would be the, how would that work. Well, a grant agreement would be in place and we would have powers within that grant agreement to be able to seek to recover the, the relief. If it was an agreement with the purpose. I mean, we did have a very positive, and obviously council goes with there as well, where the, there was a potential. To provide a partner who have to say I gave a pretty good account of the school seems to be, the school is under new management and they seem to be like positive about the arrangements. And certainly we also met the new, but there's a new committee really of the community group who I think will mostly business people who seem to be fair to which not to all look pretty positive, but I keep stressing that we're not there yet. So I think this would be a long show on the district council and this will be a big step. Councilor David. I just want to add, I think I'm, I'm welcome to report, obviously, I think it's a good example of. Unity's views on. And I think that's what we're here to do subject to making sure we. Follow the legal processes. I'm delighted to be able to support the paper. I think it's the next device. I think the community listening to them and trying to find a solution, I think we found a solution. It's one that will live the outcome that the one desires. First point in terms of, obviously, we gave the building and the money, obviously, the risk for us is that still end up with a bill for demolition. I mean, I confident that we can legally get to a position where we are if we gave the money that have been about this and no liability, then come back to account, Councilor future. Assume money was used for the leisure centre for the service and on all the conditions were met. The ground agreement in place, then, then, yes. So if the, if the, if something went. Building and change needed demolition. We can get to a position where there will be no financial come back to the council. We would write protections into the agreement that the building is handed over. And you're confident that that will, that will hold legal water. Yes, that's good. Okay. Yes. I'll add to that. So I think the risk in terms of in the future is to the school, which is obviously an academy, not maintained by the local authority. And so I think it's the DFE that would want to be short around the exit in agreements, which is one of the apps. We can choose on the list and that clearly, as we worked through the details subject to the decision today, the, the exit agreement will be something that the school and the DMV will be particularly interested to see. We have the local MP there who did give an undertaking to try and. I think it's no secret. They can't take that. They're quite slow in coming to the decision, but I think it's important that. They've used player because obviously that. So everybody, all the partners, all the people involved with this, they're where we stand. So we hope that that will go once we do this. We can get an early resolution. I believe also we are told that if, if there's confidence now this will happen. We are told that the local community, lots of people have given commitments towards supporting the nature center, they will then feel confident to come forward. I think he's that fair comment. I think that's, would you support that? I mean, that was a claim anyway. Yes, absolutely. And as I say, it's a job has the MB is he's actually a member of the community group. So he has got an interest in promoting it within government and I'm sure he's going to do that is doing that. But no, I think the comments that you've said are in terms of the local community supporting. There is, you know, you would support to get swimming reopened in the data. It's a growing, you know, it's entirely the financial cost. There was an indication that the meeting that once there's more content would come forward with financial support. Yes, I believe so. Okay. Okay. Any further comments, please. Okay. Well, this is the recommendations there on. Dean, I think it is, you know, it's awesome. But I think the, I think it's the right thing to do that we try to do a bit to try and ensure that. So it does reopen center does reopen. In the future, I think with that, I would. Recommend that we use for user recommendation. So, all those in favor of the recommendation. Thank you. That's you now in this. So, thank you for that. Okay, then we then on to six. In a commission building based day. Day. So, there you are. Thank you very much. All right, so we're bringing it before. As you can see, we've got 26 providers and their contracts and. First of all, that's 2024. So we need to recommission. So what we're proposing is to. We're going to have to like service for the next two years. Actually, because I did to see what they're actually trying for us to see if that's the offer is there is what we need. But it's also, but all. It's in the right areas so that we're not transporting people to different areas. And we're going to actually look at not only our external, but our internal. And so I'll pass you over to. This is possible, but just in my turn, I want to add a bit. So these are our opportunities. So this is care. This is care for support for people who are in the community seeking to lead a fulfilling life. It's incredibly important for that quality of life, because it provides meaningful activities for them during the day. And that's one of the things that's proven to enable people to maintain good standard of health will be for a long period. By supporting people in this way, we are very effectively reducing future of our for formal care services. So it's a service that very much takes itself in that sense. And there are. We've access these services together being past service and the. We are largely working each other. And we are really strongly ahead with our. And making sure that that is really focused on the needs that people have, and it's is delivering me that the appropriate services, but we need to take that step back and look at the overall position of both. So this will need the service. Given the, the tool make time for facts that expire and those contracts can't be extended, but they've been extended as far as they can. We do need to do a new rather than continuing with the model that we've we've had for some years. The recommendation is that we do only a very short contract to a year contract to allow us to do that strategic thinking to work out well, what is the model for day opportunities that would be most. To take a short. Deliberably designed the contracts that they could be terminated early, if we were able to be in that position, but we didn't want to be in a position of letting a short term contract and then finding that. Essentially, this should be the longest period we would need to be able to work on the long term future rapidly, and then run the procurement in time and therefore ultimately shouldn't end up in two years, but the best is to have that. I should say, it works out on two and a half million a year, but also noting that the contracts we give to providers, these are the only pay if the service is actually used so people need to choose to go to a particular service and they don't need to choose that. There's no, there's no liability for service that the people decide not to use. Thank you. Yeah, just to add to the sense, really, though, these are external care services, so they are for people who have an eligible final social care, and these services help people to stay independent, but they also play a really vital role in terms of. One is family support as well, but these services help to avoid people leading to go into. Well, dependent services like residential care, so from that point, really, really important. As Martin says, through doing. Looking at the existing contracts, and looking at the future we've identified some opportunities where we should be commissioning. Like to make on a long term basis, there'd be some significant opportunities if we did that. That's why we want to do a month of strategic review. And some of the work we've done in our in-house data services, we've not only got our traditional and social care office. We've also developed an early health as well, which could actually help people are on the lead for an also social care, stay independent longer. We've helped people to access. Many more volunteering opportunities in the community. And then also pathway to employment for disabled people as well. So we see similar opportunities in the external provision. If we do those, and also an opportunity to look at sort of messing wider issues like social isolation. So, yeah, just to commission like the like on a long basis would have been massive opportunity. So I wonder that that's what we're doing. Carl has some further details on the short term reading center, if colleagues for the things that they think. Yeah, that'll screw to me, but there's something else should be in there. I was going to ask some of you, but I'm going to talk about the control side is more on that, but anything else. I'll wait, I'll hold my. I just, I just anything, the scruity comments there. All right, yes. The scruity comments where they work. Overwhelmingly sport. Yeah. Because it's really good that obviously, I mean, I remember that days when they just used to go. I mean, they've only got to look at the restaurant, and we've got in there, who actually, you know, are able to, you know, somebody at the till and I think it is a great opportunity. So I would really support this. And I think the further we can go to get people to actually be able to come to do things that they've probably never, they've never been able to do it before because nobody's ever bothered to help them. And to show them, you know, gardening and things like that, you know, they love watching. I'm taking their vegetables and watching them. So I just think it's great. Because it's important to try. Well, it should be common. We can lead to a new two year to be extended. I'm just looking at. If you're, if you do the review, I appreciate the comments saying that it's not going to take up to two years or potentially not. Well, that does not give us enough time to procure to write a new procurement because it's bound to be some changes. And then go out to procurement and then get upset by him within that two year period. So the development of the strategy work is intended to happen over a relatively constrained time scale. It's already underway. And then the two year duration of the interim arrangements should then allow sufficient time. The outcome of that review to be considered any revision to the service model to be designed to the regular process. It's very important to be undertaken for long term arrangements be commissioned and cured from September 2026. I'd be very disappointed if we got to a stage where we need to extend two to two years should be plenty sufficient. So we've been interested on the child's on page 35, which obviously shows in terms of all the people and is it's covered on. People are using the household services are there. So what do we think. What do you think the reason for the. Yeah, so clearly, as you say, David had an impact, but I think there's this nationally very significant trend. Away from building based services for all. There are an expensive range of of there to choose available to order people, but they tend to be not. The traditional model of people sitting in a big circle in a room. That's very much not the way that the doubt to exist in the most country nowadays really we've made that transition. And that's part of the reason I wanted to take the step back and take a strategic look at what we're doing. We want to make sure that the overall service but the in-house service and then you take some questions. I mean, the need sort of link to people as those have changed and what continues to check. So effectively what we're what we're seeing in that table that you've wanted to is that are be prompted by code. We've made a significant shift in the way. So I wouldn't I wouldn't read into the table that says, well, we've made that shift in all the people out there. And we should be making the same shift in working edge adults. I think it just promise that we have made a successful shift. We need to review what the position is and what the needs are for learning. We're at the early stages of that work. I would want to prejudge where we'll come out, but that's part of really impacting flexibility because we might come up to something very different. We might not really get a range of different sort of things, but that's the difference in the needs and possibilities. Because I think the review is important, because we'll clear that, you know, people need to be very get out and about certainly those who are half bound almost and then, and it's just a valuable service. And that's just in a sense that it does, you know, it's much better than me. It does delay before you have to have more intensive support. I think it's really important we carry on doing this. And I think you're right, but how we do it is, it will be an interesting exercise. It is genuinely love changing. And through being life changing. Comments, please. Well, so, so as far as the reason why we have the mix between the next and the externally provided that between the English to be this decent coverage. But I think that it's probably fair to say that we haven't got the right level. That's the reason for the review. And so, the, the. Any organization that meets the required standard, be able to be on the list for people to choose. And then it will depend whether they get paid or do get, or depend on whether people choose to use. And to have a good geographic coverage, because if you're a small organization area where there's a bit of a gap. And they can see, well, you might have to want for a service there here that local people. But I'm saying that we need to take that strategic. Say, well, are there things that we would want to do for the long. I don't think that the project will make a significant difference in terms of coverage in. As well connected areas at this stage. But we will be active in that in the industry. It would be for all departments. It is. People accessing service. Supposed to the sort of town location. Really, I think. I think rather than just in traditional daycare, what we're moving into is day of tutors. So what we're saying is that there are more than one way to achieve the same outcome. So traditionally day of care. We are starting to see opportunities. Some of this is around stimulating the market and actually getting those services. We're creating localities. So we're not going into just having big spaces with buildings where people have to be transported into where there are. Difficult, but in terms of rural reality, in terms of people accessing. But at the moment, yes, rural reality is a problem and we're spending quite significant amount of money. Transform people to building basis. Now that might be appropriate for some people in our complex needs. But actually we could potentially develop alternatives services that could also meet those outcomes. So they've been dependent on buildings all the time, the future. So, yeah, that's the neat strategic review really so that we can get better access to. And they're really help early support to people in rural communities as well as towns. What tends to happen in rural communities, you will be a vehicle come and figure out change and the nearest town. And then you'll go to. You did mention, we also on that mean there is a in terms of getting people out and gauze change. All of technology, because obviously, is there is that potential where people can be at home and engage with other similar people. Is that happening anywhere feasible or not? So, there are. It is a key to social isolation and sometimes being able to be electronically can can be needed. Again, it's about that strategic view to people who are putting people need. And I think it is that we got some in some respects, relatively traditional services, they're good services, but they are in some respects, relatively traditional and wanting to take that time to go back to the future. And so, actually, what is it that would be meaningful and valuable to you, but what other rule. To get some good ideas. And as you say, technology may well be a useful part. It won't be. Anyway. But there are things that can be done. And I think picked up just in this point, but we are sometimes spending more on driving people around the county to get to somewhere. Rather spending more on that, but we're spending on service that they actually receive. But sometimes the technology can be very fast to work with that. But that will be issues about the reality. And of course, the rural areas sometimes the ones which are less well connected to the technology. And so, we can have John. I'll say all this is things that will building into the strategic view. Looking at the demographics, but we are taking an increase in the number. Change to be living in the rural and less well connected areas and needing to see what what is it that people need. But almost certainly a shift away from the building based services to. Which are often meaningful people, but they'll just have to be a place in all the places. So you just say that option on the actual only shows that people are getting paid for. People are using this. That's a shame for you. Well, it's because it's each part of the council's one of teams that works for that testing. Some people make a contribution for that. Some people, it's funny. We do. Any further comments there. Good. Thank you. A recommendation that they said to the commission for. To. To. Our work. Our service. We're looking forward to. All those. Thank you. Okay. All agree. Thank you very much. Thank you. Okay. I'm going to try that, which is, uh, I think it helps. Program. It's been given to everybody. 74. But it is. All eligible. The GPs across the county. We've got 80 signed up. To still. This is a game. It's just the kind of words and then. The key is, um, NHS health checks and that's what they are required to be called by the. By the national policy. These are commissioned by local authorities. It's one of our statutory public health duties. So it's commissioned by the local authority using the ring friends public health ground. But we do it. We do it. So it is one of those slightly frustrating things that. It carries the NHS badge, but it's actually a level of authority function. I'm not sure whether people necessarily realize it. But they are receiving a function, which is funds by the county council. For it is a function, which we are required to commission. It is on the basis that any, any GP that is qualified to provide that service. This is only provided. We've done significant work. You've done a very, very consider your level of work to, um, trade and courage. Um, I'm sure other words might come to find. Keep the surgery. It's a guarantee to do it. But, um, chosen not. Nothing is very clear that it's not that they. Couldn't. And it's nothing. It's not. Taking a conscious decision. We have however, made sure that there was coverage. Population of those areas. So they're going to be universal coverage across the county. Even though there are. And we have that. I hope that's, it's still meant to be. Thank you very much. You certainly have. I will just talk very briefly around what NHS health checks are. Why we do it roughly. The public health principle. Very briefly. And then to call sort of through the. And as I mentioned, this is a statutory service. So we do have to commission this. Now it is one of the few NHS band services and is focused on what we call. Primary prevention. So this is actually people who aren't already presented to GPS. For other issues. And in fact, if you do have a long term condition. You should, your health should be managed by the consultants care. They give us that long term. Conditions. The system exclusion. Chant in terms of if you have X condition, you won't be. It is time to squarely out with people who are otherwise well. Which makes it very, very useful for us in terms of. An opportunity to get that trusted. Conversation based around a general practice. People do trust their GPs their doctors their practices. About how somebody who is otherwise peers as well. It's doing because, you know, from principles from long history of study. But actually people will slowly build up risk factors in their lifestyle. For the issues of long term conditions, which eventually are going to turn into. The kind of. Mostly morbidity, rail to issues of people age. That being that they end up needing to be in hospital. Possibly in adult social care. And if we can prevent that. The period. If you're not fully delayed. Then we can keep more people healthy for longer. And some sort of demand avoidance. And element to that for NHS and other social care services as well. So that's the theory. In practice, obviously the service. But the national model is that people are invited over five years. What happens is they get the invite. Go to the GP practice and not normally by the GP, but by practice nurse or. They would have. The mind mentioned so that the height and weight. Some of the things that we're most keen to prevent cardiovascular disease or heart disease. Some cancers and indeed type two diabetes can do a blood sugar test as well. And obviously the testing and the bettering is really just information gathering. So it's very keen for these health checks turn into good quality referrals for people. Into our other primary prevention services, specifically the integrated lifestyle service one human. And actually one of the successes of the last few years of health check delivery. Has been seeing referrals to one. That's where we are within the current contract with the GPs is coming to an end. And it was a population that we're aiming at. Are those 40 to 74 year olds. There's around two hundred twenty seven. In the future, that's the question that comes in. And then the address. And then the model. The individual services invite them. They get paid for the invite. A small amount of money. And then they get paid for. Unfortunately, this is something that is very relevant to the commissioning. Really only GP practices in a, you know, have access to that patient level data where they can do that inviting process. And national models to do this really by a few people have tried it in other ways elsewhere that they need access to that record level GP data. So, from our perspective, I think from public health perspective, trust in relationship with the G3. And the conversions into. And really only GP so that they're in place now to actually provide service in terms of doing. It doesn't mean it can't work to come up with innovative ways of delivering that. Perhaps. We have to do that. By summary, then, before we move on is really that in Lincoln share. We have seen a significant. So, as you can imagine, in 2020, all health checks. And so what the, the plans that we put in place here to set out is some expected volumes and we hope for an increase. Obviously, we want more health checks completed. And we plan that into some projected figures, which you could see, and the change. Well, you know, if you haven't mentioned before, essentially is that this is considered to be a well performing service compared to other areas in Midlands across England. As you see, more health checks completed, then on the right areas, see a high percentage and actually. That's what we. And please. I'm not. The level level for bad. I'll take it for conversion of health checks and completion of health checks. So we have a relatively good value service, which is going to form it. Our proposals are essentially to keep going. We do have an opportunity, which I have very briefly. If we go through this process, and we still don't have a lot of opportunities, the timing. This means we have an opportunity to work probably bring the recommission integrated lifestyle service to ensure that the iOS. So we do have, as has been said, other GPs where that's a service and big difference to you can practice that the person, patient, work, see any difference necessarily. But we have some areas delivery and we would like to see that covered. So time to this working with the opportunity to say, should that happen again with the recommission process, we still have those gaps. They will be able to be addressed. So that's where we are. That's the campus of the service. I'll be like talk through contract. Thank you. We continue to use general practices. The main. Channel. Check provision. It's all of the requirements. It's to be delivered in one place. The advice and follow-up and then the report on what's the other appropriate services and GPs are best place. To the nation. Choose the. Is the one. Absolutely. He says access to the patient records are necessary to. In terms of the payment approach. It's proposed to retain the core element. So that is something that incentivizes both the issue of the invitations through the separate payment for the invitation and then my completion rates through the published payment mechanism. That's also consistent way. A lot of other commissioners pay an edge. GPP bank wasn't universally positive. And on the level of payments. It's a health checks and we took engagement with them. And so a lot of lift is proposed as part of the new contract model. To the completion. To address. In terms of the. The duration. We talked about a. Five year. Initial term. Possible extensions up to a third of five years that matches the invitation cycle. Whether wide the program and give certainty of the delivery mechanism. A line to that. Future changes or the future changes in the national priorities approaches for the program can still be accommodated that we flexibility built into the tracks to deal with things like. Digital delivery and small. And central changing to discover that. And then just finally. Film and methodology for this because it's a health care service. It falls under the. The remit of the new provider selection. Raging the regulations. As the appropriate. The field of legislation governing this. That. By a selection regime. Folks flexibility and proportionality. In selecting the appropriate. For the services that allow. Process inappropriate circumstances. The regulations in that. I need a stage. Suitable provided process. Part of the selection regime regulations is considered appropriate because it will make changes in the scope. We're. Opposing here, specifically the increase in the overall ratio to be accommodated. And competition isn't considered necessary in this case for the reasons that we've described in the introduction. Thank you. Obviously, it's pretty common to have been circulated is anybody wishing to add. And it's into that. I mean, I thought they can actually very interested comments. So. I'll talk to that. Yes. So the NHS nationally are piloting and trying and having. Digital provision. Well, that seems. Well, we may find. A change in national. Point in the future. However, what's happened from the first one pilots is that. State announced in. That's the. Digital health. Would be rolled out. What's happened since then is that that's been. And there's been an expansion of the pilot's program with a few of the local. Communities areas and just asked to do additional work on the pilots and digital health checks. So clearly there's been some. Essentially. Digital is. Yeah. You get something in the post so you can take. It should be. Obviously, some of the challenges around. Yeah. If it does come with more being a few years away. I think the discussions that we have. Should there be a significant national change to. It's certainly not a concern. One thing I would suggest as well is that. Although the other element that. The one. But also, what about other places of. Quite. Seems they have the data and ability at the staff. But there's no reason we can't work with you. But we have the ability to write that to try out the digital gift back on this. They needed to come down. Specifically, if we do get subject to work. We have. There is plenty of scope for innovation and without watching brief as to national policy on digital. But certainly not considered as for the proposed contract. So some changes nationally. Two years time. I think we got a five year contract for that. Well, I think it depends on the specific nature of the change. If it's fundamental that it means that we can't press continue to operate within the framework of delivery. Then we need to look to even notice and there will be. Great opportunities within the contract. And commissioning something that is. For the requirements of the new breaking. However, some of the things that are or seems more likely to potentially be. Policy changes national policy changes, but into the. And help check delivery approaches will be specifically. A common date at all reference within the scope of the contract so that those changes through continued GP delivery can be managed within the existing. In the existing contracts that we will be establishing later in the year. So. To some extent, as I say, just depend on specifically what nature and the changes that is, but. In an ideal world will be able to continue with. Through variations that are provided for within the contracts will be able to. Continue. So, how do we, I mean, so we're talking 80 different. On track. We're going to manage it. Yes, 80 different identical. Yeah, so we are. That relationships with GPs and will continue to. Through the new health check delivery mechanism. To support. A. And now from this. We will also focus on. Primary care network level. oversight. I mean, so on. In fact, this is to help alleviate. And we know. So. That's recorded on. It's recorded on the. System that we commissioned and put in place for. We can actually see what. We do that. We do that. So we, we. We threw that system. Give them their attention targets and they record on that system. So we're going to see. Yeah. You seem very keen to rule. GPC for the only game in town. I'm still not totally convinced. Yeah. Well, what you've described. I'm not listening games. But when you described, it's just basic. So. I don't know what's happened. Why did it have to be GP? The fundamental reason. The only ones that currently have access to that. GPC. So. So that they, if you were going to change that. What you'd have to do is change the information governance arrangements. In order to give. A different organization. Hey, and other could just have. Take all the tests and send them off. Okay. The providers could do some. This should be invites to the end to people. They can't check them against. This is in the conditions. So only the GP. Pass. So they know the, they know who appears to be healthy. And the 8% take up is that 8% of the. Sorry, percent of the population. I'll take up the invites is over 50%. So we're about 55%. Take the national languages. So it does perform quite well for. It's a national one. It's not bad. It's not bad. It's not bad today. Okay. Any question? Yes, comes for. Yeah, just on this data issue. I mean, other organizations have access to GP dates. For example, you know, if you use a private GP, they can request access. Is there not any way of us on centralizing? Because it seems we're almost beholden to. Yes. It's a really. I shouldn't be honest. The fundamental issue there is the lack of centralization of. The elements of GP record level data still in the NHS. So. It'd be one of the various attempts to try. What you find is that there's different elements of. The patient data stored in different parts of the system. And lots of organizations have access to what's known as the spine, which is the sort of central demographic information. S record information, et cetera. And then most providers have that system where they store information about their transactions, the hospital set, the data system, which draws some information from the spine, but doesn't put it all back on the GP to the only people that have access. Currently to that for GP records. Or the issues, the ailments, the treatments, the prescriptions. But I'll mention. And we do have you may be thinking about population health management and it's your data set. And the. That's for secondary data, it's not for primary person. Essentially, it's still has to be the GP, even though we connected with the back end data up. That's all along. If somebody's going to send an invite out currently, because that's to do with direct patient care. It still. It's not impossible to change that, but in the current context of the contract and GPs do have that trust in relationship. GPs are still a strong option. Even if you couldn't. There is a strong case to be made with GP, the still the best. That's. Don't want to be given the impression that we would change from GPs. If the data. Solve. Actually, there will be a consideration there. But GPs would still be a strong case cause of that. And there's lots of evidence. Getting the invite from the G. With the, you know, the, the. Is come to practice. He's still seen as one of the most effective. Some of the issues around innovation, I think nationally, these challenges around data are going to need to be looked at. Part of the pilot, I don't have the inside trap on one. The pilot is running into that grass being extended. But it's quite possible that the challenges around the information governance regime for different areas could be part of that. So, in terms of the national coordinated NHS teachers. Is it. No, it's still there. There's been a fault to it. There's nothing you wouldn't have thought about. But the sense I guess is that it is possible. To pull things together to get the whole, I'll get the whole black Lord. And then they don't see something much in governance or anything. So when you do see the whole thing together, it's an anonymize. So we can look up population. That's what we can't say. Right. This is, this is her record. We've been known that it's NHS number. So we can, we can pull the data for analytical purposes, but we can't do it for care delivery purposes. Okay. And if you have a question, can't just cancel the way. Thank you. Us, we're performing better than a lot of other areas. It's still a significant percentage of people aren't turning up. It has anybody been done nationally to try and bottom out why there's, there's quite a lot of opportunities. I mean, I completely get that if you're sending something out, people are ignoring it, then they're hardly likely to take up the offer of explaining why. But, you know, even if it's a long process of picking the phone up, ringing people, because it could be that 90% of those that aren't coming, are not coming from one particular issue. So how do we know why they're not? Again, it is the key question with health checks. So absolutely right. Yes, lots of research on this has been done. You'll be very familiar with the concept of housing and qualities. What you tend is fine. Is it the people who are willing to take up health checks are asked to the people. We're worried. We're worried. Exactly. And this is a fundamental challenge with health check delivery. And if we wind to time when it was proposed, you would probably say, actually don't go without model. Do some all want targeted outcomes. Because, though, is that nationally? So we do what we do. The reason why we happen to be very nice. So this is focused on people who want to be at worst, helping individuals. It's because those people are also the least likely to take up offers that proactive and defensive health care. And in some cases, that's for a bunch of environmental reasons. And some structural risks. So basically they're working through jobs. They haven't got a car to get to that. But in a lot of cases, it's to do with more social, cultural stuff. And the relationship that people have with their own health and the health system. So many people who are in poor health, they see something drop through on that. And it goes straight into the even more pile. They don't want to think about their health. They don't want to think about their health risks. They're not proactive in that way. But what they do, and this is lots of research on this, is that they wait and send it to them. That is driving a lot of the pressures on health and social care system. It's why health checks are important. The challenges that are most by definition, if you just do a universal. [INAUDIBLE] Thank you. Thank you. [INAUDIBLE] And while it's been happening to you in the health care system this way, it's very focused in the rest of the system trying to target how the indications are offering. There's a lot of work going on in the ICS and the prevention health inequalities. Again, executive group. [INAUDIBLE] And to try and say, how can we better target this? How can we cut through to the people who don't want to have good health checks? And that will be the area of practice and support and delivery for GPs in the delivery going forward. Thank you. Thanks for trying. Thank you. My question was around the two hundred percent. Most GPs do that by tax. I don't think mine certainly does. Yeah. You need to come in with this. I presume most use that model. So is there a limit on that? If they send one every month for a year? No, they don't get paid in by tax. They get paid by a person invited in that five year cycle. So they can demonstrate on the system. They have invited an individual who is eligible. And again, they don't get to decide who is eligible in terms of the criteria. That's set nationally. The document says per invite stones. Yeah, it does. It's where they are eligible. So, and they're not, and that's not going to be based on repeat. Invitations. So often text messages. I'll use now and I'll prove it to be more effective. Often a more effective means of communication with people. Letters are typically still sent as the first port of. To be encouraged to do the next. Track cycle, because we really want to focus on actually enabling people. Effective reminders and enabling people to book their health check as efficiently as possible, because that will support and courage the uptake among the eligible population. In our setting, but you've answered that in the book. Anything comments. I can't go to that. That's just a question really thought. I mean, health checks are incredibly important. I think. It may well go through. It's COVID vaccine due to heart issues. And news from America. Seven million people have probably suffered heart on. It's going to be very important. I think health checks are probably extended. We'll be able to do that if there is a. I think a lot of people probably walking around. Are we going to. I'm just. Not to do to any safety issues, and it has been important to say millions of lives. That's my understanding now. Yes, absolutely. The health check can be expanded, but that would be a national decision. No, these are not to expand that in terms of trying to. I think that's a really important thing to think of. I would say I guess it's that that challenge actually remains something that the Lincoln show. ICS needs to be taken forward as well, not just by health checks, which does have set. But by the rest of our work to try and increase access. Because we already have that's just previously discussed. Lots of people don't take up health check. Health care service offer that is proactive and preventative. Including things like vaccination tends to be taken up. That's why people. So that overarching piece around how do we actually connect with people. Don't want to come and see a health professional. That comes out more important. So yeah, I agree with that one. And yeah, that was significant scope for expanding that. You know, the excess death status. Yeah. In relation to Lincoln show we're getting access deaths and we'll expect. So excess deaths in my understanding and forgive me. I will need to go and check exactly. But certainly excess deaths have brought back down. And they are strongly by seasonal. Winter and the circulating. And we did have significant input in excess deaths, but then we had a. Under we had a less deaths than expected as a sort of. Bounce back straight away. So count, cancel enough. Now. We've not. Is. They don't have the exact things. Check that. But yeah, we have the turn to where we expect. At times. Through the COVID-19. We've actually seen. On offsetting the excess deaths by. An effect where we're seeing less people. Actually getting exposed to winter viruses in winter. Because everybody's been shielding and giving themselves over. Thank you. And some like a true civil servant. Great. Yeah. I mean, yeah. Yes. Yeah. I'll say nothing. I mean, I think the truth of the matter is that any. Redication. Yeah. There is a very. Small transfer. Anything that will be a reaction. I suppose the question is that a greater reaction. But whatever, you know, what was different. Here we go. Yes, constantly trying. In short, in fact. It's a big help. About, you know, people don't go. I mean, I've had. I mean, I've had new. I'm going for a health check. So, you know. I think you need to have. Anyway, you know, you think you're well. Same thing. You sort of go down. And then you don't go to. When there is some problems for you, you can go to the doctors. You can get the appointment. So then you go to the A&A. And I think it was probably summer where. You know, actually, there's someone that turns up at the GP. They haven't seen for 10, 15 years. Actually, there's probably something wrong with that. And they should be, you know, and. You know, that, you know, I've got sniffles or something like that. They're in wasted time. And there needs to be some sort of. Challenge on that time, I think as well. I agree with you. I think what I did on here is is pressure on GP services. They are under huge pressure. And there is. Not to go through this. It's a later topic, but there is obviously this. In the six in our elderly population in Kajibwe, which is happening faster than it is in the past with country, just because of our demographics, which means that actually more and more people are generally living in in poorer health simply because we have that aging population. The challenge that that is increasing. The NHS are looking very far about how to get the messaging to people to pay you to go. I need to see some of the campaigns around getting pharmacies to be able to prescribe antibiotics. That's something that they can now do. And to be able to answer some minor health compliance, this is really trying to do that. Take pressure off GPS, but you're absolutely right. If somebody is not present to the GP and then turns up. Because clearly this is not a sort of somebody who's just wasting time. But we do see. To where they are doing that analysis on the back of the data systems is trying to figure out the trends in the people who are frequent flyers, if you like, and work out how best to put some preventative stuff. Maybe even it's doing mental health, and so you'll be where GPS are delivering things like social prescribing now, and they have specific funding to look at that in order to simply offset some of that and take some of that extra pressure on your system. It's challenging, generally speaking, the second you create what's facing the system or people having to fill it. Yeah, it's a challenge. Okay. Very good recommendations are 66. As you're seeing approved. If central further, but it goes to the. All those in favor of the show. I'll see you in the game. Thank you very much. And with that, thank you. Thank you, thank you all for your attention.

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