Transcript

Llywodraeth, thank you very much. Good afternoon and welcome to this meeting of the Health and Wellbeing Board. I am Councillor Flour Wyniamson and I am chairing this meeting today. Please note that we are not expecting a fire alarm test today, so if the alarm sounds, please. I will not say follow-mind instructions. Probably follow somebody else's instructions to evacuate the building. This meeting is being webcast to allow those who cannot attend in person to follow the proceedings, so please, because I kindly ask you to use your mic friends and turn them on when you're speaking and then remember to turn them off when you're finished. I will stop asking my fellow members and officers to introduce themselves. I'm going to start on my right-hand side. I'm Jody Pilling, I'm the Director of Strategic Commissioning and Investment at the Council and I'm here for Jon Everson. Jonathan O'Sollivan, Director of Public Health. Claire Dolry, Acting Chief Executive at Wichington Health. Councillor Michelin, Safingongor, is there a gift member for children, young people and families? Sarah D'Sou's Director of Strategy, Communities and Inequalities in NCL ICB. Rianne Warner, Assistant Director of Place for Islington for North Central London ICB. Mike Cluse, I'm Chief Executive of Islington GP Federation. And I'm Claire Henderson, Director of Place for the ICB. John Haby, I'm Director of Children's Services. Bavignist, a senior democratic service officer. Thanks for that and we've got apologies for absence from Jon Everson and Jody is sub-street. Decorations of interest, does anyone have any decorations of interest? I'll take silence as no. Order of Business, I'm actually arranging the entire agenda. So first up we're going to do the Evidence Islington, which is item B3. Then I'm going to take the ICB piece, which is item B. Is that B2? Yes, it is B2. And then we'll do the Health and Wellbeing Board Strushy, item B1 last. So yeah, I'll just move on to the minutes of previous meetings. So these are the minutes on the 9th of July 2024. Are they agreed? What does that have on every questions? They're agreed. Fabulous, brilliant. Right, so we'll move on to the discussion items. I'll just ask if presentations can be kept fairly brief so that we can get into a discussion. So I see Charlotte, are you going to Fabulous? Fabulous. If you can introduce yourself and then start your presentation. So this is just for clarity. This is item B3, which is Evidence Islington Update. Hi, I'm Charlotte Ashton. I'm on the consultants in public health and I'm also the programme director for Evidence Islington. So I was just going to give an update today on our progress. We're about 12 months in now. So it was really just to give you an update on where we'd got to, our plans, and our priorities over the next 12 months. Can everybody see the slides? Perfect. Sorry, I thought we were going to be up. I printed off the paper, but not the slides, because I thought we'd be up. Sorry, if Jonathan's got them here, I know pretty much what I'm going to say. So really, just to kind of give a bit of an overview of what Evidence Islington is. It's a shame, scratch. Here we go. We had three core workstreams, strengthening collaboration and culture, data and infrastructure, and capacity building. And the whole intention behind it is how we, as a counsellor and as a system, can become more evidence informed and we'll research informed in what we're doing, both to support us in terms of our decision making, but also a sort of two-way street so that our work with academic colleagues can be better informed, we can inform the types of research we think would be useful for us as a counsell, and we can be seen as a good partner to work with in terms of research. So in terms of who we've been working with, this has been done jointly, a great collaboration between the council, two of our academic colleagues, UCL and the School of Hygiene and with Health Watch. So really good effect of collaboration in terms of taking pieces of work forward. And so really over the last 12 months going on to the next slide, a lot of it has been about getting those sort of foundations in place, and just to flag the money that we have received from the funder has been very much, it's what they call an infrastructure grant, so we don't actually have any money to do specific research. We've been very much around how we create those foundations and the support that we need in order to do research. So a lot of what we've done over the last 12 months is about being establishing our approaches, the governance around that, and also the team in which in order to support some of that. So we've been pretty successful, we've pretty much got a whole team now recruited into post. Last couple of people will be starting early in the new year, we have several embedded researchers who are now working in two departments across the council. So we have one embedded researcher working with our housing team and another working in the environment team. So that's sort of approach that we want in terms of taking forward some of this work to make sure we're embedding those researchers approaches into practice. We've established a strategic delivery board with representation from across the council and with three resident representatives and our academic partners on that. And again, that's being used to supporters in developing our priorities going forward and looking at how we can work effectively in terms of starting to bid for money. A really good example is we've been doing some work with John's team. We've successfully bought in some money with Kertis' team. John's just to sort of look at how we can evaluate some of the programs that we've got in place. And I don't know that would have happened without the evidence systems in approach because it's just created that additional bit of capacity to supporters in bidding and thinking through techniques for evaluation. And I think that's a type of approach we would see as going forward if we want to be self-sustaining. It's around how we support some of this in action. And we have started to establish some support which is available across the council but also to partners in terms of things like evaluation toolkits, supporting evaluations, supporting bid writing. I know we've been doing a joint piece across Claire with some health colleagues and some colleagues in the council around an evaluation that we were doing jointly. So I think again it's looking at how across the system some of this work could be better supported. Our work that we've started in our development year in terms of co-creating with residents has been further developed. We are just getting off the ground our community researcher program which will both in terms of creating a cohort of residents that can support research but also in terms of skilled development for our local residents will be really beneficial I think and have got residents involved in a number of different pieces of work. We've been doing some work with democratic services to look at how we can support residents to better understand what some of our processes are and also being creating a video with residents to look at what evidence is, what we mean by research. So really exciting things that we should be able to use across the system. Just going on to the next slide. Again I'm not going to go into detail but just included some examples of how we're trying to embed the culture of evidence use and research across the council. I think some quite exciting things. We did some really interesting work during the local democracy week where we co-design some sessions with residents and have started to create materials around our decision making processes and some of the work we've been doing around our evaluation baseline is a prerequisite for this work, was we had a core evaluation which we can share nationally and not just with local authorities but also with our academic institutions and that has been quite an interesting piece of work around how we take this out and do this across the council looking at how we engage with officers and also with members to look at how we're using research and to also look at how we could be doing and using research in different ways. I think some really interesting work in this first year which will then take forward and inform our approach as we go forward. Then just moving on to the slide about where we're at in terms of what our funder thinks because I think that's quite important. It's only five years of funding initially, although we are hopeful that if we can show success and impact we should continue to get this at least a certain amount of funding coming through. So we had to participate in a raggerating exercise where we had to review ourselves and our funder also reviewed ourselves against how we were doing and I think generally speaking, Nate considered us to be making really good progress, we've had some really good feedback from the director of a programme responsible for this though particularly encouraged by our approach to working into departments and also around how we've engaged residents within the whole of our decision-making process. They also praised the work that we've been doing around how we measure culture change because obviously that's quite a challenging one to do but they had liked our methodology and could see the impacts it was starting to have. The areas that they have floured for development which obviously now starts to form what we want to do over the next 12 months and will probably be really useful over the discussion of you guys today and was around how much additional funding we're starting to bring in in terms of research bids which we think is a bit of a challenge because we were only one year in and we also have at least evidence that we have got processes in place to do that but likewise we do need to think about how we start to do that across the system and also very interested about our dissemination strategy and how we're taking forward some of that. So that's really helped to inform if you're going to follow up the last my last slide around our priorities for the next sort of 12 months. So I think one of our core ones is around completing our evaluation baseline because obviously that will help inform where in terms of things like capacity and training we need to sort of support. We've got several pieces of work around our data infrastructure which is one of our core priorities. We'll be launching the new data hub and there's also work to look at our data maturity assessment which will again inform our work for subsequent years. And we're also doing a range of work to kind of get an idea about our training and capacity needs both in terms of mapping what is available not just from within the local authority but there's quite a lot of training opportunities available across North Central London and for our academic colleagues. But what we think is probably people aren't aware of what some of those are and also in some instances we think they could be adapted to be more relevant to local authority colleagues so we're doing some work currently with ARC, our academic research collaboration North Thames to look at how we can adapt some of what they're already doing. And then I think also just looking at how we work differently as a council with our academic colleagues to start to income generate in terms of bringing in grants and our bid writing process. Thank you. Thanks very much. Right, does anybody want any questions? Claire. That was great, thanks Charlotte. So I suppose the bit of particularly interesting are so we're just evaluating our health inequalities sort of work and I guess you know be interesting to sort of think about the methodology we're using and how we can link up. But also just thinking of the Unblack Mental Health Program that we've been running for two, three years. Yes, thank you. And the extent to which we can use sort of peer researchers, community researchers sort of in some of those areas that need to inform us more around our sort of business as usual practice so really thinking from that sort of cultural competence and so on you know sort of angle. But whether there's opportunities in some of those programs to do that sort of community research that really helps us across health and care really think about our services. And the last one was health literacy and whether within the community we should be looking at some of those areas of sort of health literacy. I know in some of our other boroughs we think we have you know some areas that we really struggle with vaccinations or screening and so and the extent to which we need to do much more as a sort of system with with local residents about understanding things like that. So I just wonder. Yeah, I mean if I okay have a comment on this. I think the health inequalities it is a really good example of where both I think we can learn from some of the work we have been doing in terms of our evaluation and methodologies but also about how we work together across the system in terms of the sort of structures we're trying to put in not for evidence is in turn to go and do the evaluation but how do we support others across the system to feel more confident in the methodology they're using in the skills they're doing. So you can definitely link up about that. We have some sort of drop in workshops in place now where people can bring evaluation to the sort of support and discussion around how best to do it. Because I think one of the things we're very keen to do is how do we make this sustainable if at five years we don't get any more money because I don't think anything's guaranteed. How have we actually embedded some of this work into systems before we start? So I think that would be quite a good one to sort of pick up in some of that. And I think yet we should see how our community research programme works and probably bring back lessons even to hear or to borrow a partnership around what works and what doesn't work. Because I think a lot of it definitely in this next 12 months will be test of concept what does work, what could we then apply across the system. So yeah I'm definitely happy to do that if that's useful. I've seen a couple of people indicate, sorry, we've got new... Sorry, we're just using, sorry. I see Sarah Dessisa and Councillor Nagonga. Sarah, do you want to go first and then Councillor Nagonga? Okay, okay. We'll go, I'll go. Councillor Nagonga, Claire Dawley and Sarah. Thank you very much. It's just a quick question for me is a curiosity to see how if there would be a way for us to include. Because when I met with our colleagues in health approach regarding our baby friendly, you know, I realized there is a problem about breath feeding. When a mother's there having babies in the hospital, as soon as they're outside the hospital after 10 to 15 days, you can see their breath feeding is really drop quite a lot. And I'm curious to understand what mothers they're struggling really for, giving them children breath feeding. Because according to the research, to the presentation they gave me before, they said a child, if they are really having their mom's milk, is having a good impact not just when they are babies, if the rest of their life is decreasing the risk of cancer, all these kinds of good reason. Now my question, if we know breath feeding have a good impact for life long on a human being, and the number is dropped, can we try to understand why and try to support mothers before by doing early on, it will going to save everybody's time, energy and money, and also pressure on NHS because they said there is many good reason. I'm a bit curious to understand what are we missing. How can we supporting parents ready to do the right thing as soon as possible when they are having their new baby born? Actually we take all three and then you can answer them. Thank you. So in the health field, there's a lot of evidence for the collateral benefit of research beyond the thing you're actually maybe giving someone a new drug, but actually the people who don't get the new drug also have better outcomes and in the National Cancer Patient Experience Survey being included in research is something that's seen as a positive patient experience and is measured. So it's just thinking within the work that you are doing, are you able to try to measure your impact on outcomes for patients and their outcomes for people and their experience because the research approach brings a different level of rigor and a higher reliability and whether there's a chance to measure that which might help in your demonstration value for money to your funders. Thank you. So I just wanted to make the connection really with the work that's going on in the ICB. The ICB has got statutory responsibilities about embedding and facilitating research and we've got a number of posts within the ICB and we'll have a director post in due course, which is going to be focused on developing research and innovation strategy. So it would be really fantastic to link in with this work that's going on in the borrower. I mean one of the real benefits that we think that we can get from this will be how we engage people in that discussion about the sort of research we should be doing and sort of really informing that research agenda rather than having a sort of done to experience. And we've been lucky enough to get some money for a research engagement network which very much ties across to some of the things that you've been talking about. So it'd be great if we can connect to those. I think it will also help us to fill some of the evidence gaps that we've got around how we take population health improvement forward. So really looking to help to, I guess, influence that wider agenda, make sure it's not just about what's done in hospital or big farm and trials but actually it's about what makes a difference to people outside of hospital in their everyday lives. So it would be fantastic. So yeah, I think really useful comment, thank you. I think in terms of breastfeeding one, I think that's something that we're really only too well aware in terms of public health and I think it's about thinking about how, as a system, we think about some of that because I'm particularly thinking our role within public health in terms of health visiting, sitting with us and thinking about how we work with health visiting around some of that. And potentially, I mean, the evidence isington programs all about wider determinants but I think we can link breastfeeding into some of that wider determinants because actually, I think some of the barriers and also some of the things that support people to continue breastfeeding are very much linked into those wider determinants. So I guess it's probably one for us to sort of take back and talk to the children and the students around how we could support. And I think it's also brings out a really important point which is what this type of funding is there to do. We know what might work in practice but we can see on the ground that isn't happening. So we've got a very similar project in housing where we know there's an intervention that works but actually our update locally isn't very good. And part of what our role is there is to look at why what is it that's happening in thisington that's resulting in some of that. So I think the breastfeeding will almost be into some of that, doesn't it? We know what the evidence is, we know what works, so what is it that we could be doing? It sort of joins up some of that and thinks about that differently. And also make sure we're speaking to the right people. And that's one of the things that we've committed to our residents around evidence is linkedin is we're not going to keep asking the same questions of the same people. Are we really getting to the people we want to? And that's a challenge for us. How do we do that? How do we get those voices around the table? And I think there should be some really good learning for evidence that's linkedin that we can share across as to how we do that better. Sorry, I'll shoot that up. And you'll see just to recognise we've got some excellent peer support around breastfeeding in Islington and we have a while the highest initiation rate. So I absolutely recognise what you're saying about the drop. And we've been doing a lot of work over that for many years. But Charlotte's absolutely right, this is an opportunity for us to really embed on the same but actively to work with our communities about finding solutions that will work best for them. If I just come on to the bit around the benefit of research being wider than those who are part of it, I think that will be really important for this work. Because we're looking at wider determinants rather than randomized controlled trials where we'll be giving us intervention to a specific person. A core thing for us will be how do we measure a baseline, anything that we do do and how does that see a shift. And that will be much wider and harder and more challenging, I think, to measure in sort of a drug trial because we're looking at changes in behaviours and shifts and also understanding from our resident and I think from our workforce around why some of this work is important. So I think that's core to our evaluation baseline is how we measure some of that behavioural thing. And I think it's a methodology which is probably still forming. So I think we've got an opportunity to inform some of that and then look at how we embed that across practice, which I think also links into your point around how we do work together on some of this and to think about some of those broader issues. Definitely in terms of our approach that we've taken today, we came up with a specific priority criteria which we all thought were important and some of that was its importance to residents but also that this was an issue that we could address at a local level. We wanted to make sure anything we did from a research lens was going to impact on our residents and was something that we, as a system or as a local authority, could influence and change. And I think that's something that's got to be core to our research at a local level. We definitely want to shift our relationship with academia so that we're not just seen as a place that they can come to to get what they need, what is it that we need and then making sure we shape their offer. And I think it'd be useful as part of that for us to have a joint conversation around how we, in terms of the bid for the new applied research collaboration which our academic colleagues are working on currently, how do we collectively come together to think about what we are saying our priorities are? I mean, I know we definitely have some conversations of ass colleagues around some of that and what would be useful and we're trying to get that into the mix. But I think now is the time to be doing that. So if you're a maybe we can have a pick it up or find. Any more questions again with a mic? Thanks, Charlotte. I was just wondering while you were speaking the sort of coincidence of the now, you're saying it's important now. The burrow partnership is sort of just about to go into a bit of a reset and recalibration. I was just wondering thinking what aspects of this could be embedded in that redesign work that we're doing together over the coming months that could make, well, the layers and layers of benefit I would have thought both way between evidence-isling to an activity and what the burrow partnership is trying to achieve. How we might do that if it's worth. I think we had an early conversation at burrow partnership when this first started to come in but maybe it would be a good opportunity to start to come back now. And I think there's probably two bits. There's a sort of methodological bit but we've been doing around our evaluation baseline and how that you might want to apply something more similar across the wider burrow partnership. But also I think looking at some of our priority areas and could those be sort of embedded in. So I'm more than happy to come and have a conversation about both bits of those to see how we could try and tie them together. So also just to build on this. One of the reasons why we've got this investment into local government is that really previously research opportunities in our government were few and far between and it's really building that. And I think one of the other key things that we really need to think about in terms of our budget is how we draw down on things such as the research engagement network within NHS social care. There's many more opportunities also. And I think one of the really progressive things we have here in the burrow but also with North Central London is about how we're both concerned about getting the right integrated care for our residents, but recognising the context of inequalities and population health. I think that's where we can create that really active approach about, you know, active inquiring and research into what's going to really make a difference for our residents. Any more questions? Conscious of time being on this agenda. No, in which case, thanks very much Charlotte. JD, do you want to... I'm really conscious you're very blind now. You're working to maybe move up to a Charlotte or... Yeah. Well, the joy of the sun it does move. Brilliant, right. So, next up we've got item BT, which is the NCL delivery plan and NCL population health and care strategy. Who's presenting a tent in Claire? Yeah. So, thank you. I'm going to introduce the item. I'll hand over to Sarah. We'll take you through the meat of it and then rean will give some sort of local examples. So, we did, we wanted to bring the population health and integrated care strategy delivery plan back to the health and wellbeing board. We endorse the strategy as system partners back in April 2023. And you'll see a lot of synergy with the priorities, with the health and wellbeing strategy that we will come on to after this. So, the focus on start well of well age well, thinking about those levers to change those enablers and the focus for our population health strategy around those communities experiencing those poorest outcomes, the wider determinants of poor health and the sort of core 20 plus five. So, as the strategy was developed, we've then moved into working locally and across North Central London with barri partnerships and so on. Really thinking about how the delivery plan will develop, developing an outcomes framework and really sort of bringing together some of those mechanisms where we can highlight progress but also really pull out sort of priorities. So, I shall hand over to you, Sarah. Thank you, Claire. So, I'm not going to go laboriously through the slides. I want to give you a bit of an overview of the population health journey today but very much recognising that population health is not new and Islington have been doing it for years, I'm sure. And obviously we see some of the impacts of that every day. But an overview of the work that we've been doing recently around galvanising the system around the population, around population health and integration. Talk a little bit about how this aligns and supports the Islington Health and Wellbeing Board strategy and a little bit about next steps. So, in terms of the journey today, the strategy was signed off in April 2023, the delivery planning July 2024, the delivery plan slightly impacted by the series of elections that we had. So, we haven't necessarily been able to bring it back to health and wellbeing boards as rapidly as would have been helpful. But in it, it effectively sets out the progress since the strategy was developed. And also, I guess, codifies the plans that we want to take forward. And in particular, focuses on the outcomes framework and the annual insights report as one of the many data tools we want to use in terms of informing where we focus our work, but also how we track the improvements that we're making together across the system and locally. The delivery plan is organised across life course, as Claire has said, with a focus both on the communities of the poised outcomes, the wider determinants, and also the five key health risk areas. These were informed by the outcomes framework. We recognise that they don't cover everything. And what the aim would be to do is to iterate this going forward. So, as we become clearer and clearer and the data that we have becomes more granular in terms of understanding need, that we're able to reflect that in the plans going forward. A number of the areas have been very, well, the whole of the strategy, but in particular, the areas that are identified were done through a process of quite considerable collaboration, particularly with, for example, on the start well areas directed at children's services. We'll see some of the key priorities that they have very clearly reflected in that list. In terms of the next steps, I mean, I think you'll probably all recognise that this is a very wide-ranging strategy, and we are all doing lots of work that was associated with population health every day. So, I suppose the key question for us at this point was, you know, how can we demonstrate the impact of coming together as a system, because I guess that's the key thing that has sort of changed the idea that we are going to be able to do more by operating in a system? And how do we track that progress as we go forward, without falling foul of that sort of trying to boil the ocean and actually not being able to do anything, or not being able to show the impact of the work? And I guess where we've got to in conversation with partners is that we would like to focus on an initial smaller number of what we're calling core or Sentinel metrics, and that we develop our ways of working together by using a systematic benefits realisation approach. I think that's just a sort of rather fancy way of saying, actually let us look critically at the work that we're doing at a system place and a neighbourhood level, and try to understand whether we are maximising our impact in the areas that we want to see improvement. Are there things that we can take from research? Are we using the best evidence or the best local examples of where we've been able to shift and improve things in the right way? Are we coming together as partners in the most effective way so that we are sort of collaborating rather than either duplicating or missing opportunities? So that will also help us to clarify roles and responsibilities because the system is quite a complicated environment in which to operate. How do we ensure that what we're doing is sort of aligning and mutually enforcing each other's work rather than cutting across each other and creating a whole range of different priorities and issues? So within the pack you'll see an example. Both of our benefits realisation work worked through on a sort of real example as it were. This is not set in stone but is just to give an example of the sort of way of working. And you'll also see that there's a worked-up example about how the different aspects of system and borrow working come together to support, for example, child immunisation so that we're seeing health and well-being more priorities supported by ICB investment supported by work that's going on in secondary and other providers as well. We need to do some more of that in terms of bringing that together but that's where we are trying to extract the maximum benefit of working together as a system. I'm going to hand over to Rian now to actually really talk about the local approach. So I've done the sort of tedious process bit but over to Rian for bringing it to life. Thank you Sarah. I guess probably as a starting point, I joined Islington three months ago, I've come from a completely different system and I think before I talk about some of the examples in New York, I think I just wanted to share how coming from somewhere else, how rich the offer is in Islington and the work that's going on in Islington is huge from a sort of a partnership perspective and very different from where I came from so just as an outside for you looking in. But with regards to sort of as partners, what's been delivered in Islington and I look around the table at everybody else here because this is their delivery, certainly not mine as a new in. But certainly vaccinations for children which Sarah alluded to have been a struggle of vaccinations across and I think there's a lot of amazing work that's been going on in Islington to really improve that. I've seen improvements of three to four percent on increasing that vaccination coverage and that's in part, massively in part to partnership working between public health, the NHS, the voluntary community sector. We've got additional funding that we've put in through our health and equalities fund so that we're actually really trying to increase that vaccination coverage in harder to reach communities and in our communities where we've got more deprivation. So it's great to see that we're starting to get that change and we're continuing to work hard on that within our sort of children's population. The other thing that's very impressive in Islington, certainly from my perspective, is the work to support people with severe mental illness. So the individual placement and support service in Islington is really showing success in getting people with mental health conditions back into work and that's reflected actually in the outcome framework metrics that Sarah was talking about. Islington's one of the boroughs where our population who have got severe mental illness are in a much hard sense of employed positions than some of our other local London boroughs. And I'll just give one more example of the great work. But again, I think there's a sort of an amazing whole system approach to aging well in Islington. We've got some fantastic teams to support proactive frailty and complex care. Our integrated community aging team, so I can't. I'll give some of the short terms because everyone refers them in the short term. I only know them in the longer terms. But our integrated care coordination to our ink teams and our proactive aging well service pours, which a lot of people know. But these are a great multidisciplinary teams of both health, social care and voluntary and community sector teams really working to keep our older population as well as possible reducing risk of admissions to hospital and maximising quality of life. And again, we're getting very good feedback around those areas. But those are just the examples I'll share for you. Any questions? I've got John and then I've got Councillor Gongo. Thank you very much for the report really, really helpful. In terms of the progress-to-date report since 2023 and I recognise this is across NCL, it's not just Islington. But and some of our exact members will resonate with this as well. Where on page 10 it says over a million pound of western children's therapies backlog so that 5,591 initial assessments around SLTOT, reducing number of waiting. I suppose with something where it goes across NCL, what I've had to take to my executive is the fact that part of that commissioning arrangements with the backlog we're taking over from statutory perspective around speech language OT, we've now had to readjust our whole delivery pathway, particularly around mental health and schools, which again I recognise has been put in there as well around the 257 school sport by 14 teams and adjusting that around because we've now had to think about how we put that in. I think what this does is, it's a bit of a gloss on it. I'd like to see a little bit more acuity. I'd like to see it broken down by, you know, NCL is very, very different, very different. And I don't think it quite shows the picture or in actual fact, how challenging it is for all partners. So I talk obviously from the council's perspective, there's a challenge for the ICB, a challenge for the wit. But what we do have is we have a backlog and I deal every single day with challenges from my most vulnerable young people and families around therapies OT that is not delivered and therefore we're having to fund that. And my members, my executive, had to then think about options that Jodi again and her team had to come up with. But there was a real sort of on pass that took place about trying to find a way through this. So I just think where some of these headlines come through around the 257 schools or a million pound invested in, how, what, and importantly, what's the impact. And I'd also say in terms of improved vaccination update, NCL is very, very vulnerable. We know that us and Camden, our immunisation update, is probably poorer. What I'm really in, so it's been a 5% increase. That 5% in Islington, 5% across the patch. And what is the take up by some of our most vulnerable or less visible communities who we really do and are challenged to try and get greater rims to take up. Sorry chair, that was a long question. Thank you. I'm going to follow John as one, the first part of my question. The second part of my question is about when we said about mental health. I'm going to focus a bit start well. I think it's better also for us to try to include about digital literacy because it can be young people, even very young one. They are spending quite a lot of time online, which also is affecting mental health, physical health, because they are just focusing, I think, in some areas where we need also to take it in consideration. And the second part is when we are talking about poverty, again, in stats well. I think I know we can resolve housing, but I think it's a good idea also to mention housing and stability because it's causing a problem with it can be young people and then families. They are not growing up in a good environment of a proud debt, damn, all this kind of thing. I think it would be a good idea also to link that to the reports. Thank you. You might just use your microphone, because it won't get picked up in recording. So I think the point she raised is really helpful. And I think it's always the problem with trying to present a high level picture is not being able to demonstrate what's really happening on the ground. And I do think that some of the benefits realization work will really try to flush out where the challenges and the additional issues are at that granular level. So I completely accept that this is a very high level overview. I think it's really helpful actually to say, actually, when we do this again, can we provide a more borough-focused understanding of whether the variation and the differences lie? I completely agree with you around us needing to have, and I didn't have an opportunity of necessarily going into it, but in terms of talking about the core metrics, we want each of the core metrics to have built within it an equity measure so that we're clear that we're not just lifting the bar further more broadly and that the inequities remain so that we will effectively measure those at the same point. But take your point also around doing that on a borough basis as well as on a system basis. I think the points you make about digital and mental health are really interesting and very useful. And I think that's probably something that we need to then begin to flush out in some of the more detailed work that we might do as a system. I know a lot of clinicians also have concerns and issues around that as well. So I think it's a point really well made. And housing instability, absolutely. So within the wider determinants, housing is a really core one. And we've been working with colleagues in housing, children's services, James Owen, and adult social care, around bringing something to the ICP meeting, around housing and health, and looking at how we can better collaborate across these areas. We've done quite a lot of work in the context of homelessness, but actually I think there's more we can do in terms of prevention in terms of identifying when there are issues in terms of people's tendencies, but also very much learning from the New Zealander work, about how we might be able to prioritise repairs for people who have exacerbations, asthma, and so forth. So I think there's lots that we can do in this space, and it isn't just all, we need more housing. There are things that we can really do, but we need to be able to sort of focus down on those. I've got Jodi. I guess just along the same lines, and the benefits realisation, and you talked about ICPS and its success, but we do have some, you know, one of the highest incidents of serious mental illness in the borough, and so that nuance for Islington, and the importance of employment, which, you know, is really important to us as a system, because we recognise how valuable it is for our residents, and I think that whilst we have had some success in Islington, and it's really strong on employment, we also have quite serious challenges, and there's quite a way to go, I would say. So it'd be really good to kind of get that, Islington lens on employment, and other support for people with serious mental illness. Jonathan? So thank you so much. I think it's very sensible to be looking at what key priority areas are, whilst taking a balanced approach about wanting to look at everything. So I would have flagged the work that we're doing, jointing around damp, mold, and how we bring health service data, which is part of the Evidence of Islington work, that Charlotte was just talking about, about how we were already creating some of those links, and just about the Sentinel reports, about overcrowding in this borough, which again, you're very aware of. I think the vaccination thing is a good example of a hard yards thing that, you know, as a general approach, it's not staying away from some more difficult issues, which are really important. Obviously, the sort of figures there, we've got in terms of improvement in Islington, is against a backdrop of a major change going on in our under five populations, it's becoming ever more deprived in terms of who's there. So actually, it's swimming against the tide. So, you know, what would that four, five percent look like, improvement of actually the population was steadier. So do you recognise that? And I obviously, when you talk about the joint work, doing it, have to talk about the work that early years, children's services do, and the community venture sector has been hugely important there. I suppose, just sort of my other sort of reflection on, particularly about how we flesh some of that, maybe more locally, but taking some of the NCL stuff, you probably know that my very supportive of the longer lives initiative about really helping to address serious inequalities in life, expectative people, serious mental illness, which is overwhelmingly, earlier cardiovascular disease, cancer, respiratory disease, et cetera. But for my point of view, broadening that out into a wider offer, whether it's around employment, housing, we're actually using to this much more light to be offering stable accommodation, which is so important for us so many outcomes, compared to the rest of North Central London and London, is actually, for me, the really important value that we can add locally, because those factors as much as anything else, which are contributing to those poor health outcomes, and I suppose the other thing just says that, grabbing some design guys, particularly the smoking vapes bill, and about how we can actually really drive change there through sort of coordinated action between councils, the NHS community and voluntary section of our communities, that has to be a huge opportunity. That's a big drive for people with serious mental illness, much higher levels of smoking, but it's also across the board, still the single biggest cause of inequalities in this borough, even though, when I started working in Islington, which was, I say, fairly quietly, 20 years ago, smoking prevalence was over a third, it's now 13% we have seen the most gigantic reduction, but if we can get even more of a reduction, we will really see a lot of benefits. Similarly, the cardiovascular approach to initially looking at high potential, but expanding that out, that has immediate advantages in terms of prevention of stroke, improving outcomes for people who are really cardiovascular disease, but if we do it in the right way, it will be hugely beneficial to other long-term conditions, whether it's most obviously diabetes, but if we're acting on the risk factors for cancer, and for risk-free disease as well. So, absolutely, a smaller number of areas to focus on, but let's look at the synergies and really maximise the benefit if we are going to do that. Come back on any of those? Just to say, it's really, really helpful in terms of how we take the next phase forward. So, thank you for your contributions really helpful. John, just wants to come back. Just really quickly, how does that adjust the ridge, the delivery plan as well? I'm just thinking, obviously, that feedback, prioritising, prioritising, but also just what Johnson said, the moving changes that we do do see, and then the triangulation of health wellbeing, which we're going to talk about here, as I'm thinking about, family health in early years, that we will be trialling in Islington. So, across NCL, we've sort of made a picture around it. I think it's probably only Camden, Islington, that will probably take this up, but I think with just Johnson's point around prevalence and the impact and challenge of our earlier years, that's family as well as young people. I'm just thinking how that delivery plan, whether we see that adjusted, revised delivery plan, what it might look like in terms of delivery for Islington, just to make sure, again, that we're trying to let them speak to all three, four elements. I'll just come back on that one. I think that's really a good point and a point made at the right point in the year as well. So, each year, we will iterate the delivery plan. I think there's a recognition that in that first year, it was a list of stuff putting it in some sort of order. I think we've got a real opportunity now to refine that and also to look at how that directly relates to what the Islington local plan is, so that we've effectively got a sort of a series of connected plans. So, you might have the NCL delivery plan, which is the big picture, but actually aligned to that. We have a series of borough-based plans that I know Ian is also working on looking at how to do that that would effectively create that overall delivery plan. So, does that come back here? Is there a disability of that? I'm also thinking about resources and scarce, anyway. And I know there's a number of various contracts, commissioning contracts that are in place, so I'm just thinking how that then gets sort of replayed, revised, ultimately. I'm only interested in Islington. This is an NSL piece here, but I'm also, you know, that perception that Islington is better off. It's not about managing down, it's managing equity across. We have that disadvantage that sits here. I'm just interested about whether visibility of that delivery plan resources will be so that we can triangulate all of those reports because I just think time moves in and out like the tide, and we've got greater numbers of young people, families, so I think about those young people and families in temporary accommodation, the inequalities that exist in there. This needs to be quite agile, mobile, responsive, can't have what we've had with the therapies. Nine months are just barely moving forward, and I'm just thinking how do we work? We know each other quite well. How do we move in a more agile way? I plan myself to be meeting on Thursday looking at what our priorities will be, and the children's trust has to be aligned. It can no longer be a smattering of everything. We've got to be really pincer sharp about what we're going to be doing, and I think that's how I'm looking at the responsiveness of that plan, sorry, Chair. So I guess the short answer is we will bring it back to the health and wellbeing board, but I think that the work on this needs to be done through a population health steering group, with borough partnerships, with drugs of public health, with your representatives like James and so forth, to make sure that we've got that built in so that when it does come back to the health and wellbeing board, it reflects what we've heard in this meeting. I think there's still quite a lot of working through that we need to do about what the borough partnership is doing in this space, it supports integration, and how this sort of links through to the health and wellbeing board. So I can't offer you a completely formulated process, but I think that is where we need to move to. The only other thing I would say is that in the course of the last year, the ICB has gone through a very, very significant change programme, and I think that the experiences to date, I can totally get there frustrating. I don't think that those are going to be played out into next year because the teams are now in place. So I mean, I can sort of apologise on behalf of the ICB, but I do absolutely recognise how challenging it's been for partners to work with us. Yeah, absolutely. I wonder if this is worth a conversation outside the meeting because I'm just a bit conscious of the board only meets three times a year, so suddenly you're getting tired of the updates, which means it's distinctly not dynamic. So I think it probably is worth a little bit of a conversation, so perhaps we can pick up our outside the meeting just on the practicalities, because I think John picks up a really good point, and I think the CAM stuff is really valid. And I say this as ward councillor in my community, and I'm sure Councillor Gongro is a ward councillor. The CAM is probably the single biggest thing that I get about health, which isn't the exact amount of health, and I get it from schools, I get it from parents, and just the general worry about access to sport is significant. On that note, I think we were supposed to vote to agree the report last time when I didn't do it. We meant to vote to agree on the report. Fab, brilliant. In which case we're going to move on to item B1, which is the health and well-being board strategy, which Jonathan is presenting. Thank you, Chair. Shall I just take the sides off my own screen rather than up on the monitor? Don't worry, I'll just take the office screen. So thank you all ever so much. So this is about a new joint and health and well-being strategy for Islington. It's a joint strategy formally between the council and the integrated care board, so for the NHS, the joint in the strategy title. I'm just going to give a brief overview about what a joint health and well-being strategy is, what it's intended to do, how we've been developing a new strategy, the priorities that we've identified, which are based on a mixture of the life-course approach, which the North Central London strategy takes, so start well and live well at age well. We've added in healthy environments for ourselves, but equally plays into the missions of the council, particularly around the inequalities focus in that work, which I know is obviously also shared with the NHS. And then having a bit of discussion in the next item, we're particularly like the board to consider the smaller number of priorities that we think need particular attention and focus as part of that. So what is a joint health and well-being strategy? Well, it's a requirement that each local area produces a strategy. However, there's precisely no guidance to what that strategy looks like, so it's very much about how we determine and agree something local. So hence, we've managed to fit this into a format which I hope works both for the council and for the NHS, but also for all of our other partners that we work with. And what we've broadly set out is sort of an approach where we think there's a broad range of indicators, which is really important that we follow, because actually if any of those indicators start going off track, or they're cause of concern, it will give us a way. So actually maybe we need to focus in on these particular areas, but also then to zoom in a smaller number of key strategic priorities where we think by working together as a board, bringing attention and sort of our influence to it, is that we can help to make a real difference and get them to those sort of the end. So firstly in terms of what we think and what we're here for, what the stress is trying to achieve. So we're trying to think about something which really encompass all the different areas of people's lives, and in lots and lots ways life expectancy, which is a product of the earliest life, probably actually the health of your parents, pregnancy, all the way through your living conditions, the access you have to health and care services, et cetera, is a really strong example of that. So you'll see in the strategy we've talked very much about, life expectancy, well to improve life expectancy in the borough, wanting to reduce inequalities in life expectancy, which remain very wide, particularly our most affluent groups, has been a sort of up and away in terms of life expectancy, everyone else is sort of chugging along more slowly, but also healthy life expectancy. And I think it's often sort of the view that actually as we live longer, we end up being ill for a lot longer, it's actually the opposite, the healthy appropylators that live longer, active far less time in ill health than others. So we think it's a real very important metric to go and particularly around those inequalities, which is we know themselves contribute to worse outcomes. So you'll see what we've done is, we've grouped this as we say under life calls and also about healthy environments. Under each of those outcomes start well, live well, age well and healthy environments. We've set out what we call a balanced score card of key out. So this is very much about indicators, which exist in terms of islington level, London and Nashville, so that we can not only track what's going on in islington for our residents and our patients, but that we can actually compare how we're doing and compared to the rest of the country and before colleagues in NCO ask also in CL, we can compare with as well. So under each of those headings, we've set a number bit. So for example, under start well, the sort of key areas that we're flagging, I'm not going to go forward with the different indicators, but every child is healthy and is good development for the early years period. We know coming up over that has been such a fundamental issue and it's really a very strong sort of cause of early and then lifelong inequalities. Early identification support for children and young people with special educational needs, fundamentally important as we've just been hearing, improving the health of one group of children and young people, including children who looked after, young people were offender and young carers and working with partners to address the wider terms of health and wellbeing for all children, young people, the general health information offer. Under the live well heading, very important during this period of time to improve the take-up of early detection and preventative measures, improving access to physical health care, including preventative and behaviour support for people with serious mental illness, which I think aligns strongly with the longer lives initiative, improving treatment and support for people who use drug and alcohol. A smoke-free generation in Islington has to be a key focus for us, improving care for people with long-term health conditions, including prevent interventions and healthy behaviour support and also taking the opportunity to enhance the opportunities of a primary and secondary prevention of common mental health problems and creating mental health and motor environments. And then under age well, it's about the importance of making Islington a more age-friendly community, which is a really key goal for the local authority and particularly working very much with partners, addressing social isolation and improving connectedness, supporting residents to live active lives, so the more active you are for longer, the healthier and more connected you are, creating a care of friendly, but where there are so many carers, I've got a very progressive care and strategy carers have really maximising the opportunities to put there. And then also given partly linked to an ageing population, is also about recognising the importance about our approach on dementia and having a much more consolidated and joined up approach around that. And then under healthy environments, just generally the importance of good housing and working together to mitigate any sort of issues around housing and health, climate action, fundamentally important in the base of the short and the long term, the importance of employment, education, skills, and lifelong learning across all of the life calls, social connectedness, mental health and well-being, and importantly thinking about the other really key drivers alongside psychological health and smoking, is about healthy weight, so really a helping people to sort of improve diet, increase levels of physical activity. We've identified a number of key strategic parties based on that assessment drawing out from that, each of which, if they agreed by the board, and they gave for a consultation phase out with our residents, would then have delivery plans developed underneath those. And the key strategic parties that we've set out are really around the early years and the early health and social development being a real cornerstone of development, about looking at how we can intervene as early as possible in terms of children and young people with special education needs, that we are meeting those needs in a progressive and timely way. The importance of heart health, so cardiovascular disease, very important focus, we know that there's a lot of people with high potentials in an early warning sign, or other risk factors for developing cardiovascular disease that we could focus in on, but then expanding that over time to a wider offer around long-term physical health conditions, really grabbing the opportunity of a smoke-free generation and action on vaping really takes the advantage of with our ageing population, about looking at how we really develop Islington as a place in terms of age-friendly communities, talked about healthy weight, really linked to healthy environments, and really helping people to remain a healthy weight, be active, eat well, and connectedness. And then the importance about climate action, air quality and livable neighbourhoods, which we know both in terms of areas like air quality of such an impact on health, but can also really improve health if we get, as we address those. And then finally, psychological health and wellbeing, absolutely fundamentally important is in terms of cross-cutting part of all of our key strategic priorities. So, in terms of what I think might be helpful for the board, but obviously any other question I have, is to ask the board to consider whether there are any specific gaps with yet to address under the four goals across the life course and healthy environments where we think the partnership could add value and impact. Consider and agree on when the area is proposed for the key strategic priority areas for focus for the health and wellbeing board, and then any other points, thoughts and reflections, concerning the draft strategy. And what I should probably add is that our intention would be to have this as strategy running till 2030, because we think this is long-term actionable inequalities. It's a shorter-term actions to be fair and longer-term actions within that mix, and obviously this would following the view of the board we were supposed to be going out for consultation early in the new year, and then hopefully coming back to the health and wellbeing board in March with a final version, which is taken to account feedback from engagement and consultation. Thank you. Any questions or thoughts? Claire? Thank you. We're probably expressing my personal bias as a cosy-up cardiologist. I just want to say I thought that there was a lot of really helpful synergy between your healthy environments, work, the health, the smoke-free tobacco, and then that feeds on into age well in having people who are more mobile, less likely to have cardiovascular disease, less likely to need support, and I thought it would put in a really helpful and succinct way. Makes the case. I'll be clear. Thank you. Thanks Jonathan. I suppose I was just looking at the priorities of the plan and wondering if we... So you've got housing in your healthy environments, and I was just sort of thinking back to the conversation about, you know, start well, so children living in poor housing and so on, whether we need to think, sort of bring it to the fore more in terms of those links with housing and people's physical health, people's mental health, you know, whether we need a... whether there is opportunity to do concerted efforts. And I've got Jodie and then Jonathan, you come back. And I think it's in there, less so in the slides, but for me, along with the similar lines, that role of universal services, isn't it? So as colleagues are at the bar of partnership, no, we bought a proposal for thinking about an all-age autism strategy. It's just how important those universal services from schools to housing to doctors, surgeries, respond to send and other needs to people, and how critical that is for us to achieve our priorities. I might just let Jonathan come back and then clarify if you can jump in then. Thank you. We can certainly look at how we can sort of bring housing out more strongly within this. I think it's sort of becoming a bit intrinsic, hopefully, to the way in which we're working together, but it was certainly helpful to affect that. And Jodie completely get the importance of the over-health of the environments and our services being able to respond to those things. So again, we can put in, make just throughout a bit more strongly. And thank you, Claire, so much. It was fairly intentional to have those different things to all line up, because we think particularly if we're going to make any, a little bit like my point about the longer lives, is you've got to actually think about the range of different things which come into play to really make a difference to the health and well-being of our residents. But thank you for making that point. Claire, do you welcome back? Yes, thank you. I don't know whether I'm allowed to say the word hair and gay in this room. But we did have a really interesting session in the Barra Partnership about the interaction between health and housing. And particularly about the amount of resources that are lost to both health and social care through the lack of available housing in London, leading to institutions like ours putting huge amounts of resources into housing people who can't get to their destination because the destination doesn't exist. And so I think that there is a much wider aspect to the housing proposition. And essentially the information received was that really the only resources in terms of housing was coming in for public, so for social care use, is coming from private landlords exiting the market, which is a really depressing statistic. But I do think it absolutely indicates the importance of having housing really central to this for all of us. I mean, what comments have you got, John? Yeah, thanks, Jonathan. I thought it was excellent. And again, just speak to the previous item we had from Claire and colleagues. I like the structure of it. Talk to the JSNA. I mean, I was a great document at Balclaim and shared with us at our management team just really helped us focus it. There's a lot in there. Pleased to see the same piece as well, so we will be having a session with our members and also a summit with our residents, which Michelin is really advocating and organising. So it's good that that's in there because it's a game so intrinsic to everything that's going on. My sort of question is, the messaging, how do you... I mean, it's the strategy there. It's up to 20th-30th. It's got all of the complexities that we see across the back. How do we get some of that messaging out there? Even the success, Jonathan, even 20 years ago, the smoking piece, a third of reduced to 13%. That sometimes is an enabler. It's an enabler. I think I'm now becoming a real minority. I don't smoke, by the way. I just want to make sure I'm very, very clear. But just the messaging and how you get some of that out there through comms or what. It's just one of what that approach might be. Thank you for that, John. So I guess one of the key things that we're flagging is about how much healthy life expectancy has improved in our own the last 10 years, pretty exceptional, and very, very big change. Many different factors, smoking actually pretty important in that context as well. So I think we'll consider how we do that best through the consultation engagement process. I think some fairly simple summary sort of messages and slides. As you know, we've got excellent links all the way across through the commuting voluntary sector across the whole life, of course, in instinct, and not least coming out of COVID, but really sustained from that. It's also the call for action about the things practically we can do to help people. So for example, I sort of, sort of, the bar of partnership was talking about complex needs around drug and alcohol, services which have really expanded in the last few years, particularly in New Zealand. And it's a real opportunity to actually re-emphasize some of that's available. So I'd want to use the consultation engagement period in a very proactive way, with our particularly colleagues in the community, to think about what are the things that can really help from a practical way, as well as, if you like, and this is the progress that we're making, but equally, these are the many challenges that we continue to have. John, do you want to come back? Thanks, John. That's by my other point. I was just going to say that that link that just runs through is that link's poverty. And again, something I must be proud of, from members' perspective, putting residents first, trying to enable help at every, every, every level of lay there, we've talked about the housing, think about the information we get back from minars and from the data, et cetera, and that we, I'm pleased to see it in there, it's more reflection and things saying, we can't lose that, because I think part of the challenge that we have, not just here in New Zealand, but across the NCL, will be deprivation, poverty, inequality, particularly in the health perspective, but also those life chances, and the affordability, we've talked about affordability of living in London, for example, but that link between poverty, work, mental health, and being able to break that vicious cycle of the healthier environment. We've got a number of enableers there, for example, thinking about child-friendly, we have that healthy stand, we need to just make sure we join it up. And so, I thought it was excellent, as it reflects all the most priorities that we'd want to say. Yeah, well done. Any more questions? I don't know if you picked up on the housing point that Claire made, and if there's any final comments, and then we can wrap up. I need to agree. We obviously just reflecting that we did actually, as the health wellbeing board, have collietum housing, come and talk about housing and health, and I think what very proactively Claire and John has been both grabbed it for the Barbara partnership, and now they've definitely in there, lots of very positive conversations going on. It is one where genuinely, once we work out the best way to bring the data together in a way which, you know, our patients are comfortable with, that could be really fundamentally important in terms of how dress needs. And, you know, you're absolutely right, there are no easy answers around housing, which is one reason why we're engaging very much about overcrowding, how do you get a much broader, temporary accommodation and homelessness is increasing everywhere, including in the instance. So again, very proactively engage with that, and I'm not going for one second disagree around the poverty point. We obviously have internally poverty board meetings happening, having a focus on health, the next one, which would be really important, but measures that we can take to bring help people to maximise income, get people into employment, where there's health conditions, but equally reflecting the other direct about how they can actually drive ill health, has to be a fundamentally important thing over the next period of time. Brilliant, thanks very much. I guess we just need to agree the report. That's pretty great. I should have said at the start, I just plan to stick in one AOB, which is also Jonathan, which is just about the NHS's 10-year plan consultation agenda I just wanted to do. I was not saying an update. It's not quite an update, is it? Thank you so much. I hope this is OK with everyone on the board as well. Clearly, a very big consultation currently, kicking off around the 10-year health plan for England. I think there's been more than 40,000 individual responses already. A few pet dogs, I think, have been photographed, et cetera. Massie got stoutless, but asking some really important questions about the future of the NHS, which we all desperately care for. So what kind of things do we think would be really important in terms of plan? Looking about how we see how we can provide more care in the community, whilst ensuring that hospital services are absolutely of the best, the whole thing about technological shifts, so how we use more digital technology, which is fundamentally important in terms of both how health and care, talking about housing, how that might operate. Music to my ears in terms of how we shift the data towards more prevention activities, et cetera. So I was just really wanted, so obviously as a council, we're going to be responding to this. We're very energized from chief executive down, we're about really wanting to engage this. I wondered if it was an opportunity for board members to reflect about how they are getting about engagement of residents and patient citizens, I think perhaps you might say, no, it's just terms. And about what sort of approaches people are taking around consultation responses. Okay, I do want to go first. I'll never go. So yeah, we're, you know, I think for the ICB, the ICS, it's a really important time, and we really want to influence. And I suppose, you know, a lot of it chimes with, I suppose, a welcome direction of travel in terms of that real focus in Darzy. And so on around shifting, shifting left into prevention, shifting upstream. We're very interested in how we develop more sort of primary prevention, secondary prevention, so that whole sort of integrated neighbourhood approach bringing together health care, VCS, and so on. So I think we are, you know, we do very much welcome it, and see it as a huge opportunity. I think the ICB will be working with groups already established, so our BCSE alliance across the five boroughs, so that's bringing together our voluntary sector colleagues. We will be working with residents, I am sure, although I don't know how at this point. And I know that, you know, there will be staff sort of groups as well, actually, to think about this. So I think, as I say, the ICB, and, you know, the ICS, very much welcomed the sort of 10-year plan, the opportunity to influence, and are doing quite a lot to try and influence as well. So a visit by Claire Fuller last week, who wrote the full report around the future of primary care, is just one example of, I suppose, we're really trying to engage on many levels, and we will be engaging in this very actively. Claire? Thank you. It was helpful having two people, whose name is Claire, who actually agree about this. So, yeah, this is really important for us. We have started to be involved in the national events that have been run. We had a regional event for Chief Executive last week. We've already been briefing out into our staff groups through my briefing and other communications to make available to individual staff the access to the consultation. And we will be doing more and holding local events, also taking it into our patient groups. So we've recently started Whittington Voices, but we also have other patient groups like the Maternity Voices that are very well established that will be part of our process. I think it's very much the three pillars of the 10-year plan, as it sits at the moment, are very aligned with the things that we do, as an organisation, and what I think we contribute to the ICB and the locality. Just a couple of thoughts on that, that are partly coming out of the CEO's events, but I think analogue to digital is massively important to us as an organisation. And that's partly because we are a community provider. And what we need to be able to have is as much digital enablement of our staff so that they can collaborate within the acute and with primary care, social services, so that we do not have people who, in 2024, have to go back to base to get the answer to a question that they can have some system interoperability in order to answer the question to the patient while they're in the patient's home. And that would be huge. There was some different views in the CEO's groups about whether we should be focusing on people who are not digitally enabled, or actually saying, let's focus on the vast majority of people who increasingly are digitally enabled and then have a special strategy for the other people who don't have as much access. So it's interesting that there's some healthy disagreement about how that might happen. In terms of hospital to communities, there's an integrated care organisation. This is absolutely what we are all about. And I think we see more opportunity for community care than some of our partners around the system who are entirely focused on acute services. And I think that's about, you know, a little bit of, if you build it, they will come. If you know it works, then it will work more and more. So we're very keen to do that. It's a strand through our CAM services and wanting them to be part of wider children's services, as opposed to necessarily walled off from physical health and other support to families. And in terms of treatment to prevention, it's interesting, I think the Secretary of State, I've heard, say that he thinks that secondary prevention is the province of health and primary prevention is the province of government and in its big and small senses. I'm not sure I'd make the demarcation in quite the same way because I think that things we've talked about today like breastfeeding, health visiting, and health promotion on a neighbourhood level is actually a partnership between health, social care, localities and government. So I just thought that that would be, it's an interesting one for us to think about. Thanks very much. Is anyone want to add anything? Would you want to come back on any of that? It's really great to hear about the level of thought being given to it. And clearly, I think Claire is your sort of suggesting it could be a very, very big shift in the power zone to the benefit of our residents in the community. And I completely agree about your final point about the importance of actually bringing things together and actually making sure that we're addressing all the different aspects, which are necessarily not just around health, but actually having a good life in the maximum opportunities so I couldn't agree more. Thanks for that. And I think the only kind of thing on the agenda is to see if there's any questions for members of the public as you're not. Which case? I think that's... I haven't met anybody. Brilliant. And we just thank you very much for your time and coming and joining us today. Thank you. We need to. Minutes. We did the work at the beginning. Yeah. Brilliant. We did, didn't we? Yes, we did. Brilliant. Thanks very much.