Transcript

Okay, good morning, everybody, I apologize for the slight delay in starting the meeting, but welcome to the combined meeting of the Health and Wellbeing Board and the Surrey-Heartlands Integrated Care Partnership. So there will be some members actually joining us remotely today, which I'll introduce as they speak. This is being webcast for public viewing, but just to say, I think there aren't any, well actually there are technically members of the public here, so I'll just remind people that there is no fire drill planned for this morning, so if the alarm does sound, please use the exit and go out to the car park and you'll be met by somebody from the maintenance team. Can I remind you, please, to use your microphones when you're speaking, otherwise you can't be heard online and it is the right-hand button that you should use, please. And then mobile phones, again, just sort of housekeeping, if you could please make sure they're switched to silent, of course you can use social media during the meeting as long as it doesn't interfere with the smooth running of this meeting. Right, so we have got a full agenda today, so just to warn speakers, I will keep you to time, please. Thank you very much. Can I welcome Toby Nash, who's taken over from Amelia Christopher. Amelia was the committee support for, I think, five years or so and did a phenomenal job, so no pressure there, Toby. Right, there are apologies for absence, which I will read out, actually, because I think everybody is substituted. So, Hannah Rostle, Lucy Gates is attending on her behalf. Nicola Airy on behalf of Fiona Edwards. Nicola may be online. Susanne, oh no, Susanne Smith, I've got down to substitute for Rachel, but that isn't the case. We have Rachel here, thank you. Sarah Grahams is Chief Constable in place of Tim Vermeer. And then there's apologies for Mark Noosey. Charlotte Canniff is hopefully online. Apologies from Richard Biggs. And then Karen Brimacombe and Lucy Clements are also online. That is always a challenge when you have such a large meeting as this, to get everybody here. Right, so item two then, minutes of the previous meeting. Just to flag up that Mark Nootey followed up on the decision at this meeting and Surrey County Council to sign the Good Companies End Poverty Pledge for Surrey. I think you've all followed up by email. And I hope that you've been able to take that or will take that back into your organizations and encourage them to sign up to that pledge. Okay, are there any other points that anybody wants to raise in relation to those minutes of the 18th of September? Otherwise, can I take it that those are agreed? Thank you very much. Item three then, declarations of interest. Does anybody on the board have an interest to declare in relation to the items on today's agenda? No, thank you very much. Item four then, questions of petitions. There have been no members' questions or public questions or indeed any petitions. So that takes us to item five. The first substantive item, which is memorandum of an understanding in relation to the combining of the Health and Wellbeing Board and the Integrated Care Partnership. It's obviously been through this board on a few occasions, but I think we're at a point now where hopefully this can be signed off, the final version. So I'll hand over to Phil Austin-Reed and Lucy will come in if she wishes to subsequently. So Phil, thank you. Thank you very much. Yeah, so as was mentioned, we started this process at the beginning of the year and there have been various points of kind of discussion, engagement, feedback that we've built in along the way. So we're at the point now looking for final agreement on what we've already experienced over the last quarter in terms of a combined meeting. So I'm just going to use one or two slides to talk us through this. Again, just to remind the aim of this whole process was to improve that collective oversight, recognising the alignment that there was between Health and Wellbeing Board and the Integrated Care Partnership of the ICS. Enable more collaborative strategic direction setting, decision making, streamline the governance, get best value out of everybody's time around the table and virtual table when we meet online. And on a practical level, ensure we're just having that one conversation. So we've been through one quarter in practice of that kind of combined approach. We had the formal meeting in September, which was the first combined meeting. We then had the deep dive where both all members around this table were invited alongside some representation of the ICB out to Gilcombe Waverley for that deep dive looking around multiple disadvantage led by those community organisations. And then we've had the virtual informal meetings. And then we've had the virtual informal meeting. And that's the cycle that we intend to kind of go with now and use to kind of cover the various aspects of both the ICP and the Health and Wellbeing Board. Thanks for everybody's feedback along the way. And we have built that into what's now been circulated and the MOU shares the common aims and responsibilities, the role of members. And it does include, I think there's a point at the September meeting around that, need to take account of regional and national developments. And we expect that to come through either the ICB and the updates that come through that route. Or it's built into the terms of reference to invite regional representation along as and when is necessary. So the terms of reference have been updated for both ICP and Health and Wellbeing Board to reflect that combined approach. And as we discussed in September, there's one or two changes. There's the two vice chairs now that have been introduced, continuing the one from Health with Charlotte. And we've been in touch with the VCSE Alliance, looking to my VCSE Alliance colleagues, around the chair or nominated representative to be a deputy chair of this board. And I believe there's a first meeting of the new board on the 17th of December, where that will then happen going forwards. And I know that with that new board, there are kind of nominated portfolios. And there's a very useful page that outlines those portfolios, which we can share in the meeting. And so we've got the MOU, which is the shared kind of direction between the two terms of references. And then we have the terms of references included in the document. And we've also got the current attempt to capture the governance around health and wellbeing. This is not intended to be comprehensive across all organisations. But it does outline the relationships between the organisations that are responsible for health and wellbeing board, ICP in Heartlands and ICP in Frimley. And the relationships between those. We've got the kind of sub boards of the health and wellbeing board around GSNA, the pharmaceutical needs assessment, and then the two sub boards that look after the three priorities. I'm sure around this table, you will look at it and probably spot things. I think it's a perpetual piece of work. So what we're proposing to do, rather than have this as a static offline document, is put it on the website so that as and when people see things and things change within organisations, we can keep that up to date. So what I would ask is if you are sharing this within organisations, wait for that online link to be shared. And then we can always be sure that we're looking at the most current version. If there's specific feedback on this version, please do get in touch with myself and we can build that in to that first iteration. But at the moment it is included with the papers. So I think that's about all I wanted to say. The MOU and the terms of reference were shared with the papers. And hopefully people feel that feedback received has been incorporated into that. Happy to take any questions on further points of clarification. Just before we do that, Lucy, did you want to add anything? No, thank you, Chair. That's all. Thank you. OK, thank you very much. And Charlotte. Hello, Charlotte Caniff, Vice Chair of Health and Wellbeing and ICP. And just wanted to endorse the paper, Phil and Lucy. And just I guess my point would be that I'm really glad to see that we are strengthening our oversight of the BCF. And I think that's an area that this board could do with having more oversight from an operational level on. And so I really welcome that addition to the terms of reference. Thanks. Thank you very much, Charlotte. Anybody else wish to make any comments or observations? No? OK. I mean, I think just one point around the membership. I mean, we've looked to sort of streamline that wherever possible. I mean, it will probably change over time. I think there is some enthusiasm to have representation or presence here from the social housing sector. So I think, and Aruna has begun a leading on some conversation, so I think we'll invite them, they can decide who attends, but to do a sort of presentation perhaps. I mean, social housing is a hugely important issue, you know, in terms of the wider determinants of health. So it makes sense to do that. So if that's OK, we'll put that on a future agenda and then we can take a view on whether they should be an observer at the board or a full member. Other than that, I think we'll wait to hear from the VCSE Alliance following your board elections on your nominations. OK. Yes. I wondered whether in light of the civic agreement it might be, so that's with the universities in the region, to sort of look how that might relate to the different committees that there are. Because I'm here from the University of Surrey, and you might ask why just from one of the universities, and might that be a lens through which there could be some governance put in place as to how to strengthen the linkage? Yes, I think, yeah, and obviously we signed the civic agreement, the county council signed the civic agreement with the University of Creative Arts and the Royal Holloway University of London and Surrey, University of Surrey, which is all about looking at collaborative working, or greater collaborative working. I think ideally though, you know, and there is some sort of governance that sits around that, the membership of this board really is to represent not just the organisation that the people are employed by, but the kind of the wider sector. So I think we just need to work through how that happens in the case of the universities. Because also, you know, the further education colleges are hugely important in terms of helping support courses for apprenticeships and skills and so on, which is a key part of the fourth ambition of this authority to grow the local economy. So I think if we can perhaps take that offline, but it's a good point. We want to make sure that we have the wider voice of all of this, you know, across all the sectors as much as possible. Yeah. Okay. In that case, there is one recommendation, which I've now lost, but it's basically to approve the MOU. Yeah, it doesn't actually say what the recommendation is. I'm not used to having paper, sorry. Right, so the recommendation is that the Health and Wellbeing and Surrey Heartland's ICP sign off or approve the draft MOU, including the updated terms of reference for the combined meeting of the Health and Wellbeing Board and Integrated Care Partnership, thereby formalizing the document. Is that agreed? Good. Thank you very much. Right then. We'll move to item six, which is enabling stronger community safety leadership and governance. And as members, the longer standing members of this committee will remember, during the time of the previous chief constable, we merged together community safety into the Health and Wellbeing Board, and that seemed like a good thing to do at the time, and I didn't think it was. But I think the way that things, and that was, you know, in 2018, 19 probably, you know, I think we found that, or the belief is that there hasn't been enough time to discuss sort of community safety issues at this board, bearing in mind the breadth of the work that we do. So work has been underway in terms of looking at how we can split it back out, but without losing that connectivity between community safety and, generally, health and wellbeing. So, right, I'm going to hand over to Sarah, I think, who's going to take us through this. Thank you. Thank you, Chair. So this is a paper, as you said, sponsored by yourself, the Chief Councillor of Surrey Police and the PCC. It follows on from a paper we brought on the 18th of September, where exactly as you described, it was proposed that there was some separate governance put in place to focus on community safety with a Surrey-wide community safety board. Since the September meeting, we have gone out and consulted on this further, which is within the paper, and I'll just point us to a couple of sections, the role of the board at five, the opportunities at six, and the consultation at eight. So the role of the board is to provide strategic leadership and direction to community safety, crime and disorder reduction across the county. We'll work through how exactly that board looks in the terms of reference, proposing the initial board to be held in March 25. It will be very much focused on the joint strategic needs assessment, and we also want to do some work on combined data, progressing that initial work that was done around shared Surrey data. So the opportunities that have been identified are having a strong strategic link into local community safety partnerships, some clarity around priority areas, an opportunity to discuss these at length has just been described as not always available within this structure. We are very keen to keep a strong link into this board, and I noted in that previous paper that the police will clearly still be represented here and will be focused here and bringing the issues around community safety. So the time scale for delivery is March 25. Following on from any agreement today, we'll do further scaping on the terms of reference, the administration of the group and the membership. But as you can see at eight, there's already been significant consultation with all the parties mentioned with overarching support for this direction of travel. So I just bring it here for those two recommendations to progress the work. Thank you very much, Sarah. I don't know if Carl Bussey is on line. Carl, did you want to? You've been leading from the county council's perspective. Anything you wanted to add? Yeah, thank you very much. Thank you, Sarah. I think you covered most of the points. The overwhelming support for the recommendation to form a community safety board was made during the consultation period, with, as Sarah says, the desire to continue the links to the Health and Wellbeing Board by making sure that members sit on their respective groups, but also through the Prevention and Wider Health Determinants subgroup of the Health and Wellbeing Board. So we'll continue to do that just to make sure those links are tight moving forward. I think since the paper was produced, there's been discussion about who may chair the board, and that's likely to be the Police and Crime Commissioner. There's also been further discussion around the name of the board, which is likely to be the Community Safety and Prevention Board. And the word prevention is in there to future-proof the direction of the board, because central government direction is around prevention, and funding streams are likely to be relevant to preventative activities. So it sort of made sense that we tried to future-proof the board moving forward if the recommendation is agreed. Thank you, Carl. Any... Yes, Michelle. Yeah, it was just a question about representation. Obviously, we're not there yet, but for the VCSE, of course, because we do a lot of work in the space, obviously around safety, but also around prevention. So just a plea to make sure we're involved at the earliest opportunity. Is there an indicative membership list that anybody knows? Carl? Not at the moment, but to be frank with you, this is just phase one of the review. Phase two will be looking at all of the executive meetings that sit around community safety, of which we have an abundance, a great deal of overlap in terms of remit as well. So it makes sense at the same time that we're forming a strategic governance under the community safety and prevention board, that we look at all of the executive groups that fit underneath, so that we're not having meetings for the sake of meetings and we are making a difference. So that will be phase two, I suggest. Thank you. Sarah? Yeah, the absolute intention is to create a group of the strategic leaders across Surrey focused on community safety and prevention, but we are going to review those other structures. We don't want to just overlay another meeting, so some of them may feed in, but that's the scaping work between now and March. Okay, well, I'm sure we'll have a look at that when you've got to that point. Anne-Marie first, and then Kate. Thank you, Tim. So will the proposed membership be coming back to the next meeting of the board then, once the task and finish group's done their work? Sarah? So I think that depends on how much oversight this group wants to have. It's brought here because it's being separated out from here, but whether there's a formal line in, I mean, we're quite happy to bring it back, but I think we want to hold the first meeting by March, so it's how we just combine that with a task and finish group and bring it here. I'm sure we've got to use that. Yeah, presumably it needs to make that separation and be done, but the membership seems an important part as it separates, and therefore if this board is saying we're separating it out, this board should also have a say on who's going to be the membership, just to make sure that the views are all considered. Kate, is yours on the same point? Mine's about representation. Yeah. Yeah. Okay, thank you. So my name's Kate Scribbins. I'm Chief Exec of Health Watch Surrey, which is the statutory voice for residents and people who use services across Surrey. I think I asked this question last time the proposal came to the board about how the voice of residents, people with lived experience, will be represented in the governance structure. I couldn't see in this paper any reference to the voice of people with lived experience or the voice of residents. It wasn't presented as one of the opportunities or one of the challenges or one of the issues that consultees wanted to see in the governance structure. So I appreciate, as you go into phase two, I just want to make a plea that that really is clear in the representation around the table, that the voice of residents and people with lived experience will be strongly represented. Thank you. I mean, I think Anne-Marie makes a fair point that, you know, we spent a lot of time looking at the membership of this board to make sure that there was good representation across all of the sectors. So could I perhaps suggest that this board will meet both in January and February. The 23rd of January will be a public meeting, or no, it will be a private meeting at Deep Dive, yeah, and then there's a private meeting in February. So could I ask that perhaps that you do, you share with us at that point the proposed membership, not in terms of the names of the people but the roles. I think that would be helpful so we can add a bit of a look at it if that's okay. Absolutely, thank you. Any other thoughts or comments? If not, there are two recommendations. The first is to agree that responsibility for strategic oversight of community safety community safety is removed from the health wellbeing board with a March 25 commencement of a dedicated community safety prevention board. And secondly, there's part of the above, support appropriate continued interface with the health wellbeing and prevention and wider determinants of health delivery board, continuing to recognise the impact the community safety has on wellbeing. And we won't put it in as a recommendation but a request, please, that you share with us the membership, the proposed membership at our January meeting. So I'd agree, those two recommendations. Thank you. Okie doke. Item seven. The health wellbeing strategy highlight report. Mari, I think you're going to kick us off. Thank you. Thank you, Chair. Good morning, everyone. So my hat here today is as the Chair of the Prevention and Wider Determinants of Health Board, which is a subgroup to this board. And I'm going to cover off Priority 1 and Priority 3 and then confusingly go to Lucy for Priority 2 so you get listening to me over in one go. Just a reminder for the board, Priority 1 focuses around supporting people to lead healthy lives by preventing physical ill health and promoting physical wellbeing. Spotlight this month, you'll obviously have more details in the pack, but the spotlight specifically is around Active Surrey, who in collaboration with local partners has initiated a new place partnership in the health and wellbeing key strategy neighbourhood of Stamwell, north and south. And for those of you who know the key neighbourhoods, understand the particular challenges in that specific neighbourhood. in Spelthorne and it is in the top 10% nationally for its inactivity levels. More than 50% of children and young people generally across Surrey are not meeting the Chief Medical Officer guidelines for physical activity. But Club 4 is the Holiday Activity and Food Programme for Surrey and this summer over 39,000 places were available in the Holiday Activity and Food Programme for children on free school meals. As I said, please have a look at the pack for more information. In regards to Priority 1 and opportunities, the Surrey Cancer Inequalities Programme in partnership with stakeholders and communities will address knowledge gaps around prevention, screening, early diagnosis, access to treatment and patient experience. And the programme itself is designed to shine a particular spotlight on invisible inequalities and intersectional factors that are experienced by priority groups but not recorded routinely when data is collected. In addition, Surrey's work in this area has been given national best practice and recognition by Macmillan Cancer. In terms of challenges, and you'll note a theme when I pick up Priority 3 around challenges, is around funding without, so the JSNA chapter on multiple disadvantage identifies a conservative 3,000 plus adults experiencing multiple disadvantage in Surrey. Changing futures bridges the gap. A prevention service shows a return on investment of Warning 4. Without a funding decision in principle by early autumn this year, although I would suggest it's now late autumn, the Bridge the Gap Prevention Service will be decommissioned from 12 local VCSE community providers who are leading on this work. In terms of Active Surrey, they are also awaiting confirmation from central government that funding for Club 4 and several other century funded physical activity programmes will continue beyond the end of this month. Thank you. Chair, are you happy for me to go on to Priority 3? Would you like? Yeah, okay. Well, just see if there's any comments at this stage otherwise. No, I can carry on and walk. Thank you. So Priority 3 is around supporting people to reach their potential by addressing the wider determinants of health. Spotlight looks at Surrey County Council who made a successful bid to Southern Gas Network for just under a million pounds, which will be available to Surrey's Fuel Poverty Programme to deliver general support to vulnerable residents and targeting interventions to victims of domestic abuse, disabled people and carers in the key neighbourhoods in partnership with Citizens Advice, Surrey Coalition of Disabled People, Surrey Fire and Rescue and I Choose Freedom, a domestic abuse charity. In terms of opportunities within Priority 3, the new Surrey Against Domestic Abuse Strategy 24-29, published in collaboration with the Domestic Abuse Surrey Expert by Experience Network, provides an opportunity for strong leadership to transform the way domestic abuse is tackled. The new strategy will continue to provide support and services to victims and survivors of domestic abuse, reduce harm from perpetrators and to Michelle's earlier point, focus on prevention, which I think is where we'd all like to focus our efforts. In terms of challenges, as I said, the funding theme was a consistent one. So for some local area coordinator roles in the Health and Wellbeing Strategy Key Neighbourhoods is due to finish at the end of March 25. The roles show a system-wide investment cost avoidance ratio of at least one to three. There is risk that this effective one to one relationship, relational support in our key neighbourhoods is lost, which will lead to escalating needs and unsurprisingly corresponding increased service pressures. The Household Support Fund scheme, many of you know, has been extended until April 25. But after that, there will once again be a gap in terms of vulnerable resident support. And the serious violence duty funding is due to come to an end at the end of March 25. So we're pending a few things, particularly around cash, but when are we ever not, I suppose. Very happy to take any questions, Chair. Thanks very much, Mark. I mean, just some comments on the funding, because we're looking forward to the local government finance settlement, which will be published on the 19th of December. So at least it's not Christmas Eve this year. But those of you that follow these things will, and I'm not making a dig, but the NHS received 22.6 billion, and adult social care received 600 million of the 1.3 that were set aside from local government. But actually more particularly, more important was the 1.3 billion, the 700 million, with 680, in fact, for the adult social care. The balance, though, is being distributed via effectively an enhanced deprivation index formula. So those councils that the government believe have seen a reduction in their income. This is a kind of, they say, a one-off sort of reset. But from a local government will, next week the government will kick off a funding review. Some have described it as a fair funding review. I can tell you now it won't be fair for the county of Surrey. And that funding review will bring in from 2026 a new way that all of the formulas that are currently used will be reviewed. And I'm afraid that it will be very unlikely on the basis that two of the key metrics that the government will use to assess the funding going forward are deprivation and your ability to raise council tax locally. We have a high council tax base here and we will be expected to optimise that. So, as you said, Murray, I mean, there are already these pots of money that we had come to rely upon both as a county council and as a district and borough councils are drying up. And, you know, we face, you know, although we are going to see a multiple-year settlement, the talk now is that not being a three-year settlement but a two-year settlement. But there needs to be flexibility in that because, as we've seen, you know, whether there are things that are outside of our control, whether that's, you know, a war or inflation and so on. So, if it's fixed for two years or three years, that could be considerably damaging for funding. But it does mean that you certainly, within that government, and I know the NHS have similar challenges, we are going to have to look very, very closely at every pound that is spent and make sure that that is spent as wisely as possible. So, you know, and we do need to protect a number of these service areas. So, I think that that is the work that all of us collectively need to do. And I'm afraid to kind of recognise that the pot is going to get, if it doesn't get smaller, it's certainly not going to get bigger and it is going to get more and more challenging to make sure that we are able to support those that are most vulnerable in our communities. You know, we have 24,000 people accessing adult social care. We have over, I don't know, 13,000 children now with education and healthcare plans. And both of those, the demand is rising exponentially. And the cost of delivering those services is also rising. So, it is important that there is a third criteria that the government look at, and that is actual need, or for actually need and cost of delivery, which we know in the South East is higher than it is in other parts of the country. So, there are lots to be getting on with. But, you know, and I think actually the Bridge the Gap service was funded through National Lottery and MHCLG as a pilot, wasn't it? And, but we have confirmation that that's going to, that's going to stop, aren't we? Okay. So, anyway, that's, you know, money is something that troubles us all every day. Sue. I think it's looking at that social impact on the people through Bridge the Gap. who are now going to be left without a service, who will then bounce around all of our different services. And if we've been working longer term with those individuals, how we can then bridge them into something else, if we can bridge them into something else. So, I think there's a piece here around our residents who will be completely impacted by the loss of that service, which has been going on for a few years. So, I know some of the Brunche organizations are looking at additional funding to continue delivery, which is great, but normally we bring the additional social value that helps to support these contracts. So, I think the resident piece here is a big one. Thank you. Sinead. Yeah. I'm grateful, Sue, that you raised that specifically because I think many of us here know the real high value in changing futures and Bridge the Gap, etc. And I know Claire and I have been talking about this closely. And I think Claire's got a bit of an update on that point, Chair, if I may hand over. Thank you. Yeah. So, appreciating the things that you said, Chair, regarding pressures, it's important, I think, to note that the Adult Wellbeing and Health Partnership directorate budget is significantly under pressure, as you can imagine. And one of those pressures is the changing futures and bridging the gap monies, which is around 1.2 million, which means it's an unfunded element of the directorate. And obviously we're really keen, having built some evidence base around the activity that happens in that space, to look at how we might support those services moving forward. We've worked closely with the ICB, so Joe might also want to step in here to look at where we might be able to find future funding. But we do also accept that we want to build a model where the voluntary and community sector becomes self-sufficient and are able to seek funding outside of the Council and indeed the NHS moving forward. But the work that Joe might want to just touch on in terms of a business case that the ICB have put forward, we've also put a bid in with MHCLG recently and hoping to hear from them next week. But we do acknowledge that that may not cover the full amount, so there is still further activity happening. Thank you. Thank you, Claire. Joji. Well, just to confirm what Claire's just said. So we are preparing a business case. Sorry, I should have started by saying you're right, Sue, and I want to be really clear that we recognise the value that the service provides. And it's really difficult, isn't it, to be in a forum where you're wholly endorsing and recognising the value that the service provides, both to individuals and to the broader system, actually, in terms of what it prevents. And indeed, of course, we had a visit there, didn't we? And we all had the opportunity to see through that lived experience the benefits that it has. And then we talk about the constraints that are financial and we need to be very open and realistic about what our current budget situations are. And so Claire is quite right. We're working together and separately in terms of how that goes forward. And there is a business case from the ICB side, which will be reviewed in January. And we're looking at, you know, sort of more creative ways in which we can fund things as well. So I'm sorry that we're not able to confirm today, but just to say that we're doing all we can. Yeah, please. Thank you, Chair. Fantastic. That's really great to hear. There's a point where we have to start consulting with staff. And this is the challenge, I think, for the voluntary sector, where funding comes really at the last minute of keeping people employed, which is really difficult. But it's great to hear that those applications are going in. There's also the cuckooing service that year on year has the same problem. So I think our multiple disadvantaged people that we work with would get everything cut at the late stage. And if we can do some planning preparation in advance and also the voluntary sector looking at additional monies, then hopefully some of these much-needed services won't be sort of on that knife edge each time. But thank you so much. Thanks, Lee. Nicola, did you have your hand up? Sorry, I can't see from here. I did, Chair. I was just wondering whether it would be helpful when we move into the new year to share the policy that's coming through the planning guidance and the financial frameworks once we know what they are for health and the NHS so that we all understand the context in which we're working, potentially overlaying the sort of positions for the voluntary sector and other partners as well. I think we all need to understand each other's positions financially and where we're being directed in policy terms. Yeah, a very good point. And I think that that is a conversation we can and should have in the new year when we've got greater clarification on exactly that. I mean, there is a lot of things coming out of government at the moment, you know, and certainly, as I say, we've got more than an eye on the funding settlement from 26 onwards. So, yeah, we'll put that, we'll find a way of doing that, having that conversation. Okay. Anything else on Mari's update? Otherwise, should we go to Lucy then on number two? Thank you. Lucy Gate, co-chair of the Mental Health Prevention Board, Public Health Principal at Surrey County Council. I co-chair the board with Alan Rostell, who represents SABP. Mental Health Prevention Board doesn't really need the same explanation. It's clear what we do. We're looking at preventing mental ill health, both in relation to crisis prevention and primary prevention, as we will be familiar with. The spotlight for this terms paper was the Severe Mental Illness Scenario Modelling and Audit, which was conducted by Surrey County Council in partnership with Surrey Heartlands and SABP. The SMI audit clearly shows that we have a higher than average excess mortality in people with severe mental illness in Surrey compared to national average. And that was really the motivation for us conducting this work. The modelling shows that reducing acute physical health demands of the SMI cohort compared to the non-SMI cohort would save significant financial funds across a five-year period. So the audit, we worked very closely with the University of Surrey to identify who our severe mental illness population are. There's a difference between expressed need and actual need. So we did look at those that are expressing with symptoms of severe mental illness as well as those who are registered as severe mental illness. And identified a number of different mechanisms and high-impact interventions which could be put into place across the system. Alongside this, we identified that people aged 20 to 29 actually are the greatest SMI cohort in Surrey with the highest prevalence rate of severe mental illness. And that those in key neighbourhoods are more likely to be living with severe mental illness. Something which we've all anecdotally known for a long time, but now we have the evidence as to where we can prioritise our efforts. And the scenario modelling, as I've just referred to, was conducted applying clinical guidance. It's given us the absolute numbers of SMI population and costs to inform recommendations to prevent the kind of late express need, which we've seen with acute service, which we're all familiar with in relation to crisis presentation. So this has informed a plan for two parts, which will be applied in two parts. A prevention plan, which will be embedded across all work streams of the one system plan. And prevention activity, which will be overseen by the mental health prevention board. And this will be a format we'll look at for the prevention board for a work plan going forward into 25-26. So this will take, as I said, for the SMI, the key recommendations for the prevention activity, which is summarised in the paper, and those for crisis prevention. And this is this population health management approach, which has been taken with SMI, has also been developed a similar approach for sleep and support for primary care, as to applying the clinical guidance as to what could be done for people presenting with sleep challenges in primary care. So moving into 25-26, we'll take these learnings for a similar approach for common mental disorders in relation to anxiety and depression. And alongside this, there is key outputs for the need across Surrey, but also work toolkits for place analysts to implement at place level. So the work plans for the mental health prevention board 25-26 will be working very close collaboration with place to deliver on that prevention activity. So beyond SMI, the prevention board has also been looking at some key quality impact assessments and recommendations that has been developed nationally and have started to work up some of the priorities for 25-26, which will include a priority focus on key priority populations of the 18 to 25-year-olds and older adults. And that's something that has come from insight and intelligence across the system from various partners and data sets that we have. In the PAC, you will have seen the outputs in Appendix 2, page 97 and 98 of the report, which shows the key impacts made this year, very much focusing around assessing need and the evidence base to inform the priorities for next year of this sub-board with, as I've said, the priority populations, some of these key interventions, some of these key interventions alongside a plan which will be developed with clear implementation, evaluation and measurable outcomes for scrutiny by this board. And alongside this, as I've said earlier, the prevention strand will run through the one system mental health plan and closely with very close engagement with VCSE partners and the co-production insights group, which also informs the mental health system committee, which oversees the one system plan and there will be close work to ensure there is quantitative inputs from the co-production and insight group to inform the development of the 25-26 plan. Thank you. Thank you. Thank you. Thank you very much, Lucy. Sinead? Thank you, Chair. I just thank you, Lucy, for that. I know that the last Health and Wellbeing Board, we looked at the One System Mental Health Plan, and I was just wondering how that connects into the work of the Mental Health Prevention Board and the work plan that's coming from that, because it just feels there's a lot going on in this space and I'm just trying to understand how it all links together. There's incredibly close collaboration between the development of the One System Plan and the Mental Health Prevention Board. So the insight and intelligence that we are using to inform the One System Plan and the Prevention Board activity is considered as one. The Mental Health Prevention Board will take primary prevention activity. And as I've said, the priority populations to really flag the key deliverables for those. So there's a vision for now to have much fewer priorities in the Mental Health Prevention Board to have a really clear focus and impact illustrated to this board and others and for residents. Then there will be a second piece which will be matrix worked through the One System Plan, which is the prevention activities, primary, secondary and tertiary prevention, which can be delivered through the different work streams of the One System Plan. So the community transformation is a perfect example of that, where many of the severe mental illness recommendations will actually sit within the community transformation work stream of the One System Plan, but we'll have that matrix reporting into the Mental Health Prevention Board to ensure it has that visibility and that importance. Thank you for that, Lucy and I know Lucy and I have a call scheduled next week, so I'll catch up with Lucy in a bit more detail. For me, I think, to Sinead's point, really, I'd really like to understand the hook into our board and the expectation from SABP. So let's have a conversation about that and really understand the governance structures to make sure you get what you need from us. Thank you. Charlotte, you're on line. Yes, certainly. Just as co-chair of the Mental Health System Committee, I just wanted to reassure Sinead that the Mental Health Prevention Board feeds directly in from governance into the Mental Health System Committee. So we would be receiving updates from the Mental Health Prevention Board on all of these items in Mental Health System Committee, which is our agreed system level cross Surrey, including Frimley's route for all things mental health. So that might help Aruna as well, because obviously SABP are also represented very centrally in that committee. Thank you. That's really helpful. Thank you very much. Thank you, Ruth. Thank you, Chair. As a summary of the highlight reports, which are quarterly that demonstrate the delivery of our strategy every quarter, I just wanted to flag to the board the Health and Wellbeing Strategy Index, which sits alongside the JSNA. Really, really important. The highlight reports demonstrate our delivery, but the strategy index demonstrate the outcomes and the impact on residents. Why I'm highlighting it is because we've had in-depth sessions here before at the board, but it continues to be updated. And two of the recent additions aligning with the Mental Health Prevention piece are from the Joint Neighbourhood Survey, proportion of residents who agree there are places where people can meet up and socialise in their local area, and proportion of residents who agree there are people in their local area where they could help them if needed. So just two examples of how we continue to monitor those high-level outcomes, and we continue to flag those when they're going in the wrong direction as part of the highlight reports. Thank you. I'll put a link in the chat. Thank you, Ruth. Rachel. Thank you. I was really interested and troubled, I suppose, by the fact that people aged 20 to 29 are the largest group in the SMI cohort, and really aware from thinking about children and young people's mental health that these are young adults, and it's not very long ago that they were children. So there's a clear connection, isn't there, between this group and what's going on in childhood. I mention it now because later on, when I introduce the annual report for the Children's Safeguarding Partnership, you'll see that the Safeguarding Partnership is clear that there's a safeguarding element to children and young people's mental health, but the remit is kind of outside the grasp of a safeguarding partnership alone. And so I wanted to kind of draw that thread of connectivity between what's going on for these young adults, what's happening in childhood, how we safeguard children with mental health issues. And I suppose ask whether you had any reflections about what needs to go on in the children's space in order to perhaps improve that. Thank you. So for assurance, the Children's Mental and Emotional Wellbeing Strategy and the work plan from that is being considered as the kind of wider children and young people focus. In relation to safeguarding, there are real challenges around the 18 to 24 group, which is one of the reasons why this has been selected as priority through the real time surveillance for suicide, prevent for suicide and serious suicide attempt and the safeguarding around that for 18 to 24 year olds. And so that is a one of the key recommendations from the initial focus work that we've been doing as part of the Mental Health Prevention Board is to look at and review the safeguarding opportunities. Once people, well, once C-SPAR isn't an option for the cohort. This is particularly important. We found in education settings where we have 17 year olds alongside 18, 19 year olds and the safeguarding arrangements being completely different. So part of this is to support that and to support professionals to have the confidence to use safeguarding procedures, both for children and for young people, which again, we've identified as a key barrier and a key recommendation to overcome that. So working very closely with safeguarding will be absolute priority through this action plan. So also important, I think, to recognize that these young adults who were very recently children and young people within those cohorts, there'll be lots of young carers who we know will have come under significant pressure to look after their parents and other family members. And we still only reach a really small percentage of the numbers that we know are in Surrey and in the system. And so, again, I think we need to do everything we can to redouble our efforts to find those young people, those young carers and young adults and support them in terms of their sort of long term trajectories and an ability to realize their potential having taken those onerous responsibilities, you know, sometimes from ages of four or five. Thank you. Yeah. Yeah, that's a good point, Sue. I mean, I think it also reinforces the fact that we do need to invest in prevention and early support and intervention. And we will continue to lobby government, not least of all in terms of some funding to assist us to do that. Michelle. Yeah, just saying in relation to our statistics around young people in the kind of domestic abuse space and violence against women and girls space is similarly as shocking in terms of what they experience as children and then what they go on to. But in terms of the general population, for us, the most damaging thing right now is pornography and online exposure, what that does in terms of your expectations around relationships, your lack of performance and abuse and influences. Unfortunately, I think that we haven't quite got a grip of that. And lots of places haven't got a grip of that. But for me, in terms of young people's mental health and as they go into adulthood, those are really crucial factors that we need to properly understand. It's not things that people want to talk about. But in terms of health and wellbeing, mental health, sharing of intimate images, lots of people take their lives because of that type of thing. We need to really address that, I think, as much as we can. So happy to support in that space. Okay. Yes, Alistair. Thank you, Chair. I think, like everyone, I share the concern particularly around people aged 20 to 29, that cohort, and also the younger cohort of 18 to 25. I think there's a real concern about this really, really useful evidence, but very shocking evidence around the SMI cohort. But I also wanted to come back to this figure that has been sort of extrapolated of, I think, a saving of $448.5 million over five years, which I think is really important for us to consider. Obviously, what we want is we want that SMI cohort, the outcomes to be greatly improved. And I think looking at recommendation three, which was about a focus on wellbeing more holistically, as opposed to just self-treating or managing the SMI, I would just ask whether consideration is being given to creative solutions, solutions based around creativity delivered by cultural organisations in the places or near the places where we know they're the highest need. Because I think from the experience of the cultural sector, we know that there are really, really great support mechanisms that we can put in place, that are in intimate settings, that are perhaps less off-putting, more welcoming, that give an opportunity for expression through creativity and give the opportunity to help support mental health outcomes. And I just wonder whether there is consideration being given to, you know, I mean, I just know that, you know, when every power matters, as the chair has highlighted, you know, a 1% investment against that $448 million in cultural and creative solutions to recommendation three would potentially make an enormous difference. Absolutely. Absolutely. That is being considered in relation to the community's work that's happening in those priority neighbourhoods and with the priority population groups, which is the priority population groups work as being scoped currently. The community work is very much supported by talking to which we all know have the evidence base of five ways to wellbeing, which includes those connectivity options, those physical activity options, those creativity options, which are very much led by the community's voices themselves as to what people would want and need developed within those communities. Absolutely. Thank you. And if I can just add, you know, if we can be of any support across the cultural sector and connecting into communities, either through the Surrey Cultural Partnership Board or through the wider cohort of cultural organisations, we'd be very happy to come to that conversation. Thank you. We'll follow up on that. Thank you. You've got lots of letters there. What do those stand for? Yeah, I did wonder. Right, okay. I think then we will go to the recommendations, which are three, I won't read it all out, but to use the highlight reports to increase awareness of delivery against the strategy, health wellbeing strategy and the recently published up and coming JSNA chapters. The JSNA is our heroic document. I would encourage you, if you've nothing else to do over Christmas, to read the odd 40 chapters or even the odd one of the 40 chapters. So they are, it is a great read. Also then to note the functionality, increased functionality of health wellbeing strategy index and then to respond to specific significant challenges of which some of those are listed. Are those, you're happy to read those recommendations? Excellent. Thank you very much. In that case, we will move seamlessly to item eight, which is the, an update on the, from the, sorry, Safeguarding Adults Board. And we should have with us online Teresa Bell. Are you there, Teresa? Yes, I'm here. Ah, okay. Okay. We can't quite see you at the moment, but I'm sure you'll appear. You're very welcome, Teresa, as always. And I think you were just going to sort of give us a little bit of an update on where things are, as far as your board is concerned, if that's okay. Yes, thank you. Thank you very much, Chair. And I, I think that Councillor Mooney wanted to say a few words before I, before I came in, but I'm happy to switch around if that's, if that's more appropriate. Oh, Sinead, sorry, do you want to say a few words first? Thank you, Chair. Thank you, Teresa. Um, I just, uh, just wanted to, um, acknowledge things we already know, really, but to really, um, say that the Safeguarding Adults Board has a strategic role, which is really is greater than the sum of the operational duties of the core partners around here. Uh, the board oversees and leads adult safeguarding across Surrey and is concerned with a range of matters which may lead to abuse and neglect. Effective safeguarding does require collaboration between partners to create a framework of inter-agency arrangements and must also consider the wishes and feelings of the adults on whose behalf they're working. So after the last 18 months, the, uh, Adult Safeguarding Board has made a very strong commitment to that strategic direction, emphasizing how safeguarding risk may be managed nearer to the point at which it is identified and by applying more active multi-agency approaches. And I think this is really shown out in the annual report that Teresa is going to refer to. It shows the challenges, the achievements of the partnership during 23 and 24, and it also highlights and summarizes the risks for the year ahead. The increasing demand and complexity of safeguarding issues in the context of resource constraints makes the role of a stronger partnership all the more critical. And I just wanted to say these words, chair, because the members of the health and wellbeing board, um, are really important, um, in giving consideration as to how we'll all continue to ensure that our organizations continue with the strong commitment and the active engagement with the board. Thank you very much. Thank you. Thank you, Sinead. Thank you. Um, Teresa. Thank you. Thank you. Thank you very much, um, Sinead. And, uh, I haven't got a great deal more to add. You have the report, uh, which I hope that you find, um, useful, um, and interesting. And it's always difficult presenting these things because obviously it's the previous year and, uh, we all work in the present, don't we? Um, so it's kind of, we're, we're at the stage of looking forward now. So I think that's what I particularly wanted to, um, emphasize here that we will be coming up to, um, a point where we review our strategic, um, priorities. I don't think they will change hugely, but, um, I, what we will be looking at is what the specific, um, focus and, uh, actions, um, uh, that we need to all work together on, uh, need to be over the next couple of years. That will be happening early in the new year. And I would encourage, uh, members of this board who have, um, partners represented to ensure, um, that they have the appropriate level of representation at the partnership board so that they can feed into that strategy, um, over the, over the next few months as we develop it. Um, I think that's all, all I wanted to say other than, uh, clearly, although this is a statutory requirement for us to produce the ANA report and present it to the health and wellbeing partnerships, um, it feels, um, obviously very, very appropriate, um, listening briefly to, to the, um, last presentation and looking at the rest of the agenda. Obviously the partnership work on safeguarding is, is, is fundamental, um, to, to many of the items that you'd be discussing today. Um, so, uh, yeah, just very pleased to have this opportunity to highlight it for you. Thank you. Thank you. And as always, thank you for all of the work that you do, uh, through your board. I mean, there, there couldn't be anything more important than keeping safe both our children and our vulnerable adults. Um, Sue, do you want to go first? Thank you. Thank you. I wanted to, to commend this, uh, report, um, and also to say how important and how good it was to see the message from the chair talks about carers and those who they look after in the opening couple of paragraphs. And I think that's, um, a really important, um, aspect to, to see introduced there, uh, right at the start of, of your message. So, um, on behalf of those unpaid carers across the county, um, I'd like to say thank you. Thank you. Thank you very much. Thank you very much. Uh, thank you very much, Dr. Tresman. And if there was, um, any, um, opportunity to talk more about how we could involve, um, the voice of unpaid carers in the board. I'd be really keen to follow that up with you. We've, we've increased our engagement across the community and voluntary sector over the last year, um, in the partnership board. But, um, as you've just highlighted, it's an extremely, um, important, um, uh, workforce, unpaid workforce out there. And we need to ensure that they are, um, that we're aware of where they are, who they are, and that they're fully supported. Thank you. Thank you. I mean, in response to that, I would say let's, let's take that offline. I'd be delighted to, to support in any way we, we can. Um, it's just so important to see that lived experience and the role of in excess of 100,000, uh, unpaid carers, but probably many more, um, you know, fully reflected in this vital, important area. So, uh, yes, let, let's be in touch outside the meeting. Great. Thank you. Any other comments or thoughts? Um, otherwise, um, Tres, thank you very much. I know that these two reports are sort of almost back to back, um, but we're now caught up, I think, in terms of, I think so, um, uh, and again, I think we're just going to have a little look at where, um, where this report comes to. Um, I mean, I think at the moment it comes to this board, it goes to the cabinet, council, and I don't know where it goes within the NHS system as well. But, um, uh, anyway, we'll, we'll, we'll pick that up with you, but it, but it's, it's, you know, it's very good to see you and say thank you very much for all that you are doing. Thank you. Thank you. So we will now move, um, to the children's, um, annual report. Oh, yeah, the recommendation, sorry, yes, which is to, to consider a note to the attached, um, annual report for 23-24, uh, and indeed to consider how we can support, uh, the board's journey for 24-25, which, which, uh, is a kind of constant conversation. So I, I'll, I'll take it those, uh, we're all happy to agree those. Um, in which case, um, I will, um, move on to the next item and we should have Derek Benson with us, the independent chair. Yeah, good morning chair, I'm here, I don't know if you can see me. We will in a second, um, Claire, did you want us ending by way of introduction first? Um, I have not very much to say in the way of introduction other than to welcome Derek and to, um, say that like the, uh, adults board, the children's is a partnership board of all the statutory safeguarding partners. And, um, um, I'm sure Derek will outline the work that was done last year and the, the, um, progress that was made towards the targets that were set by the board. And just to add that, um, although I'm the lead member at the authority in, in respect to the safeguarding partnership for children, I have a rather strange role. So I'm a participating observer. Okay. There we go. Right. Um, morning, Derek to, um, over to you. Thank you. Uh, good morning, everybody. And thank you for the invitation to join you this morning. Um, if it's okay with you chair, I will take my lead from Teresa and, uh, be very, very brief. Um, the report is there for everybody's consideration. Hopefully you've had, uh, time to read it. Um, I don't know if Alison Cutler, the partnership manager has joined us. Um, she's put in a tremendous amount of work to pull that together. It outlines the priorities of the partnership, which, uh, like as Teresa said, it's for the year from the 1st of April, 23 to the 31st of March, 24. The priorities in that year being around neglect, early help and mental health and wellbeing. Um, and again, as Teresa said, we are in that point of looking forward. Our priorities at the moment are, uh, you've taken on from that neglect, early help still there, but, um, safeguarding adolescence, which does include mental health and wellbeing, as you would hope. Um, looking forward, we're at that point where we are about to transition to the new arrangements. And as of the 1st of January, um, the chairing role will be taken over by, uh, Rachel Wardell, who, um, as always sat next to Councillor Curran. Um, the working together 2023 required us to, um, prepare and get those arrangements ready for, uh, the end of this year. And it's, um, safe to say that Surrey is in a good place in terms of being ready to start with those. Um, I would commend the report, uh, to, uh, the health and wellbeing board and the ICB and happy to take any questions that you may have. Um, as I exit stage left at the end of this month, I think I could look anybody in the eye and say, um, the partnership is in a good place. There are and always will be challenges. Um, but handing over to Rachel, um, I'm sure she will, uh, take it to, um, even greater levels of partnership working and, um, cooperation between the, the necessary agencies. And I'll stop there, chair, if that's all right. Yeah, thank you very much, Derek. Any questions? I think that there is an independent person as well that sits alongside the chair. Is that right, Rachel? Yeah, I'm, uh, happy to comment on that. So, uh, our current arrangements, and they, uh, last until the end of December, include an independent chair, which is, uh, Derek, who's with us today. And also an independent scrutineer, um, who is, uh, Liz Murphy. And the chairing and scrutiny, uh, functions in some safeguarding partnerships have been vested in one individual and in other partnerships in two separate individuals. And in some partnerships, um, they, uh, commissioned their scrutiny item by item, um, and get different people to, to do it. The guidance in, uh, working together 2023, which, uh, Derek alluded to, uh, changes, uh, some of the arrangements and makes it explicit that partnerships are not expected to have an independent chair. And it removes that role, uh, which is why, uh, the chair, the chairing, uh, comes to one of the statutory partners, which is the local authority, the police, um, or the ICB. Um, and, uh, on a rotation basis. And I'm picking, I'm picking up the first rotation. However, the expectation of independent scrutiny continues, um, and Liz Murphy continues in that role at this time. Thank you. Yes, Paul. Yeah, thank you for the report. It's a, it's a very interesting read. I just wanted to think about it in terms of how it affects operation as well as strategically. Um, I, I think we all recognise the huge pressure that children's services are under statutory. Um, and, and the challenges of staff and keeping staff and just the, how to deliver operationally. And I, I wonder whether there's an opportunity within the board's room at looking at the priorities, which is at the moment very much about theme, which is how to actually improve that working delivery between the way in which VCS organisations and the statutory partners work. Because I know that some of my colleagues sometimes can find themselves putting their heads against a brick wall. Um, and there's some different models of how that operates that work better than others. And some different practices that have worked better. And sometimes communication lines are being set up working better than other places. So I wonder if there's space in here to think about the future work programme about improving the way in which that liaison works. Um, in order to try and, um, affect the, the ability to support individual families, particularly those that are, uh, that are in or near crisis. So I'll respond to that because it, uh, seems to be directed more at the operational, um, running of the children's service rather than the activity of the safeguarding partnership. Um, but from a safeguarding partnership point of view, um, the early help subgroup is, uh, focused, uh, strongly on that interface. And because a huge amount of the early help for children, young people and families is delivered, um, by third sector partners, um, and other organisations. We see a lot of early help delivered through our schools and, um, um, educational settings. Um, and that, uh, subgroup, um, that focuses on that priority is co-chaired with a third sector partner. Um, so that is one of the important locations where, uh, the engagement with the third sector, uh, really stands up. Um, I would say, um, um, the other area, um, which speaks, uh, more to the interface that you've described, um, is the work that has been done around the C-SPAR. That's the children's single point of access. So there was a joint targeted area inspection in March of 2023, um, and that, uh, made some recommendations including, um, greater oversight, um, of early help by this partnership, which is why it became a priority, and you'll see that addressed throughout the report. But also looking at what the interface between all organisations was in that children's single point of access, it increased the multi-agency partnership presence there. And it also led to further work on what's known as the FAST process. That's finding a solution together. Um, and that is a process which all partners are engaged in, um, to when, when, um, when there's a kind of an interaction between, uh, any partner organisation engaged in children's safeguarding, and another partner organisation engaged in children's safeguarding, and there's a sense that the partners are not rubbing along together well, or they're not acting together in the best interests of the children. And so the FAST process has been put in place very much with that point of view, so that the, kind of, the, the discussions are appropriate, their child-centred, their family-centred, and that whatever organisation or agency, um, is sort of, I suppose, finding difficulty landing the safeguarding, um, situation with another partner can use the FAST process to address that. Um, and we continue to, uh, we continue to operate with the FAST process, um, and test that. Um, and two, uh, partnership meetings ago, I explicitly asked partners to feedback if they were, uh, using it and finding it, um, effective, or using it and finding it ineffective, um, because historically, when people were finding those issues challenging, they would, uh, they would write to me, or to one of the other statutory partners, or to the chair, and we were not getting that kind of correspondence anymore, which seemed to be an indicator that that FAST process, uh, uh, was now addressing some of the things that you, um, you know, that you, um, that you, you know, that you refer to. So, my hope is that through those mechanisms, um, the early help, uh, subgroup in particular, the FAST process, and then that, um, oversight, um, by the safeguarding partnership of the, of the whole of those arrangements, uh, would have rather improved that. Okay, um, I can't see any other hands up. So, um, um, we go to the recommendations, which is to, uh, note the annual report for 23-24, note the priorities for 24-26, which is around neglect, early help, and safeguarding adolescents, and then note the change in the working arrangements, as we've discussed, um, from 1st January, uh, 2025. Um, again, I'll take those as, as agreed. Um, Derek, on behalf of this board, um, can I thank you very much indeed for, uh, all that you have done, um, since you've been in the chair role, um, you know, both of these, the chair of adults and children, that are very busy, busy, uh, busy roles, and, and, um, and I'm very grateful to you on a personal level. We have all, we have regular conversations, uh, and also the, what you have brought into that role from your, uh, wider, uh, wider experience has been really useful. So, uh, thank you very much indeed, and, uh, wish you well in whatever you will be moving on to, uh, after this. Thank you. Thank you. Okay, so shall we move then to, uh, item 10, which is the Surrey-wide immigration strategy. Ruth. Thank you, chair. I'm just going to provide some context before I hand over to my colleagues Bashir and Hannah. Um, we're introducing today our draft Surrey-wide immigration strategy for your engagement and input. Of course, not a day goes by for immigration being on the news, both nationally and internationally. It's not a new issue for us, um, globally and here in Surrey. We've got a really, really long and proud history in Surrey of providing sanctuary for people fleeing crisis, but that's been particularly the case in the last few years. We've continued to welcome migrants, asylum seekers and refugees, um, as migration patterns as we've all seen in response to, of change in response to global pressures, war and instability. And our essence of our strategy and our whole board, um, of no one left behind and reducing inequalities of health have been exemplified by Surrey residents who've opened their homes and hearts to welcome new arrivals. Despite all this, we do realize this situation brings with it challenges and they're challenges that we need to face as a collective. Uh, so hence our draft strategy today. Um, some of the context and background to this is, uh, the JSNA chapter on this topic was, uh, published last year in 2023, highlighted some of the experiences of vulnerable cohorts of migrants and issues such as difficulty accessing services, difference in presentation and awareness of mental health conditions, impact of cultural differences, and the complex nature of the pre-migratory experiences. And this was brought to light this year, um, the annual public health report. We, we looked specifically at this, um, topic of the health needs of vulnerable migrants which focused on primary care, mental health, women and children, education and housing. And very recently, as you will see in your annex of this paper, um, we've undertaken quite an in-depth piece of research, uh, working with those with lived experience. So three big pieces of work that's contributed to our, our, um, draft strategy, which sets out our intent and role as a system partners of how we're going to continue to work collaboratively, uh, to ensure people are welcomed, feel safe and supported, regardless of their personal situations. And it brings together those strands of work. I just want to highlight two things to note, um, because immigration is a really, really broad, um, term, referring to all forms of voluntary and forced migration into a place. So this strategy focuses on a group that we're labelling as sanctuary seekers, due to their migration status, which gives heightened vulnerability, which, uh, therefore often needs a greater need, um, for services and support in the wider system. And the second point I just wanted to note, we've touched briefly in the introduction, that at previous meetings, we've, um, talked about our poverty pledge. Um, and as this was signed very recently, both as a health and wellbeing board, but as various organizations. And of course, we'll need to draw references, especially to some of those groups of sanctuary seekers with no recourse to public funds, and how that aligns to our poverty pledge. So two points for context. But I'm going to hand over to, um, Bashir and Hannah, who are going to, um, walk us through some of the points of the strategy. Thank you. Thank you, Ruth. Um, so it was really important for us to make sure that the development of the strategy had input from residents with lived experience of seeking sanctuary in Surrey. Um, so in collaboration with the resident insights team at Surrey County Council, we facilitated a series of focus groups with adult and teenage sanctuary seekers. And these groups were asked to review and discuss the draft strategy, and particularly looking at the strategic objectives to ensure that they reflected the experience of seeking sanctuary in our county. Overall, the reaction to the strategy document was very positive, with participants agreeing with the strategic priorities that the system had set out. Participants also agreed with the term sanctuary seeker and felt that it was a helpful umbrella term for the complexity of experience across different migration pathways. The experiences of participants in seeking sanctuary in Surrey were a mix of positives and negatives. The full write-up is in Annex 2 of the report that you will have seen, and that captures the discussions in more detail. But a few of the headlines I can pull out here. So many of the participants faced challenges in finding suitable housing, and this was seen as a priority for all participants in the focus groups. We heard one testimony of a Ukrainian family that had been asked by their private landlord to pay a year of rent up front, causing them to borrow a lot of money in order to remain in housing. The young participants that we worked with highlighted the importance of therapy and access to mental health support, given the trauma that sanctuary seekers have often experienced in their home countries, on their journey to the UK, and in navigating the complex systems once they're here. They also flagged that frontline staff and service providers need to be aware of the way that trauma impacts residents who are seeking sanctuary. Transport was flagged as a challenge in all groups, with specific problems around frequency of service, communication about discounts or financial support that was available to them, navigating a complex bus system with different providers, and the availability of service more rurally. We heard really positive reflections from participants on their experience of community integration. Many said that they felt very welcomed in their communities, and found their community spaces such as parks, community centers, and libraries to be really welcoming. And lastly, skills and education was a priority across the focus groups. Participants in particular flagged the importance of timely and appropriate access to English classes, but there was also discussions about the difficulty of accessing more vocational training, or of translating existing qualifications from their home countries in the UK to be able to access appropriate work where they were able to. I'll just move on to the next slide. So this sets out our strategic objectives. The strategic objectives form the heart of the strategy. They are the priorities and direction that the system has agreed. The objectives are categorized under four headings. Meeting basic needs of sanctuary seekers, economic inclusion, community and belonging, and working together as a system. The objectives that sit beneath these headings include access to housing, skills, and medical support, as well as objectives for how the system partners can work better together, such as better data sharing. I'll hand over to my colleague Bashir. Very good morning, everybody. Thank you, Chair. And thank you, Ruth, for providing a very high level of what we have done for the last six months. In terms of the governance and recommendation, we haven't created any different governance that was created before. What we have focused was to bring more formalized to this work. And then for that, when you see from the left side, the committee task and response subgroup, which are our education, health, and Ukrainian task and finish group that is there, that reports back to our Suri-wide immigration group, which our respective public health director, Ruth, is chairing that meeting. And then that meeting happens every two months for now. And then what we have added to our current governance is we have added our Suri Chief Excel group and then our health and well-being board. And then these are the more formalized structure that we have proposed in the strategy to see how we could bring more formalized work. And then, on the other hand, bring more senior-level buying and then focus on how we would deliver our delivery plan based on this governance. Back to you, Ruth. Thank you. Thank you, Hannah and Bashir. So, I just want to draw the attention of the board to the recommendations at the bottom of this slide. But before we go into those, Chair, there may be some questions or comments. I'd just like to applaud this team, really, for the absolutely exemplary example of that co-design and engagement with people with lived experience. When you read the report in full, it's quite overwhelming the experience that people seeking sanctuary have been through in Surrey. And I'd just really like to applaud your team for approaching your strategy refresh in such a way and also, obviously, endorse and support the draft strategy. Thanks. Yeah. Well said, Charlie. Thank you. Anne-Marie. Thank you, Chair. So, just a very good strategy. I completely agree with what's in here. So, while we're saying that those who are sanctuary seekers would, in future, be treated in the same way as any other immigrants who are being helped and supported in the system. Is that the key thing that's happening here? So, the strategy largely doesn't reinvent the wheel. A lot of what's included in the strategic objectives are already things that the system are delivering against. Sanctuary seekers, it's an umbrella term that makes up many different pathways. For example, people who've come here on resettlement schemes, but also people who've come and accessed asylum. So, there are legal frameworks within which system providers need to work in. The objectives are high level enough that we can develop a delivery plan and work together as a system in order to kind of meet those objectives within the legal frameworks that individuals are here for. So, there won't be necessarily universal treatment for all people who sit under a sanctuary seeker, but the objectives are high level enough that we can work towards them within the framework. Claire? Thank you. I noticed at the beginning of the report that there is reference to the number of young people who arrive in the county's unaccompanied asylum seeking children, those who are under 18. And obviously, the council has a statutory corporate parenting duty towards those young people, which continued to the age of 24 as care leavers when they continued to be supported by the service. So, I just wondered how much interface you had had when you were preparing this report with our looked after and care leavers teams who support those young people. And particularly when you did your focus groups, whether you had linked in with them, the user voice and participation teams, who still continue to work with those. And the other question I had, I know you refer to the big leaf charity, but did you also integrate, did you also approach the other community-based units, charities that work with asylum seeking families and refugees? I know they do some amazing work in and around the Epson group, in and around Elmbridge. There are quite a few other questions, so we might just take a couple more first and then come back to you. Sorry, Mari, I've missed you the first time around. Thank you, Chair. Mine's along similar lines in terms of interfacing of the strategy so far. I know that you've been to the Surrey Housing Officers Group. I would suggest that maybe you consider the board that will oversee this actually has representation from that group on it. Bearing in mind, housing is one of the key challenges. And those leavers often are at a district and borough level. So, I would suggest that you think about bringing them into the room to help try and unpick and represent some of the realities around those challenges. And also, I'm not sure where else it's been yet, but consideration is given to actually going and spending some time with some of the teams that we have at a district and borough level, who are working directly with those individuals. So, obviously, you've interfaced with some individuals, but I think going to spend time, because we've been managing these types of schemes for 10 years, and I think, you know, there's some real lessons to be learned from some of the people at the coalface of that work. So, thank you. Thank you. I'll start with the question on UASCRA, unaccompanied asylum-seeking children. So, yes, we did work really closely with Big Leaf, and they helped to facilitate one of our focus groups, which was specifically with young people that they worked with. So, either individuals who are currently unaccompanied asylum-seeking children, or who had come into the country as unaccompanied asylum-seeking children. So, that was one of the focus groups that we worked directly with. And we also worked closely with the voluntary sector. So, Big Leaf being one of our partners, but there are many more. We held three different focus group sessions with the voluntary sector, with various providers in the voluntary sector coming around the table to discuss the draft strategy. We had input beyond the Big Leaf charity as well. In terms of district and borough input, absolutely. So, we went to the housing officers group, but we also had a dedicated focus group with district and borough colleagues, who were either in housing or some of the refugee resettlement teams. So, I think we have had really good input from them to date. But we will continue to engage with all of those partners as we look to the delivery of this strategy. And, Mari, it might be worthwhile putting it on the leaders and chief execs agenda, so that people are fully up to speed. Just on that, Chair. We are also going to Sarai chief exec in January the 17th. Not to the leaders, but we can definitely consider that. That's fine. Yeah. And if you want to share with the leaders, you can do that as well. Good. Okay. And then I think we've got Rachel and then Paul. Thanks. It's a question, actually, that might be regarded as a bit nitpicky, and it's possible that this strategy sits in a way that it doesn't need to go into this level of detail. But you alluded to the fact that the definition of sanctuary seekers therefore covers lots of people that might arrive by a range of different routes. And we'll have a different set of rights and entitlements depending on that route. And we'll have different duties and obligations towards them. And, of course, what we're trying to do is support and enable them to live their best life here in Surrey. But there will be restrictions and there will be a range of allowances. And one of the areas that is governed really tightly is whether someone is a child or an adult. And there wasn't any reference to age assessment in here. And age assessment is very fraught for two reasons. One is it's absolutely vital that if someone is a child, they are treated as a child, welcomed as a child, supported as a child, and they become a looked after child to Surrey. It is equally important to make sure that if someone is an adult that they do not have access to children. They're not supported in places in which children are supported. That doesn't help to keep children safe. And so that's a really kind of critical point in the kind of the systemic treatment, I suppose, of people who arrive seeking sanctuary. And I would hope we might be able to find a way to make reference to that within the strategy, just to, I suppose, support everyone who sits on either side of that age divide when really we just want humane treatment for everyone. It's a good point. But, of course, the assessment of age is a challenge in itself. Paul, do you want to go ahead? Yes, thank you, Tim. I can run out. I think this is a really thorough and comprehensive piece of work for thinking. I'm really, like Charlotte, very pleased to see the lived experience element of that. I just have one observation, which is you identified four sort of strategic objectives, but my quick count then made 18 priorities and 47 objectives. And I just wonder whether you have a sort of sense or understanding within the team about what are the three or four things that really, really make a difference and therefore should have most attention or most resourcing or most bid for external funding as opposed to the other 14 that perhaps are important but perhaps not the focus of attention. That's a very challenging question and one that I don't feel qualified to answer at this stage, but definitely now as we look to the delivery of the strategy, we will be doing some of that sense-checking of what are some of the short, medium, and longer-term ambitions that we've set out in the strategy and how can we work together as a system to prioritise. You are right, there's a lot in there. Not all of it is deliverable at a kind of short timeframe, and there probably will be priorities within there that we will need to figure out with our partners. Where can we make the most impact, the quickest? And to add on to that, that the Sui-wide immigration strategy itself is one-of-a-kind work that has been happening in the Southeast regarding to our strategy. So that itself, when we look to more detail of how we would develop our action plan, there is more criticality in terms of what kind of wraparound support, how coordination and communication and engagement would happen, and what would be the roles and responsibility of not just our respective district and boroughs, but our respective volunteer sector and faith group as well. So there is a tough work ahead of us in terms of developing and bringing that commitment to the action plan to work for a mid-term and long-term plan for that immigration strategy-based action plan. And as we know, it's a dynamic area. I was listening to the Board of Security Ministry of the day around Syria, and we're just going to have to see how some of this stuff plays itself out. And so thank you very much for that. I mean, it's a strategy that needs to be built up and needs to be flexible, depending upon quite what is happening on the world stage, apart from anything else. Ruth, was there anything you wanted to say? No, just to say thank you very much for all your comments. I was smiling at Paul's comment question, because in essence, that's the very reason why, as an immigration group, we're pulling together a strategy because there was almost a plethora of priorities that kept changing on a weekly, monthly basis, but prioritisation in the new year is going to be key. Now we've had quite a lot of ongoing engagement that will be ongoing, so that's definitely our next step to translate this into a robust action plan that we can monitor and feed back to this Board. Thank you. OK, thank you. The three recommendations are to approve the draft salary-wide immigration strategy, endorse the ongoing engagement on the draft salary-wide immigration strategy, and thirdly, to approve the proposed governance structure within the draft strategy, including the Health and Wellbeing Board and ICP's ongoing role in overseeing delivery against the strategic objectives. Are you happy with that? Good, thank you very much. Right, I saw a mass of people join just a little while ago, so we are honoured to have all of you here, actually. I thought we were going to have you online. So the next item is the Surrey-Heartlands United Surrey Talent Strategy, three-letter acronym for the NHS, and Health and Social Care Academy. And we've got, I think Sue, you're going to join in as well, but... Michael, are you going to kick his off? Sue's going to. Thank you. Thank you, Chair. Thank you, Michael. Welcome, colleagues. I'm really starting the open conversation around the role of the VCSE Alliance in workforce. So I stand as the Portfolio Lead for Workforce for the VCSE Alliance, and was kindly invited to a workshop back in April 2022, which had a number of organisations there talking around their workforce and the involvement of the system. And what was really key in missing at that point was the role of the voluntary sector, and the understanding of our role within the Surrey system. Everyone told me that they would help me with volunteers, which was really commendable. But actually, through the voluntary sector, there are a number of really key high-profile roles that we deliver on behalf of some of you here around the table who commission us to deliver. So it was really great to be involved at the very beginning of that workshop. And through that, we were able to then to put in the United Surrey Talent Strategy, which I hope that you've all had an opportunity to read through. And from that platform, hopefully, I then made some impact, because I was then invited, along with the Chief Exec for Surrey Care Association, to sit on the panel for the Innovation Fund, which then saw 32 pioneering programmes go through. There were a lot more applications. And I remember at the very beginning, a colleague saying, why are we not getting applications from the voluntary sector? The statutory colleagues were really quick to mobilise into putting programmes forward for us to consider. But the voluntary sector took their time to partner with other people to put their applications through. There was huge learning, I think, for Michael, myself, Surrey Care Association, and Surrey County Council, who were also part of the panel. We really learned from each other. And what I thought was actually the issues and problems through the voluntary sector, I learned actually was the same for all of us. So it was really good learning. What was really great about the fund and the panel was that we were all equal. We all chaired the meeting. We all took decisions and actions from that. And it felt a really welcoming place for the voluntary sector to be really seen as an equal partner in the United Surrey talent strategy. And from that, with the introduction of the Academy, Surrey Heartlands Health and Social Care Academy, we were able to develop programmes through the Academy that really saw care absolutely had a programme, which is countrywide. We are leading on that through Surrey, which is great to see. And now conversations around, we're talking about a code of practice, but actually maybe a passport for volunteers that come through all of your organisations, through the NHS, through adult social care, and certainly through the voluntary sector, to have a standard that people can expect from us as organisations, but equally what we can expect from people that volunteer from us. That's in its really early days. And I'm pleased to say that we are all co-designing that together. So, I have thanked, but I would like to thank again, the workforce side of Surrey Heartlands for welcoming the VCSE Alliance. You have listened and you've heard, and you have supported us considerably through the work that you're doing. And I get invited to numerous meetings through workforce. It's almost too much for one person, and I'm sure you'd like to see other faces from the VCSE Alliance to join in some of the workforce, to really link up and join much more. There's a lot more work for us to do. We have, through the voluntary sector, seen our staff gravitate into your organisations. I think we are demonstrating that we start having volunteers that support all of us, but equally our staff are qualified, professional, and are going into your organisations. So, that development piece that we talked around in April 2022 is the foundations for us to look at our workforce as we continue on this journey. I'd like to hand back over to Michael or John. Thank you. Good morning, everyone. So, I'm a non-exec director within Surrey Heartlands, and I chair the People Committee. So, I was just going to add a couple of minutes in terms of just some of the lessons that we've learnt through the evaluation of the United Talent Strategy and the 32 Pioneer Projects. As we've heard, a key component and feature of the strategy is how cross-sector it is. We estimate there's about 50,000 people in Surrey who are delivering health and social care through all the different sectors, including VCSE as well. So, the Academy has been an absolute critical enabler to the connectivity. We've run an independent evaluation. There was an interesting network analysis as part of that to understand then how VCSE, social care, NHS are now actually much more knowledge connected, and the Academy has been a really important part of that. Just wanted to read out a couple of the key achievements. So, just in terms of training, 1,256 education and training opportunities have been provided through the Academy. You'll also see that one of the Pioneer Projects has been supporting people with learning disability or newer divergency into the workplace or paid work or placements. Again, we've been successful in 198 such people having those type of experiences. So, the evaluation is showing that the place of the Academy in the sustainability of a lot of this activity for workforce enablement is a really critical role to play. So, that therefore is leading us to ask whether the ICP can agree that we do come back with a sustainability case for the role of the Academy. I'll hand back over to you, Tim, at this stage. Michael, you don't want to say anything. Thanks, Tim. No, we're very happy to get into conversation. Thank you. Who would like to kick off? I can't believe there are no questions or challenges. Yeah, Karen, please. Just a comment, really. I think just to say the work that you've done has been a significant amount of work and I think the progress that you've made. I think what's really important is the evaluation because we start these projects and programmes and sometimes we carry them on but you've evaluated it and the benefits of it. So, just a thanks to the team that have been involved. Thank you. Thank you. John, do you just want to touch on the funding arrangements, current funding arrangements for this? Yeah, I can do that. So, we oversee an innovation fund which was jointly contributed to by the Council and by Zoe Hartman's ICP. Now, that hasn't all been spent. Large parts have been allocated to the pioneers. They've had to show in part of their bidding how sustainability will work. Now, for some it's very straightforward, for others it's very difficult, which is why we would like to pursue a business case for the sustainability of the academy in particular. We have, the panel oversees the oversight of those pioneers and where that money's going. They have to report coarsely how they're doing against their KPIs. I can't remember if it's in the summary here or not, but one or two pioneers have dropped. Others have excelled significantly. Not everyone started on day one, so although we signed this off together two years ago, actually some pioneers are less than a year old. So, next stage is to nurture them and make sure that they deliver against what they've said they're going to deliver, with the money that we've allocated. Others are to scale. So, for example, a good example for a forum like this is the Talent Hub in North West Surrey, which actually recruits and seeks to develop talent across sectors as a central hub. That appears to have got some real promise and something, therefore, we would want to scale to other areas. So, as I say, some of them have worked out their sustainability, some haven't, some for it's easier, for others it's not. But we've allocated about 5.3 of the 6 million, but nothing like that has been spent. We've got about, therefore, 700,000 still pending for allocation, but there's quite a high demand. What we wanted to do, which I think is important to reflect on in two years, is drive energy. There was a challenge for us about how do you drive top-down change, which we all know can be really hard and resisted and quite often wrongly guided, versus getting that balance and that energy of bottom-up change. And that's really galvanised. These are not big sums of money, although that's 6 million a lot. Actually, across 32 pioneers, some have got a few hundred thousand, some have got much less. The energy to be able to see their ideas and to show where they're taking them has been really comforting. When will that money run out, i.e., when will you be looking for further funding from pioneers? Well, initially, we were just going to ask for permission to come back with a case for the academy. But for the wider, we'd have to do a further report to see exactly when. It's going to be within the next two years, I would say. Others will run out faster. But as I said, if you take prescribing in pharmacy, for example, they have a sustainability plan. They will not come back for more money. Others, and it is evident in the evaluation, are struggling and will struggle. They're worried about cliff edge. But that doesn't apply to all of them. Well, I suspect the sooner we enter into those conversations, the better. Charlotte. I'll pop my hand down because I don't know how tight we are for timing, but I just want, obviously, this is a fabulous program. And I'm just reflecting on our previous agenda item around sanctuary seekers and wonder whether they could be a pioneer group in themselves. In that report, they talked about the need for their skills being recognised and being able to be in employment in Surrey. And I just it may already be that they're part of the group, Michael. But I'm just wondering whether we could do a bit of joining up. Yeah, I'd welcome that. I don't believe they are. We have got charitable support with access to employment for some groups. I don't think what you're referring to is included at the moment. We are looking for new, so certainly. I think there are other aspects of change. I don't think children's features strongly enough still as another example, so that we've recognised in the Ovalish and there are other new areas that we would want to get into. Good. Thank you. Anne-Marie. Thank you, Chair. Thanks very much for this report. It's really great to see all that work that's going on there. There's some really fantastic initiatives. Just looking at the Academy, is that something that is focused in particular areas or are things like the apprenticeships, for example, and the opportunities spread across various healthcare settings across the county? I am going to respond to that. I'm not the Associate Director of Health Integration for Sore County Council. I'm Kim Everett. I'm the Head of Programs for the Sore Heartlands Health and Social Care Academy. Thank you for inviting me today. Yes, in short, is the answer to that. We have a number of, we have within the Health and Social Care Academy, we have career and apprenticeship programs which are spread across the whole county. One of the key pieces of work we've been trying to do is understand all the apprenticeship offers that are available and pull them all together, pull all the strings together under the umbrella of the Health and Social Care Academy, recognizing there are other academy functions and other areas where apprenticeships are happening in Surrey. I mean, a couple of examples, Trainee Nursing Associates is running as a program which has a Level 5 apprenticeship wrapped around it, and those Trainee Nursing Associates are in our social care provider care and nursing homes. So that's really a real pioneering piece of work that's being supported through the Health and Social Care Academy. I mean, there are many other examples. Does that answer your question? Yes, it does. I guess a kind of further question that follows from that is, if we're looking at perhaps the apprenticeships in particular, but in general the various opportunities that are made through the Academy, how are they promoted? I noticed there was an Expo mentioned in there and several other events. There was an event at one of the colleges in the east of the county. What's the kind of wider advertising beyond the actual event based promotion? Yeah. So as well as all the careers and apprenticeship events that are happening throughout the county, we're also working in partnership with all of our colleges, which is what you've just mentioned, and also some of our university higher education providers who are starting to onboard with apprenticeship programs. The other thing we're just stepping our toe in the water is social media, and that's huge, huge. And what I've learned through the research is many younger people are accessing opportunities through social media platforms. So we've just launched all our social media platforms. Again, we're still learning as we go. So that's definitely a channel we need to use to promote. But thinking of other places we need to get to, I'm thinking in terms of faith groups and picking up on the previous point about people arriving in this country who want to get into the workforce. We've got other programs we're looking at that could lead into apprenticeship programs. Sue mentioned earlier about the volunteer sector. Something that we're looking at for next year is a volunteer charter for the whole of the county, which could enable people to volunteer to career. So there could be employment opportunities there too. So lots of really exciting work. I could talk for a whole hour about it, but I'll stop. Thank you. Can I see some hands? Yes, shall I? Thank you, chair. Thanks very much. I'm the cabinet member for adult social care. It's very interesting to hear about this. And I'm aware, I'll probably talk to Claire further, but I'm aware we probably make a quite significant investment in this. One thing I wanted to mention, the CQC report made clear reference to almost unanimously, almost, the pride and passion that staff within the adult social care setting had towards people, the care for and support. And that was very powerful, I think, in the feedback from the inspectors. So I was really interested to see your establishing a coarsary offer, focusing on the social care workforce. I just wanted to ask, really, how do you see that working out? What kind of impact that would have on Surrey County Council, adult social care? It's kind of not getting the sense from that in here. And I'd like to hear more about that adult social care perspective. Thanks. Yeah, I'll certainly make a start on that. I don't know if Surrey Care Association is with us, but they're a big partner in the Alliance. And BEX, prior to Nicola MacLeish's arrival, of course, commissioned some work, when we originally did this, into pay and conditions of social care in Surrey and some benchmarking, which was really useful. And I think it was delivered through funding from the council. The opportunities in that are obviously very difficult to be able to meet. I was pleased that the new government has made a commitment, I think it's a commitment, around fair social care pay. That is going to be a significant thing we need to see followed through, because inevitably that report that was done under, and we haven't profiled it in here, but it's in a lot of the detail, showed what you'd expect it to show, and the disparity between similar jobs in other sectors, if you like, similar skill sets required, that are paid 15 to 20% more. So there is an issue around, as we all know, around parity of pay and esteem. To pick up on the latter point, though, things that we've just profiled, such as the Health and Social Care Academy work, to answer the other question around, how do you reach people? Some of this money has gone into the digital hub, to make sure that there is a central point that people can access, to see the opportunities that they can pursue. And a lot of the funding has gone into things such as the care certification accreditation, to begin to raise, if you like, the professional image of the care sector workforce. But there is a gap still with the pay parity. Sorry, Chair, can I quickly come back? Very quickly. My question's more about the social care workforce within Sarri County Council. I think you're responding, looking at the care sector. My question was around the investment made here and what you see coming from that for social workers within adult social care. Yeah, I'm not sure I'm qualified to pick that one up. I can talk very much about the care sector and our partnership with them. I was like, oh, but I would need somebody to help me out on Sarri County County Council. Thank you. Jenna, actually, if I pick that up with Claire. Yeah. Thank you, too. May I just come in in response? I'm probably also not qualified, but we are working in partnership with the Adult Social Care Academy, which is in a matrix way. You probably saw that on the slides. So a lot of our work, where Michael mentioned about children's, and some of the other work that we're doing is a Southeast Academies network, which hooks in Adult Social Care and Children's Academy, but certainly a lot more to do. Really good point. Thank you for bringing it up. Yeah, Sue. Thank you. I wonder if you see an opportunity to perhaps support, I'm thinking now of unpaid carers, who have a whole range of skills and sometimes they've come out of the workforce because of their caring responsibilities, but whether there are ways we can connect with those who may be thinking about or could be supported to return to the workforce and bring those skills, and also often that enables them to have a good work-life balance and they can continue with caring responsibilities. Thank you. Yes, thank you, Sue. Definitely an opportunity through the pre-employment work that we're doing and the work that we're starting to do with Sue and some of our other voluntary sector colleagues on our volunteering sort of code of practice strategy charter. We're not quite sure what we're going to call it yet, but that's the general direction of travel. Because we do recognise, well, there'll be people who want to volunteer to a career, there'll also be people who want to volunteer and they'll have a whole range of skills that can bring to health and social care in Surrey. I think before you arrived we talked a little bit about the financial landscape. You know, I have to say I think the prospects of the government or anybody delivering on fair pay for social care is going to be really challenging. We know that the national insurance contributions and the national living wage are going to put huge pressure on existing providers. From this council's perspective, of the 680 million additional money coming into health and social care, that's only about 10 million of that that we will see against a current budget of 550 million. So, tiny, tiny numbers. So, I think, you know, there's going to be... So, I think it's... We'll say, absolutely, there needs to be parity of pay. And as you say, it's steam, absolutely, the case. But I have a horrible feeling that the conversations, I'm afraid, going forward in the short term, medium term, are going to be around how we collectively can address that national insurance increase rather than equalising pay. But it would be good if that isn't the case. Are there any other comments before we go to the recommendations? So, I think the recommendations are that, obviously, that we note the progress and the good progress that has been made from the United Surrey Talent Strategy and the rollout. And then, to your point, John, I think we are very happy to invite the development of a business case for the long-term sustainability of the health and social care academy. I take it we're happy to agree to those recommendations. Good. Thank you. Thank you all very much. That almost brings us to the end of the agenda. Item 12 is to note the reports from the Integrated Care Board and the Frimley Health and Care Integrated Care Board. Those have been circulated more for information. But is there any question, anything that anybody wants to raise in relation to those? If not, then item 13, the date of the next meeting. So, the recommendation is to note, yeah, which we have done. And then item 13, the date of the next meeting. So, the 23rd of January, you should have all these dates in your diary. The 23rd of January is the deep dive. And I think we may be heading north to Spellfall, if you can find your way up there. But we'll confirm the location shortly. In February, there will be the private meeting, which will be online. And then the next public meeting of this board will be on the 19th of March, 2025. And on that note, I'll close the meeting. I wish you all, those of you, some of you are staying on, I know, for the meetings. But if not, I wish you all a very happy Christmas and a beautiful new year. Thank you very much.