Transcript

Welcome everyone and welcome to our May Help and Wellbeing Board. Great to see so many people here. There are some new faces. I think what's the best thing to do is before you speak if you could just say who you are I think that might help. If we went around the room we'd have forgotten by the end anyway who you were so that'd be great. We've got a very long agenda today with lots of really important items. We must finish no later than 12.30. So I am going to be quite strict with the time today. So I'm going to everyone will assume that you've read the papers and therefore we don't need to read out anything that's there. We have got once spare packet papers if someone's desperate and hasn't got anything to look at but apart from that we'll just keep going then. Thank you. Apologies. Thank you. We have apologies from Liz Hancock, Catherine Free, Jenny Northcutt, Wessel Harding, Councillor Roodhouse, Catherine Thream, Gemma McKinnon, Sue Noils and Councillor Gutteridge. I think that's it. Thank you. Are there any more apologies from anyone that we know? Yes. Money. Thank you. Brilliant. Thanks very much. Have I got any disclosures of pecuniary or non-pecuniary interest from anyone? Okay. Thank you. If something occurs to you join the meeting please tell us. So if we move to the minutes of the last meeting which was the 10th of January, just very briefly see if there's any comments on any of the pages. Excuse me. Page 5. Yes. Sorry Chair. Could we just add more names to the minutes please as in attendance? I hear it. Page 6, 7, 8, 9, 11, 12, 13,

1. Thank you. In terms of matters arising we had a request for the ICB voice of the patient report to be on the forward plan. Danielle, have you got an update on this please? Yes. So there's been a couple of meetings that have taken place between the directors of Public Health for both Coventry and Warwickshire and local health watch organisations in the ICB. Principles have been agreed that the resident patient voice must be heard in a way that's not tokenistic that the JSN should be used as a resource as it's already been endorsed as a valid tool and that we really need to be able to understand how success from the ICS community engagement strategy have been measured. There's agreements that will convene a citizen involvement working group specifically as a task and finish group and they will be working on developing the specification for a project to understand a system wide gap analysis of community involvement activity, exploring the possibility of undertaking using needs assessment methodology. So this will be in conjunction with the involvement coordination network and the wider volunteering community sector group and the aim behind this is once the areas of gap are understood there'll be a set of system wide principles for community involvement and a talk at best practice and that will inform an assessment framework. So the work is underway, the ICB has taken on the task of developing an outlined scope and then the citizen involvement working group will re-meet to finalise that. There's a recognition that capacity is stretched across all organisations and so a portion of funding has been secured to support this using external resource and working with the universities. Thank you. Also carrying on with matters arising we did have a request for the National Action Plan for GPs to be circulated which was circulated in the bulletin but there's a local action plan for GPs which is going to the ICB this afternoon I believe and we will get that circulated after that meeting. We also requested for news on the incontinence service and an update on the new bladder service went to adult social care and health overview and scrutiny committee thank you so we can circulate information on that after this meeting. We also were asked to explore becoming a signatory on the healthy aging consensus this has been explored and it isn't possible to do the team are now looking into how we might become advocate scroll of age friendly communities instead so we'll ask them to report back to the next meeting on that. Are there any other matters arising that we haven't covered? Okay thank you. I haven't got any chairs announcements but at this point I usually ask the provider organisations to give a couple of sentences on what's the temperature like in your organisation at the moment. So we'll start with UHCW. Justine I don't know whether you want to do a little talk. How is it? Are you sitting with your feet up having coffee? Well similar to probably colleagues across the rest of the day. Very very pressurised in terms of emergency flow right across the hospital. We are readying though for our EPR launch on the 15th of June so we are trying to ensure that we're in the best place possible to go live with that will be a significant transformation for the organisation moved to the electronic patient record. So getting the organisation in that space where it is at its best in terms of capacity to be able to mobilise and readiness for that. So that's our major organisational focus at the moment as well as mobilising our improving lives programme which is all around working with partners around flowing the hospital which is really really key for patients and for the staff and readiness for our EPR. Thank you very much. Thank you. George Eliot Oh you're going to do that as both of them. I will. I'll start with some general messages. So similarly we've seen extremely high levels of emergency demand at both George Eliot and swift higher levels of demand than the winter. Actually through the front door so that has created a significant challenge with flow and ongoing management of those patients. In the south we've continued I think I reported last time on the out of area we continue to see extremely high levels of out of area patients and Birmingham, Worcester surrounding areas which has been a bit of a challenge and we're working with Miss Midlands Ambulance Service on understanding that a bit more at SWIFT. There's a lot of building work going on at the moment so the new development to the Warwick site is well underway as is the development of the Community Diagnostic Centre in Stratford. The shared hub with the Council at Stinson is about to open which is fantastic, fantastic news and Ellen Barrett Badger development work is also well underway now. At George Eliot they opened their new surgical wards a few weeks ago which was fantastic and the second phase of their CDC earlier in April they are and the reason Catherine's not here today is they are currently undergoing an unplanned CQC inspection of their general medicine and fantastic service for all of it's stressful, all of it's stressful there I think those are the key things. It's anyone from CWPT who would like to? Diane Whitfield, Vice Chair, CWPT Again I don't want to repeat demand is through the roof really in creating huge challenges but there is a real focus on system working to ensure that processes and pathways are as fluid as they possibly can be. In the last few weeks mental health has successfully commenced the community routine outreach service and have commenced the National NHS 1-1-1 initiative. Demand for children's mental health services remains really high and there's been a real focus on the urgent emergency care pathway to support children in crisis The other thing that's probably worth noting on an upbeat note for once from the NHS the Aspen Centre has been awarded the quality network for eating disorders which is really good news and three local MPs have supported two of CWPT programs for NHS parliamentary awards and they include a massive amount of cultural inclusion network for the health equality category and our trauma informed training in the education category. Good news, thank you. Public health, shall we? Not a lot of dates we've been busy in terms of the health protection space in the last couple of weeks. The information that's out there in the media around Patuses, helping Cough and the increase in number of cases has unfortunately impacted us in the sense that we had a death from Patuses a couple of weeks ago in a five-month or five-week-old baby in rugby and will work in closely with UK Health Security Agency to come up with a range of actions to support that particular community where the death has happened. Apart from that, it is because it's usually for us. Becky, do you want to talk about adults all Pete? I don't know, adults don't care. Thanks. So social care and support, we have continued focus on our preparation for CQC assurance, that's a big piece of work that's going on at the moment and that includes us developing a social care strategy. In terms of some of our operational activity, obviously we're supporting acute trusts in terms of trying to manage flow and the demand that's going through there and just because of the time of the year we've got a significant focus on our statutory returns at the moment, which is quite absorbing. So yeah, that's where we are. But the community activity appears to be moving as usual and Raymond in terms of being able to support people in the community to enable them to be as independent as possible continues as well. Thanks very much. Yes. Sorry, really quick question. Everybody's talking about flow because we always do. County's helping. Do we have any idea of the impact of what we're doing? Sorry Joanne, I missed what you said. Sorry, do we have any idea of the impact of my voice as well as yours today? Of what we're doing as a county council to help with the flow. Is it actually working for the hospitals? So the activity that we're doing is on behalf of the system. So the reality is that the work, the majority of the work that we do to support hospital flow is not under the Care Act. It's just under us supporting the system. So there are hundreds of people being discharged each week who have significant support needs. So it will be classified under the Care Act if there will be support under the Care Act. So despite the Care Act, are we making a difference? Yes. I think, thanks Jo, it's a really important point. It sounds simple doesn't it? Just get out of hospital when you don't need it anymore. It's actually very complex and it's not one organisation's job to do it. It has to be coordinated efforts and a huge amount of work goes on and needs to continue to go on to smooth that pathway as much as we can. So thank you. Right, so if we move on then there's only one else who's desperate to give an update that I've missed. Okay, all right. Okay, I see the police here, but if you want to say something, then that's great. Everybody debitated you because the world watched your police. So yeah, a couple of lines by me. So slight increase in crime recorded. I reported over the last couple of months around that, the Berglowie Dwelling, which is one of particular concern to residents has remained stable over the last couple of months, so that is good. Of course for demand so on our 101 service and our 9s service we have seen an increase of those again over the last couple of months, particularly last week when the weather was warm, it does have an impact in relation to the number of calls that we get in. However, we have implemented a number of new processes over the last couple of months utilizing our significant tech investments that we've done over the last year or so and that's around supporting our triage service. So that means we've maintained our performance levels around that. So we've now launched Callback Assist in the last couple of weeks rapid video response in the last couple of weeks and we're working with partners around right care, right person response from a regional perspective and the first two parts have come in. So we're starting to see that that's making a difference to the quality of service that we can provide around that. We've seen continued improvements around victim contact and satisfaction over the last quarter. Our investigation quality has seen that improve and as a result of that you get the feed into outcomes so those crimes that are resulting a positive outcome for a victim that has continued to improve as well. But those three remain our focus for the rest of this year as we move towards our HMRC inspection. I would say our workforce numbers are strong our police staff numbers are to establishment, our police officer numbers are higher than they've ever been before or we have quite a lot in training but as a result I would also say the morale of the force is good and that was reflected in the national survey that was published last month. Good news, Arendt. Yep, thank you. Good. Yes, Penny Anne. Thank you, Chair. I'm intrigued about the right care right person. That sounds really exciting. Can I get a couple of sentences about what it involves? Certainly, yes. So it's been coordinated through the Integrated Care Board regionally and in Warwick's year there are four sections to it and the primary focus is around supporting people with mental health and making sure that actually if people are a mental health crisis the right agencies respond around that. I can provide a brief re-noted that helps in relation to time for the board if that helps you. Thank you. Yes, please do. Yes, quickly asked, does that also include your diverse people you might arrest that need a certain way handling? Yes, it does. So it basically means we will go to cause where there is an immediate threat to life or a crime but actually others are diverted to other agencies and we will work in together as to how we make that work. The second two parts will be launched in October but upper bida, a briefing note around how we're coordinating that. Thank you very much, that's excellent. Thank you very much. Yes, Chris. Thank you. I think for, as everybody else is saying to me, as a district council we should say something. Probably more at the preventative end rather than the kind of sorting it out once people fall in ill end of things. So locally, what we would say, and it's quite local, we're progressing on with the Patmoor's Centre. Business plans being developed will go to Cabinet in early June. District Council has put quarter of a million into it helping to make that happen. We've got a new trust which is set up. They've set out their funding strategy aiming to raise about two million in total to help that particular part of the local community which just have some very particular and very localised health issues. As a council as a whole we're looking at a whole range of issues about how do we keep people being well rather than sorting them out when they're ill. So we have been training our pipeline three new country parks one of which the procurement process for almost 50 hectares of open space will be commencing back end of this year early next year there is one which is substantially now in place which is 100 hectares of open space about 20 or 1000 trees planted so far all of which is designed to actually keep people being active. And the evidence of our investment is if you look at the sport England survey of who of the percentage of people who are actually participating in an active level then there is an issue I think that we looked at why is Warwick district 10 percentage points ahead of anywhere else in the sub-region. There's lots behind and that's kind of understandable but a 10% is a very significant difference and I think that needs to be looked at because if we're trying to encourage people keeping well because quite frankly colleagues that's the best way of saving money for the NHS then we need to understand the reasons why that's the case I think I know but that's only a personal reflection and that's about having the facilities and the infrastructure so that people can do things actually at no cost so walking, cycling is relatively low costing to do on hand easily accessible but I've no proof to that but that's what we think is the case and that's kind of the strategy that we're following. The one thing on the downside of things and I think a number of people will know this is that I think this is across the board all of the districts is the rise of homelessness and the rise of number of people being held in temporary accommodation which isn't a good position for those families to be health-wise so that's kind of the warning signal in terms of what the district councils are dealing with and of course there's a cost pressure which goes without I think for hours for example hours has gone off by about 500% in terms of costs. Thank you. There's a significant issue and I don't think we're out of kilter we're not extraordinary but that's an issue that will then have implications down the roads. When you're talking about flow, best place to stop it is right at the very start. Yes exactly. Thank you. Well that brings us very nicely onto our next agenda item which is looking at our place plans and as you know these are really key to the strategy that we all adopt because this is what's happening on the ground so I'm going to ask each place lead to give a really short introduction to what they are doing and then we'll have discussion afterwards and we're going to start with North's baby. You're going to do that. You can stay where you are if you wish to present if you want to come to the front of your camera but it's probably easier if we do this. No I'm very happy to stay here. I presume some slides will appear. We're not sure where because it's not going to be there I'm told. By coming to me you're going to go to slide 6 I think I'm 11 so there'll be a bit of a steeple chase rather than a canter. Okay. Through this. But it's always good to test people's fairness with the technology. Just while that's been loaded if I just introduce ourselves so I'm Steve Maxi, Chief Executive, North oral council and chair of the health and well-being partnership in Warrington North. To my right is. I'm Ryan Coffey, Program Manager at Georgia at Hospital. I coordinate the Warrington North Place Program and chair the Warrington North delivery group and I'm here at the Warrington Catherine free and Jenny Northcoats apologies advertising in their place. And so just just while that's being being loaded and just an update from us as an organization at North Victoria Council we've got a very following on the themes that Chris mentioned. We've got a very extensive play area program refurbishment so lots of new equipment going in there and and actually if you know as the weather now turns you know if you visit our areas you'll see those places packed with people running around and doing and doing stuff and that's really important I think in terms of that informal leisure and if you look at some of the stats coming out yesterday about childhood obesity and the impact on life then that's really really important. We're also we've announced in the budget that we are looking into building two new lift centres which is not usually here very often from public councils. We haven't come to our aid in terms of levelling up funding and so we'll do it ourselves in terms of our own funding which obviously has a number of issues but we'll work our way through that. So I'm just trying to find my version of the slides and just bear with me a second. So the first slide then is our road map. So already we've heard in the meeting around partner agencies are stretched so the key theme here is around integration so we had two seven delivery groups, two seven boards we've integrated those so that we've got the maximum bang for our book in terms of the capacity that we're working in that area. So we've reviewed all of our various arrangements and so that's led to the launch of our new integrated delivery group in April 2023 very much driven by which is why he's here and why I feel a lot more confident because he is beside me to talk about some of the delivery issues at the end of this and so that then led naturally to a consolidation of our priorities that were actually north into one set of priorities. If we have the next slide please. So in terms of manifestation of that we came together to review the actions from the 2324 priorities but also to develop 2425 to see that we were still on the right track. Really really good event 74 partners and the like came together and it was good for the interface and lots of meetings have been held as a result of that as well as the business that was done on the day. So very pleased to say that we were general contentors that were on the right tracks and some tweaking from local intelligence about what we should be doing in 2425 so the outputs have been collated on that and if you're on our distribution list you never had that yesterday I believe that came out from the program office. On that could have the next slide please but briefly I'm told I can't speak to this because I've exceeded the number of slides that I've offered so I'm not speaking to this slide at the moment but you can have a look at it. I can't speak to it but you can look at it so I think I've just about fulfilled the brief there. With the next slide please before I talk anymore on that slide that I'm not talking to. So moving on into the place program so these are the priorities that come out of that work, that review work and that integrated place plan, the Washington North place plan and you can see there across the top. I hope you can see it if you may have electronically in front of you around access to services mental health and wellbeing which we've already touched on. Children, young people, wide determinants of health, healthy lifestyles and health inequalities and healthy inequalities that is the hub around those books. So that's a live program and so that's why the space is in there. There will be projects come and go out of this, each project live, project lead reporting into the progress by monthly and of course that now comes through the single delivery group and then goes to the two bodies respectively. And so we also have the clinical strategy that's also on that slide and you'll see from that that that is due to be renewed during the course of this year as we go into 2025. Could I have the next slide please? Now the law on these things is that you can't do more than five slides until before putting the Kings Fund model up there. And I think looking at the slides a whole you get 11 slides and three of which have got the Kings Fund model. So we're very much complying with our duties and probably a bit spare if anybody's forgotten to put that on their presentation. But that flippant point aside, it does govern everything that we work. That's why you see it so often particularly for our partnership that's looking particularly in those other three quadrants around some of the wider determinants. And so what we've done is mapped our activity against those, that model, and so that's the table you see at the bottom. And then the plan on the right again is, or the plan on the right that's just disappeared on the screen. But it's on my screen at least. It's fine, yes. I'm using the same device as you are, the terrible outlet to control. Yes, that's a pass around piece of paper. So yeah, so as part of the journey that I showed on the first slide around our map, we've reviewed all the GS&As in the direction north, and I'll align that to this population health model to make sure that we're in the right area. And as you can see, we've mapped the broad areas there in which we can make a difference. So we've moved on to the last slide, and then in terms of what this is actually mean, and I'll come back to that after Ryan's given you a brief update as to some of the highlights of the delivery surfer. Thanks Steve. So yeah, as Steve said, we've got a live place program where we wanted to bring a couple of examples of the actual work that sits behind them, the achievements of those projects, as each of them that run our program slide do report in their successes by monthly. So the first one I'm going to touch on is our cardiovascular disease checks project. So this was funded by the innovation for healthcare inequalities program in interest England, also known as INHIP program, and it sits in our healthy behaviors and long-term conditions priority. And the idea is it is identifying and engaging with people with risk factors for cardiovascular disease that aren't already on treatment pathways, and inviting them to clinics held in the community at accessible locations focused on prevention and carrying out a healthy heart check for them. So we've got some stats here because we wanted to focus on the impact of the projects as well. So since the clinics launched in August 2023, there's been 58 clinics held in the community. We've had just under 1,000 healthy heart checks carried out on people that live in March and north. 260 of those people have been referred to primary care for further treatment packages across the three PCNs in our place. Over 30 patients have received a new diagnosis or medication prescription and 40 patients have been put on ongoing monitoring via those clinics. And we currently are finalizing an ongoing evaluation to do a full look into the impact that we can share with partners later. So just some stats there to show one of our projects in delivery. And then the second one I'll touch on is the back to health volunteering pathway. So this program focuses on volunteer intervention to people on hospital waiting lists all the way through to post discharge, making sure that they're supported each step of the way on their pathway. So the figures for this project on the slides are just a monthly snapshot. So they collect a data on a monthly basis and March 2024 figures, other ones on the slide. So I'll just pull some of those out. Over 750 hours of volunteer time was given to patients via over 500 tasks. And that's via our responder volunteers. So they have a flexible arrangement where anyone can ask for volunteer intervention across wards, primary care in the community, and they'll go out and respond as needed. Around 50 out of hours, medication deliveries were carried out by our volunteers in March. And 2,400 patients received a comfort call. So whether they were on a waiting list for treatment or that was post discharge to check that they had what they needed, and if they required any signposting or support. And then patients are also referred internally into Georgia yet, into additional services if required, externally to organizations like Health Exchange or AGK, and we capture the figures on those as well. The program won the help force award for the volunteering collaboration of the year in 2023. So that's something to celebrate. And as of this week, I've secured ongoing funding from Georgia yet as a substantive program so we can keep the good work going. So that's just a snapshot of 2 of our projects, but all of those listed have got great updates and we can share any of interest from the slide. So, hand back to Steve, thank you. Thank you. So if I may just boost one additional point to give you the whole picture so we don't get sort of two congratulations. There are challenges and I think it's worth if you want to update, you're going to have the challenges as well. Clearly, the evolving ICP picture is something that we need to keep close to. Somehow the role of place becomes further embedded. We had quite a lively debate. I think last week, at the Kirk Collaborative Forum around how is place going to be represented on the new structures, district boroughs as well because they're not currently there. Part of the capacity of capacity is already mentioned a few times. We have fewer people attending our meetings available for our work than we had before. And that's something that we'll always look at. And the final issue then is data because we're very keen on what does all this mean which is why we've put some actual figures there to 1000 people with health checks and various diagnoses. I am continually astonished even though I've been in the health system for quite a while. How difficult it is to get up to date place based data around is any of this impacting on our stats. We clearly in the north have some challenging inequalities which is why the diagnosis of the previous and unknown conditions are really, really important. But it is still a massive challenge to coordinate the data across the system in an up to date fashion in a way that means meaningful to place. We'll continue to do that, but I just wanted to flag that up given the office membership of this body that we really ought to put some thoughts further thought into that to help evaluate the programs that we do. Happy to take any questions at the end. Thank you. Thanks very much. And you just about kept within your 10 minutes. So I will be quite strict on that. So we're going on to the south now. So it's Chris and Adam. I think going to the south. Please. Introducing ourselves. We are co chairs. So Chris Elliott, board district council, Adam Carson managing director of swift. And we've been operating this culture. It's just every year. It's just over a year. Dynamic dual continues. Comedy act. Yeah. Yeah. It's it's this kind of point you realise I probably should have gone to spec. I'm not going to say that. I'm not going to say that. I'm not going to say that. I'm not going to say that. I'm not going to say that. I'm not going to say that. I'm not going to say that. I'm not going to say that. I'm not going to say that. I'm not going to say that. I'm not going to say that. I'm not going to say that. I'm not going to say that. I'm not going to say that. I'm not going to say that. I'm not going to say that. I'm not going to say that. I'm not going to say that. 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The real focus on prevention is coming out strong at our place board and our places delivery group. Actually, it's given a bit of a catalyst for conversations about how agencies work together in ways that we haven't before. I mean, those connections were there, but it's just provided before and for talking together. So, for example, during the heat wave last summer, distant memory now, I know. But we had some really good conversations about how different agencies could support with hydration people we know turn up in emergency departments during hot weather. I think those are the kind of conversations that are really bringing the place to life and driving forward to prevention agenda. If I could add as well, on Monday, we were in Stratford Hospital and there was a South War up to the local estates forum. And again, that's another articulation, if you like, what Alan was saying is about that conversation about the public sector, what most of it, for South War up to about talking about, yes, with a particular emphasis around health and wellbeing, but in the broader terms, how do we better use our estate? Because there's a lot of resource locked up, not always in the right place or in the right way to do the right thing at the right time to get the right outcome. And that's a kind of a challenge, but working out what actually we can do better together in order to deliver some better outcomes, but also actually how do we make better use of the resource we've already got? Because, you know, I frankly can't see it across the piece that whatever happens after the next general election, there's going to be loads of new resources for us to actually play with. >> Thank you, thanks very much. And so we move on then to Robby and we've got Tom. >> Good morning, everyone. Everyone here? Yeah? Okay. So this is, again, another double. So I'm sort of co-chair of the, would be Health, Marbeam partnership with, with Money, Cat Lee. And we, at the beginning of 23, 24 took stock of our priorities. And folded our governance and simplified it because one of the challenges that we've had is within Robby is the size and scale. So lots of population growth, lots of really vibrant partnership, but actually capacity to sustain some of the work has been a real challenge for us. So that's one of the things that we've tried to focus on. So very much simplifying and resetting our key priorities into one main agenda around access to health services for Robby as a place. That is the big theme that comes across. We've done lots of talking to our community. And actually that's framed in the context of a brilliant health watch event that was running in Ben Hall during 23, 24, where we went and listened to our communities, involved a number of our partners in that. And there was a really big theme around what the people of Robby feel. They are the only place with no district general hospital. And that becomes a very strong theme when you go and talk to the community. So we were cognizant of that, but wanted to understand in the wider sense from prevention and promotion right through to urgent emergency care, how do we respond? We've got three main buckets around that. One is around the town centre and its regeneration plans and strategy and understanding how people access the impact of the wider health and wellbeing of the population around that. Aligning that with the opportunities around some cross hospital, UHW has a long-term 10-year strategy for the development of some cross and improvement of access and how that might link to health in the high street and developing a health in the high street model, aligned to the town centre plan and how we can bring that together as agencies and partners in that space. And then finally understanding some of the barriers that the people of Robby actually have to access in health care. What does that really mean? And how does that exhibit itself and some of the health seeking behaviour that we have across the patch and what we need to do differently to tackle some of that. So those are the three areas that we've very much focused on. I won't go through the detail of the slide, but I think a real opportunity and some areas for us to work together. The community integrator contract for Robby is a really important and exciting opportunity for us to work with colleagues with South Warraiture and to the link to the capacity issue. We've agreed jointly with the between UHW and South Warraiture Conference program posts that will actually help us do some heavy lifting in this space and work to support the partnership and accelerate some of our activities. I think really excited about that. Our role in the care collaborative, I think there's some themes that have come through, but actually making sure that we have a voice and that voice is heard. Very important. So how we do that is key. And then listening to very much the outcome from the health watch event and some of the key themes following that through in terms of what matters to people. A link to that. The ICB's piece around integrated urgent emergency care, which is currently live in terms of recommissioning services and what that offer looks like. So how does it look different for the Robby population to be able to meet the needs that they have? They have no A&E department and it's very unlikely they're going to have an A&E department in Robby, but actually what is the offer around urgent treatment centre? What is the offer around the wraparin, wraparin that we need to step into to support the needs of that population working with primary care community services and the voluntary sector? So that being a real vehicle to try and address some of those needs. We've delivered on a number of projects, so social inequalities fund, some work around care as place innovation. And as I say, some focus very much on the capacity that we need to move us forward and accelerate. Passover to Tom, who's here for Maddy, who you don't need chairs, but Passover to Tom. More than all Tom getting off, so I'm Chief Officer for Leisure and Wellbeing at Robbyborough Council. So I'm placed with Maddy and Justine. And I think it's quite an easy place to start in terms of the next 12 minutes, it's going to be more exciting for us in terms of the last 12 minutes has been resetting that position. And I think moving forwards, having a new rugby place coordinator role that we look into recruit to in the next month should be able to bring that along with us. So I think as an asset to the rugby place group, that's going to be really vital for us in terms of moving things forward. In terms of this next year, so building on the health watch event, we've also had a council attached and finished group looking at the emergency services and the provision in rugby because I think it's the story is, as always, we don't have an A&E in rugby, that's the problem, bring it back. That's what we see on Facebook. That's what we hear as the voice. And it's what support we can actually put out there to say and communicate to people. This is what rugby does have. This is what we are providing. These are the plans moving forward to give that assurance and to give that confidence that their system is there. And this is what they can have. In terms of the town centre regeneration, there's a lot of work that's been going on almost quietly in the background, but it's a lot of work. And I think the way we bring that forwards and include rugby place, whether that's the healthy age in JSNA, that's whether that's our area action plans and how we engage because it's one of our highest deprivation wards in the Ben Ward is going to be really key. So the role for place that's going to be really interesting. Our last slide is the Kings Fund model and how we're linking in. We weren't disappointed either. But I think it's what we're trying to show is that everything into links and we're not focusing on one particular area. So we know we're tier three in leveling up. It's unlikely, but what can we do outside of that? And what can we push for? Our area action plan pilots in the two main wards have been going over two years now, one year, sorry. And they're really getting under the skin of what do the local people need, what are the local issues and how can we get into that preventative space. We mentioned earlier about play areas, open spaces. We've got a similar scheme with our capital programmes and our pathways. So we're trying to connect our open spaces across the borough. And we're doing kilometers at a time. It doesn't look as great as a stat when you say two kilometers of pathway, but it's making sure open spaces accessible to all. In terms of the health inequalities. So, yeah, we had the health watch event, which was really well attended and we had the healthy lifestyle clinic at the Ben Hall on Monday afternoon as well, which was really well attended again. And it's just promoting that discussion for how we can actually get agencies working together. So that was positive. In terms of programmes, though, coming forward to this year, I think it's a bit more almost acceleration on some of it. So we've got the care of stress funding. That's in that's secured the tackling of social and quantities with on track. Myself and Tracy at Carver are working together in terms of delivering our hardship fund job fair and some community transport work through the social and quality funding. So it's kind of getting that local need sorted. And then would give a bit of a plug, I suppose, in terms of the borough council and how we maybe need to think differently and make sure we link in properly. Our youth service has just been awarded 70 grand for children's mental health awareness and tackling programmes from the million hours fund from national lottery. That's over the next two years. So it's an example of something that's a project that will deliver tangible on the ground with statistics. It's a really positive story to tell you the next two years. Thank you. Thanks very much to all three of our places. And it's really great to hear some real projects going on. But I'm sure we'll have an impact. But as we say, we need the data to show comments, questions from anyone. Okay. Oh, sorry. Chris. Yes, thank you. Health Watch has been participating in all three places. And I think they've been welcomed. I think we've had a constructive relationship. But if I was to set priorities for all three places, and you've heard me say this before, Chair, and I don't apologise for repeating it, it would be to improve communication so that it's done in a way that it resonates with people. It actually means something. Plain English would be quite a good start on that one. Sound administration. Do what you do when you say you're going to do it. Because that builds trust in the system. And my final point, Chair, is about engagement. That must not be for the duration of a single service development. It must be continuous. You must continuously listen to people so that you get the early warning that I think was talked about a bit earlier. But also you build that relationship, you build that trust. And once you've done that, you've got a much better chance of hearing the authentic voice of the resident. That's all. Thanks very much, Chris, and thanks to HealthWatch for all the work that they do on that, and keeping us in contact with the people that are actually using the service and what they think about it. And I'm just very conscious of what's being said about the challenges going forward. And this business about data and all these really good initiatives, how will we know if they work? Who's going to do that? How are we going to get that information? I'm looking at Sharday because you hold data on all sorts of things. And just, are we at the point where we can start this granularity where we can say, yes, that project really had an impact? For some of them, yes. So when we have publicly, readily available data that's collected nationally, we can monitor. For some of them, we can design evaluations into those programs and assess whether or not they're being successful or whether they've had the desired impact. So yes, we depend on the type of program, whether or not an evaluation has been built in, and for quite a number, we've done that sort of a big pilot, for example, that we had enough work here. We worked closely with Coventry University to have an evaluation to determine its effectiveness, and that showed that it was effective in supporting the women who engage with the pilots in quitting smoking during pregnancy. So I would suggest, if most of them don't have evaluations built in, probably the best thing to do is to build an evaluation from the beginning so that you can monitor the impact of what you're doing. And I understand this public health input to all places, aren't they? So you've got that sort of channel to try and get that data that we need. So that's a really important message to build it in from the start. And the other challenge really is where do these places sit in the big picture? And here they are beavering away at the bottom, which is really important, and then we've got right at the top, we've got this strategy going on, and there's a bit of a gap. Now, from what I hear, the places are really good at vocalizing their own opinions on this. So I'm quite confident that they're going to find their place in the big system, and it's going to work. But I would just say keep going until we do get the right links. And if they're not there, then we need to shout and say they need to be. So, yeah, so again, so now I'm looking at Danielle, because you're there, and we need to make sure that all these links fit together. Yeah, I think that's really important. It's great to hear the progress that's happening. And with the development of the care collaboratives, it's absolutely vital that that doesn't just become a layer that squashes, that the voices are very much heard and responded to. And from an ICB perspective, that's what we'll be expecting. So thanks very much for everything that is going on at our places. We do get reports of teach meeting, but it's been really important that we've heard, as it were first-hand, some of the projects that are happening. So thanks very much, and we've kept time. Gosh, let's keep going. Right, so next agenda item, which I'm always happy, is the Health and Wellbeing Board Executive Group update. And I think Becky's going to do that. Thank you. So, are you going to do it from there? Okay. Thank you, Chair. So, as you've said, hopefully everyone's had a chance to read the paper, so I'll just pull out a couple of things to draw people's attention to. So, the purpose of the Health and Wellbeing Executive Group is to set agree and review the delivery plan on behalf of Health and Wellbeing Board. So, we met in January of this year, which seems a long time now, to review the proposed plan and to make sure that we were comfortable that it incorporated all the things that it needed to. There was a focus in our discussions on how we make sure that there are effective links with the work that we're doing and the leveling up, creating opportunities agenda and also the citizen voice point that was made earlier. So, you'll see and in the pack is the updated delivery plan alongside a progress update. I suppose the key thing to point out there is that our place partners have just given an update on key aspects of what is in this plan as key enablers for delivery of the Health and Wellbeing Board strategy and there are also a couple of updates on the rest of the agenda that are key parts of our delivery plan. So, the JSNA and the most recent product that we have on that and the Better Care Fund, which Rachel will talk about. So, we are proposing and you'll see in the recommendations and this came out of a discussion that we had at the Executive Group that we want to focus on best starting life at a future meeting of the Health and Wellbeing Board. We think that there's a lot that we can connect and talk about to make sure that we really make that priority sound and that we're doing as much as we can around that priority within Warrickshire. And I suppose picking up the point that has been made from a number of colleagues in the room already, one of the things that we will need to do is make sure that we consider the relationship that the Executive has with the developing care collaborative for Warrickshire and that there is a complementary and supportive relationship, but we're really clear about where activity is happening and decisions are being made. So, that's as much as I'm going to say, Chair, happy to take any questions. Any comments and questions? I'd just like to just look at the recommendations for a minute and just see recommendation two. Approves the amended Health and Wellbeing Board's strategy delivery plan, which is a appendix one, and the proposal to develop a more comprehensive and robust Warrickshire Health and Wellbeing Board delivery plan, which I would really welcome and that we can measure. Going back to, does it make a difference? And that is, you know, I know people want to include everything, but when you've got a plan that goes on and on and on for pages, you can't get a grip of it. We really need to get some priorities down. This is what we're going to do this year, and that's what we expect the impact to be. So, I would just plead with our Executive Group to focus on that and get something really concrete. We can learn from our place partners, and they have really got some specific outcomes that they're looking for there, and that's what we need to do. So, I really recommend, really welcome recommendation two, but say please can we have some real outcomes that we can measure? And also the next one, which is about focusing on priority one, which is helping children and human people to have the best start in life. And we've got our children and young people's partnership group, which is a, an informal subcommittee of this committee, which Penny Ang shares. And I'm sure she would welcome that focus as well. And you can bring in the work that you do from your group, too. So, is there any more comments or questions on that? So, then, I'll just thank the Executive Group for their work and ask them to do even more. So, we have gone through most of the recommendations. We could look at recommendations, and do we agree those? If you don't speak, I expect you said yes. So, if you want to object, you need a shout. Okay? Thank you very much. So, we'll move on from that one. And we're going to move on now to look at public health. In my view, it's all about protection of prevention, sorry, and that protection and prevention, actually. So, this is a real in-depth look at what we do with public health, and I think it's really useful for us to understand that and understand the money as well, where it goes, how we get it, and where it goes. So, this is Charday's area. So, over to you, Charday. Okay, thank you, Chair. So, the purpose of the report in your park is to provide health and wellbeing board with an update on the new structure of the Public Health Service. It's near host direct to rate its prescribed and non-prescribed functions. Public health spending, or some of the key challenges and opportunities for 24-25 and beyond. And I'm hoping that, by the end of the presentation, some of the issues that we're grappling with will come to light and will start to make us think about the question you raised, Chair, about being good at identifying problems, issues using evidence, but not so good at coming up or delivering solutions. So, hopefully, this will give you a flavour for why that is the case, and that has always been the case. So, that's the new directory structure. The arrangement is a two-year pilot, noting that the old people direct to it, hosted three quarters of the council's budget, and almost half is staff, and it was possible for one person, which is Nigel, to continue to do it that way. So, the decision was taken to split. So, we have the Social Care and Health Directory, which is where Public Health sits, which is headed by Becky, and then the children and young people direct to it, which is still led by Nigel. Next slide, yeah, thank you. So, the changes in Public Health include the fact that Commissioner capacity moved into the service on the 2nd of January, 2024, and the Public Health Budget moved into Public Health in April. The decision to keep the commissioning function and budget in a single place, which has been allocated to Jane Coats to combine with her head of inequality's role. The other consultants in Public Health hold the lead responsibility for strategy associated with specific contract areas. So, for example, Paula Jackson takes the lead for strategy links to our mental health and drug and alcohol contracts, oversight of the commissioning process and management sits with Jane. There is a vacant post, which is the Health Protection and Health Care Public Health, and that's because Godana has retired, and we're recruiting a new consultant who, alongside the rest of the consultants, alongside Jane, will work full-time for WCC, because all the other consultant posts are part-time with us. They're doing posts with the ICB, and one of them is a joint post with Swift. Our total TF3 capacity is 3.4 full-time equivalent when we're fully staffed. Next slide, please. So, that's a list of prescribed and non-prescribed functions. It is worth noting that there is limited clarity on the difference between prescribed and non-prescribed. Prescribed functions are things we must deliver, non-prescribed functions that appear to be assumed that Public Health will fund. There are also grant conditions, including that WCC must spend the grant on activity that has a significant effect on public health and improve take-up of drug and alcohol treatment. We're working on the basis that we add money from the grants to the Section 31 grant issued to WCC to address drugs and alcohol addictions. We don't have the budget to be able to invest in every area where we think there will be a benefit in doing so, and that goes back to the point I made earlier on. We do, however, try to allocate staff capacity into those areas to maximize the Public Health benefit. We invest in smaller amounts of budget in some other areas, which are shown in Section 1.54 in the paper. So, that's the budget allocation for 24.25. This year, from the government, is 25.6 million. The pie chart shows how much it is costing us this year to deliver our offer. What's not included here are the other grants I've mentioned in the previous slide, which have been aligns to public health. So, they come into WCC, but have been aligned to public health, domestic abuse and drugs and alcohol. We've also not counted money contributed by other partners to a number of our services, including the ICB, the OPCC, and District and Borough Councils. We have also, this year, received some money under the New Smoke Free Generation Initiative. This is around 800,000, and no amounts placed in any future years. Our largest spend by far is on services against the children, with our health visiting contract accounted for our largest single spend. There are 44 people employed by public health. The categories shown above align with the categories that WCC reports on each financial year, and this information is used to benchmark our spend against that of other local authorities, and we are constantly getting emails and requests for DHSC for information whenever it appears that our spend is out of kilter without the local authorities, and we are expected to provide explanations if we book an expected trend. There are pie chats on page 5 to 6 of the report because the presentation is slightly small. Next slide. Yeah, so those are priorities for this year, health and wellbeing strategy, priorities, WCC council plan priorities as evidenced by our CDP. WCC duties led by public health, for example, safe accommodation, and the number of integrated care system work streams. We don't on an operation from all of these places, and section 1.6 provides additional detail on the areas of focus against each category. We continue to cover many other areas as well, but where we need to make choices to allocate resources we refer to these priorities. Those are the challenges that we are currently grappling with. We have been asked this year to make payments known as agenda for change, payments which appear words to staff who work for the NHS on our contracts. For example, the health-fisting contract. This has been a very tricky area to achieve a shared understanding on, and to calculate in value 4. And our location was made in the public health grant, recognizing that this is a new burden, but it doesn't cover it, and it doesn't match what we might need to pay out. We have many more providers asking for large budget increases, mid-contracts that we have been used to, and no real budget flexibility to meet these demands without defunding other work, which can take years to spend in on contract break points. We have a number of underperforming services that often trigger inquiries from the HSC, which are not easily fixed. Understanding what the barriers are to improving performance and cost effectiveness is also a critical priority for us this year. We're also working through how to navigate place and understand how we can support place priorities through the way we commission our services, and we recognize our system partners are facing financial constraints of their own. So those are the recommendations that were put into health and wellbeing board. We are keen to use this opportunity to engage with yourselves in conversation about how we best tackle system pressures together, keeping our eye always on how we get the best possible outcomes for the people of workshop. I think that's the final slide. Thank you. Thanks very much, Sharday. I've come at some questions for anyone. So when you talk about what do you say some of the services underperforming, do you give an example of that? Are you say we're underperforming against national targets or compared with our neighbours? I'm trying to think of one of the top of my head. So against national targets and compared to our neighbours, an example is the NHS Health Check Service. Our performance is a real outlier and a real cause for concern, both against national targets and our neighbours. So that's one example that really puts my mind. So this question is why and what are we going to do about it? It's a very complex historical situation. So the NHS Health Check is delivered through one service, one health provider, and they subcontracts to GP practices across the county. When the new service was designed, that model of contracting was the best way to say it. GP's not necessarily happy with that model of contracting, because prior to that time, we were able to contract directly with GP practices, but in order to make it more consistent and reduce a lot of the admin, the contract has been issued to everyone in health, which is the provider, and they subcontract with GP practices. There's been a lot of issues with that particular way of contracting. What that means is that many practices that would have engaged otherwise are not engaging. We're doing a lot of work with everyone in health with the LMC to understand exactly what the barriers are to improve optic. I know that in particular in the north, we do not have the numbers of GP practices that should engage with the NHS Health Check Service. So, all I can say is constantly in talks with the LMC because GP's listened to it. I mean, that represents GP practices to see how we're going to overcome these challenges, but that is the reason why we're having this underperformance as a release to this particular contract. I know that that was just an example, just to pursue that a bit. I mean, if it's not working, let's change it, you know, and make it a system that works better. It seems to me that health checks is, you know, in terms of prevention. This has got to be one of the priorities, so we need to find a way to make it work. And I think, you know, I'd really like to see public health really spearheading the work that we're doing because it is about prevention. And that's what we all want to do, and I know Chris spoke about that when he was here, and we need to make it work, and if we've got something that's not working. Well, let's change it, so it works better. OK, so I know that there's lots of other things that you do, but you just put that forward as an example. So, yes, so, can we? Talking about the health checks with the doctors, and what have you. But in the north of the county, we are still, over a month for a wait for even a phone call from a doctor. And they, I had somebody speak to me the other day. They tried to get an appointment, and they were told, they can't have one for a month, but they can't go into the next month's availability because they're only got a month's worth. So, phone has to have a stay in the morning. But you know that everybody else is on the phone. And they've just been told to go to the hospital then. If you've got a problem, go down there. So, it really goes into the next one as well, because I was going to mention it then about the better care fund, where it says reducing avoidable admissions. But if you can't see the doctor, they're going to go to the hospital, and they just wait and wait and wait. And eventually, they end up there and get admitted. Whereas they could have been dealt with in the first place. I'm not able to comment on that, because I know that's a separate issue in terms of not being able to get appointments. I know that many ICSs, ICBs have been asked to produce primary care improvement plans, and there's a lot of work that's happening in the background to improve that. So, that's probably a different conversation than one for my ICB colleagues to come to a comment on. In terms of the health checks, it's quite specific. The service spec is a national service spec is specific. It invites you to be sensitive to everybody. Between the age of 40 to 74 years, at least once every five years, there is an eligibility list that is provided to the local authority, which will be used with GP practices. And it informs who is invited for a health check. The check itself is often completed by a practice nurse. So, it is not a GP completed test. It's usually checking your blood pressure, whether or not you have signs for atrial fibrillation, measuring blood sugar, a couple of blood tests, ECG sometimes. So, fairly straightforward test. The reason why we continue to contract with GP practices is because of data protection. That's number one. Number two is that when something is found as a result of a health check, it is just easier to continue that pathway. The service spec states it. If you identify somebody with an anomaly during a health check, it's just easier to carry out everything that needs to be done. Make a referral if your referral has to happen. Compared to if you had to contract with a private provider, that is just one additional layer, one additional step that needs to happen in terms of sharing that data with the GP practices. Because we know the GP's are the gateways, the health care system. So, it just makes that natural sense. Most people will get their invites once they turn 40, before they turn 45, and for people who take advantage of it, it's often a seamless process. But like I said, it's a different conversation to the inability of people to get an appointment when they need it. I just picked that one up. So, Danielle, we did talk earlier about the National Action Plan for GP's and the local action panel that's being developed. Is the purpose of that to improve access? What's the focus of those action plans? Yes, it is to improve access generally and very specifically to primary care and GP's. That is a key aim in the integrated health and care delivery strategy, as you know. And there's a focused programme of work that's really targeting, supporting GP's and improving access there. Obviously, as a system, there's definite progress. That's not the same across the whole of the geography, and there are particular areas, like North Warickshire, where the challenge is greatest. And so, that's a real area of focus. So, we're aware of the issues, the focus is there. But, you know, it takes quite a long time to grow GP. So, it is a real challenge, but definitely the work is there. It is an area of focus. I'm going to lift this out of the personal, but I want to know, is it how? Is it the ITB? Is it Public Health? Who funds the well-being, whatever they are, that go into GP surgeries? Because they're not funded by the GP's themselves. I'm told they're funded by the NHS, but who knows who that is. So, they're well-being officers, essentially. So, they're lower level than nurses, so they haven't got much by way of qualification. And they're the ones who sort of triage the blood pressure, the blood sugar levels, that kind of thing. And I'm not sure that wherever that money is coming from, we're getting our bangfrog buck. But I'm kind of looking at Michelle hoping she can tell me which is the deal for it. Can anyone answer that? Does it vary from GP to GP? You're saying your GP have these people that are called well-being. I can't remember what they are, they're well-being something, and... No, it's not the social prescribers, they're called well-being. I could look on here and see what the well-being officer, let's just call them officers. But they're, I'm told that it's funded externally. It isn't funded by the GP's. No, I think we'll need to take that one away and come back to you, Councillor B like that. Of course, GPs employ their own teams, and they are looking at a variety of different skill bases. It may be that that GP's practice has just decided to employ these people. No, on this one, but that's what I'm asking about. I know that they can, but... Okay, thank you. Penny on. Thank you, Chair. A very fascinating overview. I was just interested to hear that some people are coming mid-term for budget increases that could then put risk of defunding elsewhere. Are you allowed to share with us which areas are struggling most financially? And on the other balance for that, which serves to be most at risk of defunding, of course, my main question would be how will that impact the residents of Moricha? I will ask and confirm whether I can share the actual detail and come back to you. I think the second question is whether or not we're at risk. We are currently starting a piece of work to review all of our non-prescribed spend. Prescribed means things that we must do. So we continue to deliver the sexual health service offer, not to five, in terms of health visits in our school nursing, National Child Measurement Program. Those are prescribed ones. The non-prescribed offer is what we're going to be subjecting to quite a detailed piece of work, looking at whether or not we're getting the best in terms of value for money. All of that review will result in a range of outcomes, whether we're going to re-commission, remodel, redesign, do it differently or decommission. I'm not going to assume any decisions as of now, but whatever it is we'll do. We'll be subject to extensive consultation and engagement. I made the point around about wanting to do everything, but not being able to because we don't have enough money and having to align what we do to some of the strategic priorities. It could be that there's an area of work that is currently of greater need, depending on what the GSA program of work tells us, that we probably need to be funding that we're currently not funding, and none of that money is going to be non-prescribed activity. So all of that is going to happen this year is one of our priorities for this year. So in terms of impact on the population, we will review that work, consultation and engagement, health impact assessments, often part of whatever it is we do when we're trying to take this difficult decisions, if I can call it back. Becky wanted to come in and I'll come back to you, Jo. Can I just throw in? We'll be in coach. We'll be in coach. Okay, thank you. Becky. Thank you. I suppose I just wanted to add that public health is no different, I think, to our whole health and care system around some of the demand-led and cost of care pressures. So we are committed as a system to try and draw together what are our real financial pressures and opportunities and how do we make sure that we've got a really good understanding of the potential impact on each other. So I think it sits within our broader kind of system work around how do we manage some of the pressures that we have. Yes, good. Yeah, but it's like a complete and crying commissioner. Just from this prescribed and non-prescribed, who prescribes, who says it is or isn't. And I'm really concerned to see that drug and alcohol treatment prevention and harm reduction is a non-prescribed function. As you know, we do some joint commissioning on that particular service and it just concerns me that may be downgraded within your list of priorities. So that's a good question and that's a question we've asked ourselves. Who prescribes, who determines, when public health transfer leads to local authority, the transfer was on the basis of the public health grant and the grants came with conditions and underneath the conditions, it was specific, what was prescribed and what wasn't prescribed. Now, the terminology appears to have changed. When it first transferred, it was mandated and non-mandated and so all statutory and non-statutory. And when we were presenting this report, we consulted with some of our colleagues elsewhere and sought the views of the regional director of public health just to get some clarity around prescribed and non-prescribed and I'm not going to sit here and see that I've got the answers. What we asked specifically about drugs and alcohol and the answer was that even though it fits into the non-prescribed category, because there's additional money that comes into drugs and alcohol in terms of the supplementary substance misuse grant, that presupposes that even though it's named, it's called, is categorized as non-prescribed, you must commission the drugs and alcohol service, so that was the explanation we got. So it is quite confusing, so there is no intention to defund or decommission drugs and alcohol because then the same DHS will come back and give us a rebuke. We have to deliver that. Even though it isn't a non-prescribed category, there's an additional grant that comes in that assumes that you must have some money already or just topping this up. So we can't make an argument for not delivering drugs and alcohol in particular. So I hope that answers the question. Yeah, okay. Can I just follow up with something that Felix said though? Do you say it was jointly funded and hopefully it's jointly worked? It's worked in partnership with our police colleagues. Is that how it works? How does the police and public health work together on this? We have a drugs and alcohol strategic partnership which the police are members, so we use that partnership as the forum, and then we should work together on this. I suppose just to add, in the council plan as well, we've made a priority around drugs and alcohol and how we approve it. So say no plans at the moment to make any real decisions. Thank you. Any more comments or questions on this? Thanks very much, Sharday, for clarifying all the work that you do. And you can see, if I can find the right page, we can see the recommendations to note and comment and on the structure and the activity. Everybody happy with that? Thank you. So we move on then to the better care fund and the progress that we're making on that. And I'm going to head up now, and I'll ask again at the end. We've got a meeting on the 13th of June and we need one more person to attend. We just need to be core at them. I'm sure that will be explained as we go through. Thank you, Councillor Bell. Good morning. My name is Rachel Bryden, I'm the Integrated Partnership Manager and Program Manager for the Better Care Fund for Warickshire. In the pack on page 55 is the usual summary report with an update against progress, against the Better Care Fund in terms of finance, metrics and any changes. But I'm going to just go through the presentation, which is in your meeting papers on page 61. It has the appendix if people want to follow it because you may struggle to read it on the screen. So I was asked to give a bit of an overview of the Better Care Fund because, obviously, many of you have been around for quite a while and we've got a long history of the Better Care Fund, but obviously it's new to some board members. So the Better Care Fund is effectively the flagship integration agenda for, and fund for, integration between health and social care, been in place since 2015. I'm just going to give a bit of an overview, a reminder as it says here of the policy framework. Quick update on how the funding works, the core services funded, touch on some of the impacts and benefits and also then our areas of focus in any changes as has already been mentioned throughout the meeting in terms of the new integrated care system arrangement and how it will link in with the care collaboratives as well, which was also mentioned. Next slide please. So this slide just gives a very brief overview of the main purpose and principles of the Better Care Fund. So to say it's a flagship program around integration and partnership between health and social care, in place since 2015 and it's, although there was meant to be some replacement and some changes, it's generally continued since then with some small iterations and updates. It is a health and wellbeing board level, so Coventry has effectively delivered the Better Care Fund and plan and programme and what it should do as well, so it isn't at an ICS level at the moment. And there are two key objectives which are on the bottom right hand side, providing the right care in the right place at the right time and helping people stay well, safe and independent. So there's a balance between supporting discharge activity, which has become more of an importance and more of a focus since around 2017, 2018. There's a balance between discharge activity and admission avoidance prevention activity, and that's a balance in terms of both the metrics and how the funds are spent, et cetera, and obviously the objectives. So on the right hand side is a very high level flow chart in terms of, so there are mandatory funding that comes into the majority of which comes into the integrated care board and some comes into the local authority. The mandatory requirements is that we agree a Better Care Fund plan for how we spend the mandatory but also any voluntary funding streams, and I'll come to that in a later slide. We also have some national ambitions that we need to meet, and as I said, we've got the two key core objectives. Next slide, please. This is slightly a little bit of an overview just in terms of the BCF, so it's very high level. So on the top right, next slide, please, sorry. On the top right, effectively, you will be aware, because the board approved this last year, that every year or two years as it was for that last year, we're required to submit a Better Care Fund plan for the War Archer area, which then goes through local and regional and national assurance. So we do have a two-year plan in place, which are health and well-being board, which has contributed to and signed off, and that was done last year, and that's for the period of 2023 to 2025. This year, an addendum to the Better Care Fund was published on the 28th of March, and we're currently in the process of updating the plan for this year. The updates are primarily to do with finances, so in terms of uplifts, but also the metrics are setting new targets. So when we did the two-year plan, we did indicative budgets and indicative targets for 2425, but the majority was the focus was last year, 2324. So that is the meeting that Councillor BATTERS referenced. So to meet the deadline and submit the plan by the 10th of June, which is the deadline, I have requested a subcommittee of this board to sign off that plan. It's not ready to bring to this meeting, because it's still work in progress. There's quite a lot of information required, particularly on the final side. So a bottom right-hand corner of reference is that our updated plan, and it's just the planning template, there's no narrative plan, will then have to go again through the usual regional and national assurance process. We do already have a legal agreement, the Section 75 in place, but we will need to update that subject to any changes in the plan. On the bottom left, it's just the core national conditions. So the core conditions, because there are conditions associated with the funding, so similar to what Chade has been mentioning about public health, there are conditions attached to the pooled budget, which I'll come on to in a moment. And those effectively, we have to have a jointly agreed plan. That's between the ICB, primarily in the local authority, but agreed by partners as well, so that's particularly NHS partners, and as well as the district emburors with regard to housing and the disabled facilities grant. Then we've got the two policy objectives I've already mentioned, and then there's also conditions with regard to that there needs to be a minimum amount allocated to adult social care and out of hospital services in the core budget. Next slide, please. So an overview of the funding. So the better care fund doesn't operate in isolation, so everything has been mentioned already today. The better care fund and activities are just one part of contribution to the wider system, and as has been said, there's lots of activity going on. So the national policy framework only applies to the pooled budget. So there's quite a lot of conditions and governance around a relatively small amount of the system budget, and that's highlighted there. So in red, in the column highlighted in red, that's what the conditions apply to. But as you can see, so that creates the 76.9 million. But in the middle column is actually then the aligned allocation. So this is spend at the local authority and the ICB are spending on core services and core budgets, and that equates to 297 million. So we are being transparent and sharing what we're spending as part of the wider system to look at those opportunities to work better, more collaboratively reduce any duplication. But as you can see, the majority of budget in the system is actually spent on core services, and those are either tied up in core block contracts or on demand-led services. So an example would be the Warrich Accounting Council, 180 million in terms of aligned allocation, 94 million of that relates to residential and nursing care for the local authority, which is obviously demand-led service. So whilst we talk about significant amounts of money, obviously there is quite a little room for manoeuvring some of those areas. We want to just touch on the pulled contribution, so that's circled in the red. So the budget which the NHS receives through the better care fund, which covers and funds core NHS or local authority services, is primarily the 47 million on the left-hand side. There's 5.5 million that goes, it's possible to directly to the district and borough councils, as most of you will be aware, which funds the heart service, which does a brilliant job around eight and adaptations for people in the community, and that's supporting both discharge and admission avoidance. 15.1 million comes directly to the local authority through the improved better care fund, and that is money that was introduced in 2017. And then money that's recently now confirmed in the pulled budget is the discharge fund. So this is money that started off as COVID grants during COVID, then became the discharge grant, and now is the discharge fund, which is now in the BCF pulled budget. And as you can see, there's an allocation to the ICB, and there's an allocation to the local authority. So effectively, money come to the local authority, it's a 15.1 million plus and 3.5, and then the majority goes into the ICB, and then jointly through the Joint Commissioning Board, that is jointly allocated. Next slide, please. There is some often confusion around the better care fund in terms of, and there's lots of money available and to be spent, but this slide just gives an idea of the amount that is effectively in the pulled budget, which is actually funding core services. So off the 47 million we've just looked at, 17.2 million of that helps fund, which is a contribution to the out-of-hospital collaborative. Obviously, there is additional funds in the ICB element that covers the rest of the out-of-hospital activity. There's another 41 million, for example, in the ICB, an aligned budget. So next, for example, there's a contribution of 9.2 million to domiciliary care costs. There's another 18 million spent, that's a demand-led service through the Align Budget and the local authority. 6.5 million is spent around the Integrated Community Equipment contract, which I think you'll all be aware, provides an amazing service for both discharge and admission avoidance and support in the community. And that's one of the services that's recently been re-tended. Then there's also a contribution to joint-funded continuing healthcare. And the other key element is around 5.5 million for the council's rehabilitation service, and we'll touch on some of the outcomes of that in a moment. So it just gives an idea, these are significant blocks of money that fund core services through the Better Care Fund, most of which have been in place since 2015 or 2016 or 2017. They're now classed as core services. And just top bullet points, 68% of the improved Better Care Fund, which is the money that comes into the local authority, so 68% of the 15.1 million directly contributes to base budget pressures in social care. So effectively, previous cuts that have been made. So again, the significant amounts of money here. But we do use some of the improved Better Care Fund in particular, but also the new discharge fund around some of the new ways of working. And this board has previously had updates on the work of the national different runner, discharge community recovery service, our new pathway one offer, and things like that are funded through the Better Care Fund and contributions from the ICB and the local authority. Next slide, please. Impact, so the report, and this is what I report on at every quarter to this board. The schemes, you can't measure the impacts of the schemes for the BCF in isolation, because they're just some schemes that the wider system is all obviously contributing to. But we have four national metrics that we have to measure ourselves against. And again, the update is in the detailed update more in the report. The first is around avoidable admissions. And this is something we have challenged, struggled with this year. We did set them quite a challenging target. But I've tried to put it in terms of context. So up to the end of February, which is what the data I had when I did the presentation, just over 5000 admissions were avoidable. This is admissions into the three acute hospitals in Coventry and Worship, but for Worship patients. That equates to around 15 a day per 100,000 population across the three acute hospitals. So whilst we are significantly missing the target, and obviously there's a lot of work to do, it just gives a bit of a context about the numbers we're talking about. And the same with also permanently, no, sorry, the last one, emergency admissions due to a fall. That's a new target that you'll be aware of. This is performance for last year, 23, 24. Last year, up to the end of February, there were 2,500 emergency admissions due to a fall, which again equates to around eight per day across the three acute hospitals per 100,000 population. So all the work we're trying to do is tackling these activities. Because everyone we can reduce makes a cost saving to the system, but also obviously has improved outcomes for the people in Worship. So slightly better news is that the target we always do very well on across the three acute truss is around discharge to use your place of residence. And that includes if people live in a care home, that is their usual place of residence, so then returning home. We continue to do very well in that area, despite the challenges, and we perform very well nationally. And the other one we have struggled with in the board are aware, is a permanent admissions to residential care. So again, it is higher than the target, but not too much higher than last year. This data was up to the end of February, I think the final anticipated performance of last year is about 949, so compared to 901 last year. So not, I mean, higher than we were what we would like, but still not too bad. Next slide please. Rachel, I think, sorry, we're going to have to just stop, I think there. And I think this is a really good slide to finish on because it does tell us the impact. I mean, it is important we understand the money, there's lots of money involved, but this is what it's about, this is what we're trying to do, and we are succeeding in quite a number of them. Any questions and comments on that? So I know at the beginning we were talking about the flow through hospitals, and this is part of the jigsaw that helps that happen if we get it right. Yeah, thank you for a really comprehensive presentation, and it is interesting to see the detail of the funding flows. It's quite complex, isn't it? Rachel, you're still in my place. Ah, sorry, I was saying that it's interesting to see the funding flows because it is quite complex. Just wanted to ask a question based on conversations that we've had throughout the meeting about impact, and obviously the information that's been reported gives a sense of the scale of the activity, it doesn't really measure impact. And as this is now going to be moving to the new care collaboratives, there's an opportunity for maybe fresh thinking around this. So I just wondered whether in your experience looking across the country, whether you've seen anybody doing anything else that we could take into consideration when we're thinking about how will we understand the value of the investment? There's quite a lot of work we could do around data and information sharing, both for planning purposes and planning and commissioning purposes, but also at an operational level. So some work has been highlighted that that is certainly an area for improvement that as a system we could work on, and we are working with our CB colleagues on that. So I think that's something, the other thing we'd like to focus on, and we will start to do going forward, which is what we used to do, is start presenting the performance at place level as well. So we can also start looking at how the funding at place is also then contributing to these metrics and others at place, which I think will start to highlight any differences and disparities. So that is, I think, that will possibly help as well. There is lots of good practice nationally. We do tap into a lot of it, but other areas also come to Warraiture to look at what we're doing as well. So it is a real balance, but there's definitely lots of room for more joint working as I've been said today, where we can further use our resources better. Pete, you wanted to come in. Do you just want to respond to that? No, I suppose, so I just want to thank Rachel. So for someone who understands the BCF and IBCF, that is very comprehensive, and I would suggest that if anyone ever wants to get their head around it, these slides are really comprehensive in that. So to mull over them, because the position around the parts of the allocation, which, in essence, are fixed in terms of delivering on core services, and that, the other element, which we have some flexibility on around how we spend it, I suppose, going to Danielle's point around the benefits, I suppose, what we may have done, historically, is just focus on the bits where we have some flexibility on what the performance on that is, and I suppose what we can do is, so for the 68%, which is in core services, what does that actually buy and what does it deliver? So the X-thousand of people who are able to remain at home because they have domiciliary care support, and I just wonder if that's where we can flex it. I suppose, just in terms of the context on how this worked with another systems, I suppose, there was the integration transformation fund before this, and therefore the history of this goes beyond a decade, and therefore every system is really different, and therefore it is good to look at other systems to see what they're doing, but perhaps the money which is going to be more flexibly spent, in core services, but actually where authorities and PCTs at the time started that journey probably dictates where they are now, so it is quite difficult to compare, but thank you very much to Rachel for the presentation. Just quickly, I'm Marion Hunt for his County Councillor. Reablements, I know they go in for six weeks, I've been involved with people in the community where they say, oh, two and a half, three weeks, we're going to stop now and home care are going to take over. Are we paying for six weeks? Should they be in for six weeks? Is there a paper you can give us in the community that says, six weeks is the ideal, but doesn't have to be the confirmed time. Home care say they are not reablement, home care, they are just home care to go in and care, and very good they are at it, but they are not reablement. So can you clarify for us because we're in the middle, in the community, and we don't know what to do and who to go to because home care are all private agencies now, so we haven't got any jurisdiction over them. Yeah, so the reablement service is an internal service, is up to six weeks. Now, so after two weeks, if the workers involved feel that the person has met their ideal, their potential, it can be ceased. And what I would say is it's probably quite unlikely that our own internal service, reablement service, stops after two weeks. So the statistics for that, so 1,400 people last year benefited from reablement, and of them, 70% didn't go on to any long-term services. So only 30% of the people who actually go through reablement actually have domiciliary care afterwards. So their success rate in enabling people to be independent is very hard. Our community recovery service, which is another enabling, reabling service for people coming out of acute trusts. Again, that's up to six weeks. There is more flexibility around that on when people exit that pathway and go on to a long-term pathway. But as with lots of these things, if you've got examples where it hasn't worked for people, if you forward them onto us, we'll look onto it. But what I would say is that for all of our service, but particularly for reablement, because it's internal, if someone's episode ends, we're not paying for those staff to do nothing, they'll move on to another person. So it's not that we're wasting money. But the majority of people, I think, this is off the top of my head, this staff, I think the majority of people who go through reable, their average length of support is about five and a half weeks or something, so it really does get up to that six weeks back at unsupport. Thanks very much, Jerry. Jerry Gould, Vice Chair of WCW, it's nice to see that 95% of patients have been discharged as a reference, et cetera. But an additional stat that would be interesting to see in there is the length of time taken to discharge them from the time they're ready. Because you could still get 95% or 100% but you could have them staying in the hospital a lot longer as a consequence. And so I'm not saying that's what's happening, but that only tells part of the story. So I think it would be interesting to have that additional stat in there if we can get it. We can get that information, yes, and by pathway. So you can see the difference between pathway one, home, pathway two, go to a bed of facility and pathway three to a permanent facility. Without opening up a huge on its nest here, I will say though, getting a single version of the truth of how long people have waited in hospital before they are rehabilitated to wherever they usually live is not an easy task. But that's something we should work on because we cannot possibly improve a system where we've got people with different data sets that don't agree with each other because we don't know what the picture is. So I know there's work going on in the background and we need to keep doing that because we really do need a single version of the truth on that one. So thanks very much. Thank you very much for all the work you do on this. Now let me just emphasize that that meeting on the 13th of June, we need one more member has to be a member of the Health and Wellbeing Board to attend. So please get into the road. You'll be able possibly be there because we need to be coherent for that. Apart from that, the other recommendations, you can see they're noting the performance and receiving the update. So if we're all content with those recommendations, thank you we're going to move on to another JSNA, one of these, they're really important. I'm sorry I'm going to have to restrict your time somewhat, but who's going to present it? Oh right. Okay. Lovely. Thank you. So I'm just reaching your time. Thank you. If you could just quickly take us through quickly this JSNA on empowering teachers with about children. Thank you. Thank you chair. My name is Michael Maddox. I'm the joint strategic needs assessment program manager at WCC. I'm joined by Kelly Hayward, who's our children's public health service manager. We're pleased to be here to share the empowering features growing up well in more extra JSNA, which we think is an exciting JSNA product demonstrating new opportunities in the way that we can deliver JSNAs. This is the second JSNA on our 2022 prioritization process. The JSNA focuses on the physical health of school children, and it was prioritized to support the school health and wellbeing service and the children and young people MEC offer being developed. It completes a set of three children's JSNAs, the nought to five JSNA and the children's mental health JSNA, aligning to the health and wellbeing board priority of best start to life. The dashboard provides a view around physical health initially, but we hope to be able to build it out to be able to give a much broader view of child health. We've approached this JSNA in quite a different way in that instead of providing a written report, we have built an interactive output. The intention behind this is threefold. The first is that it's interactive, meaning you can go into it, play around with it and see what the data has to offer. It's iterative, meaning that whereas previous JSNAs, the snapshots in time, this one, the data will be updated, and we will also be able to build on it, to be able to add new content as needed. And it's also editorial, meaning that we have looked at a range of data for each of these topics, and we have picked specific data points that highlight the key messages we wish to drive in the dashboard. The intention is that it will be published on the JSNA website following board approval alongside a methodology, as well as an engagement report that we undertook during the JSNA process. I would now give a quick demo of the dashboard, although appreciating that the big screen isn't working, this is a little bit trickier. You can find the link to the dashboard in the report itself, and for those of you with your laptops open, I'd encourage you to click that so that you can follow through a very quick overview, and then start exploring it yourselves. It's also provided in the Appendix 1, and I'll be referencing page numbers that those with paper copies are able to follow along. We start on the landing page, which is page 129 in the packs. There are two main ways we've created to navigate this dashboard. You can either click the next bottom in the bottom right, and that will take you through the report like a written report page by page. Or you can hit the menu button in the top left to jump into specific sections, and we're going to go straight to the menu now, which is page 133 in the packs, and this shows you the overview of everything that's in the dashboard. We've aligned it to the dashboard to the six school aged high impact areas, which were developed to support the delivery of the Healthy Child Program and Commissioning of School Nursing. And as you can see, these are very broad areas, so we've started to pick out themes underneath, but again, speaking to the iterative part of the dashboard, there's opportunity to build on this as we go along. We're going to have a very quick look at a couple of pages jumping in on high impact area to the introduction page, which is improving health behaviors and reducing risk, page 136 in your pack. Each of our high impact areas has an introduction page like this, which gives you an overview of what the high impact area is, as well as the key messages that we draw out of each of the sections. We'll then click next to the drugs and alcohol page, which is page 137 and demonstrates how we've used some of the data. So two points I really want to pull out here. The first is the interactive nature. There's lots of buttons you can go and push and explore the data and see what the messages are. But also, we have where possible pulled out things at different geographies, so this page demonstrates it at district and borough level. And just to finish off in terms of this dashboard demo, I'm going to navigate us to the nutrition page, which is on page 143, where we have, again, made something interactive that you can explore different geographies. And you can see using the map on the right, we have explored this through JS&A geography. I appreciate that's a very quick demo, but hopefully those of you with the link open, you can explore it a bit more and see some of the wonderful works that our BI team have done in putting this, this output together. I'm going to pass to Kelly now to talk over the recommendations and our approach for them. Thanks, Michael. So I'm going to talk a little bit about our approach to the recommendations for this JSNA. It's our third child health JSNA in recent years. We were very conscious that the previous two JSNAs produced 82 recommendations between them. So we wanted to take a new approach for this one with a set of principles to guide the development of a much lesser number of high level recommendations. Those guiding principles are that the recommendations need to be evidence within the JS&A. It will be a small number of high level recommendations with thought given as to how they translate into actions for our specific audiences. There's been consideration of how these recommendations will feed into the work shared children and people's partnership, and the specific recommendations and actions identified as part of this work will be collated and developed into an initial action plan. Next slide, please. So I'm not going to talk through all of the recommendations. I know that they feature in the board paper. So for the purpose of time, I'm going to focus on what some of the impact might look like around the recommendations. So number one is the development of the dashboard that Michael's briefly shared today. We expect this to be an ongoing and iterative product that can be used by all of our health and well-being partners to monitor and respond to child health needs across Warwick share, and as a reporting mechanism on the progress of those. Recommendation number two is around this development of a subgroup to own the dashboard to keep the dashboard narrative and data updated and the ongoing development of that. Number three is around that subgroup monitoring the progress against the high impact areas within the healthy child program aligned with our local need and priorities and driving that whole system approach to support our commission services. As delivery leads for the healthy child program. Next slide, please. So number four is around recognizing the impact of the value of some of the health surveillance already ongoing for children and people health across Warwick share and ensuring that we utilize that as efficiently as possible. Recommendation number five is ensuring that we fully use a breadth of data and intelligence from the dashboard to identify issues of need and respond appropriately. And the last one relates to our new children and people making every contact out course which aligns very closely with the topic areas on this dashboard and ensuring that this is used as a tool across the system to support child health and well-being. And I'm going to pass back to Michael now. Thank you so this last slide and the first three points are the arts of the board which I'll leave to the chair to go through in a moment. We also just wanted to mention some of the next steps both of this JSNAA and of the JSNAA work program. So for this JSNAA as we do with all of them, we are putting together a dissemination plan. There's places that we always have on our dissemination plan such as the place partnerships and how we link in with commissioning colleagues through places like the joint commissioning board. But we'd also love to hear if there's any groups or places that we can bring this to within organisations within the board. We'd be more than happy to support that. And similarly, if there's anything we can help to do in terms of pulling out some of the key messages and themes and translating that for different work streams and thinking about some of that. So what we'd be more than happy to support that my email is on these slides if there's anything we can support with. The second is that we will be doing a much more detailed demonstration for the children and young person partnership to give them a really good overview of this dashboard and be able to use this dashboard to provide context for future board meetings. And the third is a general point both about this JSNAA and the work program in general in that we are very keen to demonstrate impact both of this JSNAA and others. We're currently undertaking work to be able to demonstrate what impact the JSNAA has had. And as part of this as well, we'd love to hear how the JSNAA has been used by organisations on this board reflecting that joint part of the JSNAA and how all of us have that responsibility for acting on the JSNAA so that we can pull something together to feed back on. More than happy to take any questions and I'll pass back to you, Chair. Thanks very much. Yes, Penny. Thank you, Chair. Thank you for a really informative presentation. I think the dashboard is really exciting. And I think at the children and young person's partnership, it will be drawing together a huge amount of work that will be streamlined, which is key and cut down on the repetition. I noticed there was a theme there running through what might have been a barrier and a challenge to engagement neurodiversity was mentioned and also delayed communication skills and understanding the appropriate terminology. Did you engage with speech therapy colleagues around how to actually present what can be quite tricky information? I know we use social stories an awful lot to certain narratives of children. I'm just wondering if that was the step that might help with engagement moving forward around that piece of work. So during the JSNAA process with all of these sections, we aim to all strive to engage with different colleagues to help form the section in the narrative. And we did for speech and language. I believe state to speech and language colleagues. Do you have anything else you want to add on that? No, I don't. I think we had a couple of meetings with them, actually, but we didn't engage with them and we can provide more detail on that. Yeah, just think about how information is presented to young people with communication needs. It's quite a specific skill, so I'm wondering if they were engaged with them that way. Absolutely. And again, part of the iterative nature of this dashboard is we have, from an editorial perspective, chosen specific key messages, but there's opportunity to build this out and highlight different ones if there's things we think are missing. Thank you. Yes. I mean, this is a different style, as you say, of JSNAA, and it's really good that it's so interactive and it can be live. I know you're going to keep it up to date, so a really useful tool. The other thing that's slightly different is that the recommendations that you've given are not the sort of recommendations we normally get. So we normally get something that says, Look, we've given you this data. These are the priorities for action, which is not what these recommendations are. But your recommendation is that it should go to the Children and Young People's Partnerships, so Penny Young chairs that, and I will ask them to really look at this data. What are our priorities? What's screaming at us from this data and what needs to be done? And then come back to this group with that work. That would be really helpful. Thank you. And obviously, a massive amount of work on into this, and as you said, it's part of a suite of JSNAA's giving children the best stuff in life, so that's one of our priorities, so we need to work on it. So thank you. Thank you very much for that. So I'm going to move us on then, if everyone's happy with that. You can see the recommendations there, and part of it is that it will go to the Children and Young People's Partnerships. The Menopause Task and Finish Group, which I think that did this come out of the audience group to me. Yeah, I think it did, yes. So, lovely. So you've got the report there. I don't know if anybody wants to report backwards on the group. I wasn't okay. Yeah, I was. I'll just quickly feed back and thank the audience group and your committee. I think it was at that point, it was Councillor Goldby and then yourself, ran with the gauntlet. Just for being brave enough to take up what is a really important piece of work, and I think Warwick is leading, actually, on this. We are over 50% of the population. Women will go through the menopause and their husbands will go through it with them and their families. So it's important that we are doing a comprehensive piece of work, and it was really very exciting. Health Watch Warickshire and Action Menopause Warickshire were incredibly supportive and helpful, and there are some very good recommendations to come out of it. As with most things, I think Chris has alluded to this this morning. Communication is key. We're already doing a lot in Warickshire. It's about women knowing how to actually access that, and also giving GPs and surgeries a little bit more confidence in dealing with something that's not going to be going anywhere. It's going to be with us. It was an exciting piece of work, and I do think that the County Council have led on this, and by meeting with the Chamber of Commerce, we'll be looking at how their ideas and strategies can be brought into local businesses as well. One in ten women leave the workforce through menopause. In my other job, working with Invoice, I was getting a lot of women who'd reach the top of their careers, leaving through anxiety. When we look, they all have the same date of birth area, so there's a huge amount to be done. And it's also looking at when people are actually prescribed antidepressants, and actually it's menopause. So it's great we're talking about it, and incredibly grateful to the OSC, and the officers involved in actually running with this piece of work. Thank you very much, and thanks to all the people that were on that group, as you say, really important piece of work. I have already just approached the ICB on this, and I believe they will be asked to respond formally on it. They tell me that they are meeting nice guidelines on the menopause, what needs to be in place. We've done a study on it, if those nice guidelines aren't meeting everyone's needs, then we need to go back to them and say that we need to make sure that we get what's needed. I expect the review and scrutiny committee will monitor the recommendations from that report. Thank you, and ask the ICB for a formal response to it, and we'll be very interested to see that going forward. So thank you very much to everyone that was involved in that. Any more comments from anyone? Yes, Chris. Yeah, just to say that we're continuing to work with actual menopause, we're continuing to work with them, and we're holding focus groups for men. And their response to the menopause, and we're also working with GPs and pharmacists to ensure that they understand the issues that are involved. So it's a great piece of work. Thank you. That's really good. Yes, so we mustn't forget males in this, because they're often at the front end of what happens, so it's all to the menopause. So yes, absolutely, they're all part of this team. So great. Thank you, Chris. That's excellent. Yes. Thank you. So we now go on to updates from the board, where we don't discuss in detail these items, but there are some recommendations in some of them, and some very important, just because the bat doesn't mean that they're not important. It just means that we haven't got time to go through them all. So the Children and Young People's Partnership Update, which again, as I say, is Penny Anne's committee that she chairs. So thank you for that update, and we'll look forward to hearing more from your group. The joint helps them well be involved in development sessions. So we did, if you read this report, you'll see that we did have joint health and well-being boards with Coventry, which are an Coventry of the well-being boards. That was a sort of precursor to the integrated care system before that was set up. And then the question was asked at the last meeting of that, does this need to continue? And I think the answer to that is probably not that the functions of that group have been taken over, and any that will be taken over by other groups, such as the ICP, the Integrated Care Partnership. And I think what it will mean is because the joint group didn't meet in public, it was more of a discussion session, and we bring the patients' voice in, that there may be more workshops coming out of our health and well-being boards, and the ICP, the Integrated Care Partnership, to have those sort of sessions when and if they're needed. So it's a really interesting report to read. We've also got the safeguarding report, which, sorry, yes, which is safeguarding annual report, again, very important to see what's been happening in that area. Sorry, just seeing what we've got next. So, and then the Coventry, so then we've got the dementia strategy. We've been waiting for this for a while, actually. It's been in sort of entrained for quite a while, but it's now been released, and again, a very important strategy. I would like to see this come back with the action plan to this meeting in more detail, so we can see what's actually going to happen as a result of this strategy, because that is obviously an area that impacts many of our residents. So the strategy is there for you to read, but as I say, to come back in terms of how we're going to manage this on a delivery plan. And the last one is the services delegated to the ICB. So you may know that some services that were managed centrally are now going to be, or have been, or in the process of being delegated, dentistry, optometry, pharmacy, and some prescribed specialist services. Now, there's a report on it here. I have spoken to Danielle about this and think that it would be very useful. If, when the ICB is ready, they come back to us and say, we've taken over these services. This is what we're going to do. This is our plan of action for them. It's too early for that, because they've only just been given them. So I've said to Danielle, possibly towards the end of the year, that they would come back with a presentation on these services for us about how things, if they are, how things are going to change as a result of that transfer. Okay. Are there any questions on any of those board updates that people feel they need to raise, Chris? I'll be brief chat. In terms of the transfer of responsibilities down to the ICB, I have asked that the ICB keep us informed about the patient and public engagement mechanisms that will be used to ensure that whatever's put in place meets the needs of local communities and not the needs of NHS England. Absolutely. Thank you very much, Chris. That's a really important point. So finally, then, we have our plan, forward plan for the board. I haven't missed anything on the agenda. It's on page 333. I wonder if it was a long meeting. Oh, 333. And it's there. We've got quite a few things that we need to schedule in, so it's likely to change. So best starting life, dementia strategy, discussion and the transfer of services, just to name three of them. So we will be updating that and getting those on future agendas. Anything anyone wishes to say on the forward plan? Or, indeed, anything else that people feel they have to say before we close the meeting? In which case, thank you very much for your patience and thanks for your attendance. The meeting is now closed. Thank you.