Transcript

Transcript

Okay. Good evening, members, colleagues. Thanks for coming on such a cold night. I was in Waitrose the other day and it was colder in the store than it was outside. So that was not just the refrigerated part. So, welcome to this meeting of the health and health scrutiny. Thanks for attention. Please note, the meetings may be recorded and broadcast by people present. You may be picked up on recordings. Council recordings are covered by our privacy notice, which can be found at barnes.gov.uk. Please note, we are currently in the pre-election period. We are currently in the pre-election period in advance of the burnt oak by-election on the 13th of February, 2025. During this time, ordinary council business can continue, but members are reminded not to refer to candidates or parties in relation to the upcoming election. Thank you. Thank you for your support in ensuring that these principles are respected at all times. Can I remind members to use the microphones, which is a message to me as well? We've yesterday had the sad news about passing of councillor Eva Greenspan, which is very sad for a longstanding member of the council. I wasn't on the council when she was the mayor, etc. But I have sat on strategic travel with her. She's obviously very experienced. She was a very experienced. respected member of the council member of the council. So no doubt there will be messages at the council. I don't know if any others briefly. I know lots of people have already asked to speak at the main council meeting. And certainly it's just very, very sad. She was a huge character. And she will be very sorely missed. But thank you for mentioning it. And hopefully she was an amazing lady today at her funeral. You realised, I think, councillor Sargent and... I mean, she really, she was an architect, finished a psychology degree. She was just, you never know. We all sit here. And you never quite know what people... Then she had decided to become a concert pianist. She suddenly learned how to do, how to learn the piano and then not went to grade seven and whatever the kids normally do. Eight, sorry. You know, she became a concert standard. Really? Yeah. So it's things like that. She's now just doing a PhD at the moment. So there you go. And she said, there's never anything. You must always go for more. So there you go. I think that's the message. Thank you, though. Can I agree those as a record? Did I get... Sorry. Okay, do we have any... Okay, do we have any... Any absentee... I'm not only... Decoration of interest... Any pecuniary or other... Okay, update from Cabinet members. I don't know if... I know that Councillor Moore is... I would like to speak briefly about the very positive CQC... Sorry, Dawn. Okay. Yeah. Councillor Edwards is going to say something briefly about the CQC report. I don't know if, Dawn, if you want to... you would want to add any... Thank you, Chair, and thank you, everybody on this committee. So, yes, in August, the end of August, we had three days inspection from the Community Care Council. And sorry, that's not what it's called, is it? Anyway. And the CQC inspection. And so there was quite a lot of inspectors all around the council over those three days. And I think a number of some of us in some of us in this room were interviewed. And the results of that inspection were public as of Friday morning. And I'm pleased to say that... Rondon Borough-Barnock got a good inspection. Now we need to take into account that there are only three words that they can use. One is need for improvement. Your is good. And the third one is... Is the other word? Outstanding. Sorry? Inadequate. Oh, okay. Well, we didn't get inadequate. And we got a good inspection. I'm led to believe that... Nobody in the country is that outstanding. So, we did really well. And I want to take this opportunity to thank Dawn and all their staff who worked very hard over at least 12 months to prepare just for this inspection. Bearing in mind, there was no extra resources for doing that. So, the day job also had to be done. And so I'm really, really pleased. And if there's any detailed questions, I'm sure Dawn can answer them. But I think everybody in the room should be proud that the London Borough-Barnock did well. We have an interesting demographic change occurring in our country. And particularly in Barnet originally, I think it might have been yesterday in the Times, that in 2003, we had 7,000 in England and Wales, 7,000 people who were centenarians. 20 years later, that's more than doubled. And there's now 15,000 people who are over 100 years old in England and Wales. And I remember when I was a child that that was something that, when someone reached 100, that was something that was on the TV and people got a telegram from the Queen and it was a big, you know, good news story at the end of all bad news that we got in the news at 10. So, it's an interesting demographic change and it's particularly prevalent here, I think, in Barnet. And that presents us with huge challenges in terms of our service delivery. So, it's a positive thing that people are living so long. But also, we know that in the last 20 years of a person's life, they're more likely to get ill and in need of support, both from the health services and from adult social care. So, I'm sure you'll join in congratulating Dawn and all their staff for this excellent results that we received on Friday morning after a long wait. Because it was in the end of August, so it took to Friday morning before we got the final outcome. So, I'll try to answer any questions that people have, but also be fair to Dawn as well if there's any specific questions that I can't answer. So, thank you. Dawn, is there anything specific apart from positive results that you would point out? I think you said the staff, the comments on the attitudes of the staff and that kind of thing would be particularly sure. And they're definitely, I would say, things that could improve their methodology. But they were, and the process actually lasted to 10 months. So, it was quite a long, and the report is like well over 50 pages, a lot of narrative. So, the things that I'm personally very proud of are that uniformly we've got a really strong desire for continuous improvement. So, in a way, I think probably if we hadn't said that we had areas for improvement, we may inspection objective process. You'll remember Mr. Monday. So, but we do, we were already taking action in the areas for improvement they identify. So, they report, although it's different from the information that we have, that some of the assessments, and we know that they have because, because of, you know, we know because we can check records. So, we're slightly confused about that, but we should do more to improve the uptake of direct payments. And that's something that all councils should be trying to do because it's a tool for, in the prevalence of young black people in mental health services. Now, that's, we're not alone. That's a national issue. You know, I suppose if you're thinking about this in terms, like Ofsted, we told them the things that we wanted to be better at. But, yes, that's probably it. Thank you. The staff should be congratulated for that outcome. Yeah. Do you want to come back on this, this point before we ask for any other questions? Yeah, I just wanted to add, because I know Dawn won't say that necessarily, but I think the report was also very complimentary about the senior management leadership style. And, you know, staff appreciated the support that came from senior management. And I think it's important to say that because, as we all know, adult social care is a challenge for all local authorities and increasingly so today. So, I knew she wouldn't say it, but it was very clearly there in the report. And I wanted to say it publicly and thank Dawn and her management team for the brilliant job that they do every day for our residents. So, thank you. The other thing is CQC are very interested in scrutiny. And for them, actually, scrutiny comes over really well. So, you came over well as well. Yeah, no, it does. It does. It really, you know, so just a little pat on the back for the committee, because it doesn't always. So, first of all, I'd also like to put on record, you know, looks like a very encouraging performance with regards to the social care reports. So, a sort of dual question. Part one is, what are you the most proud of in terms of best practice that we might be able to impart to other local authorities differently that works particularly well? And the second question is, what do you think might be the biggest challenges that we face in the medium term? Well, I think that the thing that comes out for me is something to be proud of is the approach that our staff have to strength-based assessments. It's quite clearly an approach which says, what can't you do? And, you know, empowering people to recognize their own strengths. And this is really part of the success that I think that our staff have in working with people with increasingly complex needs as the population gets older. And what's not in the report necessarily, but we already know this, that in Barna, we have a particularly large cohort of people with learning disabilities as opposed to other local authorities. And this presents us with challenges, not only because many of them are working age and wanting to live independently, and that's a big challenge for us, but because the staff adopt a strength-based approach, they work with people about enhancing their strengths and encouraging people to recognize their own strengths to be as independent as possible. So that's what I think is a really marked part of our practice, which I'm impressed with in the way our staff do that in a very meaningful way with the people that come to us for support. I forgot the second part of your question, sorry. What do you think might be the biggest challenges that we face in the medium term? There are a number of challenges. And I think the challenge for us is a demographic one. So I think the statistic I gave you before is something which in Barna, as we know, we have a larger, older population than we have. There are three boroughs in London, and that's a growing population. And that will be a big challenge for us going forward. Whether we will have sufficient resources to meet that demand will be a challenge in the coming years. And I think I also, because I mentioned the demographic figure earlier on about the growing population of people who are over 100. So if you think about that today, that's people who are born in the 1920s, who are still here, still living with us and still, you know, for most part, trying to live a good quality and dignified life. And that number is growing. And, you know, as you get older, you will need more support to live a dignified life. So that's going to be the biggest challenge, but not just here, but in most authorities around the country. So the proud thing I'm proud of is how our staff work to enhance and help people understand that they have really, they have their own strengths as well. And we should be proud of it. And that's the first thing. And the second thing is the growing elderly population, which will continue to rise and be a challenge for us, but also all the local authorities up and down the country. And I think, you know, the government's setting up some commission, which is looking at the future of adult social care. And that's for another day due to the increasing demand on our services. So we did have a discussion, you know, as you know, sorry, as you know, the government's introduced announced 600 million pounds for local authority, adult social care services. And I think I said it at the last meeting, it's not, it's not a panacea to the challenges that we face, but we welcome, I think that's somewhere in a region of 2 million pounds extra that will probably, that's got to be confirmed yet. And yes, the budget will go through its normal screwed decision making process in February, the next month, really. But, you know, there are challenges, there are challenges for us, and there's no question about it, but we do welcome the, the additional resources that's come. We know that it, you know, spending on social care is actually going up, you know, is increasing. It's not a matter of, I think, are obviously concerned that any, any cost pressures or savings don't impact on residents' assessments. But I think they've been, certainly have to show thinking that goes on behind each, each cost. I don't know if that was a question or statement, really. Okay, any other questions to the cabinet member? Thanks very much. Thank you, everybody. Thank you. Councillor Moore, is there anything that you want to add from your perspective, just on your portfolio? Yes, thank you. Just some brief comments, if I may chair. Can you hear me effectively? Okay. Lovely. Yeah. Okay, yeah. Okay, thank you. So, I mean, the first thing, of course, is to reiterate my thanks to staff and senior officers for the positive CQC outcome, and their ongoing work in social care and health, and how important that is. Okay. The second point I wanted to make briefly was, Councillor Edwards started his remarks talking about the numbers of, the rise in the number of centenarians over the last several decades. And I think the point that I would make there is, in light of both our growing older population, but also the fact that a proportion of older people live their later years with one or more ongoing health issues. You're going to take two reports on vaccinations during this meeting, and I just wanted to reinforce the real importance of vaccine uptake. And I don't know whether others picked up from some of the reports on the numbers of people being admitted to hospital with flu over the last several weeks. And I think the genuine frustration on the part of some of the clinicians that they were seeing people coming into hospital with severe complications from flu who were eligible for a vaccination but had not taken that up. And so when you're looking at your reports, you're taking these reports around the vaccine programs, really understanding the potential impact that that is having on the health system in general. We have the same thing applies, of course, to our younger adults with complex needs, and our children in schools and their ability to engage with school and go through their education effectively. If they're not taking up vaccination opportunities and are becoming ill. And so I just wanted to put that on the table as it can look quite academic when you're looking at vaccine uptake levels, but actually these are the real impacts of that not happening. And it's particularly important in a borough where we do have that older population. The only other comment I would make is the Joint Health and Wellbeing Strategy is reaching its next stage of development at the Health and Wellbeing Board on the 23rd of January, where we will be agreeing the priorities that will then go out to wider public consultation. And to thank anyone, all those who have put in comments thus far. So thank you very much. I'm happy to answer any questions, but I wanted to keep that report brief. Thank you, Councillor Moore. Any questions to Councillor Moore on health and well-being generally? Thank you. Councillor Cornelius. Sorry, Councillor Moore mentioned encouraging people, obviously, to have the vaccines and that it's interesting how many people in hospital don't have, haven't had it. But do they also count the people who can? Do we have a note in hospital who end up still with flu or COVID, please? I think it was an anecdotal comment that was made by clinicians, and I think it was part of their concern that they were seeing people who hadn't, not everybody that they were seeing had had the opportunity to take up the vaccine. Of course, people will have different strength, different immune systems. Some will have taken up the vaccine, may not have good inherent immunity. They may have other complicating factors. But I think the point I was, I think the point they were making was that where people did take up the vaccine, it protected them and reduced the chance of them being admitted with severe complications. I don't have the figures for those who have and have not had vaccine, have not have, haven't have not been vaccinated. But it was it was really reinforcing how important encouraging people to take up vaccine opportunities is and the implications in that case, because we are seeing quite a significant number or had been seeing quite a significant number of people coming in and having to be admitted to hospital. And the challenge, additional challenge that presented, particularly given that the influenza wave was happening earlier than has happened in some previous years. So it was merely an anecdotal comment, but reinforcing the important vaccination. And when you and when you've looked at the papers, you'll realise that the it for some of those vaccines, it the percentage uptake is not as good as we would ideally like. Thank you. Thank you. Thank you. Thank you. Thank you. I think the public health would like to comment. It reminds me of when I was at the department, we we use Henry Cooper, the boxer, to use the slogan, get your jab in now, get your jab out to to improve the uptake for older people. It was quite successful. It was quite successful. Any other questions? He goes to council more. Thank you, council more pleasure. And that leads us on to we haven't got the minutes. I believe they will be going on to the vaccination programme and this is the updated item, isn't it? The updated report that was tabled as opposed to the original one. And I believe we've got, is it by Vita? This is from public health. And perhaps you'd like to gentlemen, would you like to introduce yourself? Sorry about that. I'm Daniel Stuball. I'm the prevention and vaccination project manager from North Central London Integrated Care Board. So are you going to make a short introduction? You know, you know, it can be brief, you know, in terms of hopefully members have read the report. Just a brief introduction to, and then we can have questions. Yeah. Okay. We're taking for this coming year, but also some of the achievements in the past year. Immunisations really requires a collaborative effort because there are different responsibilities across the different system partners. So NHS England are responsible for commissioning of the vaccination programmes. Integrated care systems have a duty of quality improvement, and we as a council deliver population health initiatives, including promotion and engagement of vaccinations overall. And I just wanted to also highlight that Carleen Kavanagh is here from Vaccination UK. Vaccination UK, our new school age immunisation provider that took over the contract from CLCH in September 2024. All right. Welcome. We can see you on the screen. Thank you for joining. Is that Hannah? Hannah as well? Or just Carleen? I think it's just Carleen. Yeah, I don't think Hannah's able to join us this evening. Sorry. Okay. That's fine. Thank you. Thank you. This is a comprehensive report. Going through the report. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. I have a comprehensive report going through the different stages of the vaccination program. From children to school age to pregnancy, etc. I don't know if people have got questions. I wonder if we could have. It talks about there's been a decline in the terms of naught to five. There's been a decline at age five of a take-up. And so, GP practices have been alerted to this. I don't know if there's any more figures or any background to that particular area of decline. So, we noticed this decline for the polio preschool boost of the DTAP a couple of months ago. And through work from GP practices, we've understood that in late 2022, there was an additional polio booster vaccination campaign that took place across London. And what seems to have transpired through that is that parents took their child when they were between two and three years for an additional polio booster vaccination and then believed that that was their DTAP preschool booster. So, didn't come forward for the DTAP booster, even though they received invitations from their GP practice. So, all Barnett GP practices have now contacted all of those missing immunizations to remind them that that is one of their required vaccinations in the terms to obviously bring up the decline that we've seen in recent months. That just more in race to polio to that particular vaccine. We've been able to conclude that because of, because the DTAP vaccination includes polio and of the polio campaign that that was what the link for why it's declined. Other questions from members about the report? Councillor Sargent, excuse me. Yes. Thank you very much. That's the two main kind of feedback that we get when we're talking to our residents about flu. It's always that they make it easier. I think that that's an unfortunate example that you can give because I think the reason that now pharmacy, GPs and doctors and a whole wide variety of different organizations can give the flu vaccine to try and make it easier for patients. And that's unfortunate that actually because different organizations are providing it that it did make it more difficult. But that's something that definitely we can look into and make sure that any patient and public communications regarding where you can get the flu is much easier for everyone. And you don't have to book an appointment. You can walk in and get a flu vaccine. So on the one hand, it's been positive. On the other hand, I can understand it can be quite for care home residents, people in care, but also for care staff. So when we are talking about protecting older people, I just think it is getting quite complicated. You've got your COVID vaccine, you've got your flu vaccine, then there's another vaccine and people aren't sure which one they're supposed to have. And if you've got a cold, you can't. But the only cause is that for eligible groups, co-administration still remains the go-to method for where people are eligible. Just really to try to reduce the complication whenever possible. And we do have assets that we have. Thank you. How's the stock? There are a couple of things. In care homes, do you know what the uptake is of the staff that actually work? That would be really important for people obviously going to care homes. The other thing is you were saying about suggestions. You've got 63 counsellors who really do. I don't know if you ever think of somehow giving us something that when we see people, we can say, have you done? Have you taken your three different populations? It's just a suggestion. Yeah, I was going to follow up from that. The reporters talk about variation coverage across groups in the bone. Particularly certain ethnic groups have got a lower coverage. just wondering, you know, and it also talks about you've got some funding to appoint two health ambassadors. hosted by groundwork, I think. Presumably to work with different communities. Could you say a bit more about that work and how worried are we by low coverage in some communities? Yes, I will hand over to Vivita. We had some funding from the department of levelling up housing communities. And we were able to have about six health ambassadors across VCS organisations and individual health ambassadors. That funding has since run out. But we have, you may have met Farah Josephs, who is a health ambassador who initially started out working with the Jewish community, but has now expanded to different groups. So she works with asylum seekers, refugees, you know, women's groups. She has now become the senior health ambassador through the cancer screening programme. And we are now in two health ambassadors that will work underneath her and utilise her experience. So the aim is, although the main aim is cancer screening, they will also be engaging with other health topics that are relevant to those communities. Because if we go, you know, just in with cancer screening, they'll switch off. You know, hey, diabetes, long-term conditions, physical activity. So it will be a whole, like a health focus, holistic approach to health ambassadors. Okay. Perhaps they could come back at a future time and a bit more detail about how they work and how they're reaching out. Hi there. So first of all, thanks for the report. Very interesting read. Going to the other end of the age spectrum. So I was actually quite intrigued by the routine childhood immunisation. And on figure one, the first graph that's in the routine childhood immunisation section, if you look at most of the vaccinations, I think they're colour coded. But I don't know which ones they actually refer to. There are five different colours. And they all seem to be going on an upwards trend, which is quite encouraging from January 2020 to basically the first quarter of 2024. And then there's this dip in 2024. So I just wondered whether you think from the analysis that you've done, whether this is the beginning of a trend that we haven't seen before, or is this actually just a peculiar quirk that is specific to 2024, while the prevailing long-term trend is actually moving in quite a positive direction? So the dip that we can see in that graph is related to what I spoke about regarding the polio campaign. So the vaccinations that have gone down are the four-in-one booster at five, and then that's also impacted all vaccinations at five. So because the children who are now approaching five would have been those that were eligible for a polio booster from two to three, and then not come forward for their four-in-one booster. That's why we see this dip, but we are engaging with practices and the public to rectify that. So we see this as a quirk that will be fixed in the short term rather than a start of a downward trend in uptake and vaccination. As a follow-up, how can you rule out that it isn't the start of a trend where possibly – so if you think of it as numerator over denominator, where the denominator is like the total population of a given demographic and the numerator is the total number of people that have taken the vaccine that's available, is this because the total number of people that have taken the vaccine that have taken the vaccine that have taken the vaccine? Is this because the numerator has decreased or is it because the denominator has increased? Because I think one of the strengths of this report actually is that there seems to be a bit of a hyperlocal recognition of different community groups like asylum seekers and homeless people who we might not have featured in the same quantity in previous reports. So, you know, how you know whether this is a short-term or a long-term trend? The MMR2 data hasn't been impacted in any way compared to the data. And historically, the MMR is the more difficult vaccination for parents to vaccinate their child against. And that is sown to be continued on a steady trend and upward trajectory. And that's given at the same appointment as the DTaP vaccination, which is at three years, four months. So, we don't see the trend of MMR uptake linked more closely with the general trend of vaccination uptake than what we see through the DTaP. Any other questions, Councillor Cornelius? Yes. I was just going to ask the second paragraph since May 2024 for central London and I presume when you give it a colour in the graph, you actually call it the booster. So, the DTaP or the 4-in-1 vaccine protects against diphtheria, tetanus, pertussis, and polio. So, the small a is for a cellular pertussis. And, yeah. Googled it. It says DTaP is diphtheria, tetanus, and the a is a small a, and it's and. Cheers. So, he's Googled it. Emma, Mortis, you'd like to. Sorry, I should have introduced you before. Did you want to say something? No, no, no. It's just to say I think it's a small a because it's a cellular and then pertussis. But I think that's a small a as opposed to it being the and. But that's my understanding anyway. Yeah, just to clarify. We should have put it in brackets to make it clear on the report. And so apologies. I didn't know that. Thank you. Could you just repeat that as to what it should be? We didn't quite hear what you said. I think you must be mute. Can you hear me now? Apologies. You're muted. Sorry, Emma. Can you hear me now? I mean, anyone else can correct me, but I believe it's diphtheria, petanus, acellular, pertussis and polio. Does that work? Is that? I think that's correct. Daniel, Janet or Pavita, please correct me. Perhaps we'll reply to you, councilor Cornelius, just explain why it's called a four in one. On this council, Chakrabarti. Sorry, this is not a question, but I was just going to say in reference to the point that was just made, I could be wrong, but my understanding was that the four in one is quite a standard definition in most health literature. So even though it was written as DTAP in the report, it's quite clear what it actually is, if that health literature is understood. But yeah, perhaps, so there's no confusion as far as I'm aware. Any more questions on the report, Councillor Sargent? It's got an icon. I missed that. So page 37. Yeah, the pregnancy, yeah. There's an appendix A on vaccinations in pregnancy. It doesn't look as if it opens. Just have to, we'll have to email it to you to make sure that you see it. And I didn't have a problem, but yeah. And just a quick extra one. Could we see the teddy bear vaccine? Could we see the teddy bear vaccination adventure when it's done? It just will be like relief from everything else. I'll make sure you get a copy of that. Okay. Thank you very much. Unless there's anything else. Thank you for your contribution. Going on to the HPV vaccination, which is related. So I don't, you might want to stay there. And this is, we're welcoming, talk about, I mean, is that right? Probably Carol? Specifically with HPV, is that your main concern? Yes. The project convening on. Am I happy to go ahead with the introduction? Would you like to say a few, just a few words on that particular vaccine? Yep. So the report that we submitted provides a project overview of the, of our HPV vaccination project that aims to improve HPV vaccination uptake in Barnett and our neighbouring North Central London bars. A little bit about the program. So the HPV stands for the human papillomavirus and this vaccine has been part of our school age immunizations program as of 2008. So initially this program was introduced to, um, girls in year eight that attended community schools. And this was a two dose program in year eight and nine. And then in 2019, it was also introduced to, um, for all school age children. So both in year, so both school year eight, for both girls and boys in year eight. And then in 2023, the, um, vaccination dose was switched to a two dose program to a single dose, which is offered in year eight, um, for both girls and boys. So the HPV vaccine is known to protect against, um, a variety of cancers that are linked to the HPV virus. This includes the cervical cancer, um, and has up to a 90% effective rate. And other cancers include the mouth cancer, head and neck cancers, and also genital warts. Um, so in Barnett, HPV vaccination uptake has experienced a, um, significant drop. So in 28 to 2019, uptake amongst girls in year eight was at 80% and, um, 60% for boys in 2019 to 2020 respectively. And, um, currently from our recent data. So this is the, um, academic year of 2022, 2023, um, hitting like 45% in boys. Um, so the report, what we're looking to do is, um, work, use, deliver some engagement work to hopefully to gather some insight into the barriers and attitudes, current barriers and attitudes towards vaccines. And hopefully, um, look to create health emotional assets that, which can be shared, um, directed for parents and carers and school age children. And this will also be used both in Barnett and also be shared with our neighbouring North Central London boroughs. Thank you, Pat. Um, thanks for the report. It obviously, it was an alarming drop, which affected a lot of other programs, you know, from the pandemic. Uh, um, and you obviously tried to get back to pre pandemic levels. Uh, you've got, you know, you're working on health promotion and you've got talks about an online survey. Um, I just wondered, what are you finding? Do you believe are the barriers to take up? Because that is quite alarming. It is a big drop. And, uh, uh, it puts, it puts young people at risk, does it not? Yes, definitely. So, um, we have identified that there are multiple reasons that are linked to this drop and uptake. Um, firstly, the disruptions that were caused by the pandemic. Um, we also believe there's an increase in vaccine, which has also come up with, um, other vaccination programs as well, such as our childhood immunizations program. Um, we believe this might be linked to potential increase in misinformation. So, um, there are various communication channels that, um, community groups use specifically community groups that are on the lower end uptake, um, that are our target groups, um, for this type of work. So, um, and also believe there's a link in operation delivery. So, um, across London, there has between vaccine. So, um, in London, there are various, um, school age immunization providers. Um, we do have, we do currently work with vaccination UK after September, 20, 24, as a provider, um, for, um, a number of years before this. Um, there's also a varied engagement with schools. So, um, there was also a variation in HIV uptake in, within different schools in Barnett, um, and billions might be linked to various levels of engagement. Um, parent and carers understanding of HIV uptake linking to, um, an increase in number of consent forms, which varies with remote schools as well, which also links to our ability to deliver the program, do the HCV program, considering that the vaccination is delivered up. Um, we see schools must be catered for this, um, to reach young people, um, to comprehensively work with schools. I think Carleen may be, um, the best person to respond to this and engages with the schools and deliver the vaccination programs in schools. Hi. Um, so, um, well, we, we, we've, we've just been taken over, um, to Vaccination UK. So we've just completed the flu program, although we're going back into schools and trying to catch more children due to the uptake in A&E services. Um, but what we are doing is we're really making engagements to try and go into schools and discuss with senior leadership teams, um, just to explain what the HPV and the DTP and meningitis programs are all about, um, and try and get into assemblies and just to explain to the children as well what it is. Um, we meet a lot of barriers, including, um, you know, parents just won't accept their children are, or they think they have to be sexually active at 13, which isn't the case at all. So we're trying to break down those barriers and explain to parents exactly what it is and how it can protect the children going forward. Um, we, um, uh, so we were doing the same when we reach our HPV campaign, which was start after Easter. But at the moment we're kind of, we send the school, send out information. We send text messages. Our nurses are calling parents if they haven't returned a consent form, answering questions if parents have any queries as to what it's about. So we really are trying to push to get those numbers up. Um, we initially go in. So when we go in to do, um, our HPV, we'll be targeting year eights, but we'll do children who are out of cohort. Um, we'll do them as well at school when we go into visiting school, which saves them coming to clinics at weekends, but we will also offer weekend and, uh, after school appointments at various clinics around the borough. So we are trying various things to try and catch those and, um, increase the uptake. Thank you. That's helpful. Uh, big questions to, um, on the HPV. Thank you. ...to do focus groups with communities across, um, the lower uptake communities across Barnett and North Central London. Um, so they are interviewing, they, they met with, um, uh, year seven children. And some of the language that we use, someone, some of them didn't even know what a cervix was. So when we use cervical cancer, it's, we have to be really careful about our language, our health promotion assets towards young people. So they understand what they are getting. And if they can understand that they can be influences to, um, their parents and carers. So, um, yeah, for you. Uh, questions. Yeah. Points. Okay. Thank you for, oh, sorry. I should just track about it. So I actually was a little bit curious reading this report about the degree of causality and how much can be attributed to the pandemic disruption. Because my understanding is that this is not a situation where, um, or maybe it is a situation. Uh, does the analysis show that it's a case of some vaccines were sort of disrupted because of pandemic delay. And then there was a backlog and that's caused a decline in the uptake rate. Or is it a case where we actually have, um, oversupply of the vaccines and people are just not coming forward because there are fewer people, uh, attending schools, uh, compared to pre pandemic trends. So I'm just trying to establish what degree of causality, uh, that can be attributed given the evidence available, uh, to pandemic disruption versus other, uh, non pandemic related factors. So it's, I think it's hard to, as you said, it's hard to put it down to just the pandemic. Um, we, we have had schools where they had great uptake in a deprived area. And then after the pandemic, it's just not recovered. And I, and we are still trying to figure out what the exact reasons are. I think maybe Carleen may be able to add to this a little bit more because Carleen has, for us, it's a mixture of reasons. But I think through the focus groups, through the online survey, we're trying to understand, is it due to operational deliveries in school? Is, are some schools more engaged at a certain school, more educated than others that they can understand and sign consent forms? Um, so it's, it's hard to know, it's hard to know, but I think the whole process of doing this HP project will help us lead to those answers. I don't know if Carleen wanted to add anything to that. Yeah, thank you. Um, we, we do have an issue cause obviously all our line, our consent forms are online. Um, and, uh, some parents have digital poverty. They just don't understand. Um, or they just sort of, you know, put it on their to do list and it just doesn't get done. Um, we've tried giving paper. And as I said, our nurses do call them and try and do verbal consents with them over the phone. It's helped to complete the form. Um, people have just lost a lot of trust. Um, I know when we call people and say, you know, um, we did this vaccine. They go, Oh no, no, no. They just say COVID. And when we try to explain to them, it's not COVID. It's something else. They really do need kind of winning around. It's getting better as the years are going on, but there has been a lot of damage. If you like. And people just think, well, um, they're kind of backing off vaccines thinking they'll just use, um, you know, Oh, I'll just chance my luck or I don't know. But there's a lot of distrust I think around vaccines, unfortunately. So we need to work on that and try and change people's attitudes. So, so thanks for that. Um, so when looking at it operationally, it's a bit of an eye opening revelation because I, I get the impression that maybe there's too many, uh, communication channels that actually causes confusion. Like I've, I've never heard of a system where you, you receive a phone call. Um, and you might think, you know, these days with the, with the level of sort of cyber crime and scams that go on, you know, it can be quite difficult to distinguish a genuine sort of vaccinator from a, from a fraudster. Um, and I don't know. So there's always that trade off, I think, between, um, using as many communication channels as possible to expand coverage, but then also making sure that each of those channels are effective enough to actually have a material impact on, uh, uptake. So yeah, so see actually how this, how this, how you take this. Yeah. Sorry. It just sounds like we bombard people, but let me just quickly just go through our process. So we obviously send our communication to the school, the school send out on our behalf to those parents and those year groups. And it just explains about the vaccine and there's various, um, questions like an information sheet and a link to complete the consent form. And we ask the school to sort of send reminders regularly about three weeks before we go in. Um, and they also give us a list of contact details. We also text parents initially just to say, you know, please complete the form. We haven't, if we haven't had one back from them, we, we take out the ones that we've received a yes or a no consent from. It's the ones that we haven't heard of, um, from like the non-returners that we may, you know, we'll send two or three text messages. Then we may call them if we have time and staff availability, just to say, look, um, go through it. A lot of our schools have got maybe more, um, cultural needs or, um, language barriers. Um, and it's those really that we try and put a bit more help into, like we'll send text messages in different languages and information links in different languages so they can see what it's about. Then when we get school, um, we're trying to get the schools to onboard to help us, you know, so they'll bring the children down that perhaps haven't consented or we haven't heard a yes or a no from. So the staff will do the children that we've heard. Yes, consents from the no consents. We won't even see. And the children, which we haven't heard either way from, um, we will try and contact the parents then using the child's phone because they typically answer from the child's phone and want to say, look, we've got your child here. Would you like this vaccine? Sometimes a child will interpret and tell the parent or they will say, yes, I do want it, but we call the parents and try and get their consent first. Well, we do get their consent first, or they'll say, no, I don't want it. And that's fine. That child goes back to school. So, um, we don't just hit them straight with cold calling. They're kind of given warnings and they, it does say in our literature, we will call you if we do not hear yes or no back from you. Sorry. Thank you. Um, just, just, um, picking up on your point about there's a lack of trust, you know, the damage has been done by the, during the pandemic years. And, um, you know, scepticism among say parents, do you think, uh, it needs a big, do you think a bigger push from government and from state bodies to reinforce the importance is, would be needed, would be helpful? Yeah. Do you feel we're getting there anyway? Um, I don't know. You mostly feel like you want these influences on TikTok. You just need somebody to promote it. Um, I think the hesitant also is that because the parents aren't with the children when they're given the vaccinations in school. So they're worried what we are giving their child. They don't trust, you know, they said they've signed up for something, but you'll just give them a COVID cause you have them there. They, they, you know, we really struggle trying to say we, we wouldn't, we can't, and we don't even have the vac. We don't do that COVID vaccines at school at all. So, but, um, that's, they really do, um, don't trust them because they're not with their child. They, they can't be sure that you're not going to give it to them, but it is good. Like this year, um, particularly with flu, um, we've just taken over the Barnett team and we've been offering flu injections in school, whereas previous years, um, if child wanted a flu IM injection, they've been going to clinics. Um, so that's been quite an insight going into schools this year, doing the IMs. Our, um, uptake was good. Actually we do Barnett and Enfield and Barnett have, um, they had a 46, 46% uptake for primary schools and 36% for secondary schools, considering Enfield have got like 23 and 24. So it's, it's been good. Um, we've had a lot of engagement actually with, um, head teachers and rabbis who've really kind of pushed for the children to have this and that's made a big impact. You know, if they've been on board, then the consents really go up and the engagement goes up. Yeah. Yeah. But as regards to how to get people's trust, I'm not sure. It's a bigger problem, isn't it? Okay. Um, interesting. Councillor Purber. Yeah, thank you so much for the reports and also thank you for, uh, providing us a, uh, a description of how you notify students and also parents with regards to the vaccine. Um, so my question is in relation to the notification periods and the process itself. I just want to understand, you mentioned that, um, it goes directly through the student and the parents, they usually answer the phone, whether it be through the student or they'll get an email from the school, or maybe they'll get a letter. I wondered whether you do anything, uh, related to coming into the school. Um, like, uh, you know, when it's parents evening and you meet with the student and you also meet with the parent individually and you explain the importance of vaccine. Yeah, that is something we, um, as I said, we've only just come into Barnett and we are working on that. I know having been with Enfield for a number of years now, that's, it's always tricky. You're just, you know, they, we're just asking for five minutes of a year group assembly or a parents evening. We have done some of that, but you, um, when you do the parents evening, typically the parents that are compliant and engaged will come and talk to you. Um, the others kind of just skirt around you. Um, it's, it's really just trying to give the information to the students, um, and the parents, but, um, we, yeah, we're open to doing any of that and we are looking forward, trying to get into and giving them plenty of time. So not hitting them just before we come and do the vaccine, giving the parents, you know, a few months notice, you know, to go away and do their research and, you know, answer their questions before they sign up and consent to that. Thank you. It's obviously very, you know, difficult work in a way with parents and schools, uh, it's going to take some time to get the rates back up again. Um, first of all, I think it's worth acknowledging as well as a, as a committee that it's very encouraging that this project is taking place with a specific focus on HPV because otherwise half, half the analysis here might never have come to light. Um, and in the identified risks and challenges, there was something I read that was quite interesting around, um, accessing school immunization data, which includes HPV vaccination coverage. You said that there'd been some difficulties in attaining that data from NHS England's commissioners. It's only available upon request. I was just wondering, could you comment on that a little bit more? Like what precisely is the difficulty in accessing data? Um, so I've been asked to present full level update data at our quarterly meetings. Um, and then at the end of the year, when we, when they do an audit, they'll provide us some more detailed ethnicity or any other protected characteristics. No, it's just pretty much what we get. Yeah, that's right. Um, I was going to ask the panel, do you think this is counterproductive? Sorry, who's that directed at? Um, I mean, the, the, the speakers is, is, is that state of affairs that you described? Is it counterproductive? Um, I mean, it's, it's, it's, it's very different. Things may change and they may have a last, uh, view on sharing school level data. But I think at the moment we have access to, you know, particularly HPV level data. Uh, and we can see which schools have lower. Yeah. Thank you. Uh, very interesting report and, uh, uh, uh, wish you well in your, in your work. Thanks very much indeed. Uh, to, uh, uh, the, uh, social connects to the adult social care performance report. Uh, Paul, thank you. I know you've been waiting patiently. Um, uh, I don't know if you just want to make any, a few points on, uh, what this particular, uh, report is anything, anything new that's come out of it. I know you talk about some measures that are going up and a few that are going down as is the way, um, anything, uh, you wish to note before we ask some questions. Yes, it would, that would be helpful. Um, so the, the, the performance report we've provided, uh, to overview and scrutiny is an update, uh, on performance and adult social care. Um, and it's using indicators that we, we monitor as part of a national, uh, adult social care framework, uh, or ask off, uh, as we refer to it. Um, and it's a set of indicators used by all local authorities in England to measure, to measure outcomes. Um, it, it's, uh, a collection of data, um, that, uh, we submit, uh, both as part of our annual statutory returns to NHS digital, um, as well as, uh, data that we gather from surveys we conduct, uh, on behalf of, uh, uh, NHS digital, uh, with our kind of long-term service users, uh, as well as our carers. Uh, so the, the data was published, uh, in December, um, and that's the information we've provided in the report, um, uh, and really we, we, we, you can think of the data in respect of two parts. There's the data that comes from our, our kind of our core systems data, uh, and the data that comes from our, our surveys, uh, at a really high level, um, uh, the, the data that comes from our, our kind of case information, um, is, um, uh, so there's 5,715 individuals, just for, for some context, uh, and overall performance, uh, across all of those measures would be considered good, uh, and, and four measures improved from last year. Three stayed the same and three reduced slightly, uh, but, but overall we would consider all of them, all of them good. So for context, our, uh, uh, our performance was better than national London averages in seven out of the 10 measures, uh, and better than national averages in, in nine out of 10. Um, uh, it, with regards to the data that comes from our surveys. So we do two surveys, uh, on behalf of the NHS digital, uh, a users, uh, survey. So that's all of our long-term service users. So we do that annually, uh, also a carer survey, uh, which we conduct every two years. Um, so, so it's important to know that the surveys are conducted on a small proportion of, uh, our residents, um, so that they, they, they represent about 7% of our overall kind of service user group. Um, and again, um, at quite a high level, um, that there's seven measures that come from our, our users, uh, and, uh, in those seven, um, that we saw, uh, improvement in five, uh, uh, and the reduction, uh, in two, uh, and again, um, we, we, we tend to compare the surveys against London rather than national averages, just because of the, uh, the, the kind of the statistical, uh, differences between, um, London, uh, and the rest of the, uh, and the rest of the country. Um, so comparing to London, uh, our averages were better in two measures, uh, and then marginally below for the remaining five. Uh, in the survey of adult carers, uh, there were five measures in that group, um, um, uh, and, uh, uh, with three of them improving and two reducing, uh, and again, comparing ourselves to London, uh, we were better in three measures, uh, and marginally below for the remaining two. So, um, and obviously there's a lot more information in the report, a lot more detail, but that's just a, a high level description of, of how we performed. Thank you for that. Um, it's, it's welcome, isn't it, that, um, you've got an increase in, uh, you know, of people independent after 91 days. I mean, quite a big increase after charge and also, uh, people who feel, feel satisfied with the services that they get, which is probably, you know, is in line with what the CQC has said, uh, and also, uh, people feel safe and secure, et cetera. Um, I just wanted to ask about the paragraph, um, where you talk about a reduction, uh, in the, uh, individuals offered a preventive reablement service following discharge, which is reduced by 15, 15.3%. Uh, as the service looks to focus preventive service to those who benefit them. Um, you probably are going to say that this is, as people become more independent, therefore, uh, they don't need, uh, they don't let, you know, they need the service less and less. But on the surface, it looks like quite a big reduction, um, in people offered this service. So I'm just wondering if you could just explain a bit more about refocusing the work, which is what you're implying in the, in this paragraph. Well, is it all right if I pick that one up? Yeah, cool. So, um, so you will remember, because we've told you before, we have, uh, one of the highest rates of hospital discharge in London and often the highest numbers. Part of our overspend has been driven by the demand coming from, uh, for care post hospital discharge. Um, and 80% of our reablement activity historically has originated from hospital discharge. Uh, we have been working with our NHS colleagues to promote more independence in hospital. So there, there are a number of things I think that have happened since the pandemic. One is, uh, a culture, um, has developed in the wards where things that used to happen on the wards, like people getting dressed in the daytime, um, starting to do kind of the things that would support you to do day to day activities has not been happening, uh, so much. And we've been working with Barnett Hospital over the last, gosh, perhaps nearly a year now, um, with, um, therapists to, to, to make, to do that. So we've been making sure that people are more active before they leave. We've also been more robust with our NHS colleagues where they would, and at the height of the pandemic, I think it's fair to say that most councils gave reablement to pretty much everybody. Um, to, to, uh, to, um, to, um, to, um, to manage that demand, our reablement in one year, which I think was 22, 23. So really, really big increase. So it's not, we are absolutely giving reablement to anybody who would benefit from it, understand and are giving the right messages to patients about who, who, who actually needs reablement doesn't. Is there any, sorry, is there any risk, risks attached to this at all? No. No, no. I mean, if there were any need for somebody to, if somebody, how can I, sorry, I'm, well, I'll start again. So nobody would go home if it was not safe for them to do so. If that's, if that's what you're getting at. Um, and if somebody needs reablement and they, they, i.e. they, they're appropriate. Doc. Thank you very much. I couldn't agree with you more, um, about the getting elderly people moving. It really is. I so agree with that policy. Because you, it really, really, um, very quickly, someone who can be very able, as soon as they go into hospital, can be done there to improve that figure. Sorry, did you say, what have we done to improve the figure? I said, what can be done? Oh, what can be done? What is being done then? Because that's the disappointing one in red, isn't it? Yes. And so, um, yes, it is disappointing. Um, I suppose I would reiterate or remind the committee about what Paul said about the limitations of the survey. Um, and what we are doing is, uh, working with the carers about how we improve the experience of carers. And it involves, uh, five main areas and bear with me if I'm doing this from memory and I get to four and I can't remember the fifth, which is, I think the. Um, and I think the other, just another thing that we are doing across north central London, the five carers centers. We're working together. So, uh, you know, you could be, you could live in Barnet, but get admitted to, I don't know, University College London. And they will, they will, um, with permission, say, can I give your information? They're the biggest part of the social care workforce. So they're really, really important, but I share the disappointment. But I will say, no, there are issues with the survey. Um, and it does make me think that we, we started our own local survey of people who draws her and support. And maybe we. That's a sergeant. Yes, first of all, thank you for that. Um, would you like to say a little bit more? Yeah, I think, uh, Paul, that is definitely one for Paul. Paul. Yes. So, um, certainly the surveys, we're always thinking about how we can, um, improve, I suppose, both the responses we get, um, but as well as the, the, the response rates we get. Um, so we do quite a bit of work with our, um, kind of colleagues across London to understand, uh, kind of how our response rates compare to others. Um, so although it's the views of quite a small proportion that that's just how the design of the, of the surveys work within it, it's digital. Our response rate for our user survey is actually slightly better than, than when we compare ourselves to, to other London boroughs. Uh, and for our carer survey, it's slightly below. So we're, we're, we're roughly in the middle, but we do do slightly better with one, slightly better with the other. Um, some of the things we're doing, uh, to try and improve take up. Um, so we, we, we, we're looking at the quality of our own data. So obviously the, the surveys go out based on the information we have in our own systems. So, uh, if we have the wrong address, because the, the, the survey is a paper-based survey. So we're, we're not allowed to do anything digital at the moment. Um, it's all a very much a paper-based, uh, uh, survey. And that's, that, um, um, directed by NHS digital. So if our address information has been updated, obviously the survey won't go to the right, right location. So the first thing we do is making sure our data is as accurate as it can be. Um, we make sure the layout of the materials is aimed at, uh, the particular, uh, individual. So, you know, make sure that they're easy to read. Um, there are, there are multiple versions of the surveys as well. So we can, we can offer surveys in various different, uh, languages, uh, hard to read, uh, easy to read version. So large print. Um, we also offer a lot of support for individuals, uh, perhaps who need some assistance with the completion of the survey. So we offer a telephone number that, that residents can contact if they would like some support, uh, with completion of the survey. Um, we also encourage our staff to promote it. So obviously our staff are speaking with residents, uh, you know, regularly. So we ask them to promote the return, make sure they're aware that they may receive one. And if they do to please, uh, please complete it and to return it. Um, we also work with our providers. So similarly with our, our, our, our staff, we, um, we, we, um, we work with providers to make sure they're supporting the residents that might be in their, their residential units. Uh, to a look out for the surveys and, and make sure that they're passed on their, their, um, uh, the occupants, uh, and then also support them with the, with the completion of the, of the return. Um, as well as simple things like the, the, the, you know, the, we provide a, um, uh, page for return envelope. So residents don't have to, uh, pay for the, uh, the return of the survey back to the local authority. Um, but we're always considering kind of other things that we could do to try and, uh, I suppose, but improve both take up, uh, and response to the survey as well as, uh, the, the actual responses we get to the questions included. Right. Right. Councillor Sargent. Yes. I do appreciate the challenges. Yeah. I think it's a very difficult. I just wondered if there are any locations where the care center does it all together. I don't know. I, but I, I do think it's going to be. We will be having the carers action plan. I think. Yeah. We look forward to seeing that. Yeah. We will be going to the more detail. Uh, and the other point I wanted to make was about the risk management. And I was particularly, um, because I see a, uh, trust pilot survey that, that showed that how bad, uh, the equipment providers were. And if one of them said counselors doing anything about this. I do realize the difficulties because you did mention it before that there are very few providers now. Um, and I just wondered if you could have a repeal. You're probably stuck with it, but dealing with the service that people are very unhappy with. I mean, it does say, uh, uh, uh, performance remains below expectations in that. In in dramatic. So, uh, I think all, uh, boroughs. probably stuck with it, but dealing with a service that people are very unhappy with. I mean, it does say performance remains below expectations in that, in the dramatic, so I think all boroughs are creating problems with this. I don't know, it's an ongoing issue that we've raised before. I don't know, are you looking for some current state, you know, is there any prospect that it will improve? Is that weird? I don't, I don't see that without, I mean, we're really, we've got these four providers, haven't they, and I think three who offer the service nationally, or something like that, and they all, when I looked at the trust, they all were equally bound, whereas I remember the old service, you know, MediQIP, the old MediQIP, you know, and I looked at those, it got very few, it's just something, you know, that I do feel very concerned about, and I can't see it improving, so I wonder if we could have a report about what we can do on this. Any comments? So, we can certainly bring either a separate report or include a section in the next performance report. There was some further improvement in quarter three, because obviously this says quarter two, and we are still working with the other person. I wonder if we could have one of the question or provider, because they just need to feel that there is a real concern about this. Yeah, so, we're going to, are we, shall we ask for a separate report on this issue for the, you know, for a future meeting, as you were talking about asking the providers to, to, to, to, to give evidence, you mean? Yes. I don't know the feasibility of that, given if they're, if it's a contractual arrangement, I don't know. Let me look into that. I also don't know if scrutiny would have, like scrutiny has the power to require an NHL registration. So, therefore, they fall outside of the department. We can certainly ask if one of them, if, if a representative from the provider will come along. I don't know that I can like to carry it, but, but I, I suppose, I suppose one of the things I would say about our, our current provider is that they, in the previous income, so there are some things that, and then they had a cyber attack. So, those two things happen to the current provider, all things, in a public committee meeting, for obvious reasons. And, obviously, cyber attacks can take an awful lot to recover from, and that, you know, obviously, NRS are a national provider, so that affected their operations. in terms of potential opportunities, fraternities are, which are limited. You know, the cost to us is quite difficult. Cost could be covered in any report, but that would be helpful, I think, you know, to show, yeah. Anything more on the social care performance report? Anything more on the social care performance report? Hey, thank you, Paul and Dawn. Dawn. Having a forward plan, and our forward plan, obviously, we've got, um, the next meeting, I didn't realise it was till, not till May, it seems a long time from now, but, um, uh, we will be taking in, in the, uh, care as action plan. Can you just, should. And to, uh, quality accounts from the three trusts, performance report, um, additional roles in primary care, three items from NCL ICB, so additional roles in primary care, NCL primary care, access recovery plan, GP registrations in Barnet, implementation of carers action plan, um, yeah, our full agenda for the next. For the business. Yes, just going back to the minutes. Um, and we didn't, sorry, there wasn't an opportunity. And I don't remember seeing the draft letter. And the next meeting, as you said, is going to be May. And I thought we were going to discuss the letter. So, um, could you give us an update? Are we here to discuss the letter now? Yes, of course, um, apologies. There must have been a misunderstanding. I thought it was about just circulating to the committee, rather than discuss and approve it, uh, publicly here. I thought it would be built within the, um, committee. Fortunately, I have the letter drafted. Uh, I, um, I meant to circulate it ahead of the meeting. I wasn't working today. That's why I didn't get, uh, to do it. I'll send it around first thing, uh, tomorrow. Uh, I do have the, uh, I was thinking, um, about the timings, um, as well. It would be prudent, uh, to wait. Because we are awaiting the announcement of the public health grant, um, imminently. In those, uh, if we would, if it would give perhaps more, uh, substance, uh, to respond. But, uh, regardless, uh, I, uh, I'm happy to share, uh, the draft imminently. Because I had it already. I just, I was unsure about presenting it in public. That's the, the reason why I didn't, uh, with, uh, the committee. That is definitely, um, in, um, in progress. Yeah, you're right. You're right to, to raise that one. Um, are you okay for the letter to be circulated? And we could give our comments. And we don't have to wait till the next meeting to send them if it, if once it's agreed. If it can be agreed via correspondence within the committee that I, I, I think that's, uh, potentially mentioned obviously the, the information being available pretty soon. Do we have a date for that? That's the, that's the promise. Obviously there is no guarantee, but we were said, uh, we would, um, that the grant would be in the mid January with options in case we do get a better funding or if we're not expecting better funding. Yeah, that was, that's what I was thinking on the last days, how far, uh, to go into the details. So we can have, uh, I, I have a core draft and then, uh, there are options on how, uh, uh, how the conclusion, uh, perhaps you could circulate the draft and then we have to amend it at the last minute. If yes, if there's any, if we get some wonderful new funding, I, I am not overly optimistic that we would get a grant that we wouldn't have to comment on. I would say it that way, uh, and perhaps wait for the exact, uh, amount, uh, or principle. They'll come in the letter exactly if, uh, if everyone can comment and agree on the actual, the core letter and we can then finalize it once we get the actual information. And if we could be sent the actual, thank you. Okay. Uh, any other business? At nine o'clock, I declare this meeting closed. Thank you. And I hope you all keep warm tonight. Thank you.