Transcript

...scheduled for Committee Room 1, and so we're in what I hope will be a space that gives us a nice, intimate discussion and make things a little bit easier for all of us, but we'll see how we proceed. So, good morning, I'm Councillor Alison Moore, Chair of the Health and Wellbeing Board. Thank you for attending our meeting this morning. Please note that meetings may be recorded and broadcast by the Council or by people present. Please note that we are currently in the pre-election period of the burnt oak by-election on the 13th of February. 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 for your support in ensuring that these principles are respected at all times. Can I remind members and officers to use the microphones when speaking by pressing the middle speaker icon? And that way we can all hear. Well, I hope you can hear me. Excuse me for my slightly croaky voice this morning. I hope you can hear me. that the memorandum of understanding that the memorandum of understanding that was approving life chances for those young people who are young carers sorry, sorry, be endorsed by the board. We all agreed that not all of our partners have yet signed that memorandum of agreement. And so there is a request from the executive director of children and families to just prompt everyone to go back to their bodies, and their partner bodies, to endorse that. If you need a copy, that will be available from PACS, but actually it's in the papers and the minutes of the meeting that we've just approved, the meeting that we approved at the last meeting, but those are online. So if we can move on to absence of members, we've received apologies from Pauline Coakley Webb. She's substituted by Councillor Zara Begg, who is the cabinet member for equalities and the community and voluntary sector. We also have apologies from Dawn Wakeling, who is substituted by Jess Baines Holmes. And apologies received from Kathleen Isaac and Mo Sorinola will be substituting, and you're in the room. Originally, I thought you were joining online. That's wonderful. Thank you. We also have joining us online Deborah Sanders from the Royal Free Trust Barnet General, Monique Gardner from Inclusion Barnet, who's one of our voluntary sector partner organisations, and Daniel Morgan from the North Central ICB. They are all joining us online today. Chris Spencer, I'm the Interim Director of Children's Services, and I'm also here online. Thank you, Chris. I was about to introduce you because we were going to welcome you to your first meeting of the Barnet Health and Wellbeing Board. So, Chris, welcome. I hope you'll find us helpful as a forum. Welcome to us, and you are joining us online. And I hope you heard the call for people to sign the memorandum of agreement. I think it's really important that we do, and we had a very fruitful discussion about that in July. So, thank you and welcome. And I think that covers everybody that we need to. So, declaration of members' interests. Does anyone have interests to declare as part of this? No, thank you. Thank you. Make sure I get to the buildings. And so, with no direct declarations of members' interests, there are no dispensations granted by the monitoring officer relevant to this meeting, and there are no public questions and comments. We will therefore move on to item six, which is the Graham Park Neighbourhood Project. I'm really pleased to see this item back at the Health and Wellbeing Board. As noted in the report, we focused on the Graham Park Project back in September 22 in what was a very dynamic Health and Wellbeing Board meeting held at the heart of Graham Park, where residents and residents and local partners were able to share their passionate views about their community and about the services and to really speak to the need for concerted action within Graham Park. It's what our work here is all about on the Health and Wellbeing Board, bringing partners together within and beyond the council to work together, focusing on a range of issues, but in this case, the neighbourhood project. The Graham Park estate, I make no apology for being a champion and advocate for the work that we do. We have an opportunity in the context of the Health and Wellbeing Board and our partners to make a real change, a step change for those residents to help to change their lives. And so I welcome our speakers to the table today. We have Sophia Lalani, Rachel Wells, Jane Williams and Ali Rahimi, who will speak to different aspects of the project. Rachel, I take it, Rachel, I take it you'll be leading and will people introduce themselves as they begin to speak? Sorry, before we start, would it be possible to get the Teams window that I'm sharing up on the screen so people in the room can see it too? So I'm sharing the slide, I'm sharing slides on Teams, so is it all right to get that up on the screen? Okay, okay, okay, all right. Late notice about the cancellation of that planning meeting, we had already set everything up in this room and it would have been, it would have taken too long to set ourselves up in committee room one. Okay, we're good to go, okay, thank you, I can see everybody has a device in the room so hopefully you can see the slides in front of you and those of you who are on the line should also be able to see them. I'm Rachel Wells, for those of you who don't know me, I'm consultant for public health and I have the lead for neighbourhoods and communities which includes working with Graham Park and I was at the meeting a couple of years ago in Graham Park when we kicked off some of the work that's moving forward, so today's going to be quite a dynamic sort of session. It's going to be quite a dynamic session, sorry I shouldn't be sharing that yet, because we have got people who have come to talk to you today. We have Jane Williams from CLCH, which is a new partner, we're not new partners, but in terms of this focus on Graham Park, it's a more new joint venture really. We've also got, and she's accompanied by Kate as well, who is a public health registrar, working as a Darcy Fellow at the moment. For those of you who are familiar with Darcy Fellows, we also have Vicky Folger, who is going to speak about how things have developed in Graham Park. She's going to speak first, in fact, around governance and how that has developed, because that was one of the key outcomes from the meeting that we had a couple of years ago, was that umbrella of governance and structure. And we've also got Ali, who's sitting right behind me, who is going to talk to you. He works on the community garden in Graham Park, which if any of you have gone to have a look at, you'll see that it's due to start again very soon in March with activities that are going to be going on there. I did have a look on Friday, and I do know that there's one radish and one beetroot in those tubs that no one has claimed. So we'll hear a little bit from him also about his experiences. So I'm going to hand over straight away now to Vicky. Sophia's going to stay here and drive, and then hopefully that should all go quite smoothly. We can have questions at the end of each speaker, or if you prefer, at the end of everybody. Good morning, everyone. Thank you for having me. My name is Vicky, and I'm Rachel introduced. I work at Barnet Council. I'm a project manager in the corporate function, and I have experience working within neighbourhoods, looking at them from different perspectives, which is why I was brought in to help and support following the last one of the health and well-being boards where there was a decision and need for more concentration around Graham Park. So just as a little introduction, following the last section and some further conversations, it was decided for some new structures and governance arrangements to be implemented. So myself and a small team took kind of an overview of what was happening, what wasn't happening, and what we needed, and we implemented a new structure in June 2023. We brought together over 20 different active organisations that were working with and in support of the community. So these range from public health to organisations like GROW, like FUSE, like Collindale Community Trust, and a lot of different examples. So these range from public organisations, the BCS, to smaller community-led groups. And we have taken these organisations, and we also looked at where we have evidence and knowledge of the need within the community, where do we need to drive and deliver different projects and support. So within those groups, we took an overview and thought, where do we need to have some sub-project groups to drive and deliver specific initiatives. So we've implemented it with the Adults Health and Wellbeing Group, which is what the FIA, Rachel, Jane, collectively drive and deliver with Kate as well. So we have children, we have children, families and young people, community safety, which do a lot of work as well with the Met and Clearhall Build, which I'll go into a little bit more in detail. We have a lot of concentration on communications, culture and engagement, which is such an important part of working with that community. We are implementing a housing and long-term maintenance group at the moment to look at how we support residents through the transition of the change, but how we make sure that it is a sustained community moving forward. We have Make It Happen, which is our kind of economic development drive, and that also has some connections back into health. And meanwhile, placemaking, where we are looking to deliver improvement to the space as it is now, and looking at delivering things like the community cafe, where we can bring people together and have a space for activities to take place. So to ensure that we are not only accountable, but delivering in support of the needs of the actual community, and not just what the specific areas want to deliver, we have set out and all have agreed to deliver in support of some functions. So we have the social life framework, which is currently on its second version. So this was initially brought in, I believe, in 2019, where a theory of change for growing part was created. A lot of engagement work happened with the community and engaged partners, and we brought together kind of what we call more locally a wheel of delivery. So it has our selected themes on it, and then the dimensions which we're delivering against. We, throughout the end of COVID, and more recently up until 2023, we have done a refresh of that, taking into consideration the change that COVID did bring about for that community, for their health needs, and the redevelopment, and the redevelopment to look at how can we realign and ensure that what we are doing, that we have confidence that that is still delivering. So we are due in March, actually, to provide an update on how we have delivered against that, so we can make that available to partners here as well, because there is health data that will be brought into that, but we've also done, within the social life framework, looking at how housing, how physical, how a lot of the other strands we support actually impact on health, and how supporting those elements can actually then support the health of residents in the community. So that is something we will be able to share. Obviously, the health needs assessment has been a big drive, and is the reason that this review and the reason I'm here speaking to you all today. So that's a big part of what we do. I know that Rachel has previously done a lot of work in defining and looking at what that needs to be, and that assessment, along with some of the pieces of work that are happening more recently, are going to be driving part of what is the objectives and the delivery plan for that group moving forward. Each year, we set out a delivery plan, and we are currently and actually have a workshop this afternoon to look at what is going to be the Green Park delivery plan for 25-26, and what are our priorities there. Again, that is something we can share and have kind of wider engagement on if partners are interested. And then lastly, we have been supporting Clear Hold Build, which was a MET initiative. We launched the kind of flagship one within London, within Green Park. We have had a successful clear, and we are currently within HOLD, and we are working with our community safety team, with the overarching coordination group and the MET, to devise what does BUILD look like. And a lot of that is going to be from a health and engagement and a physical health angle. So looking at how can we support to rebuild and structure and bolster that community. When we started back in June, we did a little exercise because everyone, well, Pete, sorry, not everyone. Pete, I'm in my Green Park head now. Green Park is a very heavily engaged community. We get a lot of feedback going, you know what the issues are, just deliver. So we had quite a nice exercise, really, where it allowed us to look at things from a different angle. Everyone in the room had had the information, knew what the briefs were, knew what the challenges were. And we did a bit of an exercise around, okay, if we were looking in 10 years' time, what does a perfect Green Park look like? And just to highlight some of the bits that came out of it. And it was quite a nice collective. I think we had four separate groups. But when you looked into the detail of what came out of it, they all wanted similar things, just communicated in slight different ways. So there was a want for reduced levels of crime, to feel safe walking around the estate, for young people to be able to be out with their friends, be a young person, and enjoy the facilities without fear of crime, to improve how we can report crime, and how we make it easier and safer for people to feel like they can, and to build stronger relationships between residents and their partners. And it's actually quite nice, because we did a bit of a stop check a few months ago, and we have actually been able to deliver against all of those outcomes. But what we interestingly had a conversation around was all the kind of impacts that allow that to happen. And they do stem from community safety, health, and better engagement. So again, it brings me back to the point of it's so important that we work and drive as a collective, because you'll hear from some examples from the Grove, but doing little initiatives in areas work can impact on so many different places of our community that we need support. And it brings together, and it brings together communications, and it helps to open up those channels. Just a little example of some of the things that we've done so far. So there have been some resurfacing works which have taken place. We've done some shutter painting, so these are on some of the empty commercial units, just to make the space feel nicer. We are working with Common Futures and Notting Hill Genesis, and then our wider partners, to deliver a youth strategy. And with this, we are developing a youth advisory group. And this is a group of young individuals from the community. And they now will come into our different boards. So they will, at some point, come into the Adult Health and Wellbeing Board and give an opinion on how can we get youth and young people better engaged, what is their reality of how they feel they can connect with health, and what their kind of concerns are compared to what the data and kind of industry is telling us. But they also go around. They're a really good communication tool for us. So they started doing some TikToks, doing some Instagram, and they go away and engage with groups that we may not get in different cohorts. They're actually doing a lot of exciting work, so there'll be something to look out for in the next year. We've looked at our expanding and better promoting our offer for children and young people. We've delivered multiple activities around physical and mental health. We've got an increased CCTV presence now, and have been able to clear some areas and footfalls, which have then created greater visibility and safety and have driven away some of the issues that were faced there. And again, continuing to engage with the community in a more positive and structured way, so reducing down any duplication there. And we have now got a co-created community brand, which you'll see in the bottom right corner of your screen, Sarah. So what next? So we are committed to continuing to collaborate with residents and partners. We're doing our review at the moment, and we will be getting something out, but we've got the information we need, and I think we're really going to get some energy into it this year, and we're looking at what can we do, what can we do better. We are going to work to strengthen the community by giving you opportunities. So we are launching, or have launched, sorry, I should say, a community fund where there's going to be a panel of local community and organisations, and then local groups will be able to bid to get some funding to drive some initiatives themselves. And we are going to keep working collectively, bringing in the right partners, and, yeah, hope to come back soon and give some more updates. Oh, just, yeah, sorry, I forgot about that bit then. Just a small, small update, because I know I've probably gone slightly over as well. The Adults Health and Wellbeing Group, so we had a little pause on the group following the movement of one of the chairs. We've reconvened the group in autumn 2024 with our new co-chair, Jane, from CLCH. They are going to do a presentation, so I won't try and be a health expert. We're bringing the group back together early this year, and we've been doing some work already over a few workshops at the end of 2024, and there should be some big updates, hopefully soon, coming out of that area. But we are driving with the Adults Group how we're going to be looking to work with some other groups, delivering in more dedicated sprints. And, yeah, hopefully we will bring some more back from there. Thank you all very much for having me. Thank you very much. And does anyone have any burning specific questions, or can we move on to the next part of the presentation? Thank you. Thank you. Councillor Edwitz. Councillor Edwitz. I'm Councillor Paul Edwitz. I'm a councillor in High-Barnis, and I was just looking at something in the high proportion of children and young people. Excuse me. I'll catch an alley. A high deprivation score and a high... I'm wondering... Hugely, is the honest answer. We've, as a group here as well, for the adult side, had a lot of conversations, and they make it happen that health is a blocker to economic and getting into employment. But that's why it is so important that we have the Make It Happen, which is our economic development group. So they look at economic access from different groups, different ages, in different circumstances, to have those different access points. So we support and drive apprenticeships. I can't remember the figures off the top of my head, but I do have them. But we've had a real look this year in getting people onto training courses, getting into work experience, to break that barrier of losing the confidence of being able to be in employment, when you've been able to have improvements to your health so you can go back to work. Because I think that's an angle that we weren't looking at, or that wasn't more generally looked at before. But, okay, if we get someone back to a position where they can work again, how do we deal with the confidence, deal with kind of the shy away, and the fear someone would have if you've not been within that situation for a very long time. We also look at, with the economic, with the schools, and with the youth advisory group, how can we show the importance of economic, of employment, and that it's around how do we communicate those earlier barriers? So are they a health barrier? Are they a kind of social influence barrier, whatever they may be? There is a lot of work going into looking at that. There are other benefactors that impact it. And it's unfortunately not an overnight fix. But I think our figures this year, through the concentration that's been put on it, have improved. And we have got more people through those channels. And it's something we will continue to look at and deliver on. But I'm happy to have a separate conversation if needs be as well. Thank you. It's a really important question. And the flip side is also true. There are very strong correlations between socioeconomic and other deprivations, and other health indicators, mental health, and a range of other things. And we'll come to talk, for example, about the Healthy Hearts programme, and availability of, you know, healthy food is intimately tied up with poverty and economic deprivation. So I think it's a really important question and an important driver in this area, as it is in one or two other, a number of other areas in the borough. Okay, is there a, Councillor Begg, a very quick question. So thank you very much for your question. Our colleague from CRCH may know when she comes to present, if that doesn't answer your question entirely. I've just seen the rating here. So what sign really is almost 50% of growing participants are registered to have really top services for them. If we swap over, it might be handy. Yeah, Councillor Begg, that's one of the reasons I ask for very specific questions, because the next stages in the presentation will pick up, absolutely pick up some of those issues. Okay, as we move on now to the CLCH aspects of this presentation. Hi, I'm Jane. I work for Central London Community Health Care NHS Trust, who provide community services across Barnet. I'm a programme manager there, and I've recently taken on the role of the Adults Health and Wellbeing Group for Graham Park. We wanted to do a bit of a dive into our own organisation's activity in relation to Graham Park residents. And because that represents only a small percentage of what we do at CLCH, I had to spot. Much of the information supports the needs assessment and hopefully gives insights into how we may go further with integrated working, joint initiatives for the benefit of Graham Park. So I'll talk to the slides, the first slide there. Our services are mostly nursing or therapist-led, and we're delivering mostly adult services in Barnet. The data I speak of for CLCH is from a one-year cut of data. So there were 760 CLCH service users living in the Graham Park area. This was about one in ten of those living in that area. They had 8,450 appointments. That's about an average of 11 in the year. And 65% of all appointments were for those over 65. That's a reflection of our services, not necessarily the population. Like I said, we only provide a limited number of children's services in Barnet. We saw a very diverse range of patients, around half from the BAME group, particularly other Asian, Black Caribbean, Black African, and lots of different languages spoken, including Italian, Barsi, Tamil, Portuguese, Arabic, Somali, and Albanian. So, talk to the next slide. This is our own CLCH activity data for that one-year cut that I spoke about. A bit of heat map there on the data. So, over half of all CLCH appointments were for just one of our services. That's community nursing or district nursing, which is our biggest service. 63 people received this service in that year. 15 of them had weekly contact or more. MSK Physio reached more than any other service, with 234 service users, followed by podiatry. Our diabetes service had above average levels of did not attend, with one in five not attending. It has improved since this. So, if we move to the next slide. So, this is the Everglade practice now that I've put in. We can see, which was mentioned earlier, around half of all people living in Grand Park are registered with the Everglade, and some other practices there, which is slides. So, here you can see some data from the Everglade surgery. Compared to England, the Everglade has a lower positive experience of GP practice, and a lower experience of making an appointment. When we look at the quality outcome framework disease register compared to London, it's higher numbers. And here, we're getting into, okay, what have CLCH targeted around Grand Park? And maybe this can generate some ideas for going further, with how we might work in a more integrated way for the health benefits. So, we have worked with the Everglade put on education, coordinated by the practice manager there, around diabetes. We have offered our quality improvement coach training to voluntary organisations. It hasn't actually been taken up yet, but we have had further discussions internally with the Barnet Training Hub as to what training we might be able to offer to build up our community relations and working together. We did have Bina from the Collindale Trust come to our away day for our clinical leads. So, internally at CLCH, we've got a big focus on tackling health inequalities, and it was really great to have her there and giving her insights and really about how we can engage and better understand our communities. So, that's something we want to go further with. We've also opened up our estate. So, we have Grand Park Health Centre there, and that's been used by some of our voluntary partners, like Healthy Hearts. So, that's been really good. And we do that across CLCH as well, opening up our estate to our community partners. We had a big estate programme as well, which was a huge project for us, where we reviewed attendance data by patients' addresses and realigned all of our clinics to better fit the population, the demand. So, for example, we do now have MSK Physio at Graham Park, at that clinic site. So, there we, I don't know if you know Graham Park Health Centre, but we have four clinic rooms, two meeting rooms there. So, we have diabetes service, children's eye screening, wound care, and wisdom health there are there with the children's services. For staff to move there, we did address a lot of the Graham Park myths with our staff to encourage working at the site, and we have actually a management presence there now. Our management base is there, and we all come together on a Thursday. So, we've all got to know Graham Park a lot better since that. In relation to sort of health promotion activities, DLCH has been present at quite a few of the different events, the Urban Games, the Change Grow Live event. So, that's with our learning disability team, our respiratory team, all going there and making up presence and getting to know colleagues and obviously meeting clients as well, people who live on the estate. So, since this report also, we've been working a bit closer with the Everglade practice to see how our diabetes specialist service might support more proactively with the primary care patients who are living with diabetes. We've also been helped with the Locality Matters, two workshops, and that group's come together, sort of shaping a proposal for potential funding to support Graham Park and the sort of ideas they're coming up with, their holistic support workers, so case management, that's what our community partners are saying is needed. And the Everglade worked really hard, they're putting on an event this Friday, bringing some mental health providers together and inviting their patients in for that. The North Island Trust are also using our space to deliver a mindfulness course, that's in February. The next, these are our neighbours, like get to know your neighbour, get to know Graham Park. The chap on the left there, that's Dillish, he's a patient representative, someone with a learning disability who works with me at Graham Park on a Friday, and we thought we'd get out and interview different people for our newsletter. So we have about 600 staff, it's a great way to promote services. And so we went and interviewed MaxAbility, who provide inclusive art classes. And this links to, again, something we do across the LCH, which is linking to making every contact count, understanding our community. I have any specific questions before we move on to Nick. Good morning, I'm Nick, I'm GPN, Clinical Director of Place for North Centre London ICB. So, I think there's a couple of things I can think of. One, when I look at your data, the number of patients accessing your services, the multitude of services is quite astonishingly high. So, you know, people getting 11 appointments and actually some of them have been referred to multiple departments within your services. So, you know, when I'm thinking about this, I've got patient X being referred to the physio, to the podiatrist, then to the district nurse, and then to the whatever else is, and they're going round and round different services. And what I see, I mean, so my practice is not too far down the road, but a very different population. But we do see some patients from Collindale in my practice registering. And what you tend to see is that when patients, you haven't actually grasped the underlying problem for the patient, they will come back and back and back, and you'll do multiple referrals with different agencies. And that's when you see this pattern. And often it can be loneliness, depression, unemployment, housing issues. Most of them are non-medical. There's a medical crossover. But they're coming to you saying, I've got pain, I've got this, I've got that. And actually, then you refer them to about 20 different places. But actually, until you sort out the unemployment, the loneliness, whatever, a housing issue, they're just going to keep coming back and going round and round services. And that's one thing. The other thing that strikes me is that they've got a low prevalence. And I use the word prevalence for hypertension, heart disease, cancer, dementia, and asthma. That possibly is because no one's actually done a deep dive into is the prevalence correct. And it could be an underdiagnosis because that data doesn't fit with the demographics. So I would suggest that we consider the practice do a prevalence drive. Now, without recommending people, there are people that can come in and do that where it works out in the practice's favour because it does cost money to do a prevalence drive. But there are companies that can come in and do that and that can increase your cost. Is that case finding, do you? Potentially, I can't make recommendations. But there are lots of people that can come and do that for the practices. Because I think their prevalence is known, which doesn't fit. And I think that is also an issue. And actually, when you don't make diagnoses for hypertension, cancer, dementia, we're going to have problems down the line. So I think there's another thing there. I think there's also, you mentioned in here, low for long-term condition. I think there's probably an issue here, which is underdiagnosis again. And then the only other thing I was thinking about is we've got high for unemployment. Now, we know that unemployment leads to, you know, problems in the future. You know, accessing healthcare, having good nutrition, education. It's a domino effect. So what can we do differently with that group of patients to improve employment and socialism? Because what you described to me is that a lot of them come from certain groups of ethnic backgrounds. So how do we engage with them differently to the rest of the population? Because it's quite unique, isn't it, to that population? And is it that we need community leaders from their groups? I don't know the answer to this, but differently. I mean, certainly all the work you've done is amazing. And what I'd like to see us thinking about next. Yeah. If you want to take off the other bits offline, we're happy to as well. Yeah, I think we're going to meet, actually. Oh, I work with Moe. And I think I've met you before on cancer. It's interesting you say that. Sorry, I'm going to try and pick up your points now. But, yeah, Kate, who's our fellow here, we've been scoping and looking at other models of care for community working. Because CLCH, I don't know if you know, but we cover, like, not just Barnett. And our Westminster colleagues puts on the trail of the Brazilian model. I don't know if you've heard about this, but it's a household approach. So you're not just as different as you're not just, like, taking one person, looking at your long-term condition. And it's integrated with primary care. And it's very preventative. So it's picking up all of the things that you say that aren't the appointment. But those winded, determined, holistic approach. So we're just delving into that. We'd love to meet with colleagues to explore whether that might be something. Locality Matters, who were commissioned by Notting Hill Genesis. And within that, and that's had really good engagement, really good attendance. So the Collindale Trusts are a big presence and a big voice there. That's where they're saying, like, the case management, community workers holding a caseload, if you like. Out of that workshop, it was perhaps a focus on long-term conditions. It would be rather look at the evidence and be guided by the Graham Park voice as to where we go with that. But I think if there are some funding avenues, we could do something that is quite different. You picked up a point about CLCH, you know, patients coming to different services. So we've got a pilot project, not in Graham Park, but in the north locality, where we've got different specialisms, specialty services. And so we're having an MDT approach with our district nurses and our therapists who are working in the community can tap into that specialist input. And so they can bring patients there so that we're having one view and a collective view of how to the care plan. And so that's something that we have been thinking about internally. And obviously, even better, if we grow that to include other partners, a bit like we have the Ageing Well MDT, which I'm sure you know about. High unemployment. I think within this, going back to the Locality Matters workshop, I think it's the Shore Trust that was mentioned to me. Thank you. Thank you very much. And I think that really highlights the challenges that we have with Graham Park in terms of early intervention, early intervention, general wellbeing, as well as a range of health needs, some of which are undiagnosed, unrecognised. And I would go so far as to say one of the challenges until recently has been the general wider challenges on the estate. may well have impeded people's engagement with those broader services. And one of the points about Clearhole Build, unlocking that good will is the wrong word, but that helping people to feel more confident about the community has been really important in my mind with people's engagement. But recognising there's a lot going on, and the more we look, the more we'll be able to define where we can make a difference within that. Yeah, I think coming into this role, like we really would love to do co-production and do co-production well. And that's what Kate wanted to, we've got Kate Aldarsey Fellow, thought we could do that as well. But when I've come in, people have said, oh, the community's been over-asked, so you should present a model. So I think that's a challenge of how do we co-produce with a community that's had so much focus on it and hasn't necessarily got the solutions they need yet. That would be a challenge. Three speakers who indicated, oh, four now with Jess. So Chris Spencer has been waiting patiently online. Chris, over to you. Good morning, everyone. And thank you for the presentation. Very interesting for a newcomer to learn what's happening on the Grand Park Estate. I think you said, and forgive me, the line is a little bit interrupted at this end, but I think you said that the provisional services for children is limited. I'm not sure why that might be. Is that because the services are provided by someone else or is it just an area which is under-invested in? No, we don't. We, in Barnet, CLCH only have the contract for more sort of specialist services. So it's Whittington Health. So, yes. I tried to make that clear, but, yeah. Maybe that's the subject of a further discussion. Yeah, we need to. There is a children's group for Grand Park, I believe. So I'm the co-chair for adults. Quite a lot of work goes on through the local schools in the area. But I think that's a very good question, Chris. And maybe it's a subject for that future discussion. Yeah, and again, I guess if we go down the road of a household approach, I mean, people live in families, don't they? So looking at them together makes good sense. So it's a good point. And I know best the work of Orion School, but they do a huge amount in and with the community as well. So thank you, Chris. Could I, as Sarah, you indicated, and then I've got Paul and Jess. Hi. Hi, I'm Sarah Campbell, Health Watch Barnet Manager. Thanks so much. And it's really good to hear from you. And it's kind of building on some of the points both you and Nick were making. We've really appreciated, so our Healthy Heart Project. I don't know if you've been involved, but CLCH have helped us get venues for events in primary care locations in Graham Park, which has been great to be able to do. And we've also done cancer screening stuff off the back of that as well. And we also ran a course with Everglade Medical Practice, a healthy heart course, which was engaging people who weren't engaging with their GP, but did have heart conditions. And that was really valuable. And we're hoping to rerun it because people were able to actually meet the social prescriber, meet the community pharmacist, understand their roles, build relationships with them. And these are people who weren't engaging with their GP at all. So it'd be great to look at how we can build on that further and how we can link in. I mean, I'm wondering about the long term conditions appointments that people are having as well. And the signposting opportunity there as well as the diagnosis stuff sounds really important. So, yeah, just to just to bring that in that we've been doing that. We're hoping to do more and it'd be great to continue those conversations. I think. Yeah, totally agree. I've seen them there. And I think one of the things that the Healthy Hearts Project highlights is the importance in communities of community champions and peers in terms of building that confidence within communities and with individuals with some of those health conditions. Can I move on then to Paul? Paul? Paul? Paul? Paul? Paul? Yes, thanks for your presentation. I found it really interesting, particularly the family focused work, not just looking at just the individual kind of person having a health experience. But I also wanted to pick up Nick's point about the prevalence issue and in thinking that what you said that there's underreporting here clearly. I'm just wondering what recommendations we as a board could make to take that particular piece of work forward. I'm not sure who would do it and who would pay for it. But if there's if that helps us head off things in the future by knowing a little bit more about, you know, that particular population, then it is worth doing, I think, because early intervention is obviously a better method of treatment than having to deal with, you know, a chronic condition. And so it would be really helpful if we could look at it. I mean, obviously, if things cost money, then that was always a challenge for us as politicians, particularly. But I think we ought to have a look at that, how we could put that idea. Well, we'll clearly be minuting and making part of our recommendation is to make comments. I can we ensure that minuted in this within our minutes, there's a very clear desire that collectively we explore that because I think it's it. I shared Nick's comment, actually, when I looked at the data, it didn't quite make sense. And so I would like to interrogate that and see what it tells us and I'm playing to Councillor Begg's comment about inequalities and being forensic in a sense with our with the way we're looking at it, whether our opportunities to look at that potential around the under diagnosis, it would make a great deal of sense how we approach that with a primary care setting. I'm looking to Simon and Nick to unpick that. But it is certainly something that we'd want to want to be able to move forward. I think we will pick it up with practice. Yeah, we'll pick that up, actually, I think. And Nick, you are obviously for anyone. Nick is the interim borough clinical lead, so therefore works with GP practices and primary care provision across the borough. But I think that's a really helpful comment. And what we want to do is support them to know their population best and have the sorts of the interventions that will make all the difference in that early intervention, prevention early intervention space. Yeah. So finally, I think for this section, Jess. Jess Plains Holmes, Director of Commissioning for the Council. The CLCH data, as I was the former commissioner in a previous life for the CLCH services. And it is interesting looking at the amount of contacts. They're not individual service users. They're contacts that you've had with people. Make me wonder, Nick's point around whether or not it's almost sort of medical failure demand. We're not managing the sort of primary core. And therefore, they're hitting lots of other services. And I think that intervention is really strong. And they're able to understand what the root cause of whatever it is. Particularly since some of the people you're working with may not be helpful. Sometimes have very well-informed patients. That's got its own disadvantages sometimes. But, you know, having that support for the practice that's able to really recognise that perhaps there's something else going on. Or that this isn't a medical issue. Whether it's something you want to look at at the Borough Partnership. I mean, I don't work for the Everglade, but they do have the additional roles. A very strong social prescriber, health and well-being coach, dietician, farm determinants, which I think we mentioned earlier, that really impact on your health outcomes. All of that, you know, in that area. It's a high deprivation area. It contributes to people turning up at the GP. I'm sure. I'm sure you're absolutely right. I think some of this comes down to being very individual focused and focusing on. And where those other wider determinants prevent people from having the energy and the confidence to engage in the way they might. But I think the understanding is very interesting. Given the broad mix of resident backgrounds on the estate. Simon. Simon. Thank you, Chair. And I'm sorry for coming in a little bit later, but I wanted to hear the conversation play out. So your question triggers a thought, Jess, because I wouldn't look at this only in an NHS context. But I do think the data is really fascinating because, you know, it's a super ordinary figure to me. I'd be really interested, and I think it is a Borough Partnership question, Jess, about how we may also map the demand for statutory services. Because then you're looking at people who will have, I should imagine, quite inconsistent experience of drawing on services. And this is a population where, you know, I think it feels implicit to me, like a neighborhood-based approach will help people have a more joined up and connected experience, whilst also making their life easier for partners working together to deliver those services. So I'd be interested to take it into a Borough Partnership conversation, because there are obviously questions around data interoperability and information governance. But if we could build the demand from the community for health and care services, I think that would be really powerful. And the other bit I wanted to say is that this is a reflection, I think, of, so just looking at your slide, Jane, this is a reflection of NHS demand, what it is not reflective of is community needs. So, and that's, you know, that's always the problem we face, isn't it, as providers and purchasers of services. Mental health comes out as a big need. So, in some ways, there is a point about bringing all of that data together within the bounds of confidentiality or whatever, but making sure that at a really granular level we understand what is clinical need, what is social need, what is, and where we have tools where we can shift things, and whether that's a conversation with Barnet Holmes as a partner, with Notting Hill Genesis as a partner, or with wider health or voluntary sector partners, and where we can address and make those shifts. And I think that's a really important point. And for future working, so if we can make sure we minute that. But Simon and I have been talking a bit about neighbourhoods and how you can use our collective resources for better outcomes for individuals and communities. Yeah. And I think that's the bottom line here. I think if you can build that rich picture and get everybody, everybody say there'll be a lot from the housing, adult social care. And there will be some data from the Joint Strategic Needs Analysis to draw on as well. Though that's not as yet as rich a set of data as I would like it to be. My aspiration is it will eventually encompass that richer set of data from which all projects like Graham Park, but across the borough, can have a jumping off point with public health aspiration around being data led in the most positive way. And I think that's really important. I don't mean that data is always the pinnacle. There's a lot of soft data that goes around communities as well. Well, Jane, if nobody else has any burning questions, thank you very much for bringing that to the table. This is, I hope, the beginning of a long and fruitful relationship with the Health and Wellbeing Board, but also journey within Graham Park and that we'll be checking in regularly on the outputs and the outcomes that we create collectively for the local community. So thank you. OK, and now if I can welcome back to the table. I just want to introduce you to Ali. Ali, what involved in the story? Fantastic. Thank you, Rachel. Welcome to the table, Ali. I think we may have met before, but I've certainly had some interaction with Grow as a project in the past, but also I was at the Graham Park conversation meeting at Saracen some months ago, so we may have met there, but we've certainly seen each other before. Looking forward to hearing what you've got to say, so thank you. Hello, everyone, ladies and gentlemen, privileged comrades, if you like. I'm pleased to be here to represent Grow Future. I am being local to Graham Park, I am aware of certain issues that exist. I'm sure you will hear. So I'll try to explain as much as I can about Grow, that I board the council, et cetera. As I said, I've been involved in, over the past year, first as of all, the project assistant. The project is run by Grow, Agro, Ecological Farm, and Outdoor Learning Hub, based at the Totrich Academy, the Arnos Grove. We grow and sell fresh food for school, canteens, and run education and community programs, including this one in Graham Park. Grow took on the running of Graham Park Community Garden in December 2020. From the initial kickoff consultation, to the left, to the table. The growing decisions each week, community members helped us to decide what to grow and how to run the program. This picture was taken in January 2024. A group of residents joined us to hear about potential gardening plans, and vote on their favourite fruit and fish to grow. This focus group was advertised with the help from Cullendale Communities Trust and Notting Hill Genesis. A few SE views and posters in and around the state, and 15 participants attended and continue to contribute to the project. Community members from all ages and backgrounds joined us at weekly drop-in sessions, to the next week. This program is taking place on Fridays, 1.30 to 3.30 p.m., and 5 to 6 p.m. every Friday. Here are some pictures taken from Agro, to the left, showing the children. And July, which is at the centre, will be at the fruits and children over the moon. And June, to the right. We show the range of, shows the range of the community members, families, and young people, to adults, and those who use the centre for Friday prayers. Over 250 adults and children attended these weekly drop-in gardening sessions from March to October. Saracen High School students joined us for a weekly after-school club during term time. Activities included pollinator monitoring and making tomato, chutney, planting bulbs and vegetables, clearing beds, and learning about compost. We also hosted two drop-in sessions on site at Saracen High School. And the workshop for the mothers and daughters group, we lifted. Each month, we hosted workshops which responded to community needs and skills, including co-hosting a sign-making workshop. To create our garden signature. Where possible community members, such as Buki, hosted their own workshop. Tuki ran a workshop on herbalism in July, attended by 15 people. Overall, 300 people attended monthly community workshops in October. Together, many community members have helped create and maintain the space that is Graham Park Community Garden. And each share their names on the sign. In particular, community volunteer has been able to come on board as a garden assistant. Highlighting how the garden is not run just for the fun, but community. What happened to me, I didn't explain. I had a 2023 life-saving operation. I had 24 hours to leave. So, I didn't remember the operation, everything else. So, I was confined to the house. And one day, I went out. It just happens to be Friday. Seeing them working there and starting. It took me out of all my depression and anxiety that I had. Coming from a farming background as well. So, it helped very much. And it boosted my morale. Just to explain this. And it was nice. On 31st of August, to mark the end of the growing season, we hosted the community celebration and barbecue. We plan to carry on growing, eating and celebrating together in 2025. Our most popular event of the year was the summer celebration and barbecue. Attended by over 80 guests where they were all rushing to have the barbecue and eating food. And this concludes my talk. And I thank you for listening to me. If you have any questions, if I can answer it, I will answer it. If I don't, then I know someone who can. Thank you so much, Ali. And well done for this project, your presentation and the project. I've been very clear what it's managed to unlock on the Tottenham Academy site. I have great aspirations for doing similar things within Graham Park. And I think it's a really innovative use of space. But that sense of ownership, I think, is really important. Does anybody have any questions? First off, Nick and then Paul. No questions, but just two things. First of all, thank you for sharing your personal and inspiring story. And I think it's, you know, this is a really powerful message for people that are going through similar experiences. So thank you for bringing it here. And I would love to see this somehow maybe get into the Barnet magazine and other places where people can learn about these things. In my practice in Mill Hill, we've just bought an allotment for patients. And one of my partner, GP partner colleagues, she's really into this. So we're trying to get patients to come. And so I will let you know the details. And Rachel, I can see your eyes lit up there. I'll be there. You need to just call my name and I'll be there. Thank you. Yeah, so it's a really good thing because what we recognise in primary care is actually a lot of patients' needs are met not through medicine but other avenues. And this is a real way to bring communities together. And just like your eyes lit up there, we've got lots of patients that are great to get involved because what we're now seeing, particularly since the pandemic, is loneliness and depression and anxiety is surging. And we've got to think of new innovative ways to bring people together so they feel part of our community and we can get them better. Because giving them medication is not the solution. So thank you. Thank you. I couldn't agree more. And actually a number of schools across the borough are doing similar. Some of our migrant organisations have used their allotments in a really positive way for exactly that. It's a fantastic expression of getting your hands dirty. There are good biochemical reasons for that, microbiological reasons for that being positive. But actually it's just all round a positive activity for people. Paul? Yeah, I don't really have a question. But I just wanted to say I'm very familiar with Grow because as a governor at the Totsbridge Academy, I was there at the start of Grow arriving at the school. And it's been absolutely a brilliant experience, not only for the school, but for the students that go there and what they've learned about growing vegetables. And it's become a success. And I'm really pleased that it's gone to Graham Park. And I congratulate you for getting involved. It's a really important project. And it's been brilliant for a lot of the students at Totsbridge, particularly those who are not going to go off to Oxford or Cambridge to play in and develop. And so congratulations on your involvement. Thank you. And encourage other people to do as well, I think. Well, I do. Don't worry. I do. I take them out there to get involved. That's a moral boost for everyone, every community. They think that they own that place and they won't allow anyone to disturb it, to destroy it. And that is the sense of ownership makes them feel happier. One of the things that I was particularly conscious of at the growth site up by the Totsbridge Academy was the way some of the beds were, essentially a family worked them together and the importance that had within the wellbeing of that family unit. Is that happening in Graham Park as well? Yes, it is. It's a family. A mother comes with the children and they assign them a pot or something to plant. And then they can see it growing. And you should see the joy on the children's faces. And that's the reward we get. If I get it. It's nice, yeah. Just thinking about positive activities for young people, given the challenge around some young people and antisocial behaviour on the grandparents' day. So, because there are females involved with the Muslim community, it's very difficult to interact with the male. But when there's a female, they all get involved. They all come in there. They're all having, contributing, and taking whatever they planned. So, they feel the ownership. This ownership makes the place safer. Yes. We don't need the security. No, security guards. The whole community is security. So, the whole community is protecting it. Protecting it, yes. Excellent. Yes. Zahra, and then Jess. I just want to say a big thank you for your passion and commitment to the community. And we want other communities to know how they can embed it. It's highly recommended. I would 100% recommend this for other boroughs as well. That's fantastic. And we are minuting all the detail from the meeting. But one of the key things to take away is to talk to our columns group and make sure that we are featuring the project in the best way possible. Because it is such a positive message. But I know you're part of a growing network of growing projects across the borough. And I think that's something that we'll be focusing on. It's a strand within the current food plan. And I think it's really important that we maximize the benefit, both in terms of the outcomes of healthy eating, but actually also all of those mental health and wellbeing aspects of getting together, forming communities, growing together. I just think it's really important. And it's really interesting to know that a GP practice is doing it as well. I just wanted to say one thing. You mentioned about the health care and people who are depressed. And this part of it, I think, being a patient myself, I can see how much it has affected me, you know, in boosting my response. I didn't want to get out. Because I wouldn't get out of the house. After this, I can't stay at home. I really can't stay at home. I really can't stay at home. And I keep encouraging other people. So I think it's an excellent idea for GPs or practices to encourage their patients. It's nice. And I think the individual GP practices, it's something that, obviously, through our social prescribing group, actually, a group of social prescribers, that it be one of those, that we create opportunities to be able to refer into. And certainly, my experience, for example, with one of the migrant groups is exactly that, that in terms of confidence and depression and malaise, it's helped people through that barrier where they can feel that they can take ownership and come out into the world again. And that's certainly been very evident. We're interviewing a number, actually, that went to one of the, last year, went to one of the migrant-run allotments. And they hosted a Friday evening for councillors and council officers to demonstrate, actually, what they had done together. And I think it was a really important part of that process. So, if we have no other specific questions for Ali, thank you. Thank you very much. Thank you for coming. Thank you for the work you do. My pleasure. And delighted for the difference it's made to you, as well. Thank you. Because it beams out of you. Thank you. Okay. So, we've had a really good discussion around individual items. Is there anything in these last 10 minutes or so that anyone wants to raise in that broader context about the project? And any final questions? Jess, sorry. Thank you. Thank you, Nick, because I keep missing Jess because she's off to my net. I'm always not in the eye line of the chair committees for some reason. It's... I'm starting to think it's personal, but I'll assume not in this context. Thank you, Chair. What I just wanted to follow up on, in the first presentation, there was reference to the priorities that came from the community, one of which was to feel safe walking around the estate. And I know there's a particular reference to that being about safety, sort of personal safety. And then I noted on later slides, there are references, which I was really pleased to saw visually impaired for residents with mobility challenges, is that particularly in that part of the borough, that we need to be thinking about what we're doing to make sure that the built environment is accessible to people. So they talk about poor lighting, they talk about pavements and all of those things. And it looks like, at least from the slides, that there was starting to be that, actually, this is about making sure that everybody is able to physically access the space. And I just wondered, particularly when we're looking at the placemaking framework, whether there is accessing their community. Can I just clarify, are you talking specifically Graham Park and the concourse, that area? Because obviously that's one place that's particularly challenging. Yes. Okay, so Vicky is quite likely to have a view, given that one of the groups in the new structure is around placemaking. So I'll hand over to Vicky to see her view on that one. Thank you. So we've been able to make some improvements. There are aspirations to make further improvements, but one of the pieces we're going to be looking at through the housing and long-term maintenance group is how the new, the interim improved areas and the retainer of redeployment that you can notice when you change from place to another. But we actually had a conversation earlier this week in the placemaking workshops for the wider council of how do we address that across the borough, not only within Graham Park. I know they are looking heavily at Collindale, but one of the things that the group of, meanwhile, placemaking is likely to transition into the longer-term housing group. But that's one of the things they're considering. But we obviously now, we have highways internally. Since they've moved in, we're developing how we work with them, how we work with them better as well. So, it's not there, but we are making progress to get there, and that is a concentration of how can we make that a safe environment that is maintained to a level that we're all proud of. Thank you. If I might add on that, I think one of the challenges with Graham Park is that the regeneration project has been in progress ongoing for, well, just over 20 years, and therefore it is a real problem. And for those with disability or those who are getting older and have mobility problems, you know, there are sections of pavement that still need sorting. There has been some very particular work. That came out very energetically out of the community meeting in the autumn, but it's good to see that that resulted in immediate action with some of those key areas. But it will be an ongoing challenge, I think. And it's both physical safety and actually making errors reference in the report to making some key hotspots around the estate area safer and more visible, better lived, which I think is really important for people's well-being. Jeff? And just to come back on the point around the issue around where the area you live just outside your house not being accessible to you, is it prevents you accessing the rest of the world? I mean, I think when we talk about, you know, the importance of economic, you know, prosperity and Barnett, and we talk about people not being able to, not being on their high streets as much. If you can't get out of fact that people should access their community. And I wonder if there's anything that you're doing that's specifically with people who have mobility or visual impairment where, you know, things like ward walking in the area and saying, actually, rather than needing to pick these things up one by one, you know, let's go out together as team groups. And this is where we bring together the different departments that can deal with the environment and essentially make the environment better, but we work on it as a collective. So we're not looking at it in silo from a highways perspective, from a grounds, from a lighting. We bring all of those areas in to say, how can we make this a better place? So we are now transitioning to look at things from every angle. And it is looking at it from the angle of being conscious that that accessibility, like you said, whether it's health, safety, access, it prevents people from accessing all of the services. We're looking at it now from that wider angle of how can we be an enabler instead of being a blocker? And by us coming together, what else can we give to the community through stream like the area instead of having like that blanket deployment? Really helpful. But I think that Jess's point about those with lived experience, being able to get out of their door, actually walking the area. You can, we can, you or I could look at it and perhaps miss something that's clearly a particular barrier for particular people. So walking the area and being able to do that would be really fantastic. And I think it would also increase engagement in the community because it would help with that sense of being heard, that individuals feel they're heard. And I think that's really important. But that keys into some of the work that the council's done in terms of understanding what the roots are of those members of our more disabled, community with disabilities of a range of different kinds, who perceive that they are not necessarily well served by the council. So I think it would be very positive in that specific context. Well, members of the Health and Wellbeing Board, I think we've, I hope we have met the recommendations that we have before us so that the council notes the progress and provides feedback on the work related to the Graham Park, to health and wellbeing in Graham Park. I think we've probably done that more fulsomely than we do in many items. So we will use the minutes as the guide for all of those recommendations. And I will make sure that, as chair, that we collate those together and ensure that both you get those, but actually that they're registered as part of our work together. So thank you. Everyone is presented today. All of the team behind it. It's clear that we are on a journey, but really beginning to feel that we're making significant change. And I shall look forward to hearing again about in the future, but actually coming out on site as well with you. So, and joining your health, your adults and health group. Thank you very much, everyone. And sorry, Sophia, one last word for Sophia. Ali's just brought some information with him about Grow that he was hoping to hand out to people, if that's all right. Thank you. Please do circulate that. Anyone who could sing about the Go Project is... Absolutely. Thank you very much, Ali, for that. Thank you, all of you, for what you're doing on the ground. Thank you to all your volunteers. And we can now move... Everyone, I hope, agrees with those recommendations. And then we need now to move on to our second item, which is dealing with the draft health and wellbeing strategy. And I'm just going to brief... For those online, Ali is enthusiastically sharing a flyer linked in with the Grow Project. Thank you all very much. And we would normally take a quick break, but I think we'll proceed straight on, because I know that some of our clinical partners at the table... Thank you all very much. Have commitments... Have commitments as we go forward. So, our second item is... Is dealing with the next stage of the development of the Joint Health and Wellbeing Strategy. I'd just like to make a couple of points before we start. The Joint Health and Wellbeing Strategy is key to the remit of the Health and Wellbeing Board. And that was abundantly clear to me when I was being interviewed by the CQC, actually, for the recent adults inspection. And that was one of the areas that they wanted to focus on. And it's key in our role in convening partners from the Council, the NHS and community and voluntary sector around our common agenda that is improving the health and wellbeing of our residents and our communities. And it sits alongside the NCL Population Health and Inequality Strategy. But our job within Barnet, of course, with that as our backdrop and driver, is the defining of our Barnet-specific challenges within an increasingly diverse population and with a significantly growing ageing population within Barnet. So, what we're doing today, Joint Health and Wellbeing Strategy, as our Office of Speakers will talk about, is we're in the middle of the journey in developing this. We have had workshops, a wide range of engagement, which you'll see from the engagement paper, the consultation and engagement paper that sits alongside the item in the committee papers. And our job today is to agree that we accept the key top priorities that will drive what will become a 10-year plan with interim milestones. And in defining and agreeing those priorities today, they are effectively set. There will be, obviously, a further phase of consultation. And how we enact those and how we deliver those is part of the development of both the final stage of the strategy and the action plan that will take it forward. But it's really important today that we agree those priorities. We're already working. I mean, it's an exciting time because there's a lot going on nationally within the context of health. There's the NHS conversation. We're running a little ahead of that, the outcomes of that. But I think we're already working with the grain of the Secretary of State's aspirations around care closer to home, focus on prevention and early intervention, and the better use of digital and data. So we don't anticipate any big surprises. We think the priorities we're setting will flex around any outcomes from that. There's a lot of activity across partners that doesn't, is not contained within the joint health and wellbeing strategy. The joint health and wellbeing strategy does not define any partners activity. It certainly doesn't define all that the Council does within public health and health. What we're doing here is we have the opportunity to define those areas whereby coming together as partners, defining those common goals, we add value that we can make for the health and wellbeing of those individuals and communities. And I believe also progressively together working towards enabling individuals and communities to have the tools and the motivation to take ownership of their own health and wellbeing going forward, because I think that's really important. Nick alluded earlier to the fact that not everything needs a medical solution, but actually where there are many things that we can do in our lives to improve our health and wellbeing alongside the work that the NHS does for and with us. They are shared goals, as I said, and we hope by defining those shared goals and delivering on those, we can collectively make a step change for those individuals and communities. And I think that was illustrated perfectly by the previous item around Graham Park, where actually, increasingly, by bringing people together, recognising the common challenges there for the community, and finding ways to deliver solutions for that, is making a difference to the health and wellbeing, and will continue to make a difference to our health and wellbeing of a population who, quite frankly, over the last 20 years have felt a bit left out in the cold. And it is very important to me that we start to do that. But Graham Park is not the whole of the borough, and there are individuals and communities across the borough who need what we're talking about within the health and wellbeing strategy. So our role today is to approve those priorities subject to comments, and I'm going to hand over to Claire to lead formally on that introduction. Thank you, Chair. And I feel as though, following Ali, I'm just going to be a bit disappointing, I'm afraid, but I'll try my best to talk about the health and wellbeing strategy. So I just want to take you back, first of all, to October 2024. So when the board met informally, as part of a seminar session, to go through that first walk through the data and the information that we'd collated through the JSNA, the Joint Strategic Needs Assessment. Board members endorsed the fact we'd have a 10-year strategy at the time. We also talked about some cross-cutting principles that would underpin all the work within the strategy. But most importantly, put forward that first set of long-term priorities and short-term goals, that we'd go out and talk with residents, with service users, with different professional partners, to see if those were the right ones. Because we know that data and information is one thing, but actually sometimes professional and lived experience can or cannot support that. We really thought that was an important step of the process. So, to take you through, Bryony's here, who's been an integral part of the engagement process. I'll let Bryony introduce herself. Please do speak as clearly as you can, so that those online can hear us, because we're going to be asking our partners online to sign up as well. Of course. I'm Bryony. I'm the Peer Co-Production Engagement Leader, Inclusion Unlimited, the Community Interest Company Consultation and Engagement for Health and Wellbeing Strategy. I really enjoyed working with Claire and the Bargain Partnership and the Health and Wellbeing Board at large, because it's been a great opportunity to ensure that the Health and Wellbeing initiatives truly represent the diverse voices, needs and priorities of the community. In terms of the purpose and approach, as Claire said, the purpose of this consultation phase was clear. It was all about bringing together a wide range of knowledge and expertise. It was an opportunity to make sure the strategy reflected not just the data we already had, but also the real-life experiences of residents and the professional insights of partners and local stakeholders. So our approach was evidence-informed and action-oriented. Claire had utilised the Joint Strategic Needs Assessment key partners to produce some initial draft priorities. The aim was then to focus on areas where there is a definite local need, where there are actual local levers, whilst avoiding duplicating any ongoing work. We did not communicate to participants that we were coming from a blank slate. We were transparent about areas of insight that we already had, and the remit and scope of the Health and Wellbeing Board. Frequently asked questions and case studies were shared to provide context and illustrate past focus areas. The data and initial priorities were excessively presented, and we provided opportunities for participants to validate or challenge them based on their lived and professional experiences. Co-production was at the heart of this work. We did not aim for consensus, but for a collaborative process that allowed diverse perspectives to shape the strategy. The co-production is about bringing together lots of different kinds of expertise and understanding, about gathering many different pieces of the puzzle, including often missed pieces and missed voices. And I think Claire has done an excellent job of putting that puzzle together to form a strategy. In terms of engagement activities, we designed a flexible, accessible and inclusive process to gather input. We reached out and promoted the consultations through mailing lists, professional networks and community groups. We engaged by conducting focus groups, one-on-one meetings, online surveys and a citizen panel, tailoring our approach to the needs and expertise of different participants. We used tools like Mentimeter for real-time feedback where appropriate, and we provided participants with opportunities to follow up after their initial engagement if they so wished. In terms of representation, we promoted the engagement opportunities widely. We worked with a range of groups of internal and external stakeholders, including residents, BCSC representatives, and professionals from health and social care and education sectors to capture a broad spectrum of voices. We included the Barnet Multifaith Forum, Barnet Age Friendly Champions, the Royal Free Patient Participation Group, and the Learning Disability Strategic Partnership. You can see a full list of the collaborators in the consultation report. I think the diverse representation is reflected in the strategy. On successes and impact, I think this phase really demonstrated the value of genuine engagement and actions. The process really underscored the importance of collaborative and community-led approaches to health and wellbeing, addressing issues at neighbourhood level and developing local partnerships. There was also a challenge back to the board to be realistic about what it can achieve, and not to raise expectation of change or improvement if it cannot be delivered. Again, a rundown of all the findings can be found in the consultation report. But it's been fantastic to work with Claire and the Health and Wellbeing Board, and really see the sincere willingness to listen to the community and if she is all the more strengthened forward. And it does really reflect a commitment to inclusive and collaborative working, centring the voices of those most effective. So just last from me, big thank you to the Barnetboro Partnership, and the Health and Wellbeing Board, and everyone who contributed to the phase, and another well done for Claire for pulling it all together. I'm really looking forward to seeing how the insights shape the approach to health and being moving forward, and I hope to other stakeholders going forward. I'm now going to pass back over to Claire, who will be able to share more about the children of our authorities, how they were shaped by feedback and the stress. Absolutely, thank you Bryony, and yeah absolutely every morning to get a good pep in my step. So I'll talk through kind of how the priorities and goals have changed from the version you saw in October, and I'll go through some of the high-level changes, but happy to take any questions on other things if you've solved them. So in terms of the four long-term priorities, I'll go through them in order. So start better has become start and grow better. Mainly to reflect the fact that through the consultation it was felt that particularly teenagers and young people weren't as prominent as they could be within those priorities and goals. And certainly we've added in a goal that has made around good mental and emotional health for all children and young people explicit, because although the data was showing actually it's starting to move slowly in the right direction, we felt actually it's not should be there as something for health and wellbeing, or to drive forward. The other big change really around this area was around children with SEND, children and young people, and increasing the join-up of services. Again, I think it's a reflection that there's been work done over the last few years to really support the board and the board members. Live and age better, so the second priority. I think this, we've just done some wording just to make some things a bit clearer to people, because I think when you take this out actually people interpret words in different ways, so we've tried to make it a bit clearer about what we're trying to do. But actually a lot of the feedback in this area are not necessarily about the goals and priority itself, it's around the actions within it. So certainly in terms of older people, you know there's a growing over 65 population in Barnet and will be quite quickly over the next few years. So certainly actions pick up things like falls, prevention and frailty around dementia friendly. And I think during the next phase of consultation, we really want to strengthen that area in terms of actions to support. The third priority, around better places. I think this is the kind of newer one of the four. I think actually of all the consultation, of all the times we ask people to prioritise, the factors that really influence kind of social and physical environment factors, which I think we heard in Graham Park and I think is reflected across the borough unsurprisingly. So really wanted to focus a priority around actually the social and physical factors, and also a recognition that these affect everyone across the life course. So we heard about, for example, loneliness and social connectedness for young people, but also for adults and for older people and age groups and different communities, trying to bring that together. We also added within this priority a goal around affordable healthy food. I think I put my hand up. I think that's probably something we should have had from the start, particularly with the Barnet food plan. But again, that was quite a number of different forums and a number of different ways as well. So it's on there. Finally, better health for all. I think again, a little bit of wording change, just to kind of really make clear what we mean by this particular priority and the goals. But we've added in a goal around services and provision being culturally competent, because I think we heard examples of not just health services but other services as well, which had barriers for people to access all the way through. So actually trying to identify where, trying to explore that with the actions underneath that. So those are the changes to the long-term priorities and short-term goals. Just to kind of reflect what the chair has said. So the board is asked to approve the draft today. And I suppose what my direction, my suggestion to the board members are, is very much it's the long-term priorities, short-term goals, that provide the framework for the document. So actually the next phase of consultation, then we have to significantly the document. As I said, those are the key things. The actions, the measures, the things that go around it, actually we've got a next phase of really making sure we can measure progress on the health and wellbeing strategy. And then finally, my kind of final piece back to the board. So the challenge that was made to us in October was to keep a small number of priorities and goals for the health and wellbeing board to focus on, keeping in mind that realistic yet ambitious view that we wanted to have. The number of priorities has slightly grown since you saw it in October. So actually, if you feel as though we need to narrow those back down, again, that's something for today's discussion. We'll probably pick up after we've had the discussion. So, the first question really is the fundamental one. In terms of, I think it's worth remembering that this is setting a ten-year strategy, but with essentially falling into three-year phases. So, in that context, any comments from the board or board members who are online about the numbers of priorities and whether we think we've got the balance between that focus and the depth that we want to have within this document? Do we think we've hit the balance right? Do we think there's anything we would want to reduce in this? And I suppose, is there anything we've missed? Nick? Just to say, I'm very happy with it. I don't think, you know, we've looked at it already in lots of details. And thank you for all the hard work that's gone into it. And obviously, being able to iterate it has been great. So thank you for doing that. I'm very happy with it. Thank you. And I know it's a huge... I think people don't recognise the huge amount of work that's gone into this. So thank you. Absolutely. And I think the point about the breadth of the consultation and engagement is a really important one because while it's an owned document, a co-owned document across the board, we absolutely want it to have the voice of local people and local organisations within it because we cannot deliver this without both the heft of those local organisations and their activity, but actually with local people, because part of this is about supporting them to look at their own health and wellbeing. I've got Paul, but could I take Debbie Sanders first? Because she hasn't had an opportunity to speak yet. Deborah? Yeah, thank you, Alison. I completely echo what Nick has just said. I think we should be ambitious. I think we should be ambitious for our population and our communities. And I think when you look, when you think, oh, my goodness, there's a lot there, but we are talking... It's 10 years. So it's a 10-year strategy, isn't it? So I don't... I think it's... I think it's perfectly in the right space. The other thing I'm always interested in is, you know, I always want to see, can I see a read-across between what's here and what's in the clinical strategies that we've developed for both the Royal Free London and our individual hospitals. And I can absolutely see all those read-acrosses, which is really good. So it's great to see everything sort of feeling really joined up. So very supportive. Thank you, Deborah. And that's a really important point in terms of the read-across to our clinical partners. Obviously, I was conscious that we wanted to have a read-across to the population health and inequality strategy, but a really good point because our clinical hospital partners are critical in the delivery of some of these issues. So thank you very much for that. Paul. Yeah, thanks, Claire. I agree. I think it's a really good report. Can I just be a little bit picky? Not with you specifically. And I'm not normally one who focuses on detail. But I'm just interested in the figure of when we talk about the age in population. We stop at 65. And I read an interesting article, I think it was in the Times, a week or so ago. 20 years ago, I think, in England and Wales, we had a population of over 100, about 7,000. That's now gone up to nearly 15,000 and growing. So when we talk about 65, A, you can't even get your pension. You save pension now at 65. And so people are forced to work, you know, those few years longer. And that growing elderly population, particularly for us in adult social care, is the one where people, you know, they're more likely to be, you know, sort of ill health. And so I'm just, in general terms, questioning the cutoff at 65 plus, because many people are living another 35 or more years beyond that. And so I realise it's a national figure. But I just really wonder whether it's not really giving social care as we go forward. That's a really interesting point. And it's one we've been talking about offline. There is a period between 65 and potentially over 100 where your needs are going to be evolving during that period. If you think about that, that's 35 plus years. And if you think you read back from 65 to 30, you're a young adult. So I think it's a really interesting point and one perhaps we should start to think about as part of the delivery of this. Because what we're about is enabling a longer, healthier lifespan, looking at where we can intervene and support people prior to 65 to ensure that they are enabled to be mobile and healthy as long as possible. But the reality is that once you're into your upper 80s and 90s, you're going to have a different set of challenges from those you would have at 65. And we've been talking offline, Paul, about what the picture of a 65 year old is now compared with our parents' and grandparents' generations. And Deborah talks about being ambitious for our community, absolutely ambitious for our community, to increase that sense that you're still, you know, 65 is the new 40, that you can live longer and healthier, connected, mobile, able, but knowing that that is not the reality for a proportion of our population. And there are many reasons why people are not in that position. So finding ways of threading that through. Claire? I think I can make two suggestions. I think one is around the narrative. And I think picking up actually, it looks different depending on the age and the stage of life you are. And I think the reason why we put live and age well together is actually some of the kind of behaviours, habits that people have earlier in life to help you age better as well. So I think it's certainly something you can do about the narrative. And I think also it's picking it up in the actions, because I think actually there are specific sets of actions, particularly around that population. So I can work with colleagues around that. Thank you, Bryony. And just to add to that, it did actually come up in the consultations with residents that it's for the ageing population and many groups as well. One of the comments I would make actually, if we are a borough with an increasingly ageing population, which we are, understanding what that really means across that lifespan of our older years. And that it will mean different things to different people in different circumstances. That's really helpful. Now I have Simon Zara. Thank you. It was a very brief point. And I take Paul's point. Interestingly, Age UK worked with people over 55, which I think some people over 55 are slightly offended by. I do wonder if we could, if we haven't already, connect the work that Age UK did on the council's behalf as part of our age-friendly borough, particularly the survey work that we did, because it was actually very well responded to. So we have more than a thousand people. And that did use an intersectional lens to look at cutting that information to understand sort of resident focus and consideration. And then also, I think the point of our narrative, Claire, is really important. That there are going to be lots of data that is cut on the basis of over 65s, because those are national data. But that doesn't stop us from looking at things in a more locally focused way and narrative approach. That's a very valuable point. Thank you, Jess. And absolutely, linking into the age-friendly borough work is important. And that does, just as I was saying, not everything is in the health and wellbeing strategy. Actually, some of the outcomes from that work are other council services who can be positive enablers. And those conversations are already feeding in to, for example, the walkabouts in wards with environment and safety officers, and recognising some of those. It's not just Graeme Park, actually, that has some of those impediments to getting out and about. And so, bearing that in mind as we go forward. And then that very valuable comment, actually, from somebody in one of the discussions, where you could use records of slips and trips and falls to inform pavements and roads work as well. So, thank you. That's really helpful. So, I have Simon and Zara. Thank you, Chair. Just to echo other comments. So, I think as a draft document ahead of consultation, I think it's really good. I think it reflects a lot of development and a lot of contributions. So, I think the team should be really pleased with what they've produced. So, I've got no specific comments on the document. I'm, in some ways, getting a bit ahead of myself and thinking about the delivery planning for this. Because I think already starting, you know, because the strategies should set out where you want to get to. We're already giving good thought to how we're going to deliver it in the measures of success. Something we need to think about is how we might want to do target setting for this. So, rather than just saying improvements from a baseline, actually, where do we want to get to? And look at, you know, look at some comparative data. The other bit as well, and this is contrary to being an NHS bureaucrat. But, so sometimes quantitative data only gives you part of the story. I think about Nick's world. You know, you can look at a practice and look at CQC and QA and GP patient survey. But, actually, sometimes, you know, perceptions of access are more powerful and aren't really teased out from the data. So, perhaps as we're entering into delivery planning, thinking more creatively about how we bring together, you know, intuitive data. So, just some thoughts on the next stage. And I think Sarah's about to say, Sarah will make a comment in the morning. In the moment, I suspect about, about quantitative data and the Healthy Hearts project. So, mine is just 65 years. I don't know. I'm just looking. I think, to some degree, it depends on your own personal context in that. But, Sarah. Yeah, thanks so much. I think it's a great document. And it's been really good working with Claire and Bryony on this. And that you've achieved a huge amount as a small team. And I can really see how, I think there's a solid framework already. But it's really changed quite significantly as a result of the consultation so far, which is great to see. I think I'm a bit similar to Simon, sort of thinking ahead to the formal consultation. And I'm sure we'll have more discussions about this, but just to say here. I think, speaking to Bryony recently as well, it sounds like the two areas are the monitoring evaluation and the activities. Well, there'll be a lot, the idea is there'll be a lot more further development in the consultation phase around them. I mean, I was particularly thinking of the Involvement Board, and we're keen to get, as Healthwatch Barnett, to be more connected with the Involvement Board and the role they might be able to play in terms of monitoring and ideas about how we do that monitoring. I think it's great to have the 10-year plan, but the regular reviews, so sort of linked into that. Yeah, and in terms of the activities, I mean, there were just a couple of things I noticed within the consultation document and the strategy. There was talk about, you know, loneliness, need for more connection, need for face-to-face events, but also the type of events. And maybe digging down more into that, or maybe there's already, I haven't read it line by line, but maybe there's already more in there about that or understanding what people are looking for. That would really support us, support the partners we're working with, I think, as well. Access to healthy food, I think that's really interesting to see the affordable food club idea. We're doing, we've been doing workshops, sort of food bingo and healthy eating, different healthy eating workshops, you know, how can we link in with that? Yeah, so I think it will be, and things like how can places be welcoming to older people? I just think there's a real opportunity to delve down into that and what the specific actions are. I mean, I'm sure this is what will be being done anyway. And also, where are the opportunities for VCSE colleagues? What do VCSE colleagues feel they can get on board with it and help to deliver? So, yeah, it would be great to be working on that over the next few years. That's great. Now, Janet wanted to make a comment. Do you want me to go, Bob? I have one comment that has come to me from a fellow Cabinet member. She raised the issue, it won't be a surprise where it comes from, that nowhere within it was there any reference to violence against women and girls. And it's obviously such an important part of the work. Now, I said at the outset, not everything that the council and partners do is encapsulated within the Joint Health and Wellbeing Strategy. But I want to put just to the to the meeting today whether there is and it didn't and there wasn't a reference back from any of our consultation partners. But bearing in mind what Sarah said about did we talk to everybody we should have done? Are there any is there an appetite for looking for work around the health and well-being and mental health aspects of the impacts of violence against women and girls within this? And I put that to the meeting because it is something that was quite strongly held. And I suppose I am slightly surprised that it didn't come up and therefore just challenging back and saying, is there somewhere that we ought to be feeding that in, particularly in the living well and the enabling side of it? I put it to the to the board today. Do we think that there is a place where that can fit and would be valuable to have? Or is the reflection that it didn't come back from partners because it's seen as a strand of work in its own right, with which we link through other strands of council and health work? I mean, just I think personally, I think it would be great to add that in. Yeah, maybe also specifically mentioned, but we do get that feedback regularly from members of the public. It's a huge issue. You can't separate it from health. I would agree. And the impact on victims and on the families of victims and communities and confidence as well. May we take that away and look for somewhere for that to just fit in logically, given what you've just said, Sarah. I'd be pleased to do that, I think, to make sure that we could pick that up. Okay, may I pass on to Jess? Did you have any comments to make about that? Fine. Janet. Yes, thank you. Just to close this item. Thank you to all members of the Health and Wellbeing Institute for your input and feedback. But mainly to Claire and Bryony who fought this draft through this initial consultation phase. And it is a huge challenge really to pick out those priorities that we all agree on and where we agree that we have an impact potentially. And as Barnett's Director of Public Health, I would like to say on our behalf, and I think it's safe to say on behalf of everyone here that areas that are important, but not included specifically in the health and well-being strategy to improve health and well-being residents. And I just feel important to give this reassurance so that we can actually deliver our commitment. Thank you, Chair. Thank you. And if there are no further comments, I would just like to firstly reiterate that there is a strand of work throughout the Council around health and all policies. There's a lot of other work that goes on as core public health work, which is really important, and we'll come back to some of that in a minute when Janet gives her report. And then just to reiterate my thanks to all of the board members for the input formally and informally that you've made. And to thank for the comments about monitoring and outcomes, absolutely. I can be a terrible scientific data anorak around this, and I think it's really important. We can have great aspirations, but we've got to make it work on the ground and be able to look back in three and six and ten years' time and say we really made a difference, and here is how and why. And I think that's – and for the public to be able to recognise the difference that we have made in telling that story, because I think that's really, really important for their confidence in us. And then finally, a big thank you to both Claire and to Bryony for the outstanding work you've done in bringing this together. And to all the consultation partners across the borough and beyond who've contributed to making sure that we have a joint health and wellbeing strategy, that we have confidence going out to the next stage of consultation, but also that we will welcome coming back in May and be proud of and excited to work forward and deliver over the next ten years. So thank you very much, and I think we have delivered the agreement around the priorities and the recognition about the next – that we're ready to go to the next stage of consultation. So thank you, everybody. Absolutely, yeah. I know Nick will now leave because he's chairing another meeting, but I wanted to get that agreement in place with everyone while Nick was still here for the discussion. Thank you, Nick, very much for being here. Lovely. And, yeah, and thank you very much for the warm words of endorsement. That has, yeah, it's been a bitty few months. I think it's made, dashing from my kids across country to Barnett-Coptell Leisure Centre to do a session, much, much more feasible. So thank you very much. Next step. So we'll move to the final stage of consultation, which I think, as we've alluded to, will focus on the whole document, but really hone in on those actions and those measures. So certainly the points that people have made today will pick up in that phase. We'll put it on the Council's Engaged Barnett website, so it'll be available for any residents or any organisation to view. We will send it out to all the people involved in phase two of consultation, so the phase that's just ended, so they're aware. And we probably won't do as in-depth as consultation work as we did previously, just by virtue of Briley is going back to do other stuff. But we'll try and engage some of the key partnerships, particularly the cross-sector ones, to really hone down those actions. So, yes, if you want to have a conversation with me after today, I'm more than happy to do so. But, yes, I'll be coming to you. Thank you very much. And that feels like quite a milestone for us. And I just reflect that, obviously, the last time this was done, still under COVID regulations, much of it was done online, just excited that we've been able to do quite as much face-to-face and engagement as we have, and a real sense of collective ownership around it. So, moving on to the next item is our update on communicable diseases. It's a verbal update from Janet Jomber, and she'll make reference to the other reports. But I would just say that members will note that we circulated the reports that went to the Adults and Health Overview and Scrutiny Committee last week. And those are both really good detailed documents about the work that's been going on. But over to you, Janet. Thank you, Chair. Yes, please do have a look at the report shared. It is the main item at the moment. As the flu cases and numbers are still high, as has been held earlier this month, there is learning already to take on board for the next season. The flu start for next autumn. Besides flu, what is relevant, norovirus and Mpox, because it's still an infection of interest so far, there have been no links identified between the cases. Sarah. Yeah, I just had a question in terms of the flu vaccine. It is something that we promote. I wasn't sure, so I had my vaccine earlier in the autumn, but I was trying to find out in December and January for a relative who's in Manchester, I was trying to find out flu, and I tried a lot of pharmacies, and I could not find a flu vaccine for love nor money. But I don't know the availability in Barnet, because if we're going to promote it, then people aren't able to access it. Do you know? We have got anecdotal news that some pharmacies have run out of vaccines at some point. Yeah. So I haven't been notified about any current issues. Okay. But it should be a direct vaccine. That's reassuring. Anecdotally, I've had one or two reports. I don't know whether there are, we might consider, at this point next year, whether there's anything about availability and just... We've seen it over the past years that at some point, too late, I'm just seeing it's important. That prompts a thought on my behalf that because there was perhaps a slightly earlier start to the flu wave this year, and perhaps people's consciousness of when to have a flu vaccination and that people may be leaving it that bit longer, and therefore the peak demand is around December when people are thinking about having family around, visiting elderly relatives. And I don't know whether there's some thought perhaps to feed into regional or national comms about starting, you know, how that plays into those vaccine, the vaccine comms earlier in the autumn. I don't know. There is planning in place to ensure that the most vulnerable people, children, it is also about to, it's a balance between a vaccinating, but also to ensure that also it's not very healthy. And with that in mind, you know, it's that population of particularly older members of the community who are in other ways reasonably healthy and able, but certainly early on in that flu wave, a couple of times in national interviews with hospital clinicians and their frustration that a number of the people that they were seeing who are having to be hospitalised with flu actually had been eligible for but hadn't taken up their flu vaccine. And I think a degree of frustration on their part. I think just as you say, that perception that flu at its worst can be a killer and recognising whether it's being combined with a bad weather period or other reasons, other respiratory complaints, actually it can be quite serious. And I think we tend to, I'll stick my hand up and say I was in the 1968-69 flu epidemic and I was off school for three weeks. And so I've been left in no doubt over the years that actually if it, if you're going to, you can be quite ill with it. And, but that's, it seems to have kind of receded in people's imagination, as you quite rightly said. And so recognising that it can be a serious illness is really important and the vaccination is a positive thing to do. So thank you. And Janet, did I understand that you would circulate a written report for private consumption? Or we were just going to rely on the adults and health reports? No, that is, we didn't intend to separate the adults at all. Thank you, that's very helpful. And thank you, Janet. Moving swiftly on to the forward work programme. You'll note that compared with the original work programme, two items had been removed from this meeting's agenda. The Fit and Active Barnet report and the ICB Joint Capital Resource Strategy, those will come to our May meeting. That will mean our May meeting is quite a, will be a dynamic meeting with quite a big agenda, but I think we'll all be ready to go at that point. So is there anything else that we think needs to be added to that work programme? So that's at the end of the agenda. So we're now, I have no items that are urgent. So we can now call the meeting to a close. And once again, thank everyone, both online and in the room, who's joined the meeting. Thank you once again for an engaged, dynamic and vibrant discussion. And while this meeting may not be so great for the IT backup, the audiovisual, actually it's been quite nice being in a smaller room because we can see the whites of each other's eyes more easily. But thank you, everybody. And I look forward to the next phase, next meeting, and to all the meetings in between times. So thank you very much, everyone. And I formally close the meeting. Thank you. Thanks, Deborah. Thank you very much.

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