Transcript

I'd like to welcome members to this afternoon's in-person meeting of the Rutland Health and Wellbeing Board and to members of the public who are listed in fire teams. We have another busy agenda, today's meeting, so firstly, to practical matters. We're not expecting a test of the fire alarms, so if the fire alarm does sound, could the attendees please exit the building via the nearest exit? The rallying point is the rear of the car park. I'd like to remind attendees that they need to please raise their hand if they wish to speak and that for the benefit of the webcast and the recording, they just switch on their microphone when addressing the item and switch off when they have finished speaking. I'll refer to the scrutiny officer from Democratic Services if I need to record a vote of any procedural matters. Thank you. So moving first to apologies, Jane, have we received any apologies? Thank you, Chair. Yes, apologies have been received from Karen Kibblewhite and David Williams, but we have Alison Gilmour in attendance as David's representative. Thank you, Jane. So the record of meetings, so this is confirmed that the minutes of the Rutland Health and Wellbeing Board meeting on the 16th of January 2024 are an accurate record. Would any like any amendments make into the minutes? I was not able to attend the January meeting, so I'd like a proposal for the minutes, please Thank you, Mike, a seconder, please, thank you, Tim. All those in favour, please raise your hand. Thank you. Anyone against, please raise your hand and abstinence, B, and two, Sarah. Thank you, Chair, so minutes are now confirmed. Thank you, Chair. There are no actions arising from the last meeting, so we move on to agenda item 4. Any declarations of interest for this afternoon's meeting? No, none. Patitions, deputations, and questions. Have we received any petitions, deputations or questions? Non-received, Chair. Thank you, Jane. Questions with no just from members? Non-received, Chair. Most of motion from members? Non-received, Chair. Perfect. Gone through them. Now we have the first two items on the agenda are we have some visitors today. So number 8 is the right-care, right-person overview and update. It's a verbal update from Chief Inspector Audrey Denver's of the right-care, right-person approach. So can you come to the table and present to the Board, please? Can I call you Audrey? Can I call you? Sorry. Can I confirm you can? Oh, I can definitely hear me coming up, and I'm all right. Good afternoon. I'm Chief Inspector Audrey Denver's. I'm currently based within the contact management department at Forest Health courses. I've been asked to come here to give you a bit of an overview of right-care, right-person. Can I just ask, just to get a flavourful of us to the floor? How many of you have heard of right-care, right-person? Right, and you may all have, at least there's a reasonable amount of understanding in relation to it's right-care, right-person basically came about because I think there's been a recognition over particularly last at five or ten years that the police getting involved in lots of matters which were perhaps not best to take primacy on, particularly those relating to people in a state of vulnerability, mental health, et cetera. Right-care, right-person is effectively a threshold that gives an overview now on as to when the police will get involved in relation to certain matters. For yourselves, as a health board, the probably two key areas which would impact upon yourselves, and that would be people who go absent without leave from mental health establishments, that's usually in Leicester, it's usually sort of the Bradgate Unit or sometimes Arnold Munch, and also walk out from health care places, again, usually in Leicester, it's usually for Leicester or in Fermi. In addition to that, there are three other strands that also relate to right-care, right-person, those are concerns for welfare, transportation, and the police use the mental health powers, but it says that there will be those two key strands that are going absent without leave and also those who are absenting themselves before they've actually received treatment for mental health, sorry, from health establishments, which are probably going to be two of that nice partner to come involved in. What ordinarily happens is partners contact us to say someone's gone from the Bradgate Unit or someone who's gone from Leicester or in Fermi. We, traditional the police, have then gone involved. We begin to search for the person, undertake checks, et cetera, and it's been recognised that actually we're not best placed to do that, particularly for the people who are in mental health crisis, and a number of times we actually realise that we don't have the powers to do that, and again I'll give you a bit of a real example, but slightly anonymised. Somebody is at the Bradgate Unit, that there's a voluntary patient, they've not been sectioned, they leave the premises, the Bradgate Unit then contacts us to find that person. We don't have, unless there is an immediate threat to that person's life, we don't have any powers to do anything with that person at all, and live them to try to persuade them to return. And very in mind, you might be dealing with someone who might have some mental health challenges. It's what it has been, it's been recognised actually we're not best placed to deal with that. It's what we have been doing, and we've constructed the documents, considerations before you call the document, which is the circuit latest one of partners. It's what I actually say, before we are contacted, there are sets of considerations that partners really should go through before they contact us, so if there is any influence that there is a threat to the person's life or immediate safeguarding, anything involving child, child vulnerability, et cetera, any technical exploitation, et cetera, then by all means contact us. But what we are doing is changing the focus of the partner agents is to, instead of them automatically contacting us, to actually see what the partners themselves can do before they make contact us. So what we are asking for is the various institutions and establishments to make their own inquiries in trying to contact, for example, a person who has gone missing or trying to locate a person. And it's after they've exhausted those inquiries, and they realise actually that they potentially can't contact the person, and potentially there might be a threat to that person's life health or welfare that we might become involved. So, the right care right person is really about, just about, it's about ensuring that the focus is to get the right person to deal with that person rather than always sitting with the police, because as I said consistently, it's been found, particularly over recent years at the police, spending a lot of time dealing with matters, which we're not really best placed to take promise, if all. So that's really a bit of a, and I've only got 10 minutes, a bit of a brief summary about what right care right person is, and the impact that it might have even yourselves in the partner agencies that you actually work for, what you might find is that, as opposed to a police officer being dispatched to an incident or to a job, that we are probably going to be asking the agencies, well, actually, what have you done to the owners, pushing back on to those agencies for them to take promise, for them to make those inquiries, which in the past, we perhaps would have taken. Can I, I've got a list of, OK, so I've got Debs, Kim, anybody else wants to, yeah, oh, oh, oh, oh, oh, everybody on this side of the room, I'll go with my first three that I'll come back here, OK, Debs, if you want to ask the question.

Thank you, and thanks for the update. So I work for the Integrated Care Board, where I was previously the Chief Operating Officer at Leicester Hospitals, so I know quite a bit about this issue. I think it's just reassurance for both the Health and Wellbeing Board and any of the public that are listening, that actually both UHL and Leicester Hospitals and LPT have in their policy, a series of actions that they take into account and go through when somebody goes missing, and although contacting the police, it's part of that policy, it's not a, we're contacting the police, and I said that's not our problem, so I think you're right in saying that actually people under health care are best cared for by health, and that they can't obviously drop everything and go out and look for a patient that's absconded when they're looking after all the other patients that are in. So I think this is the right thing to join the conversations together, I think, to make sure the policies are linked, and I don't know if you get the opportunity to have a look at the policies of both Leicester Hospitals and Leicester Partnership Trust, and indeed for Rutland are surrounding hospitals because it's not just organisations within this ICS that are really involved just to reassure yourself that they're ongoing conversations I think are helpful, so there's a comment rather than the question, thanks. Can I? Just to realise that just to give you further assurance that there's been a lot of involvement of a lot of strategic management, strategic partners, areas I don't know if any of you sit on either the strategic or the tactical group, so you're clearly aware of that the issues have been discussed at that high level, so it isn't something which we've just locally introduced ourselves, we have thoroughly involved all the partner agencies in coming to the processes and protocols which we currently are applying. Thank you, Chair. Thank you. Kim? I think that's what the comment I was going to make as well, I just wanted to ensure the public that are listening in and partners on the board that a lot of work is going on and has been going on for over a year now around this implementation and how it affects us locally and how we can respond locally, because there's already been some really good work locally that we want to build on, that we don't want to just dismiss, so we were doing an awful lot of this already from my understanding, but it is about a ratio into the public that we will have strategies in place that if the police aren't the people to respond, there will be some understanding about who is that response to the public, so it's not about a reduction in services, it's just about a change in an agreed format of who does it, and that's more of the kind of public. Thank you. Dawn, thank you. Thanks, Chair. Yeah, just to add to that, from a children's services perspective, there's ongoing work in relation to children and how right care, right person relates to children's services, and I think we're quite a long way off, agreeing joint protocols around right care, right person approach in relation to children and young people, that's national, it's not a local issue, fully engaged with the strategic governance that surrounds this for the subregion, and from a children's perspective, it's not just about kind of concerns for welfare, it's also about how police are discharging their duties in relation to safeguarding and how that fits with the right care, right person approach, and that's been done very much at a strategic level, but both subregional as well as nationally, so I think it's worth this group understanding there's another piece of work to be done in relation to children and young people. Yeah, can I take you up on that actually? Do you have concerns about that being put in place and a better system put in place that will have a good, I'm trying to think the other way, a net, it will catch it, it will catch it. Let me help you. Thank you. Yeah, I mean, frankly, we do have concerns from children's services point of view in relation to right care, right person. This isn't a local, I'm speaking from a national perspective as well as locally, and colleagues with the national police leads for right care, right person are working with the Association of Directors of Children's Services and the Department for Education, as we speak, to agree and produce a jointly agreed set of principles based on the right care, right person approach, but we do have some quite serious concerns around the implications for safeguarding duties, but work is happening. Would you like to make any comment of? No, I think we're fully aware of those concerns, and I know some forces have taken a different stance and they are treating children differently. Unless your police, as Stauns alluded to, we're waiting for a national steer, I know it has been flagged and there are some concerns, understandably, in terms of how children are dealt with in the right care, right person, but unless to share, I think in line with pretty much most forces, we assess any incident based on the threat of risk harm and the vulnerability, and if we need to deploy a resource, let me just assure everyone in this room, and also the one listening as well, that we will deploy a resource. We will always look to deploy a resource where there's any influence that someone's life might be at risk, although there's a possibility of some sort of serious harm, so we'll always look to deploy a resource for me when we spot that. Thank you very much. Hi, I think my colleagues have already covered the points I was willing to raise. I guess just one side really, it's just thinking very selfishly, thinking about my mother in a local care home with dementia, and I know that there are people there that do upscond, does the same apply to those properties as well, or are we just talking about their interface with the healthcare system? At presence, the focus is more on partner agencies, again, what we do is we assess ever incidents, as you pointed to, so for example, if we had a, in your situation, you say that the loved ones has dementia, if there are concerns for their welfare or for their wellbeing, then the expectation with that we would naturally get involved, the last thing we would want is for any serious harm to come to your loved ones. Thank you, Mike, would like to ask your question? I was, but I was actually going to ask about the situation as it relates to children, so the previous question's covered it. Tim, did I ask you? Thank you, Chair. The only point I was going to make, because I was at a previous meeting, where one of the issues raised was that it's depleted with the drawing from certain areas, the effect on staffing, particularly out of our staffing, is the, you know, we've got the depth of staffing to deal with issues that may arise. Just another point I was going to make is, I gather this was piloted in whole, is that correct? And it might be an idea. I don't know whether that pilot could be circulated to see how it worked out. It was, I think it was Humberside, who were initially very cool. The irony is, before I came out with a person, we actually had something left called MAA, and that was the most appropriate agency, and it was very much the same principles as in that we were looking to make sure that it was the most appropriate agency that took the lead to deal with the incident to support the person. We have worked with Humberside, we've been up and visited, we've made sure that if there are any key lessons for us to learn as a force, also I think we've been on Humberside and actually part of the national RCRP working group as well. So a lot of liaison has been undertaken with Humberside, not just while I think the College of Policing as well, they very much held up on Humberside as a beacon force, so a lot of that learning source has already been shared. All right, thank you, anybody else want to ask any questions? Janet, thank you. Yeah, thank you. I just wanted to tell many people actually go missing in, in say, a year or a week or whatever. I wouldn't have the figures for Rutland, I know for less or less issue in Rutland, we take about six thousand, I think, missing persons reports in totality, but that can be anyone who's missing for a short period of time or for some people who might be missing for days. So I haven't got the figures specifically for Rutland. It's been such in a year or the six thousand, it's not in a year or? I think not in a year, yeah, it's in the five and six thousand usually go missing for a year. Those are, it's short term, it might be some kind of a children's term, it might be someone who's just needs some time away from the family for a day or two, you know, 99% of those will well return, you know, so I haven't got the figures for Rutland unfortunately. Do you want me to get you those figures for Rutland at all, right? It's a huge national problem, I think, with a fair comment, anybody else like to ask any other questions? So, just what I think one from our side, are we providing enough support to you to take this forward? I think it's been a gradual incremental process isn't it, because the one thing which we do want to make sure is that the partner agencies that you've got your structures and your processes in place, it's good to hear that you've obviously got policies which are already accommodating, the fact that there is more expectation in terms of the activities and things which you guys will be undertaking before you report into the police, so I'm not getting the vibes that the partner agencies are not supportive of it, but I think what's happening is obviously sometimes just resourcing for partner agencies, sometimes quite challenging. We've had a few occasions where some of the frontline workers haven't been aware of the RC/RP principles in some of the establishments that we've worked with, so again, it's just really trying to ensure that we clear there's a good level of knowledge in this room, but ensure that the knowledge is filtered down to those on the front line who are actually going out there and doing the doing, and so when somebody is reported missing you and somebody does walk off from a health care establishment, et cetera, that they actually know what to do, so again it's just making sure that the front line is fully aware. I think that's it, thank you very much for sharing that with us, and keep us informed. Okay, thank you for your time, thank you, thank you, bye bye now. Now moving on to agenda item number nine, Rutland Health Protection Annual Report, we're pleased to welcome Fiona Grant Consultant in Public Health from Listershire County Council and Energy Patel Strategic Lead Health Protection Lister Shire County Council. It's about to come and present, thank you very much. Good afternoon and thanks for having us here, so we're bringing across the 2023 Health Protection Assurance Report to the Health and Wellbeing Board to provide an overview on health protection performance, key incidents and other significant matters. The report has been prepared with contribution from key partners across the system to assure the Director of Public Health that processes are in place to protect the health of the population. I must note that there is reference to an LCC strategic plan which has been inadvertently included in the report. There has, there have been some significant changes in health protection such as the establishment of the Integrated Care Boards and the formation of the UK Health Security Agency. The report gives an overview of the five strands of health protection which include outbreaks and communicable diseases, screening programs, immunization programs, healthcare associated infections and preparedness in response to incidents and emergencies. It's worth noting that the local authority doesn't commission the majority of these services which contribute to the protection of the population's health, however, assurances sort to ensure that arrangements are robust and meet the needs of Rutland's population. The first key aspect that the Health Protection Report covers is the prevention and control of infectious diseases. The report lists the roles and responsibilities of the agencies that we work with with the direct public health holding overall responsibility for the oversight of any incidents or outbreaks. COVID-19 is the first communicable disease covered in the report and the first case in Rutland was notified in March of 2020. The first national lockdown was announced earlier in the same month and the Director of Public Health produced a local COVID-19 outbreak, control and prevention plan to build upon existing response mechanisms. The next communicable disease in the report is measles, a resurgence of measles was reported in England in late 2023 and at that point the majority of cases were identified in the West Midlands, predominantly in Birmingham. Locally, in order to prevent outbreaks vaccination remains a key priority, the World Health Organisation recommend 95% coverage of two doses of measles containing vaccine and in England this is combined with mumps and rubella, the MMR vaccine and it's given to children aged 12 months and a second dose at three years and performance of age. In Rutland, estimated coverage for two doses at five years old is around 85%. It's higher than other areas in the country that have had the outbreaks but work remains ongoing to improve this. There were cases of inferior identified in England, non in Rutland and in new arrivals to the country. A local group led by the integrated care system was established to ensure that population who were at risk could be vaccinated and that local health care providers were aware of the evolving situation. The next section of the report covers immunisation and childhood and adolescent immunisation uptake is better in Rutland compared to the England average. This is essential to help protect the local population. HPV uptake continues to be a system priority particularly because of the links between HPV and different types of cancer. It's offered to children when they're aged 12 to 13 years old and it's delivered via the school aged immunisation team. Rutland did see a decline in vaccine coverage in 2021 because of the impact of COVID-19 and local lockdown. However, a catch-up programme was put into place and offered to all children to be relatable. HPV has now moved to a single dose vaccine and will continue to work to ensure eligible people receive their vaccinations on time and particularly looking at vulnerable groups. Seasonal flu uptake of the seasonal flu vaccination has improved since the COVID-19 pandemic and performance in Rutland again is better than the England average. Performance also exceeds the World Health Organisation's target of 75% coverage and the flu letter for this year has now been released and will continue to work with a range of providers to ensure Rutland's population can access the flu vaccine conveniently. That would be from GP practises and from community pharmacies as well. Priorities for 2024 for immunisations will be to continue to increase uptake of the MMR vaccine as well as other childhood immunisations to maintain uptake of influenza particularly in high-risk cohorts such as care home residents and increase uptake of HPV amongst both boys and girls to reverse the nationally seen down trend. Commissioning responsibilities for immunisations will be delegated to integrated care boards by April of 2025 so we'll continue to have a view and see what that looks like and the impact that it might have locally. The next trend of health protection covered in the report is screening and screening detects conditions within the healthy population who may have an increased likelihood of developing a disease. Overall, cervical and breast screening programmes nationally have experienced a downward trend locally Rutland has seen a similar downward trend in these screening areas as well. However, they are performing better than the England average performance. Biocancer screening on the other hand has nationally and locally seen and would increase in uptake which is positive to see. The next section of the report covers sexual health. The integrated sexual health service detects, prevents and treats sexually transmitted infections in the local population. From April 2024, the ISHS service provision is being commissioned as an independent service and Rutland maintains the current agreement per year to the 31st of March 2025 with the longer term service provision to be procured this year. An online service has started this month to offer a range of testing options for sexually transmitted infections and to treat chlamydia as well. A sexual health needs assessment covering less cheer in Rutland was completed in 2023 and several recommendations made around STIs and can be found online. Chipper closest is also covered prevalence of TB across Rutland remains low and it's lower than the England average as well as the East Midlands average. Work will, however, continue to improve BCG vaccination uptake and TB screening eligibility criteria awareness. It's been identified that engaging with non-UK born arrivals at an early stage is key and to encourage these populations to participate in screening and vaccination programs. Healthcare associated infections are also included and many of these are preventable. The data is collated by the Integrated Care Board and it covers Leicester, Leicestershire and Rutland as a whole. Internet and responsibilities are listed within the report and a system approach is taken to respond to any healthcare associated infections. The Integrated Care Board's infection prevention and control team and local authority public health infection and prevention control teams are in the process of sharing educational resources to expand IPC learning for both general practices and care home staff including sessions on CDIF and CRO. A new ICS community practice has been convened with relevant stakeholders and is in the process of identifying current system issues and developing and coordinating relevant strategies. For emergency planning, the local authority works with the local resilience forum to undertake the annual exercise program and to respond to incidents that has they arise. We continue to ensure partners are clear on the response to major incidents including roles and responsibilities. Contingency plans are also reviewed regularly and risks associated with changing weather patterns have been identified with mitigations in place for for example prolonged periods of hot weather. And then finally the report covers air quality. We know that poor air quality poses a huge environmental risk to the public's health and can contribute to morbidity and premature mortality. The Scotland County Council does not currently have any declared air quality management areas but a local air quality strategy is being developed to prevent and reduce polluting activities. The LLR respiratory working group chaired by the ICB plays a key role in linking air quality monitoring data, health data and clinical colleagues and processes together alongside housing. The 2024 will continue to consult and monitor planning applications that may have a significant impact on air quality in Rutland and to provide local support and relevant information to encourage potential sustainable behavioural changes and increase understanding of air quality in Rutland. So overall we seek to assure the direct public health that processes are in place to protect the health of the population and will maintain and improve progress on the key health protection indicators. Thank you very much. I can't. Do we have anybody with any questions? Yeah thank you Chair. That's much question more of an addition to what news and fairness report is presented. So thanks to news for presenting in both of the report. It's been a while since we've published a health protection on your report because COVID got in the way. But we're used to it on an annual basis and I guess for me the reason for bringing it here is quite rightly the business of the health of wellbeing board is focused on that long-term improvements in health or about service changes. But actually how we protect the population from threats to our health and hazards to our health be it infectious disease or major incident planning or similar I think is important and I don't want the health of wellbeing board to sort of not be cited on that. As a news said at the end it's a funny world of public health I think my statutory duty is just to be assured that plans are in place. But that seemed to disappear a long time ago Fiona well knows that when she started on the day of the first official COVID case in last year I said don't worry emergency planning and health protections are fairly short small piece of the portfolio. Which I guess actually keeps on reminding me is not really the case anymore because we are heavily involved in outbreak response. The point being hopefully the report reassures the board of A there's a breadth of nasties out there that organisations like public health, the ICB, LPT, UHL, social care are involved in dealing with be it infection, venture control, advice through measles, petuses, et cetera, et cetera. And I think that the new year's last point is the key one in terms of when we deal with things which are happening in Rutland we work together well on a Rutland basis. A lot of what we do is inevitably done on an LLR basis because infectious diseases don't respect borders. But where that does happen again as Fiona and Anuj know well, inevitably there is a focus on the city because of the lower vaccination rates et cetera, but they are effective in making certain the partners across LLR don't lose sight of Rutland specific needs in that one. So hopefully it gives reassurance both in terms of the current picture which is not bad in terms of screening and vaccination rates, there's always room to do better. But also just being assured that Rutland is part of my part of planning. I think you've got anyone there, my question would be what else should we be doing, could we be doing, is there anything other than increasing vaccination rates? I shall look to my expert leads. So in terms of trying to improve vaccination rates obviously we work really closely with partners, obviously ICB NHS colleagues, volunteering community sector really across the board. And there's a lot of work going on, for example, trying to understand in terms of vaccination what some of the barriers are to that uptake, so for example doing some behavioral insights work with particular groups, so for example recently Anuj was involved in some work with the travel community to try to understand why their rates of MMR uptake are lower than other groups. So it's that kind of thing really trying to understand what the barriers are working together with partners to try to find different ways, so for example sometimes a mobile vaccination unit will be taken to a particular location, there's been a lot of promotion, webinars all kinds of things to raise awareness of, you know, particular challenges we have. So for example, people may have been aware, there's been quite a lot of coverage recently around that, to raise awareness of some of those infectious diseases and also improve access and opportunity for vaccination uptake, it's a huge amount of work going on around that at the moment but very much joined up with partners. Thank you, thank you. Yeah, I'd like to mention Mobile Van, because it's going to say access to services again traditionally across L.L.R. that conversation would probably be around ethnicity and language, through a lot of perspective, advocating for the use of the mobile van to get out to our outline communities. Although we've had, you know, when we've done that for me it's just we had a really good uptake in wherever it, where they weren't coming through, so we're wrapping them, but I know usually only you managed to get the mobile van out to a lot of them to go. Do you want to make a minute? Thank you. I've got a question on immunizations, particularly MMR, but also I'd just like to make a comment there, quality if that's okay. On MMR, obviously, had a recent outbreak of measles and every sort of welcome would seem to have an outbreak. I think the last one was in Pulte a little bit with it a few years ago now, and she just crabbled to get involved with it. I just wanted to do, do we know the best strategy to improve MMR? Is it through health, or is it the school, or family hub, social media? I don't know. I don't think there's a single best way to tackle it, but priorities at the minute are timely vaccinations, so making sure children receive their vaccine on time, and we've seen outbreaks mostly in younger children rather than in adults, so whilst it's important that everyone gets their MMR vaccine completed, it's really important for children because of the way they interact with peers that they receive both of their vaccinations as soon as they're invited. Thank you. Yeah, we could give a chapter of this on this one really, couldn't we? I don't think there's any particular setting, you know, you'll know as you would expect to see, there's a bit of a sort of slackening off in vaccination post-COVID because people are kind of allegedly vaccine-fertied, MMR comes with its own history around the Wakefield scandal as well. I'm tempted to say, 'cause nothing actually gets an upturn in vaccination rates other than, 'cause they don't waste a good crisis, because to some extent with measles, you know, people have got complacent and forgotten that in a small number of cases it can be a deadly disease for younger people, so I think the current numbers in Leicester City and Birmingham have probably impressed upon people's minds that need to get vaccinated and where they might have forgotten. I don't know, it's a big quality. You're air quality. Air quality, I just want to make a quick comment. The reason I bring this up, because I'm on the panning and licence committee and recently we've had a couple of other occasions concerning quarrying, and it's come up particularly with small particulates, 2.5 micrograms, and there are ways that this can be screened for actually and real-time assessment, and while this came up, I also, I still take the BMJ, there was an article in there from the United States which once again added to the growing body of evidence of how small particulates adversely affect health, and they do have more effect than we previously thought. Again, we can do a big session on particulate matter. Rutland, of course, is always different, there are some things you can do something about in terms of PM2.5 and some things are harder. So if you look at that map of air quality and PM2.5, the small particulates you refer to across Leicester, Leicestershire and Rutland, as you would expect in the city it's worse because it's driven by traffic. Once you start looking at Rutlands, you then start getting a sort of agricultural blow-off because of the small particles coming off the soil. So overall there's no particular hotspot issues with Rutland, as Anuj would say, there's no air quality management areas, but there's always something for me and maybe the quarry in one is a good example of making certain where industrial processes are in place, that they are effectively, the environmental permits, they've got the screening that you need to put in place, I know that's more of a regulatory issue, but that's more the kind of things you need to make certain that it's done. Thank you. Kim, would like to ask a question. Thank you. It was the comment on overall cervical and breast screening programmes nationally have experienced a downward trend and in Rutland that trend is also a bit, but not as much as England. Just why do you think that might be where the bowel screening is covered as the uptake, but the breast and cervical, and also the next part of that is what role do you think women's health hubs will play in trying to increase those rates, if any? Thank you. So I think in terms of the screening overall is obviously part, in no small part, reduced as a result of the COVID gap, so there's still been some sort of catching up and a bit of lag where some of those programmes didn't run at all in the same ways they hadn't done previously, so that's part of it, and I think you're still starting to see that. I think the difference with breast and cervical screening and bowel cancer screening is that they've got their developed a new way of testing that they use for bowel cancer screening, which is the one through the poster rather than having a more invasive procedure, and so the thinking is that that's made it a bit more palatable for people to uptake the bowel cancer screening, but there's a lot of work going on to try to improve those other screening programmes, particularly for women, and I think you're right, those hubs could play a key part in trying to sort of make some of those services a bit more accessible and more appropriate for the women that they want to particularly target. Thank you. A couple of very quick questions. The first one is that I'm surprised that you haven't got the antibiotic resistant to pseudomonas done as an infection to worry about, because I keep hearing on rumours about it being there, and not very nice, et cetera, and my second question is, I notice that you say bowel screening eligibility has changed, what has it changed to? I know with bowel screening there's been an additional clinical condition has been added as part of that, so that's what the cheating is, I don't think there were any other changes with it, but it was just one additional clinical condition that was added to eligibility criteria. So for the antibiotic resistance that's covered by the integrated care board, and our role as a local authority is much more restricted, which is why it wasn't included, so it's not that it's only less important, it's just that our role is a bit distant from what the ICB are doing. Thank you. Any other questions or comments? No. Well, thank you very much in very, very detailed, very, very fantastic read, and I did say, that's not as sarcastic, but it wasn't. I was really, really enthralled by the author, thank you very much indeed. We now have a slight change in our agenda. We're going to move on to item number 11, right, so I'd like to draw this discussion to a close. The motion is that the Board notes the relevant health protection annual report 2023 and recognises the specific health protection issues that have risen locally, the steps taken to deal with them and the particular areas of focus for the coming year. All those in favour, please raise your hands. Anyone against? Any abstentions? Thank you Chair, that's unanimous. Thank you. Okay, so we go back to, would I go to go on to number 11, we're swapping 11 with 10, I would like to propose, I'm going to swap the agenda, from number 11 to number 10. So that Sarah Prima can leave, she has somewhere else to go. So, do we all agree that we swap those two over? Yes, thank you. Sorry about that, so item number 11, Lester Lester and Rutland LLR integrated case system ICS update, so report number 62, 2024 from Sarah Prima, Chief Strategy Officer, the Lester Lester and Rutland Integrated Care Board, so can we please present your report to the Board of Sarah? Thank you Chair. I'm okay until four o'clock, so hopefully this report won't take this long. I'll take the papers read, but there's just a couple of things I wanted to point out, you'll note there's a couple of changes in personnel in the ICB, a new chief exec and we are in the process of recruiting a new chair, that process is still ongoing. I think very importantly, I just want to touch on the specialised services delegation. So these tend to be low volume but high cost interventions that have since CCGs came into existence before ICBs were in existence were actually managed by NHS England as a Direct College Commission Services from providers, for example from acute specialist providers and from mental health specialist providers, but there is a wide range of services that cover specialised, there's over 100 lines of specialised services nationally and 59 of those services have been delegated down to ICBs from the 1st of April this year. So ICBs are now responsible for the management of those services and there's a range of services in there including reading, cardiac and cancer services and as I say there tend to be lower activity but higher cost items. As an East Midlands region, no sorry as the Midlands region we have decided that we'll manage those across the region, mainly because of the fact that they're low activity but high cost and the MIGL-B Sol which is the Birmingham ICB is going to manage those services on behalf of all 11 services in the Midlands. That doesn't mean that LLR will not be involved in that work, we will and we will make sure that we can develop those services in line with the need of LLR population. But I think that's really important piece of information and change that's happened in the last few months and as previously mentioned in the previous report, over 24/25 we'll be working on bringing in summarisations of vaccinations, delegated down to ICBs and also another 29 of those specialised services will be delegated in 25 to ICBs. The other thing I wanted to touch on is that our operational plan and our yearly operational plan is underway, the plan is due to go to NHS England on 2nd May and for an ICB board sign off towards the end of this month, so just before 2nd May. So at the point of which those two things have happened, either the ICB has signed it off our NHSE and England are happy with the plan, it will be published publicly. It's still working in progress at the moment, so not available for publication. And I think the other important thing is to say that we have put in an expression of interest for the Work Well Initiative, which I think if we get that bid will be really important to LLR, but we still await the outcome of that bid, hopefully sometime this week because they did say that that is no by the end of April. So I think they're the important things I just wanted to point out, Chair, thank you. Thank you Sarah, have any questions about that, the content of that paper? Yes, Mike, thank you. Yeah, thanks Sarah, I suppose I'm just thinking about the delegated responsibility and I get what you're saying about doing it on a regional basis and we'll have an input. I suppose there's a couple of things, but I'm not quite said, so take kind of specialised cancers, it's clearly something about doing it on a regional basis because alone, fully. But does that then extend into the delegation also looking at the kind of prevalence of those specialised cancers and would we pick up, so it's from a Rutland point of view, would we pick up anything, who would pick up sort of an understanding that the A cancer I can't think which would be was more prevalent in this as well as kind of access issues about reality, it's almost like what's the scope of the delegation I suppose. So we take on everything in relation to that particular pathway if you like in terms of, it's already done on a regional basis to be honest and also cancers, I won't say it's more complicated, but there is a cancer network and an alliance which also sits at a subregional level I think, which does a lot of that work that you're talking about. So I think the benefits will be to link the local work, the local intelligence, particularly around some of the things we just talked about about access and how you get into populations with that regional work that has been ongoing for a number of years, so I think the benefits of delegation will bring those two things together. Any other questions? Okay, thank you. Sarah is up to you, you can stay where you can go. No, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, 10, which is the Rutland-Hole Systems Approach to, oh, sorry, hang on. Yes? Yes? I have got it. So, thank you Sarah, I'm glad to bring that discussion to a close, and the motion is that the board notes the update from the LLRCS, and long those who play the please raise your hands, anyone against, any abstentions? Thank you. Now I've been resolved by the board. Thank you. So, we will now go back to number 10, Rutland-Hole Systems Approach to Healthy Weight. I don't think I like this, just like any of it. We'll now receive report number 572024 from Adrian Allen, Assistant Director of Delivery, Public Health, and Mitch Harper, Strategic Lead, Rutland Public Health. Adrian and Mitch, would you like to now present your report to the board? Thanks, Chair. Mitch, he's going to do the presentation, thanks. Thank you. Just fair with one second, why we're just sort of in a present and I'm going to share some slides. Okay, brilliant afternoon, everyone. So, yeah, I'm going to present an item on a wholesome approach to Healthy Weight for Rutlands. I'm going to take the paper as red, but I'm just going to highlight a few areas to contextualise this as well. So, in terms of why it's important, maintaining a healthy weight can improve quality life and reduce risk of some health conditions. There's some link to obesity on the right there, but it's just important to note that this is around promoting a healthy weight, so it's not just around obesity, it's not just around overweight. We're also incorporating underweight and malnutrition into consideration, but this infographic just demonstrates the significance from an unhealthy weight in terms of risk and around various health conditions that are preventable. So there's lots there that you can see within that infographic, there's also significant cost considerations in terms of the impact of overweight and obesity rate at ill health. A lot of this content does cover overweight and obesity, but like I say, it's more so than that. So, in 2014-2015, there was an estimated NHS cost of 6.1 billion related to overweight and obesity. When you add in the wireless society costs, there's an additional 27 billion as well, so you can see the significance of that, that is national, as you can imagine, but plays through at a small scale for Rutland as well. That was 2014-2015, likelihood based on trends of what we're seeing are that that has increased even further. We have commissioned weight management services within Rutland and across LLR, some of those related to tier two are commissioned through the local authority by the public health and some are through the integrated care boards in the more specialist tier three and four. What we can't do is rely on these services on their own, whilst they may achieve their outcomes in terms of weights and reduce risk of various conditions. They are individual focused and when I present the data in a slide or two's time, you'll see the significance of that and how we can't necessarily reach a population level intervention through individual behavior change alone. Sorry, it's a bit slow to change. There we go. In terms of the data for Rutland, this just presents overweight and obesity for adults reception year children and year six children as well. Focused on the adults, 55.5% of age 18+ are overweight or obese, as of 2021-22. A very rough crude estimate of how that equates to population size, there's around 33,000 adults in Rutland, so there's around about 18,000 who are overweight or obese in Rutland. That is statistically better than the England comparator, which is just under 64%. What we want to allude to on this, though, is that doesn't necessarily mean we're good in terms of a comparator to England, but that doesn't necessarily mean we're doing well and we don't need to worry about this. It is still the majority of our adult population at 55%, and based on the previous slide, the implications for cost and health conditions are quite significant still, so even though it might come across as green when you compare it, it doesn't mean it's all rosy from that point of view. When you look at obesity alone, it's around 20% prevalence for Rutland, which is around 6,500 people, and that again is significantly better than the England average, but the same point resonates is what I just made. Based on children, reception age, it's about a fifth of the reception age population. That equates to just under 200 children, of which there's 750 at the time of census at reception age at that point, so that is statistically similar to England, so we're not better on that indicator, but obviously, as time progresses, although these trends are quite consistent, the children change within that reception age by year, and then when we look at year six, it increases from that reception age from the 22% up to about 28%, which equates to about 250 children. So in terms of what we could do, oh, it's not changed, I'll start talking and it will change in a moment, but in terms of what we could do about this, so like I say, we can't necessarily rely on individual behavior change alone, that is part of the picture, but it's not the sole thing. What we can do is look at a wide range of things related to a complex picture in terms of causes and risk factors. The infographic here is an evidence-based approach to this, in terms of the whole system approach to healthy weight. You can see there's nine strands to this, and their potentially will be more if approved than as we start to delve into the detail, but these cover all things such as how we can create a healthier food environment for people to adopt healthy behaviors, how we can look at creating healthier workplaces from a healthy eating and physical activity point of view, similar with schools, linking in active travel, an education piece, and also how we promote the local opportunities and community engagement as well. So you see there's a wide range and this pretty much comes into everyone's business across the council and partners as well, and you'll see there's a lot of social, economic and environmental focus as well as lifestyle-related stuff, which brings in the wildest elements of health. A lot of this covers the life course approach, so it's not just adults, it's not just children, it's looking at all ages because there were different interventions and different policies and other bits that we could do at different levels, and the intervention types are very different across these as well, so some of it can be related to policy levers at local level, some of it can be national policy that we look to adapt locally, some is around health promotion and educational piece, and communication engagement and education as well. So it will change again, but in terms of what's already happened, we've started some conversations on this in staying health partnership. There's broad consensus that this is something that we should be looking at from a strategic point of view and coordinated point of view, and we started to build some narrative, some of which is reflected in the paper that you've received. We've started to look at some of desktop mapping around those nine strands that we've presented from the previous slides, so we've looked at what the current activity is, what the gaps are and where potential opportunities are, and we started to very initially score those in terms of the strands and trying to look at where those priorities may be going forward. It doesn't need to be more detailed added to that mapping, but it's just a start point to help inform any decision-making at this point. This scoring is a one-page overview, it's presented in Appendix B of the paper, and what's important to note is that it doesn't necessarily mean we've got a lack of provision in those nine strands, some of them may have a lack of provision, but there is a lot of work already going on across all nine of those at varying levels, and some of this is around how we can coordinate and focus on how we can do things differently, whether that's targeting those population groups most at risk, or whether it's influencing policy in areas where people are best placed to change things, whether that be planning, whether that be transport, or rather areas as well. The scoring and the priorities are likely to change over time if it's taken forwards, and it's a long-term approach to this, so it will, like I say, as the details start to get added, priorities change, opportunities change, whether that's locally or nationally, those scoreings and priorities will change with time. The proposal then is set out in more detail in the paper, but just to give view and overview, the recommendation is that we consider a proposal for Rutland's commit to a long-term whole system approach to healthy weights, and that would be led by the subgroup, the Staying Healthy Partnership. There's another infographic here, and it does touch on OB to begin, it's healthy weight or inflated now, and I'm not going to go into this in too much detail, because it is largely a project management approach that you would be familiar with, but phase one is a round set up which were on that journey at the moment in terms of strategic buying and building some narrative. Phase two and three have started to happen to some level to help inform that phase one, so I'd say some narratives start to be built, some desktop mapping has started as well. If it's approved to go forward, we'll look to take that further in terms of the detail that's within those two sections, and then over time that would look to inform what the action may be. It is acknowledged that some of the actions that are identified within this may carry a resource ask, and that may hinder progress in certain areas, so there's some things that we can do within existing capacity, some things that were getting on the table, as in when those opportunities present whether that's nationally or locally with funding opportunities, and over time that will start to be mapped and managed within the Staying Healthy Partnership, and reported back to the Health and Wellbeing Board, has appropriate, and that will constantly be under reflection and refreshing as things progress. I think that is, oh sorry, so two alternative options, these are in the paper, so I went to one of these too much, it will flick over. So option two is continuing as existing, so there isn't currently a strategic focus on healthy weight in Scotland, while there is activities going on across those nine strands that I mentioned, there's limited coordination from a strategic centre, it's difficult to know where gaps and opportunities may present themselves, weight management services will continue to be commissioned in current arrangements, but like I say we can't rely on that solely. And then the third option is whether we wanted to hone in on one of those nine strands or a couple of them, and really look at the detail of that and how we can take that forward. The limitation of that would be that it focuses on a certain area and excludes others, so the overall outcomes in terms of healthy weights may not be achieved while we focus too much or too heavily on one of these sections. So that's it, and then it's just a couple of recommendations that are in the paper for the committee, and I'll leave that with you, Chair. Thank you, Midge, really good papers. Absolutely, fully supportive of the whole system's approach. We can't underestimate the impact of weight on the whole host of long-term conditions, and it's been proven in all of the work that we're doing in long-term conditions, so it influences all aspects of health care, mental health included. I just think it's useful to let the Board know that the ICB clinical executive has approved a review of a system-wide review that gives less to less to Schurrenrittland, a wide review of weight management services, because there are discrepancies that exist in the provision of services. I'm really encouraged that from a Rettland perspective, we want to concentrate on this, and it's important, because there are certainly opportunities or sometimes easy cuts or services like these, and it is really important that we keep them going, but I would like us to link in with the system-wide approaches as well. I think they'll have things hopefully to learn from the approaching Rettland, so we get that Schurren across the Board, and I know that you referred to, there might be some areas where funding might cause a problem, and we always know that that's an issue, but in terms of true integration of health and social care and the work of this Board, and we do have the better care fund, there isn't a lot of money available in that fund, but it's certainly something that we should look to should we get recommendations that come forward, because this is massive implications on the whole host of services, both in health and in care across the system. Thanks. Absolutely, thank you. Yeah, thank you, thank you Chair. So, yeah, no surprise to find I'd be supportive of the whole systems approach to healthy way, that's possibly not the biggest surprise to anybody to this afternoon, and it's not to sort of say well actually what about three, but before you put the options on, I was looking at appendix A in the scores. They are all important, and I know you said, Mitch, that scores might change, and we need to complete the mapping. If I was looking at those though, generally, we're scoring ourselves higher around the kind of things that maybe people would think of first working in school settings, doing the health promotion, health education side of things. We're scoring ourselves lower around kind of environment planning, active travel, making the environment more conducive to physical activity. So in my mind, I'm thinking I want to say one, but if I was going to put effort into it thinking about where we've got opportunity, and where we can get really big drivers, you know, it's probably the ones around planning them, active travel, physical activity environment, because my question was going to be, is there anybody that leaps out or an organization that leaps out at the moment, who's not on the staying healthy partnership, that you would want around that table or this table, and just to pick up on Dez Point about that, I think you're right there, we just be aware of the system review. I did ask that that comes to the health and well-being partnership, aka the integrated care partnership, because I think it's important that that comes to a partnership arena, not just the ICP, so that would join in, but I'm almost less concerned about weight management because of the kind of draft score that you've prepared. So it's like comment, but then a question you might want to come back on. All the comment on that? Yeah, no good point, and we do have some of planning and transport represented in staying healthy, which obviously from a food environment on new developments in particular, it's a big opportunity for us, and I guess with this scoring and prioritization, depending what those interdependence are over time, we'll set some of that, such as the local planning development, it offers us a great opportunity now, and that would help with that prioritization of bumping it up, whereas in a year or two planning may be lower on it and something else swaps through. So yeah, but they're largely represented, but we wouldn't be so insular in the staying healthy partnership if there is opportunity to look at other projects outside of that representation. Thanks, Mitch. Let's pass on to Tim now, please. Thank you for the report. I hold wholeheartedly behind the whole systems approach. I mean, as a GP, I sat at my desk and saw a series of people asking for weight help, help with their weight, and we had drug reps, institutions in that drug, all entirely useless. And I don't think we go, it's going to be any better based people on the run. So, and I'd just like to back up what I've said, because I think it's the combination of healthy eating and the exercise as well, that is important at here. As you all seem to add, I don't remember, I had a meeting with you about looking at the data, and I did look at the fingertip government figures data, and I sort of looked at obesity and noticed that one area is really quite below the national average. That was Richmond. I think 5% in reception age. Why was that? But he actually doubled up to year six, still well below the national average. And again, what causes that? It's just interesting to know these reasons why there is the weight gain in those particular years. Yeah, I mean, I don't know a lot about Richmond, if I'm honest, but in terms of the data that plays through, like I say, is at that point of that year six or reception age children. So, technically, it is a whole new group of children for the following year, but a lot of the trends do tend to be consistent, so it does make it more valid than that alludes to, I guess. But yeah, and they are small numbers, and it's often a sample, so it is difficult to play through. But there's lots of examples of whole system approach to healthy weights that have happened, so we will be looking to incorporate a lot of that learning into then, especially where it's in more rural areas, such as what we've got locally, so yeah. Thank you very much. Sarah, just for your question, please. Yeah, so I support the strategic approach, and I think we need to do it strategically. What I do wonder whether there is merit in, because of gas resource and time, I do wonder whether there is merit in concentrating on certain areas of that journey that you put up on the screen, and to get some quick wins, and to work with the people that you can have most influence over where your levers are the most to start off with. So, a little bit of what Mike said, but also work with those that have got the levers already, so you can get some quick wins. So, I completely agree we should take a strategic approach, but I also think we might need to think about how do we then target that strategic approach along that journey snake up there. Any comment, Mitch? Yeah, I agree in terms of the quick wins and getting some things in place that just as looking at this in general will help to push along. Yeah, and I guess those, actually we took this as a desktop mapping piece, but the next stage is mapping in a more broad sense and bringing the community involved with that in terms of engagement, and so that will help to inform that in terms of priorities, and hopefully there will be some quick wins that we can play through from there. Thank you, Mitch. Oh, Deb, I have another question. Sorry, I don't know, I wouldn't often do this, but I'm just curious about Rutland's figures being better than the national average, and thinking of adults, do you think that there's anything to do with, we've got a growing elderly population, and we know that the elderly tend to lose weight towards the end of their life, and whether the comparator of the age range affects that position. And I suppose what I'm saying is it's support for, we shouldn't let rest on all our rules, because the damage from health care will have been done at an earlier age. The indicator that was, it's a good point, the indicator that was presented there don't believe breaks down by age, but we can talk to our business intelligence just to see, because if we can control for that, that will help to inform that data set. I think one of the, one of the big things that does stand out is that national evidence around obesity and overweight, does show in more income deprived areas higher rates than the lower income deprived. So there might be some natural playthrough from that for Rutland's, but we haven't seen the evidence locally to fully link those two together. But yeah, we can look at the age and, like I say, trying to standardise for that as much as possible so we can see whether that's at play or not. Thank you. Any other questions? No? Okay, so let's draw this discussion to a close. The motion is that the board approves for a long-term whole systems approach to healthy weight, be developed for Rutland, and approves the approach to be delivered by the Rutland staying healthy partnership subgroup. All those in favour, please raise your hands. Anyone against? Any abstentions? So that's been resolved that the board has proved for a long-term whole systems approach for healthy weight, be developed for Rutland, and approve the approach to be delivered by the Rutland staying healthy partnership subgroup. Thank you. Check, can I just add a slight ride to that based on the two points that have been raised. One that whole systems approach, but I think Sarah's point is important that we look for opportunities for quick wins with targeted, but that we also link to the LLR system-wide review again to see if there are any opportunities for joint working and, again, quick wins. Perfectly feasible. I don't think it changes what we've just agreed, but I think there may be perhaps a code of skills to go with it, to recognise and include those. Thank you. We're now moving on to number 12. This is going to be an online presentation. So this is the Joint Strategic Needs Assessment, Updates and Timeline. The first part is the chapter on mental health and dementia. It's an adults-focused report number 6024 from Hannah Blackledge, Lead Public Health Analyst, Lettershare County Council, and Amy Chamberlain, Senior Public Health Analyst, Lettershare County Council. So Hannah and Amy, are you both? I've got one of you. Do we have the second? Hang on. That's Amy. Oh, Hannah's just not showing. Hannah's a... I think I'm going to come right there. Blob at the moment. Thank you. So, over to you now, Amy. Thank you. I'll just share my screen for a presentation. You need... You just thought again, Amy, because you were very quiet then. Um, yeah, can you hear me? I'm still very cool. Let's do some technical fiddly. So, Amy, hello. Talk to me again, please. Hello, Hannah. Still very quiet. Can you make sure you're close to your microphone and that you... as talk as loud as you can, it's... I don't think we're going to get much louder. So, you may see a few looks. I will tell you, if they're looking confused, don't worry. Yeah, please. So, Amy, they will do you now. Thank you. Perfect. Thank you. Um, so we're going to pull out some of the main findings and headlines of the mental health and dementia adult share SNA, with more detail available in the report that's been distributed to you all. Hannah and I will be happy to answer any questions that you might have at the end. So, this JSNA is an update of the 2018 adult mental health JSNA chapter, and it includes a more detailed section on dementia than was available in the previous JSNA for Rutland. This JSNA includes comparative epidemiology, GP disease resistance, survey and service use data. And we have acknowledged in the report that there are some caveats with the publicly available data. So, including things like the time period for which it relates to and its reliability, with small counts in the data for Rutland, sometimes making it difficult to determine significant differences. So, the JSNA outlines some risk factors. So, there are many risk factors and groups at risk of poor mental health, including those with protected characteristics. And these are discussed in detail in the JSNA. So, we've reviewed these groups systematically in the full report, and this site just kind of pulls out some of those which are most relevant to Rutland. So, for example, we can see older adults, they experience higher prevalence of mental health conditions, particularly dementia, and we know that Rutland has an older population compared to the national population, with a steeper projected rise in the older age groups in Rutland than nationally, which is likely to exacerbate this difference in the future. We also have, for example, we know that armed forces personnel are increased risk of post-traumatic stress disorder, depression, and anxiety, and we know that the proportion of Rutland's population age 16 and over that reported previously serving in the UK armed forces was significantly larger than the proportion in England. So, the JSNA is considered these groups at risk in the report. The mental health needs section of the JSNA, so this covers the national and where available, the local estimated and recorded prevalence of common mental health disorders, as well as severe mental illness, suicide and self-harm, dual diagnosis, eating disorders, and also mental health service use. So, on this slide here, none of the prevalence figures here for common mental health disorders are particularly surprising. We can see low prevalence of depression compared to nationally, increasing trends in depression in accordance with the national trend and with almost all dementia diagnoses in those age 65 and over. What is interesting here, though, is the estimated dementia diagnosis rate. So, here we see that less than half of those age 65 and over that are estimated to have dementia actually have a dementia diagnosis recorded on their GP register in Rutland, and this is significantly worse than the national average and the benchmark goal, and it suggests that more than half of those living with dementia could be going undiagnosed and not receiving any treatment. So, this is looking at the mental health needs with regards to severe mental illness. So, with the prevalence of severe mental illness, we found that the number of people on GP who practice registers across Rutland with the diagnosis of schizophrenia, bipolar disorder and other psychosis was significantly lower than the national average, and we also found that the prevalence of severe mental illness on GP registers was lower than what was expected from the estimates. Now, this data can indicate that over half of people experiencing severe mental illness could be going undiagnosed. So, the table here on this slide, it outlines some of the outcomes in those with severe mental illness, and as expected, the data shows that people experiencing severe mental illness are more likely to have adverse health outcomes. So, we can see that the risk of premature mortality in adults with severe mental illness in Rutland was almost 4.5 times higher than in adults without severe mental illness in 2018-20, and this was similar to the national picture. The outcomes data is though based on small numbers, so does need to be treated with caution, but with poorer outcomes identified, it'd be important to look at scope for prevention and either diagnosis to improve these, some of which is likely possible through physical health checks and cancer screening. However, we did find that as of June 2023, less than half of people registered with severe mental illness across Leicester, Sharon Rutland had completed a full NHS physical health check in the previous 12 months, and in East Leicester, Sharon Rutland, the breast cancer screening coverage for women with severe mental illness compared to the general population was relatively low also. If we move on to suicide and self-harm, there were 45 emergency hospital admissions due to intentional self-harm in Rutland in 2021-22, and this equates to a significantly better or lower rate than the national average. The number of suicides in Rutland were low, so we found that there were a total of seven suicides in Rutland between 2020 and 2022. However, again, estimates indicate that the number of people having thoughts of self-harming and/or attempting suicide each year in Rutland could be much higher, which indicates a potentially higher level of need than is being evidenced by the service use. The GSNA covers mental health services for adults provided through the NHS and other community organisations, and the services are primarily commissioned and operate across Leicester, Leicester, Sharon Rutland, and cover a range of talking therapies, mental health units and teams inpatient and outpatient services, services for specific mental health conditions, services provided specifically for older people, support provided by practitioner partnerships, and also volunteering community-based services. Now, as a result of this joint provision, most of the publicly available data or mental health services is only available at ICB or sub-ICB level, rather than at local authority level. The main report contains some outlines of these individual services, and then there are some further details available on these services in the appendix. So, moving on now to the identified needs and gaps of the GSNA, so we identified that population trends and projections such as steep projected growth in the older population, and a large projected rise in dementia point towards increased mental health needs in the future. A need for further investigation of the mental health needs of Rutland's armed forces population was also identified. In adults with severe mental illness, as discussed, both the breast cancer screening coverage and the proportion receiving a full physical health check were relatively low. Gaps are also identified between the estimated prevalence and the number of patients in contact with health services, and this may indicate unmet need, particularly for dementia for service, sorry, for severe mental illness and also for self-harm such suicide. Across Leicestershire and Rutland, there were perceived gaps in the continuity of care between emergency department and general practice for people self-harming, particularly those without a permanent local address. And then also across Leicestershire and Rutland, there is a perceived lack of flexible outreach for people sleeping rough and perceived low uptake of treatment for people with personality disorders. So if we look now at the recommendations of the GSA, these include to seek opportunities for prevention and early detection of mental health conditions, to monitor and improve the uptake of physical health checks and cancer screening, so particularly among those with severe mental illness. To recognise and address issues associated with Rutland's variety, such as access to services and hidden pockets of deprivation through improved joint working. To enhance the continuity of care for those experiencing self-harm, and then also to improve access to mental health services, so particularly in communities where there may be a stigma associated with living with mental health condition. There are also some more intelligence-based recommendations of the GSA and these include assessing and monitoring the effectiveness of the Rutland Women's Hub service, which is currently being mobilised, to ensure that this service is meeting the needs of women in Rutland. To enhance local data collection on mental health inequalities, prevention and services, particularly for vulnerable groups such as pregnant women and armed forces populations. And then also further modelling of the impact of current demographic trends, so looking at those projected steep increases in the old population and the impact of these on future mental health needs and demands for health care. And then finally to assess in more detail at a local level the needs of some of the risk groups identified such as prisoners, travellers and also armed forces personnel. So that kind of covers some of the key take-homes of the mental health and dementia adults, JSNA and Hannah and I are happy to answer any questions that you might have. Thank you very much Jamie, so okay I've got my steps. I'm sorry this pan is not working. Right, oh I've got to go up the end then. Let's see, thank you much, Deb, to start with you please. First of all thank you for the report really comprehensive. I suppose my question might be more for Mike and it's he's throwing at me. It's a general question on statistics really because there are quite a few of the elements related here to suggest that we've got lower levels than we would anticipate having in Ritaland. And yet, and I get what a benchmark, a benchmark target is important, but with a smaller population we know that small differences in numbers can have an adverse effect. But also we've got better survival rates for example in Ritaland compared to the national average and we accept those. So as a question of why don't we accept lower detection rates on some of the things, why is it automatically that we're not, that people are suffering not detected rather than they're being a lower incidence. That makes sense. I think so, I mean I looked at Amy and Hannah, past me would say it's the difference between a kind of population level where because it's kind of more of a sample you would have a confidence interval around it and a variation. But if you're looking at it, no that doesn't make sense. I was going to say if you're looking at a detection rate you just kind of detect them, but luckily Amy's got a hand up. So I'm going to shout out. Amy would like to answer that please. Yeah so I think you're talking about the difference between the prevalence estimates and how we're saying that there might be a gap between the estimated and the recorded prevalence and that this might mean some people are going undiagnosed. Yes that's it. Yeah that's because we're looking at different sources of data, so the registered prevalence are those that have been diagnosed with the condition at their GP practice and then we're also looking at some national prevalence estimates and applying those to the population of Rutland to identify estimated prevalence of the conditions and therefore if we compare them we're kind of seeing that when the estimated prevalence is higher we're identifying potential people that aren't actually registered at their GP practice with that condition. Does that make sense? It does and I understand what you're comparing. I suppose what I'm suggesting is that some populations have better health outcomes than others. So the suggested prevalence, when do we accept that the suggested prevalence might not be right for that population because there might be healthier I suppose there's one getting that. Yeah I think that's a great point and there's always shortcomings with those estimates but they sort of the best we've got and something that we can't ignore if that makes sense. We adjust them as well as we can for age and mainly age and sex and a little bit for the probation but it's very likely that the true prevalence is actually lower. It's closer to those demands but even national particularly for the over 65 dementia estimates that is the national standard approach. So we can't ignore it but we need to treat these estimates with the bit pinch of salt basically. It's likely that Rutland actually truly has a lower prevalence but it's all triangulation between the estimated maybe hypothetical numbers, the service use numbers whether it's primary care through QOF or secondary care contacts and out of that we get some picture but we have to report that there is a potential gap. It's a potential gap it's not a detected gaps potential one does that make some sense? It does thank you. Thank you thank you Hannah. Pass over to Mike now please. Hannah just picking out a guess for me it's the difference between an estimated prevalence and a modelled one because if what you're saying is I mean it's not like we've just applied a national estimate to Rutland's population gone this is the figure. If that's taking account to some extent in the modelling for differences in age etc etc then it should have subject to what you're saying about everything has a level of imprecision about it does at least allow for changes in the population so you know what I mean it shouldn't be gross error should it? Yes yes so therefore we are reasonably confident that this is properly adjusted definitely for age and sex in all cases. Some of the national estimates although dementia national estimate it's also just adjusted for age and sex so demographic structure doesn't is adjusted for very well what may not be adjusted for that well is the levels of social deprivation but I don't think that is that would you know change those estimates hugely it's probably less but it's not yeah there are problems but as I said the national dementia estimates is only age and sex adjusted as well so so we're pretty confident these are these are good estimates but they still just estimates not not not the detected detected the only way of dealing with it would be to do a well-designed local survey but the closest is we've got decent national surveys and current population structure but that makes sense I know it's a it's a technical thing but thank you for that that's very detailed thank you are there any other questions or comments Ian I thought you might want to yes thank you good afternoon my name's Ian Crow I'm the armed forces representative here today first of all kind of say excellent paper thank you and I really appreciate that you've put in an armed forces community section and highlighted the importance there I would take issue with what you talked about with regards to the recommendations you talk about looking at more detailed armed forces personnel for me regular armed forces personnel are comprehensively looked after by the defense medical services my real concern for Rutland are the veterans is the veterans community you you rightly point out in your report that 6.9 percent of the population are veterans in Rutland and I know you're going to hate me for this on the 5th of April the ONS produced the latest research they've done on statistics with regards to suicides amongst veterans and it was startling they talk about between males between 25 and 45 years old are twice as likely to commit suicide if they have served in the armed forces and I think that's such a telling piece of research that we need to make sure that any work that we do includes and focuses on veterans in the community because we must address that the other point I was going to make was is it too late for you to adjust your report to include that latest research and include that ONS reference because I think it's very telling and very important so two points first focus on veterans and second can we include a reference to the latest research thank you Amy Amy let's answer that sorry I still have a hand up so I may answer I think the report actually yes and where of these I think it was out of once we've sort of finished drafting so so Shaw can can include that if if we wish we I think as we would we did try to find more information on veterans but that actually the report represents what was at the time of writing we sort of have to put I think end of end of and of February was the cut of point for collection of all all the data and evidence for for the report thank you it looks like Alice oh thank you thanks it's just for for the board to know that obviously to do an analysis on suicides to know whether somebody's served you can look back to see if they've served but to be able to do some prevention work we need veterans to be identified so we do have a scheme within the NHS and lupus within the ICB about GP accreditation for veterans and we are trying to encourage the population who have been who are veterans to register with their GP as a veteran so we can help process that information in with the answer your question or would that be enough or do you want more no that's fine thank you Alice I'm sorry thank you chair Amy and Hannah thank you for this is really timely report LPT are just about to start work to develop their new strategy for 2025 onwards so it would be a useful insight into us being able to tailor that to local need I guess I've got a couple of points in devs raised one of them one was the automatic assumption that we don't accept the figures around the lower prevalence rates across Scotland I think seeing it written down in black and white some of the recommendations that you made I think once it's written once it's read once it's seen it stands and it has quite negative connotations but as in terms of how we plan our services going forward if it isn't accurate if we are looking at lower prevalence rates I guess the other area that I would just like to pull up is especially in relation now actually in relation to dementia and to mental health that it is not entirely a health response it is a system response when we're looking at mental health there is something about early intervention and prevention which is a public health responsibility working with our partners in the local authority to a social care response and I would like to see us move towards a much more social social model as opposed to a medical model when we're starting to look out and tackle and address some of the issues that are related to mental health so especially things around the homelessness agenda and being actually able to hold down a job work it's multifaceted it is not purely a health response that we were looking forward to respond to this JSNAs I think that's important to mention and to caveat in this report but no thank you very much really really timely we look forward to it being published I'm hoping you're happy that I can share and start to use this internally to inform our approach in developing the strategy going forward and it might be helpful actually to have a separate conversation outside of this meeting to follow up with you both thank you guys any comment Amy or Hannah probably not all of the in front centre oh and came thanks chair for those who don't know me I'm Tom Godfrey I'm the director of the Toronto services worldland and really interesting and really good report a couple of questions from my perspective obviously it's an adult mental health JSNA I think I'm right in saying there is reference throughout sometimes to 16 pluses and sometimes to 18 pluses which in my world 16 pluses still children and young people but so first question was is there an intention to do a JSNA around children and young people's mental health so that's the first question the second question was really around the section that talks about at risk groups and actually being explicit about at risk groups particularly care leavers and children from overseas and particularly on a company to sign them seeking children and young adults so and I think it'd be really powerful and important that those two particular at risk groups are referenced explicitly because we know that they are two groups who have particular trauma traumatic experiences that can affect their mental health and their mental well-being and it'd be I think it'd be good to see that kind of reference to explicitly within the JSNA but more widely is there an intention for a JSNA in relation to children young young people I'm not sure anyone would like to comment to that yes sir I think I would envisage that the best staff life chapter would probably pick up and elements of that but there isn't currently in the plan a specific chapter on mental health children and young people so we would need to make sure that that's added into the best staff for life can I make a request that as a board we have a we say that that should happen won't you right do you want to say something to that yeah I'm sort of looking to colleagues really I come over the last time we had a discussion about the work plan for the JSNA health and well-being board because I'm happy to go if the board think we need to insert that fair enough but something's got to get knocked out so we need to bring something about that says what your properties then we'll work it from there that's a future thing that we can look at that but yet we will take that on board and add in just to reinforce that I would actually agree with you and wholeheartedly I think post-COVID it's a system it's a real system risk in terms of that early intervention prevention agenda otherwise we'll have another generation of people with fairly significant mental health issues absolutely thank you I got my list here sorry I've got team waiting very patiently and came so we'll do team and then we'll do came well thank you very much for the report it particularly brought out from me the trouble that people with mental health issues have accessing physical health for example you brought out the breast screening as a particular one I think what's not mentioned here in access to mental health service is it needs to be timely in my experience if mental health issues are left for a long time without someone assessing they can escalate to be much more of an issue and I think that needs to be brought into the report I do thank you Tim so I think we need to set that on board if we can or at least make that note on to Kim now please thank you really comprehensive report thank you thank you very much just a couple of things the dementia strategy the LLLR dementia strategy has been signed off at cabinet so that is no longer in draft and just for kind of wide of listening if people are listening in that although the rate dementia diagnosis rate is that you put 49 percent that has increased over the last six months due to an anticipatory care project that was that was through ICB PCN and Rutland County Council Abbondur services and the RISE service so that trajectory has changed and the diagnosis rate is increasing the other couple of things are just around information for work for the IDG and the supporting good mental health work stream of the health and well-being that noted that the uptake of breast screening are those with severe mental illness is lower than it should be and also the suicide and so far number of people having thoughts of suicide is higher in Rutland I think there's some pieces of work that we can start to look at locally in Rutland what what we do do in target work for those areas question around perceive lack of outreach for people sleeping rough there was something on your power point be interesting to understand that bit more because our numbers are extremely low in fact I can tell you probably who those people are sleeping rough so I've been and and I do know that they do have outreach support so just interested where that where that data came from over to you Amy oh Hannah that that was more of the feedback from blessed to share and Rutland commissioners so so I think somewhere in the text we say that this is a you know the footprint of commissioning footprint for for for some of those some of those but we you didn't find at the time anything that was specifically specifically Rutland rather than Listershire East Listershire and Rutland so I mean Deb's was coming in I may comment Sarah's probably gonna say the same thing okay so we we don't have a Listershire and Rutland commissioning footprint anymore that disappeared when we had at the ICB so I think it's important I didn't pick that up in the report so I think it's important in Jess and that is the we altered the wording on that Lola, Lola, Lola, what else do you see she's don't exist anymore and therefore that that piece of information probably needs to be amended Sarah that's my comment yeah I do I was going to talk about the dementia diagnosis rates actually but what what Kim's just said is really important and I think we need to get the figures updated because I thought we had been doing quite a lot of work about getting the numbers up so I think we need to get the current data in it and then say that we have got an ongoing project to increase the prevalence rates because at the moment it looks as though they're quite low and actually they're not sorry I just don't know if I thought that's if we can reflect that though I think they would be really useful because that's ongoing work as well it's not just it's a pilot but it will be after the evaluation ongoing work and also the the MP for Rutland has also got a dementia campaign this year in place so it's it's really important to to reflect all the work that's happening right Katherine would like to comment just a quick point leading on from that we we do have a more up-to-date dementia diagnosis rates but we can't split the not from the east less to show but I think you can interrogate GP systems at that day I think we have a bit of a Amy you'd like to make a comment yeah and I was just going to say that we'd need to make sure that anything we put in the Gessner would be publicly available data if we're drilling down at those lower levels we can consider putting the small counts in the report and I think that's a fair comment so I'm not quite sure what we should be suggesting now the numbers we don't think are reflective of what's happening but we're not sure whether we can get that data available for everybody I think at the time it was written it was probably quite right so does the does this is it has it already passed its date is it is it now out of date is well if it's difficult to get the exact data I think it has to be put into context about the work that's been done to increase that diagnosis rate so what would you like to recommend Kim's anything we should be doing oh sorry Sarah can you put your microphone on please you need to go back and look at the published dementia diagnosis rates because I can't remember off the top of my head how often they are published so I think that's one thing the second thing we need to do is to look at Rockland GP practices and what their rates are now that might not be publicly available data if you know what I mean but it will feed it feeds into the prevalence rates because that's how they get that's how they get them they get it from GP that's where the data comes from so before we make a decision on whether we need to change what's in that report in terms of numbers I think we just need to have a look at where we are now on what's available but I do agree with Kim we need to qualify that statement by saying we're doing lots of work in this area to increase rates right and the other only thing I'd like to add there is about the fact that diagnosis is not actually a very accurate tool at the moment skill it's based on you know a number of things so it can be quite wrong at times but I think we have got a concern as Kim says we need to know what's happening so I'm suggesting what am I suggesting Johanna you've got your hand up sorry it's probably historical but I'm tripping yes I mean the data are for the I think the data is there it's it is a nationally published figure that 48 something percent so so it stands as for that period of time and that's the one published we can qualify it in the sense that there is a work ongoing in their indications of increasing rate locally but because of the statistical sort of nature of that document I don't think we'll be able to include a lot of new information that makes that makes sense and it's also comparative I mean that's from fingertips so so they estimate the the rates nationally and they adjust it and compare it with it without the national areas so it was true at the time of that statistic being drawn but maybe not accurate now that they're going through at the time let's end to Mike now please yeah so I was going to suggest I'm wary of getting into publishing nationally available data and then saying we think it's wrong because things might have moved on but what what the public's supposed to believe you know so rather than kind of go can we pull out this data and refresh this and refresh this because Hannah says you know sooner or later we've got to draw a line underneath it what I would suggest is clearly as a board we need to take on board these recommendations or not I think taking on board the recommendations gives us an opportunity then to then say well what's the response and the response is what we're doing about it what do we think that difference is made to that to the data so I want to wrap up if we could a discussion about how things have changed and whether the data is accurate or not into a conversation about doing something about it instead of going back for a further injury thank you Janet yeah I was involved in the health watch report for dementia both across the LLR and also for Rutland and I've been trying to follow the discussion of data etc but from I don't have the figures in front of me but from what I recall the estimated number of people with dementia in Rutland was much higher than the seven that is mentioned in the report and was actually mentioned to us by the Admiral Nurses when we were doing the background research so if you go down the avenue of checking the data for adult prevalence can I ask that somebody absolutely clarifies the young onset dementia prevalence as well please I think this is all work going forward all of this so that and I think as Hannah says the data at the time was correct it was what's nationally available but it may no longer be correct and what we do about that going forward is we look at get what can we do to actually make it more much more accurate based on what Mike was just saying so thank you for that are there any other questions comments observations and the data is not correct there's potentially is more updated data yeah so I think we've had enough conversation here and I think we need to draw this discussion to a close and I'm not sure that we could approve and I don't know if I have any else's opinion here because it we're asked to approve the mental health and dementia JSNA the publication supports the findings and recommendations of the JSNA and notes the contents of the JSNA I would say that as it was written yes we probably could and if anyone has a comment on that or should we put a comment at the bottom saying this needs to be reviewed I'd like your your reaction so I think all those favor of publishing as is please raise your hands okay so we've got one two three four in favor and those against one two three four five against another abstentions so I think we will take that forward to another meeting to clarify what we're doing with data and where we're going Mike I suppose that's going to be my question is is who gets the job card to take it forward because clearly there's some organization as Alison would say we'd want to have a discussion but it's not for Hannah and Amy to be charged with leading the implementation and again I think you know coming back to the point and what we've just voted on yeah there might be a lot of things that we want to say and do about say dementia diagnosis do we honestly think that there is no problem with dementia diagnosis I don't think we're saying that so I think the broad recommendation stand there's then a question for me about what what then comes back to the board and who's doing it and he's taking it forward oh Sarah can I just check the numbers because I had my hand up for accepting or proving so can we just check the numbers okay I've got a we look like we're a stalemate now so I think I could be persuaded either way around but with one rider on the report particularly the bit about armed forces and dementia and armed forces and veterans that actually the recommendation should be about veterans and not about serving armed forces and if we could have a statement in there which suggests that some of the data since publishing the report has improved or we think has changed then I think that will allow us when our conversations with the public given it's a public it'll become a public document I'm just conscious that that we need to be able to be assured that what we're signing off we believe to be the case okay that helps or not sorry for me it's just the amendments that we talked about and and Hannah so the the outreach and the sleeping rough just to clarify that because that is looks like it's less to share data not rutland data and the context of the we're doing some more work around dementia diagnosis to increase it and again that context is what I was asking for through my which if we have assurance that that is it is in my instinct and this is from where I'm sitting is to say that it's what was produced was produced at the time there are perhaps need to clarify and update as a separate entity and might it's going to frown at me now I think no I'm I'm kind of with Kim I think I would separate out where the board wants to see a different definition because I think it's important so veterans I think it's great to me I think the rough sleeping one again is it is more like an egregious error because I think we put less your daydream when it should have been rutland so I think that's right I think the kind of I as again I'm wary of going don't worry folks people things have got better because that's what it was at a point of time and then we need to take it forward otherwise we've run the risk of you know what happens if things get worse do we go back and say actually we should have published that one so two out of three for me ain't bad are we willing to accept that modification the veterans and the rough sleeping and perhaps a comment that these figures at the time it was written and therefore if anything else comes ahead and it gets used as evidence it has to be with that proviso it was at the time so should we change that oops yeah can I just add it was the figures reflect the data available at the time rather than just things with the figures at the time so there's that question there was the data correct because I have a feeling especially on the young dementia as I said I'm I'm worried about approving something as fact when in actual fact it's debatable whether it was fact and that takes my point as well that you know when how are we going to measure whether things have improved or not if we rely on the data that is possibly spurious in the report and Hannah would like to make comment yeah so in defense the data were as published by national sources by office the fingertips and and we can obviously it's it's not that the veracity of the data is on the side of the office for national statistics or whoever provided those for us so so they are as true as they were published so we never know whether they're actually true or not and that's that's out of our hands we're publishing that we're basically putting in whatever's available to us and and yeah so that was my main point about the veracity of the data that will never be the dates are there and the sources are in the documents with all the other amendments we're happy to correct apologies for the for the rough sleepers because that was something that that was basically one of the less to share less to share points so I had my double I had my dad I had my doubts from the staff whether they should go in or not but easy to I think there is a zero of people sleeping actually rough in rather than some of the last survey so that's in that that's in the document too there's one yeah there's one now okay so I think we've come to a resolution there that we will accept the the board approves the mental health and dementia JSNA with bodies those two amendments the number of rough steepers and the armed forces and statistics and to accept that the results of the research were based on data at the time so that when it's used it's it was and it will change sometimes for better sometimes for worse so taking that can I do that okay so do we understand what we're saying good so all those in favor please raise your hands anyone against and their abstentions oh you're abstaining sorry Janet Deb's sorry Chan and I'm not abstaining I just think from this conversation this leads to a piece of work I think we need to do in the subcommittees of this board to ensure that we have this sort of conversation before it comes to the to the board so just my apologies as chair of the IDG in advance because we should have been able to pick up and the opportunities of these discussions to clarify our issues so that when it comes to the board we're not having the degree of debate so we'll take that action thank you for that Deb's okay so so this is the joint health and well-being strategy before we start I think I just want to share with you the the good news that Catherine has been promoted I want to embarrass you in public and it's an interim six-month acting up role she's now the interim head of service for adult social care so congratulations from us well done so this is report number five eight stroke 2024 from Catherine Woodison interim head of service adult social care but written when she was health and integration these which gives the board an update on the progress of the joint health and well-being strategy delivery plan and highlights elements of the public health outcomes framework Catherine over to you thank you yes so just a few bits to pull out from here and we have done some work on the strategy delivery plan so we have a new updated version of that which is has been included in the papers and that's really just to try and help us focus more on information and reporting and there is still some work to be done on that plan which will be done over the next quarter I'm currently doing a in the middle of doing a 12 month review of the strategy delivery that will be available at next that the next health and well-being board what it has shown is a lot of progress in the work of the delivery of the strategy lots of new initiatives are now embedded and are working as business as usual so we have had some hiccups but there's majority of really good progress in implementation so a couple of examples here the learning disability annual health checks for people age 15 plus being a little bit concerned about you know how much these are happening so we've got some verification that we've got some good figures on those there is also a learning disability annual health check pilots so this is to help more complex situations people who are afraid to you know come forward for their checks so that that team will go and visit people in a more comfortable environment home their own home and schools etc the we've also got in the children services a good process whereby they can highlight any concerns with anyone they're working with now day who their fill needs to receive a health check just also wanted to highlight that the oral health team has been in a visit the early years a dozen early year sessions at the family hub around you know oral health so that's supporting priority one for priority two a couple of examples is the arms forces community health and wellbeing plan has been developed and there was a February there was a workshop that took place in February and the delivery is now commenced making every contact count training has started to be delivered across what can count to count the adult social care and that would drive in driving that forward to increase offer and take up equitable access GP surgeries have implemented a priority phone line to improve access for the most vulnerable patients or those at high risk and some figures for the acute respiratory respiratory illness of is provided over 300 appointments between December and February 2004 with regard to growth and change and I think we're all really aware of the levelling up progress that is progressing with a government sport and delivery team meditech facilities will be at Oakham Enterprise Park and there are indicative Moby hub routes been identified and some outpatient services are being delivered from RMH an x-ray and ultrasound occurred two days a week which is some examples of more closer to home access and the priority six dying well is really taking momentum now since it's taken over by somebody call so the first steering group was held in January it's really good attendance from a range of partners and looking really looking at exploring engagement and also looking at population health management approach to dying well and a productive pathway mapping workshop was held in March it's just about really identifying what's already available what the gaps are for we've seen good services at the end of life so just a few examples of progress then moving to the public health outcomes framework for upland and I've picked up a couple of things here so you know just heard it's the the the JSNA sounded a little bit concerning around mental health and one indicator of low happened people reporting low happiness has improved from 4.7% in 2021-22 to 3.5% in 22-23 and it's significantly better than the national average so it's potentially seems you know lots of good work that's happening including the work of the Rutland neighborhood mental health group and something that we're not performing so well on is musculoskeletal reporting long-term issue with that well the figures are there but but I know one of the things we're looking at is a healthy work places projects and we know that depression can affect physical health and workplace maybe part in that so that's early stages but that might have an impact on that issue that's I'm just going to move over on the public health outcomes framework to Mitch because we have there is a report about life expectancy and a concern around that so much is going to take that one for me thanks Catherine and so yeah the first indicator that's expressed in the public health outcome framework is around life expectancy and so for those who have already seen both male and female life expectancy for the year 2022 has decreased by approximately two years for both males and females so it's something that's been highlighted in something that we wanted to explore for obvious reasons because it's quite a significant decrease on that yearly trend and so some of the things we've found are that so I just find the slide and so excess deaths were high in 2022 for Rutland's that is the same time period as life expectancy updates so excess deaths were the highest in East Midlands although all these Midlands areas in terms of local or forestry areas were above one in terms of a ratio on excess deaths Rutland was the highest for that year the positive side of that is that that has now decreased in terms of excess deaths only for 2023 so whilst we're still above a ratio of one we are quite considerably less than 2022 figure so that alludes to an improvements and excess deaths is likely a contribute factor to that life expectancy decrease we've not got life expectancy data for 2023 as of yet and so we don't know what the impact of that reduced excess deaths has on life expectancy but we will see that next year in terms of a wider perspective of what that life expectancy decrease may mean mortality rate has increased for a couple of conditions one of our indicators is long-term conditions considered preventable that has increased for the same time period so 2022 and also circulatory diseases mortality rate has increased for that 2022 year as well disease surveillance for those conditions has stayed the same so it's not necessarily saying people if there's more people with those conditions it's potential that that could be worse outcomes for those people with those conditions in the first place based on interest in terms of interpretation of this and it's very difficult to fully put into what the reason and is but based on the time period being 2022 there's potential that COVID-19 was still at play at that point during the peak of the pandemic Rowland did have a delay compared to a rare reason in terms of the implications of cases ill health and mortality related to COVID-19 so there's potential that delay is playing through in terms of the outcomes from the pandemic as well considering it is 2022 data also as we always do with Rutland we need to acknowledge that small numbers are a factor for Rutland's and while life expectancy is one of the most valid indicators for Rutland's the further trends moving forward will help to really highlight whether that trend is continuing or whether it is an economy for that year like say we're in 2024 now so we've not seen 2023 data playthrough or 2024 as of yet there is also a three-year trends for this data so for life expectancy that does show any sorry a decrease for male and female but as you could imagine as this is a one-off going down at this point in time in terms of the data available the three-year data hasn't gone down as much as the one-year data if that makes sense so for the three-year data from 2020 to 2022 Rutland is significantly better still for life expectancy both for females and males so that is a more valid measure because it's over three years we can be less influenced by those small numbers so part of that is a wait and see but also what do we potentially want to look at now so yeah that's where we've got to with that review Right I've got the herbs and then Mike thank you thank you both clearly we need to do a bit more work on that position but I just I've got a data query given that we have an import of elderly population into Rutland because of care homes and some of the issues there's the life expectancy but based on anyone currently living in Rutland or is there any criteria about how many years you've had to live because if you come in with ill health and for example if you move from Corby to Rutland Corby's got one of the lower life expectancies and you bring your life expectancy with you or is does it go from birth or just just a query on how it's calculated I think more important is to remember it's based on standardized populations so it does take account of differences in the Rutland population but now such a question is it's probably based on where you die as opposed to where you live but it shouldn't be such an issue because ultimately controlling for those differences in population It's just we have seen an increase in population coming in from outside and then send it because of the care homes so so people who weren't in Rutland before which is putting pressure on care home that was my reason for asking but actually we need to triangulate the data with our long-term conditioning data in health and what's happening anyway and to see where where the treatment gaps are and what we can do and to try and cover that off. Thanks Deb, Mike. So let me just thanks to Mitch for this one. I mean I don't want to say it has running but it is a concern because we're up and we don't do worst in these Midlands for health and certainly not on such a central and indicators as life expectancy. I do think it's interesting I would hope as you were saying Mitch that this is a bit of a delayed reaction because we know that life expectancy nationally took a big hit in Covid for 2020 stroke 2021. We didn't see that drop in Rutland I think we have probably the least drop in life expectancy for that year but we've then seen it deteriorate in Rutland the next year whereas the rest of the country has fared not so badly so I'd like to think that almost like the first way you've got shoved into the 21-22 figures and then the big 2021 January wave got a little bit later in Rutland and that got shoved into the 21-22 figures if you see the logic of that. My fear would be and we're worrying one is something related to the population Deb as you were saying but we do know that you know if you've had Covid there's been an increase nationally in terms of deaths from CVD because of the after effects of having Covid it's not directly related and recognising that Rutland figures can vary a bit because of small numbers I think it's definitely one to keep a watching weight on because if it is a delayed curve of Covid and it bounces back great if so our population is such that it's more at risk if you liked of the after effects on general health due to having had Covid in the past then obviously that's a longer term problem. All right I feel that any other comments questions Janet? Yeah I'm just wondering if again associated with Covid but there was a general reticence of people to come forward for medical attention during the height of the pandemic there was a lot of fear about when we were in lockdown etc and has that delay in seeking medical attention also come through in figures as well. Do you have any comment Mitch? I think the only thing I'd say is well one yes that could be at play but if you look at the trends compared to other areas Rutland is a little bit different but again going back to that delayed part of that that might have been played into that delay as well so if you look at the timestamp at that point i.e. 2022 Rutland is a bit of a anonomy compared to others but it's whether that's a delay or whether that's different because all of our areas would have had similar issues in terms of what you just raised at varying levels I'm sure but there would have been some of that at play for all areas not just Rutland except that with an older population demographic than other areas and as the older people knew they were much more at risk if they caught Covid perhaps that fear factor played in more in Rutland than say in Leicester City where the demographic is a lot younger I don't know if you're expert yeah I mean it's a consideration obviously it's quantified that is very difficult but yeah it's another consideration and it might be multifaceted it's not just one thing that's probably contributing towards that. Mitch there's one obvious question and that is when's the next data set so when is the next update on these figures so we know whether we're trending down or trending up so unfortunately it's an annual update and so it would likely be I don't know when it was exactly released but the first couple of months of 2025. Everyone had their own comments so let's draw this discussion to a close the motion is that the board notes the further developments of the JHWS delivery plan and notes the public health outcomes framework update for Rutland report all those in favour please raise your hands anyone against no any abstentions no okay we'll move on to number 14 better care fund just conscious of the time now so we now have report number 612024 from Catherine will listen on which briefs the board on the 202325 quarter three BCF report Catherine over to you. Sorry Catherine can you put your microphone on please thank you. Yeah report is focused on the quarter three ECF report which looked at it's I'll be quick which looked at metrics and also spend an activity on certain areas of the BCF two-year plan I talked yeah so the metrics as we talked last meeting our Rutland set metrics they're all in the report but I guess just to say that the metric for discharge to the usual place of residence has improved in that quarter what we are what hasn't improved and is not on track to meet target is avoidable admissions so numerically wise the number over the quarter is 43 above the target the week set for ourselves in Rutland what I did include in the report was the work that is happening on health and care collaboration and focusing on comorbidities and risk strategies etc and also things like the Wizzan boxes in care homes so obviously the health and care collaborative work is still progressing and we hope to see some impact of that on avoidable admissions one metric there and the spend an activity that needed to be included this time it's just on certain areas of the plan and that I've listed here so care services etc absolutely no issue with that at all that's all on target and that's fine and just that the Rutland BCF partnership board is still happening that's meeting every quarter just as a governance around Rutland BCF rules and processes and we did the board did approve monies for two schemes one was the community inclusion officer and one was a customer feedback contract that's being delivered by health watch thank you any comments or questions anyone go any questions anything all right okay so we have really had a discussion where we've heard from Catherine so thank you the motion is that the board notes the content of the report and notes that the Rutland 2020 325 quarter three report of the better care fund gained approval from the chair of the health and well-being board on from the ICB executive team and was submitted to the national BCF team on 31st of January 2024 all those in favor are it please raise your hands I guess yes everybody um so that's been resolved thank you moving on um so the update from the subgroups the first subgroup we're going to be updated by is Dawn Godfrey Director for Children and Families so an update from you Dawn please um thank you chair um just to say I actually wasn't in attendance at the last children new people's partnership due to leave so capitalist Smith obviously chairs the partnerships and may be able to give an update from that actual meeting what I would say is um the current um children and people's plan runs till 2025 we're starting next month to look at the new to start the planning um for the priorities and the new plan from 2025 um to run through to 2028 so the planning for that is already starting um and the priorities that and the actions that had been identified um for the current children new people's plan and now embedded within business as usual um so I think what I would what I wanted to let the health and well-being board know is um there's some been some really positive and really good progress um and partnership progress um in relation to our children new people's plan and now we're in the process of doing the doing the next one um and that's it from me team is there anything you'd like to add to that no I've heard I haven't didn't know I have to give a report but nothing doing is fully important thank you thank you thank you Dawn sorry can I just add um the the intention will be that we bring the new children new people's plan through this board um the earliest that anything will come through would be I think probably the October health and well-being board um I know the dates haven't been set but that would be the intention thank you chair um so we received a comms update um our last IDG dimensions a dementia subgroup is being set up got a lived experience partnership group in play which I think is really helping in putting into how we look at services and there's also discussion on how we maximize the opportunities to connect with the voluntary sector and some of the initiatives that they have particularly when we're publicizing services or changes and picking up some of the issues like vaccinations for example um as we go along we are looking at um our same day access um services and looking at how we can improve the model of care so it's less confusion confusing to the public so we'll hear more about that over over the coming months we reviewed our terms of reference and we agreed to include a deep dive in um into each priority area as part of the integrated delivery group and that would allow us to really focus on some of the risks that there might be to delivery that we can then draw draw attention to the health and well-being board and also work out what further actions we need um to do to address them we received a presentation around dentistry um there's been a national action plan can i just sorry i'm so sorry can i just stop you there we've hit that wonderful hour 430 and i have to ask whether or not you'll agree for an extension of the meeting time and we'll extend with 15 minutes um and we'll get it done by then won't we so do we have to ask for a vote yes all those in favor of extending okay sorry chair um so we received a report on dentistry and particularly the national action plan and how it translates to Rutland there's a lot of work that's required um still on dentistry as we know we're awaiting the oral health needs assessment which is due out to the end of May a couple of the the sort of elements in the national scheme um involve new patient premiums attracting new dentists and and and plans uh that they have nationally in doing that an increase in the uda payment which is the unit of dental activity to again to try and encourage more NHS dentists and there will be some re-commissioning of um uh UDA's in OCO which should come into play at the end of the year so we we recognize that dental is is both a local and a national problem um we've got the commitment of of um the commissioning team to continue to update ODG and I suggest that we request a report to come an update to come to um the health and wellbeing board I thought it was in September but it might be October then whatever the meeting is or the December meeting depending on on the agenda chair. Thank you. Thank you any observations or questions or comments? Chair and I'm hoping that I'll be able to bridge that gap between all of the um reports you've been receiving today which have got 21 22 sort of data on it to operationally what we're actually doing um about some of the concerns and issues that have raised in those reports so hopefully I'll be able to bring us up to present day with this one. So um the Rutland neighborhood mental health group is led by Mark Young who is our senior mental health neighborhood lead continues to meet monthly and they have given feedback into that JSNA mental health and dementia chapters and they organize meetings to work collaboratively with a number of partners specifically Listershire Recovery College P3 which brings in our mental health and housing vitamins and rise integrated neighborhood team they also work very closely with public health and one of the examples of that is recently they have been supporting the voluntary group that the high five group have set up with the five neighbouring villages where we identified an area that perhaps we want to support with areas of deprivation within them to bring the group together to explore how they can support and improve the health and well being in that area particularly rise met with the group in March to discuss the current support of further joy platform and social prescribing and carers we had enormous feedback of you know real appreciative um we're trying to get them to actually help themselves not do things for them and they now have introductions of where they can go for further support and advice linking them into the wider voluntary sector network which also meet on a monthly basis. Peppers are safe place which is our crisis cafe in a previous naming I've now submitted their proposals for changes to their mental health cafe which have been accepted and one of those is looking at opening a hub in the town hall at Upingham we recognize that that will complement their existing offer in Ocom and they're actively recruiting new listeners and have received a good response to their advert they're hoping to launch the Upingham hub in mid-May and there has been a large increase in numbers of people accessing the cafe a 133 percent increase in the period from November 23 to February 24. Public health have shared the draft armed forces health and well-being action plan 24/25 at a recent workshop in February and one of the actions specifically for the RISE team was regarding how we can seek to reduce social isolation and loneliness in the regular armed forces families and how we can support them. We've spoken to the color sergeants at Kendrew valorix and they have agreed for the RISE team to attend coffee mornings for family members and serving personnel to obviously increase that comms and that link into the joy platform and all of the voluntary sector in self-help and they're sharing some of that on their social media channels as well. We've also been supporting the veterans breakfast clubs that are held in Rutland as well. We're finalizing the revisions to our RISE integrated team leaflet so that we've actually got something physical to hand out to people as well as supporting the launch of the joy platform which has now been launched across county city and Rutland linking us all in together. We've got role of banners displaying in Upingham and surgery and a medical practice to try and reach out to the public so that we can have some more of that self-help going off as well raising that awareness and we've got mental health awareness week coming up in the week and beginning the 13th of May and we've been and speaking to active together looking at organizing mental health walks and looking to start a mental health at the mental health cafe the walk will start from and we know that walking can have profound positive effects on improving people's mental health and several of the current walk together walks are focused on walk and talk providing a safe space to talk with like-minded individuals and whilst receiving physical activity. We're also organizing a where at Green Day on Wednesday the 15th of May and we're just finalizing details of that. On another note hopefully you may be aware that our local GP mental health lead Dr. Cora is leading as leaving us in June and we're actively working with our colleagues in LPT to secure funding to extend her role beyond June because of the incredible work that that link has had with all of the mental health work. We're also linking in with LPT to discuss how we not only recruit the lived experience partners which are working with our co-production on participation groups but also a peer support worker to work with our local community mental health worker to support our group mental health sessions which have been incredibly well received in the county. The three conversations community rehabilitation worker it's still working at capacity they've started a weekly drop-in session at the five elements cafe in Upingham and although it has had a low take-up to start with the numbers are increasing and that is purely a drop-in session there's no prior you know anything needed people just chatting talking and our three conversations worker works with people there. The Getting Help in Neighbourhood funding in round one that Age UK had for their befriending service was extended by 12 months into year two and we're pleased to say that it has been extended for a further 12 months and Age UK continue with that very successful befriending service. We are waiting information on the annual health checks for people on the SMI register the Serious Mental Illness Register and we understand that GPs are going to be performing those physical health checks which will release the mental health facilitators which are currently doing them in PCN to actually do more focus work with individuals and we've requested the data about how many people we have got on the SMI register in Rutland you will note that the report we had earlier was county and Rutland figures combined and we have pushed for those Rutland numbers. We continue to work in young people's arena the section 19 panel MDT continues to meet every fortnight and we have early health services the GP for mental health lead and ourselves looking at cases particularly with children and young people with special education needs and we are also meeting with Alisa Goodman from Age UK about dementia support services in Leicestershire and Lisa has confirmed that she will be covering Rutland from April 2024. Mark Young has been facilitating the community mental health and well-being team MDTs since the end of August and involved in those meetings has been the GP health lead and from the PCN community mental health worker from RISE the mental health practitioners and facilitators mental health social workers clinical consultant psychologists and since March 24 we have also invited members from adult social care particularly the front door adult duty team and they are becoming regular attendance attendees each week that MDT has been incredibly useful for supporting those particularly with complex needs to make sure that there is a joined-up approach to supporting those people. There's a new project that was designed by a member of the RISE team and launched in February called menopause matters and the group meet monthly in the Oakham refill shop on the first Tuesday of every month between six and eight at night designed to bring people together discuss anything related to menopause and the first menopause matters social awareness group only saw one person attend but they're left with very positive feedback on social media and since then the second meeting had three people and the third meeting has had five people with the original person attending all three sessions so it's gaining traction very proactive with researching information to share with the group which is very encouraging as our aim for this group is to be completely sustainable without the need for anybody within our team facilitating the group so chair that's just a bit of a operational what's happening on the ground presently that's fantastic thank you very much any questions or comments Janet thank you what else work just wanted to know and this was a question that somebody asked me and I wasn't able to answer is how RISE and the joy platform going to sort of integrate or is one going to sort of take over from the other or so the joy platform is RISE they are both the saying so we case manage all of our support on on the joy platform so the joy platforms made up of three different elements there's a GP element but they can actually refer directly into RISE from their system one and platform into the RISE platform and the RISE team are linked into the marketplace the marketplace is the public facing part of RISE so all of our voluntary sector organizations are on that marketplace including RISE so the public can actually click on the RISE tile in the marketplace and directly refer themselves into RISE so right the joy platform is RISE it's all the same yeah part of it that's all I needed to know thank you thank you very much for that so um um let's just um we're now um then we got I think we're gonna have to extend again um we've got about a minute to go before the next deadline so um are we happy to carry on for another 15 minutes to deal with um Adrian and the annual work plan all those in favor please raise your hands thank very much everybody in favor yeah thank you so we're now going to pass over to um Adrian Allen assistant director delivery public health on staying healthy partnership uh texture um I'll keep it brief because a lot of these things have would be mentioned in other items and there's the three core elements of the work stream in the staying healthy partnership um the first one being the the arms forces work so the paper came to health might be aboard in January um uh following that there was a workshop which was really well attended by partners and and representatives from the barracks um the outcome of that is an action plan for 24 25 has been developed and that plan is is now working its way through that that process has been really positive from all partners which is great um just mentioned by Emma Jane the high five projects which is the project that started in Greetham changed names um not so long ago that continues evaluation now is on the agenda and they're starting to look at how that project can have some sustainability moving forward but also take it out the learning from that project and look at how that can be replicated in other areas which again there's some really positive things coming out of that which is great and then the third work stream is around the whole system approach to healthy weight which we've had a presentation on today and which holds the detail and that's it thanks to Jim um so I think that's the end of that bit so the next is number 16 there's anything I've got to do there no number 16 review the forward plan and your work plan so what are we proposing for 24 25 does anyone have any other items they would like to propose for inclusion on the board's work plan um and we'll take that um so as that you have any changes to be made thank you so if anyone wants to email me with their suggestions that's fine let me know and then we can add it into there and then we can have some exciting things in our work plan oh would you want to say something depth I'm just going to say there are two things that we said we'd pick up the new children's plan plus the dentistry me, Melly, if you want there's always one um any other urgent business I've been told of anything in particular no um okay to the date of the next meeting we are setting the dates for all the meetings at the next um at the annual council on the 20th of May so the dates have not yet been set so we will let you know as soon as they have been put in is that all right Mike? Roughly though we still do cool things wouldn't we so after May 20th we'd be looking at May April May June August July August I will we will let you know so I declare this meeting is closed at 4 47 thank you very much everyone it's been excellent thank you thank you for watching [BLANK_AUDIO]