Transcript

and it's not live stream okay so good evening everyone the meeting has also been recorded and available on the council website and obviously welcome to everyone any member of the board unable to join the meeting in person is able to join remotely or they would not be able to move or second or most not vote with regards to the meeting you have to get please remarked if it was just an old-fashioned method really embracing your physical hands I'm not going to dictate which one to rise being that then myself the chats will not be warranted during the meetings then I know that disappoints some people who love the chats anyway apologies for absence item one received apologies from from an Ashton chief executive at Muir University Hospital but we're grateful for Tom Ellis who's not on line but he's in his is this script said you're actually in his place in your prime and in your place uh marie truva everyone uh she is no longer a member right but we'll change the management is that if you don't have a place in power me yeah so it's just you sort of yeah so it's interesting that both of you have double-barreled names that is that how you get the job no i don't know she doesn't have the job anymore we have our teacher uh lorraine central chief executive which is now i think she's the chief executive of the peace land foundation do we have anybody from it tell me is there anyone online who's on it was in the script on i thought he had you there are three but apologies from doctor понимаю I'm not speaking very well, a clinical director of New England Health and Care Park, but in his place, I know we've got in her place, in her place, we have nobody? No, he's in here on his own accord. No, he's in here on his own accord. There wouldn't be anyone in it. There wouldn't be anybody in it. So Joan Fraser-Wise is in her own place. No apologies. Nobody online except Anne-Yola, but she's not a member. And is there any other accordion? No, not at all. Laura is a busy ramble. Does everybody know each other in the room? Yes. Declaration of Interest? No. Minutes of the last meeting that we found on pages 3 to 18. Anything on page, we just get to go through for accuracy. Thank you. Thank you, that's far the most sufficient minute paging. A few of you know that this is for this organic ginger shot. Anything on the minutes? 13, 14, 15? This was only 16 days ago in January. Sorry, I was an actressy and I appeared to have been renamed, Nicole. Oh really? Not only the double barrel but now renamed. Joan's face is white. White and it's great for the set. It's not important for ladies. And I'm going to go out on a limb and suggest that maybe Holly Whiffield is Holly rather than Holy. Yes. I just thought these sorts of things are dubbed quietly. No, I'm sorry. You know I saw out on the camera and we've been quiet. I knew I'm counting quiet. Well, thank you. You know me, Julie. You want the office of room. No, I don't. So, irony is that a premium can kill. Can we all agree loads of minutes approval as a correct record? Yeah? Yeah. So, we are rearranging the agenda because of other commitments, if that's alright. So, in place of, well, not instead of, but the rearranged order. Can we, is it agreed we can take item 6 on health, the Newham Health Equity Programme update? Yeah? And I hope Adiola's online to do it. Yes, I am. Thank you. The item 6, 7 and 8 we'll take first. Oh, I see. Yeah. Right. We are being very concessionary or something, Adiola. You're doing three items, 6, 7 and 8. Thank you. Do you want to kick off with, can you kick off with number 6 so we don't get too confused? Yes, I appreciate that. The health equity programme. And can I just say, before you start, that I was privileged to introduce a Health Equity Toolkit, which is mainly for practitioners, but I think Adiola and Jason will probably talk more about that. So, number 6. Brilliant. Thank you. Christine, do you have the slides or do you want me to go? Are you okay to share or do you need me to? Yeah, no, that's fine. I can do that. Give me one second. I've got disabled sharing, really sorry, I need you to. I can enable you to share. This is very amazing. One moment, colleagues. Come on to yourselves. Don't have any people there. Sorry, just a second. We've all got them. So, just while we're getting the slides up. Is it working now? Yep. Okay, perfect. Let me just see if I can turn this into... Can you see that, colleagues? Brilliant. Yes, yes, yeah. So, this is just the standard update. This is item 6 and it can flow into item 7, but I'll pause between them. So, from the Newham Health Equity Programme. This is just to remind you of our 24-25 priorities. One is influencing sustainable systems change in tackling health inequalities. The second is to support individuals and teams to embed health equity in their day-to-day work. And the third is to capture learning and best practice from across the health and care system to develop an accessible living repository of work. And across the top, there are the action areas across each of those rows. And we have three of these items are, have been signed off by both the Health and Wellbeing and the Health and Care Partnership as system priorities around unpacking around better, better and more appropriate granularity of recording and reporting of ethnicity data to include their own S18 plus one. And unpacking the Black, African and the Black, African and the Black, African and white other categories so that it's meaningful for practitioners to be able to identify which communities to work with and support around having equity objectives or equity goals within the health and care partnership joint planning groups. And around having equity objectives built into business cases and by extension disinvestment cases so that we can maintain that focus on a fair and healthy borough. This is a highlights, the highlights slide pack, which you would have received in advance, looking at how we, sorry, I'm outdoors, there's a little bit of background noise, looking at where we've advanced those priorities across the programme. Again, referring to the, the support that we give to diverse health and wellbeing communities group that where we're looking to empower that group to be able to take some decisions on how we prioritize funding is appropriately hard working communities against pre agreed priorities. And then there's some discussion about that ongoing at the moment between Jo and myself about how we facilitate that in a proportionate and sensible fashion to meet our system goals. And looking at the milestones coming up for the next month that we want to continue to progress the work on ethnicity recording and reporting that we want to progress that piece about funding and that we want to build on today's launch of the health equity toolkit and there's a separate slide about that. We also planning some deep dive sessions to support the framework, the frameworks and the tools to be better used. And we, the team hosted a session, the first of a couple of sessions, starting with a public health team to capture some of the insights and the learning from the past few years of equity work we've done a lot. Before, during and after the pandemic, there's a lot of insight together and the sense making that so to support sense making about how we work with our communities, one of the things we've all noticed about working with health equity is that some of the system learning. doesn't always embed and come back as system knowledge to be built on that sometimes it stays in people's heads and it goes with them if they leave the system, sometimes it just it isn't built into business as usual. And the purpose of the program is to make this business as usual. We're mindful of some of the risks in the background of the cuts being placed on the ICB and the noise across the system with NHS England, of the marked and deep financial crises that all the partner organizations in the place based partnership find themselves in. which always traditionally something that impacts equity that often some projects and actions are seen as nice to have not essential and again from today's workshop launch that I think. And I would encourage members of this health and well being board to adopt the view that actually thinking about working thinking about achieving fairness thinking about delivering equity is also about efficiency. And it's also about getting important outcomes that will provide savings in the long run. We have a couple of examples of some things that will that are being presented to our board our leadership group. And that are live in the system, this is an NHS inequalities funded projects that's hosted by East London Foundation Trust. It's one of two projects that are looking at faith adapted approaches to therapy and support. This is one that's taking place within elsewhere frontline staff are being trained to deliver a modified behavioral activation training. It's been modified to take into account Islamic faith and it's very much behavioral activation is about dealing with depression by not waiting to feel better, but by acting as if you are already. That's the recruit way of putting it with that affecting my taken, but it's proactive and it's supporting people to start to kickstart that that their improvement in mood by. By behavioral activation. This is the Islamic version of that which uses teachings and faith adapted support. And so far about 60 members of staff have been trained to do that and about 18 existing patients have been supported with this particular approach. Sorry, 74 professionals. There are resources that also go with that and some outreach that took place, particularly during Ramadan with the Westfield partnership, which is an Islamic supported space run by the new Muslim Foundation. And by looking at clinical supervision and maximizing the reach through appropriate comms and leaflet support. As mentioned before, so there is a companion piece to that which is an academic project that currently didn't win funding, but that's about supporting imams to deliver a tailored depression treatment. In the context of the mosque and faith community, and that will come around again to be reworked to see if it can take acquire funding the same professors of the professor goes on a mayor is the author of both of those projects. And we've worked closely in partnership with the mental health partnership board and the mental health clinical leadership in Rana Tadiki on landing those two projects that you're both very important, very useful. So our health equity toolkit we launched earlier today. Adi, Adi, Adi, Adi, Adi. Can we pause there? Also just because the sound is a bit tricky. If you just talk a bit more slowly, the sound will, because the sound is a bit tricky. Yeah. Did you want to pause there? Yeah, I think we should pause there. That's all right, Adiola. Yeah? Yeah, that's fine. And there's quite a lot of detail there. Just, I'm ignorant of this one. On the faith-based therapy, I should know now, BAI started being offered in NTT. NTT is? Is that talking therapies? Newham Talking Therapies. Newham Talking Therapies. I apologize. So Christine and I on a side issue are starting an initiative with particularly NHS colleagues to eradicate abbreviations from Health and Wellbeing Board. Thanks, but we may have dropped this one. I apologize. It's just that we're trying. I mean, I did the same at school governors last night. We're trying to make everything accessible in terms of not using, you know, feel after afternoons and things. And then the other one is partnership with NCT run men's group. Totally, you know, in terms of mental health particularly, I mean the whole dynamic thing, the idea of men talking more in secure places really agree with. But NCT in that case? Adi? I asked that. I just thought it was a child trust or something. I don't think it's the National Childbirth Trust. I think it's Newham Community Therapies. Or I think it was a different acronym. But I will find out what it is and send it around. And sorry, abusing the chair just before I bring others in. On the highlights one, the overall status green. This is on the, there's no page numbers, but the, after the, the highlights sheet. The one with the green dot, yeah. Overall status. There was the scope and review of 50 steps of discussion on equity of literature in JPGs. The planning groups? Yeah. Yes. NHS. Exactly. Well, healthcare partnership rather than NHS. Yeah, yeah. So I'll be clear everybody that this is obviously owed by this as overarching group, operationally delivered within, you know, settings across, primarily, all I've heard so far, I think is community health provision, not yet primary, but that may be part of my ignorance. And then this is also reporting in at an operational level for the place-based partnership. Is that? Yeah. Yeah. Okay. So, any questions, Roxanne? Shall I very hold a bit on this one? Yeah. Yeah. The one with the green dot, sorry. The highlights, January. The highlights. The highlights. It's item six. Item six. We've gone to item six. The highlights. Yeah. Highlights. Yeah. Highlights. Yeah. Highlights. Yeah. Highlights. Yeah. Highlights. January. March. 25. Yeah. And my guess is it's page three. That report. Right. Any comments or questions, observations, anybody at this page? No. No. Everybody happy? Yeah. Yeah. I think it's really positive seeing some different examples as well. Yeah. The work is being picked up. Yeah. Exactly. Yeah. And this faith-based adaptive therapy is certainly, I think, to be welcome, because it's about people feeling confident within non-clinical settings. I'm just going to add that, you know, it's taken a little while for this programme to really gather momentum, because really what we're trying to do is change systems. And so we can't do quick fixes. So I think it's been really encouraging. I think the team have done a really good job of trying to galvanise everybody and pulling lots and lots of different pieces of the system to try and share. So the vision and the ambitions have always been part of what we do in our roles, but actually trying to coalesce people to actually work in the same way, I think is really exciting. And I think, I think we should all, all of us take a little bit of a pat and back, because I think it is quite a big thing that we've actually managed to do. So that's all I just wanted to say, counselling. That's absolutely fine. And that's absolutely fine. And I don't think we should lose sight of the very valid point, as Iola said, about so often. It's project-based without necessarily having inbuilt sustainability indicators, because otherwise people go, a team member leaves a team, and then the work is lost, and all of that, that we've experienced through quite a lot this month. Okay, now, Roxana's called up, I can see her hand is coming up again. Okay, so, could we, for a bit of the presentation that I mentioned before we pause, and then just give a highlight section, and then also the faith adapted to therapy. I'm building on what's just been said about motorists have found this to initiate systems-wide shift in practice and servicing issues. At this stage, and appreciating that this is early doors, what material impact does it have in terms of the number of beneficiaries? This approach is touching. At what point can we begin to scale up, so that we are able to shift the dark on those significant issues of health and equity, that lead to the poor health outcomes, and the life expectancy, and then the drain of pressures on the system? I was interested in the faith-based approach, the faith-adaptive therapy, on the mental basis, I mean, what specific thing was, is being delivered, and then just the thought, and this is something that has struck me in a variety of different conversations as it relates to our ageing well people, and different ageing well individuals within the range of completely different groups, including those that are very different. How much does the system appreciate that when we're looking at issues of, say, loneliness, isolation? For some of our ageing well crew, actually, given the lived experiences where they've been very active and they've worked with their lives, being able to access a talking bench or a cafe where they have a chit-trap is not really their thing, they want to be doing the practical things, where they get sense of, what's the word, purpose still in life, but as opposed to just being shot to the sidelines and just have a chit-trap. And I say that from the event experience, I have an Asian well father. And one of the things that's striking me in my engagement with my father, as he's aimed him well in this new kind of era, including early stages, and what potentially could he drive this memory of? He's bored. He's really bored. And there isn't enough out there that he knows about for him to access in a practical way, because of some of the specificities of what he's used to and being retired through the normative lens that actually doesn't suit him, when he feels redundant. So how can we work that through it? So, well, there are lots of questions there. Let me answer a few of them. But as you were able to show up. So let's, the last one first. So to Not For Nothing is volunteering and employment a big strand in the Asian well strategy. Like, that came really, really clearly. It all, you know, remember we did a huge engagement with people as part of that strategy. It's a very, very significant strand. So that's active work. For example, active work through our volunteering team to support and reach out and create volunteering opportunities for older people who are active in their community. There's no, you know, there's no one thing that's right for everyone. You know, different people have, you know, the strategy needs to speak to the kind of huge diversity of needs that people have and how they find meaning and social connection in old ways. But absolutely came through really strongly in the strategy. And that's why it's a big plank there. In terms of the other question that I will just touch on is the kind of overall impact of this, these talk about numbers. Yeah. So I think we are some way from being able, because it's a whole system change thing. It's about every, every way, every, every touch point for people in our communities in the health and care system. And really examining and changing how they operate to better meet equity outcomes. So I think it's increasingly reaching a lot of people. And because for example, every, every commissioner in LBN has equity objectives for the areas in which they commission. How you translate all of that into the kind of cumulative impact. So, so I think what we should be seeing increasingly are better outcomes within individual service areas. And examples where this work is translating into, into, into better outcomes with, with those service areas. I think it's another very complex thing to then consider what the cumulative impact is, given that there's so many different inputs into the population level health inequalities. But I do think we, we need to start getting to that place where at least we're starting to, to track what are the service level benefits in terms of better outcomes for, as this example, the men going through. This kind of experience or what, you know, the, the faith based therapy and what, what the outcomes that was having, for example, in terms of what you'd want to see is people sustaining their, their experience of therapy because they found it more acceptable. They found it something that was more spoke to their experience. And those are the kinds of positive outcomes we would want to see. Yeah. Yeah. And just to support what Jason's saying, I do think that, that we do need to get better at reporting on the outcomes of some of these. Some of these are, um, still, as Jason said, kind of early days. Um, but part of what, um, Addy mentioned in her update is, is about having a gate review process for these projects, which will say, what have you achieved? What outcomes have you got? Um, you know, in terms of. That also being linked to ongoing funding, um, because there is money, um, health equity funding linked to some of these. So that is quite important. And the other point I wanted to make again, which was about, um, your well-made point about tailoring things to communities. Part of that will be helped by our neighbourhood approach. So as we start to embed, you know, build on the neighbourhoods, embed the health equity work in the toolkit into those neighbourhood teams. Um, that should help those in this, in terms of understanding communities, because you're closer to them, um, in those levels. Any other takeaways and then we'll continue with the presentation, is that all right? Yeah. Um, we mentioned aging world, we've talked about, um, uh, natural protein loss, um, so quite a huge amount of brain issues. Um, so quite a huge amount of brain issues. And it's interesting. And it's important that one must, um, um, take advantage of the depth of parenting beliefs and the relevance and the evidence of that it does. I think that one is suffering with them. Did you catch that one earlier? It's about brain injury and, uh, I'm so sorry. I didn't. It was very quiet. Um, it's about the relevance of, um, late adaptive therapy, talking therapies in those with dementia or bright brain injury and traumatic brain injury. And often it's a very, very lonely space in those individuals that suffer with those conditions. Yeah. Yeah. I, so that's beyond my area of specialist expertise. Um, but I think that for anyone who has a cognitive vulnerability, um, and is developing frailty, then things that are familiar and comforting become increasingly important. So I'm not sure that this particular program that else to running would be the right program, but I think that the, the partner program that is still seeking funding around providing, uh, psycho-emotional support within a faith setting would be much more appropriate. Um, but I will talk that thoughts, um, Dr. Mackey and think about how I can connect. I'll feed that back to colleagues running this project. Would you like me to continue with the rest of the, um, the pack? Yeah. Yeah. Yeah. We'll continue to rest. And then, uh, there's another. We've got a few more slides. The health equity toolkit which was launched today is basically. Yeah. Oh my God. Yeah. I feel like I'm moved not to take one. So, um, just, this is a quick overview of the toolkit, um, that, uh, if we can start on the left and in the middle, that we have, uh, uh, we basically, we've, we've shared these tools with you before, but we, these are the tools that we've been developing over the past couple of years in the program. Starting with the route map, um, and then adding in the art framework. And, uh, it's inspired by Julie Powell's pithy phrase, does it look like Newham? But does it look like Newham tool? Um, which has been refined. And, uh, I'll show you another section of that in a moment, but refined to be put in a Power BI dashboard. And able to, uh, tell you to, uh, a place neighborhood locality level. What's your, what your area should look like for something universal or evenly distributed throughout the population. We start with this, which is the program managers reworking of a standard five step framework into four steps. So this is something that can be overlaid over QI processes or something like, uh, uh, appreciative inquiry or, um, other change type frameworks into four simple steps. Also the public health approach is a similar four or five step framework. So you start from the left hand side with understanding where you are and what the issues are. Then you deeper dive into the data to understand the problem much better. Then you're considering the change ideas or looking to see what works. So whether it's an evidence search or it's a co-production process or all of the above, that's step three. And then step four is implementing prototyping or piloting ideas. And at the same time developing your evaluation measures. So that instead of having step five evaluations, we've bundled that into step four to prompt people to think of evaluation at the beginning of implementation so that they can create a baseline. Which isn't something that's necessarily done with a great deal of fidelity at the moment. Uh, this is looking at Dylan in its power BI form that Dylan gives you the opportunity for a, the whole of the borough or a patch of the borough for a given age cohort to find out what's the. What's the, what's the attendance or uptake of your service should look like in two sectors and. And. As much as granular ethnicity as you like. Um, we would ask the system using off the shelf to look for one S 18 plus one. The most granular off the shelf framework, but this can actually go deeper than that. And can tell you at a. At a. At a. At a. Ellis. Ellis away award level. Who you should be seeing. So if for example, you have. A locality with a. A service with a tight locality. Um. Front door. You can map around that and see what your footfall should look like. Uh, this allows us to be able to say around, say for example, a family hub. Or a library. Who we should be seeing. And if anyone is missing. And we use this methodology for the safeguarding adult board. Represent represent represent refer representation project. Where effectively we overlaid a Dillon calculation on the service. The service metrics. So who was being referred to the service. And found substantial cohort for missing. So pretty much all South Asian cohorts. Some black African. And. Uh, some. Eastern European cohorts were underrepresented. Whereas other cohorts. What cohorts were. Overrepresented. And a more detailed analysis then followed to find out that also. There's some biasing around age and sex. Looking at. So that's our toolkits. We put these online. Uh, put them on the well-newham website. So that they can be accessible outside the council architecture. Um, we're still working to make sure that's appropriate. There's interest outside newham as well. So we're looking at how we can, without taking up too much time to support a community practice. Around those framework tools and disseminate the learning more widely. So that people can take advantage of this. The idea is it takes some of the. The heavy lifting and pain out of the beginning of the pandemic. The heavy lifting and pain out of the beginning of an equity project where we found. Using that four step process to benchmark. Quite a lot of people can get stuck at step one. Looking to scope and understand the problem. Being able to use Dylan. Uh, is a really quick way of seeing if you've got an issue. If you've got an ethnicity based. Um, variation or disproportion or under representation. There's an issue. Um, if there's a sex based one. Uh, there's an issue. And thereafter the qualitative piece around the rest of the equality act would be. If there are reports that certain communities don't like using your service or have had a negative experience. There's an issue. So this is a really simple place to start. Uh, but backed by good public health methodology and data analysis. Um, this slide just covers the areas of focus for the next three months before we report to you again. Um, and which is very much supporting those. The three, um, recommendations that are, were signed off and we're taking forward. And continuing the, some priority work. And as well as using the existing, uh, PDP review within the council to support the commissioners around those mandatory objectives. And while we are changing the appraisal process and the focus of that, we're not changing having objectives. So that's still something that will remain within commissioner and public health objectives. Great. We would now. Yeah. Yeah. That's the end of the slide. Pick on that item. I think so. Just on the health equity toolkit. Cause I just introduced and then left you as practitioners today. Um, you, you mentioned if we look at the horizontal bargrass per ward, we can disaggregate that further to the, what's called sub regional, you know, those things that are sub ward level. Um, ISLOs or what they're called. Yeah. Um, we can actually make certain, um, take a random example, class those out. Um, no, but any ward that you can actually, uh, disaggregate black African, black Caribbean. I think it's important that, you know, we've got a bigger of the total population that even that we don't know. There's children, but it would be as accurate as we could make it. And it would show clear differentials in terms of say type two diabetes incidence or, you know, cardiovascular and all that. But also where services weren't reaching those populations. Yeah. Yeah. Yeah. That's the real value. That's the real value. And then does it look like a new tool. It helps the service understand is it reaching those that it should be reaching. And this toolkit is accessed with all the protections that are partners that we invited to this afternoon. Yeah. Sarah, did you? No, no, no, no. I was just looking very intently. Yeah. Any questions on that? That toolkit? No? Okay. So your report back with the good work being done. Um, next time we meet on that one. Yeah. Yeah. We're taking, so the recommendation is to note. Is that okay? We noted that. Next one is eat well. So we're segueing almost seamlessly. I guess it was presented this. I think it's Adiola again. Yes. And of course, before we even start, we did win an award the other day. I can't resist serving 70 for that one. Well, it's on page 43 of the main document. 45. Oh, right. Sorry. That's not this. I'm too. You are a page behind. I'm sorry. I'm next to the next one. I'm just as well. I'm here. You're another person. They're more rich. Adiola please. There's no irony in the idea. So while you're kind of. You're trying to. So this is an overarching snapshot of all of the ambition of all of the potential activity within eat well. Some of this is already happening. Some we are developing. So and eat well is putting together within the 50 steps public health strategy and the public health team focus areas, the food strategy, the health promotion strategy, and with some of that long term condition prevention and management work into one big focus on finding the levers and pulling them around diet related disease to make a difference. But particular reference to where we have system defaults, particularly ones where we're in control. So if we're providing food, making sure that we're providing food that in the long run is not going to lead to disease outcomes. And the underpinning science of this is what we now understand about the causes of type two diabetes, but also the causes of heart disease and some cancers that ultra processed foods and some of the refined carbohydrate in particular. which are unfortunately the most affordable foods are driving quite a high level of the disease burden in that long term condition space. And there are things that we can leave us that we can pull and systems that we can influence. This particular report is without food strategy, food strategy and food security will be reported on next help and well being board. But we are looking at some of the areas in the health promotion and where we've made some progress and we started something so in that peer support conversation. In looking at the referral conversation and in looking at some of the tools and assets around supporting people to to think about eating healthy and making sense of that. And there's also a nice update on the food food food food food and vegetable on prescription where we'll be piloting that supported by our NHS colleagues. So this month and the last this quarter we've launched the first ever Ramadan health champions taking the opportunity of a change in eating with fasting to create 12 community champions to support. And also learn and upskill around how eating differently can impact the way that they fast and recover, but also supporting people who have health conditions to make sense of of that and to fast safely or to to do with Ramadan safely. Sorry, this is not in the pack. So can we be circulated straight after this? I've seen this, but in other contexts. My apologies. I thought this was attached to the previous one that it got attached obviously after after it was sent through to Christine. I do apologise. I thought it had been attached. On the peach sheet. Some of the points on the sheet that there's provided, for instance, working with NHS now, a medicine test and learn for fruit based on prescription vouchers in Green Street, which is there. The nominated 50 of 90 participants for social subscribers, new Ramadan health champions, maintain healthy efforts Ramadan event. But this one that's, I think, quite unique as a partnership. Tower Hamlet, socialising the Birmingham City Council culturally tailored CBD and diabetes perfection. I've had some conversations around this. Can we just expand that one because it's because it says further down that we're engaging in recruiting BCS as well into that model. Yeah. So we we reached out to Birmingham have a food strategy that has some national traction. And as part of that, they have some overlapping demographic similarities with us and Tower Hamlet. As part of that, they've been exploring using the healthy eating plates and creating culturally competent versions of that. We that is something that we have asked our weight management providers to do over the past three years. And they've worked with us on that. Tower Hamlets had also reached out to Birmingham as well and were curious about their assets. So between us, we are looking to test with specific communities and sharing that between us so that we can so that we don't have to duplicate and so that we're making public money go a bit further. So that Tower Hamlets will be testing with Somali communities and Bangladeshi communities. And we'll be testing with Pakistani communities, West African communities and Caribbean communities about if these assets work for them, but also what would be helpful, how they think about food and particularly thinking about those those the relationship with the likes of carbohydrates and fats, where all the flavor and fun is so that we're going to be setting that up over the next few months. We are also looking at the fruit and veg on prescription if I pivot to the next slide so that you can have a look at that. This is to be able to this is a modestly sized pilot we're maximizing it as much as possible, so that we again make the money go further and that we reach and maximize impact as much as we can. But by now, if you've seen the health, the food foundations broken plate reports, or which uses some data that's been some of my favorite science since about 2012. But looking at the cost of healthy food, if you use the healthy eating plate to describe healthy and unhealthy, that fruit and veg, leafy green veg, fish, lean meat, all very healthy and good for us, but they are per calorie more expensive. And that price gap between the affordable food has been increasing year on year since about 2000 and 2005 that according to all healthy guidance, if someone were to eat the recommended diet for health, they'd be spending 70% of their income if they're on lower incomes and the food that's available and freely available throughout most of the borough and most areas where there is deprivation challenges is the food that is health harming. So the ultra processed foods, fast food, and there is some evidence that refined carbohydrate, even staples like rice, bread, pasta, can also be problematic, particularly for people who are at a greater risk of type 2 diabetes and overweight, that those sorts of foods drive overconsumption, they also drive overweight. We know that if people need to make a healthy diet change for their health and well being there are a number of free services out there, again, some of those can be optimized and tailored for our populations. But one of the main barriers that we consistently hear from partners and from the community is that the cost of food is inhibiting them. So by putting in this fruit and veg on prescription, we get to test how acceptable a voucher system is, which is also helpful for our food strategy because it's likely that future food support will come out in voucher form. So to understand how we can make that acceptable is really important to test and learn with this, but we are being able to partner with the social prescribers in the area to recommend and suggest individuals and potentially individuals in multi person households or who will benefit from this to be able to test whether providing this. This support to be able to buy fruit and veg from the local market in this case Green Street and local providers, particularly linking up with shop healthy, which is another initiative that's within this pro this group of programs with the food strategy. To see if they helps them continue to take advantage of those programs and get the benefit of them. I'll send this round so you can look at the detail. But again, here is just the underlying qualitative insights from some of our peer researchers. And also health watch carried out in both in Newham and previously different health watch sorry Julie in Tower Hamlets on looking at the inhibiting effects of the cost of healthy food, but also the push factor of the cost of unhealthy food. It is often the most affordable and the most available so that being able to provide an alternative that is affordable and accessible is really important that we work through how to do that. Thanks very much. We have learned. We have learned. Oh, sorry. There's learning from Tower Hamlets. Yeah, I'll just this last one is the Ramadan Health Champions. I'll just stop there. That's the second time in a day I've heard about food vouchers because the arm that does the food vouchers within the preschool meal contact was on the Newham Homelessness Forum talking about vouchers as a way forward for, you know, people accessing food. But I mean, to a certain extent, I think we as policymakers still need to push central government or whoever to say that vouchers is one way, but really it's about, you know, some bigger issues about the price of food, about the whole thing since Brexit or whatever, even the supermarkets that are there and having fewer supplies of fresh fruit or vegetables anyway. So Mounted is one thing. It's a bit like, you know, sticking glasses to a certain extent in my opinion, but that's just the personal bit. Roxanne, did you want to come in on? Free School Mills is one of the pillars of everything that Adele has spoken about and that's under threat over the last years and that would be disastrous. Anything that we can do to lobby. But there's also, I mean, speaking of somebody who's a teacher then policy person in education, it's very inaccurate. It's one of the four indicators of poverty and we have about three school mills in criteria records. So we're starting a sort of four indicator for what's the other bits that are going on in the system, you know. And we tried to be earlier, Sarah doing the preventing the chicken chop scene. So it was nine in Prince Regent Lane, for instance, you know, and we had pushed back on that. We're 32, aren't there, from Forest Gate Station to St. Angela's. Yeah. Not chicken chop, but fast food places. Yeah. 32. And so we're up against quite a big forces. Just my last point on the health champions, because I think this is important, that we've got at the bottom on the pink sheet, you know, monitoring and evaluation. Well, that can't seem to be worse than that. We've got a lot of people who are volunteers, but throughout the 50 steps we have said about impact and, you know, how we're going to evaluate. It's hard because it's a bit like, you know, I'm a school governor, so is Sarah over here, how do you evaluate the work of a voluntary group? But if we still aren't then called to account because we're the use of public money or whether we want to make even better health outcomes. So I think that should not be lost in a sort of, you know, we're doing some things, but we should evaluate. Sorry, Sarah. I think you, Chair, just picking up on Wax's point about preschool meals. So we have our eat for free, but then the mayor of London has sort of, well, not enhanced it, it still costs off money, but he has replaced that. What we have seen in the last year is more people actually signing up for the actual preschool meals. So people premium, and we've had a real push with schools to do that, because actually we recognise that eat for free and preschool meals is not forever. So the more we can get onto preschool meals, the better. But our campaign really should be around secondary education, because kids don't stop being hungry. We will eat, in actual fact, eat more unhealthy at the age of 11. But I think that's, it's more difficult to do on the basis that they may be canteen-based. But we really should be pushing for some form of reduction for secondary school meals. There's that frightening statistic that the real disposable income, you know, people will be spending, you know, just 70% of what's left just to try and make certain around five a day. Yeah. We're just in a frightening way. So the biggest issue we have with secondary schools is, of course, their parents, their parents give them three quid or whatever it is for school lunch, and it's cheaper to get chicken and chips for £1.99. And so there's, they pay £1.99 for that, and I don't know what they spend the pound on, but you know what I mean, it's, that's what we have to stop. It's those outrageous fast food places that just, I mean, you see it all the time at school time. At the end of school, they're viewed on the pavement into them. I think there was some movement there in terms of planning legislation that we were trying to make certain that there was, you know, it wasn't just a straight change of use thing, you know, but that's on clutching a straw. Well, I think we'd like that, but other boroughs seem to be able to do it like ground betting shops, but we don't fear to do it. I don't think, I think we use all of the, all of the tools that we can. We do. Yeah. I don't think there are tools that we, that we aren't using. I think the problem is that, it's a change of use, isn't it? Yeah. Is that, is that it all happened historically, and we have what we have. Yeah. Sorry, Mum, Ted, you wouldn't come in. I was just going to, you know, point that you've made about, sort of, you know, the food being spent on the past, but then, once you take that away, what, what is available? No, no. You know, it's, you know, the other side to it. At the moment, they've got something to eat. Yeah. We've got to find alternatives. Yeah. Yeah. And we did have that project, didn't we, in Boris Gate, where we were, had healthy chicken or something. Yeah, that's the kind of project we need to encourage. Yeah, yeah. Um, but those days of funding are gone, I think. Anything else on the Eatwell program? Again, this will be coming back to us. And it's obviously a diet-related disease, particularly that 70% of our adults on that, is it, you call it the basal metabolic inhibitor. Yeah. Um, when it's adjusted for ethnicity or overweight, which. Right. There it is. Body mass index. Body mass index. Yeah. Body mass index. Okay. The next one. Is this your idea? Oh, sorry. What do we do with this one? We've got to note it, is it? It's a note. It's a note. Okay. And is there a third one? A million healthy parts. Yep. Oh, a million healthy parts. And this is in the supplementary. We've got all of this, I think. Yeah. Okay. Thank you colleagues for your patience. And you're letting me do these first. So this is for information. Let me get the pack up. So Jason and I are part of a, an ambitious Pan London initiative to improve outcomes around heart disease, which have, sorry, I need to find the. Make this go as a great. So citywide, do it once for London, improving heart disease. So this is the, this is just to let you know that the, the, this is happening and it will be influencing some of our priorities, but also there's a strong push for this across North East London. There are a number of us involved with the program within the system. But it is happening across the whole of the borough. So there's the whole of the city. So that there is a way of aligning some thinking, aligning some practice. We're sharing some of our good practice. Other people are sharing their good practice with us. It's the leading cause of early death and early loss of vitality and frailty. Reduced quality of life. It's preventable. Much of it's preventable. There is significant potential to save lives. And so this is a five year program that's looking to improve awareness, engagement and outcomes. There are. Looking about bridging the gaps in health and equity across the city. There are, as you would imagine, colleagues, a significant number of inequalities all falling in fairly predictable places. We're looking to an extent to prompt, to quite a large extent, to prompt a social movement around health, but to, and to be effective in bringing with it the things that need to be part of the, part of the conversation and part of the activity. We are evidence based, as you would expect, coming from public health England with Professor Kevin Fenton. And that we also want to build on what we know works. And we're also keen to include diverse stakeholders from businesses, academics, the NHS in all of its layers, local governments, and of course communities. This is just the graph showing that the increase in improvements in the directly standardized mortality in people in London under 75. So this is what's considered to be avoidable deaths, deaths under 75. And that year on year improvement, which started to plateau a little bit round about 2016, 17, and in the post pandemic years has started to reverse. It was expected that after the pandemic services would recover, but they haven't this around heart disease. It had the recovery hasn't and the downward trend, or at least the stabilization and improvement hasn't recovered post pandemic. I thought that colleagues you'd like to see what the data is for Newham side lifted this from the our excellent JSNA. And then you can see Newham on the left of the pale bar that our avoidable premature mortality is higher than both London and the national figure significantly higher. So again, that is also likely to be impacted by the previous item. We're talking about diet related disease and the demographics of our borough. That's the impact of our populations, our global majority of populations at the risk of having higher, the negative impacts or the risk impacts of overweight and diet related disease at lower level, lower risk thresholds. And those risks are translated into heart disease and type 2 diabetes, type 2 diabetes itself is a risk factor for heart disease. Different populations, their risk, different inflections of that risk, but put together that Newham has a lot to gain from this program. This is another of the charts from the million healthy hearts and minds pack during a circulatory disease. Both men and women have contributed to a major driver in the gap in life, the gap in improvements in life expectancy. The initial focus is high blood pressure or hypertension to the to the medical background. And one of the reasons for that is it's it's both a risk factor and a risk and a condition in itself. It drives a lot of blood pressure issues. It's also associated with type 2 diabetes. We can also we notice that when people go into remission from the from that type 2 diabetes, they stop needing their diabetes medications. They stop needing their high blood pressure medications, the indicators around blood sugar go back to normal, that indicators around blood pressure go back to normal. And it's the reason why we've been hearing both diabetes work prevention work and detection work and heart disease blood pressure protection and different identification and prevention work together for a couple of years now in Newham. And it's the reason why we're trying to identify controlling controlling controlling blood pressure improves your risks, improves the risk that you'll have a heart that you will avoid having a heart attack, or at least pitches into the future. And it's something that is fairly easy to measure. There are numbers of free opportunities and there are the NHS health check program and I knew him to do anything does very well in this program. We form highly, but there's always more to be done, but the there are substantial number of people that don't. connect with the health check program because it doesn't speak to them, or because they haven't fully realized that there may be benefits from them, or that there are still elements where it is inaccessible. So we're looking to scale and democratize where access to advice, information, awareness, and also testing. It also coincides, sorry, aligns with the national objectives for NHS England. Sorry, that's just the national objective slide. that the program leads Professor Kevin Fenton, Julie Billet, and others have ensured that this is an NHS London priority. And obviously there is some concern that the noise and changes at the top of the NHS may impact this. It's impacting mood more than forward momentum, I would have to say. But it is a priority. It's also an ICB priority and there are a number of strategic drivers and links, particularly with an inequalities angle. This is, I customised this slide a little bit, and I can add to it a bit more. I apologise that the text on the left is tiny, but these are the list of conditions with high blood pressure on the top, then dietary risks, then high low density lipoprotein, so bad cholesterol, various plasma glucose, then various other bits and pieces, including tobacco and alcohol. So this is the contribution from the global burden of disease, showing the risk factor for and illness from heart heart disease, circulatory disease related illness, the highest risk factor is high blood pressure. But there are other components in there, including diet, and I coded this looking to simplify as much as possible for when we learn medicine in community. We're exploring, taking this three element approach that pretty much all of heart disease, type 2 diabetes, kidney disease, and a big chunk of cancers are caused by, and apologies for D2M and CBD in note form, by what we eat, the yellow boxes, how much we move and how we manage stress, what we manage stress, which is where things like alcohol, tobacco, being sedentary, but also eating disadvantageously come in, being able to support people to think about where they may be able to address any of those, want to make a change, particularly around stress, where some of the other issues may be stigmatised or feel too hard to do, but looking at how people think about stress in their lives, and what they may be able to do around that, all of these are ways in to have a conversation to think about supporting people to make changes, hopefully proactively, but also in response to finding that they have high blood pressure, or they are in fact developing a cardiac condition. Like, so this is the program objectives to raise awareness and engagement on prevention, both use data and evidence to target interventions to support and amplify existing efforts in CBD prevention. And this is not just with the public, this is across the system, I'll show you the work streams in a moment, but there is a need for health and care system to improve its performance around heart disease and blood pressure management and control, and being able to engage that diverse coalition of partners, including community voices, to be able to co-produce and deliver solutions to make improvements across the whole landscape of high blood pressure and heart disease identification and management, and to identify a sustainable funding model, which in the current climate is probably one of the more challenging elements. These are the areas of prevention and focus for the program, and in the centre, as you can see, community engagement and mobilisation, and I'm really pleased that I'm the co-chair of the work stream around community with Serena Simon from Westminster City Council. And we have, as our first set of deliverables, a really wonderful advisory group of partners, both within the system and within the community, who are committed, active, knowledgeable, and really, really keen to drive this forward as a priority. This is the diagram of the governance. Yeah. I reckon the previous slide is probably enough for now, because we're going to come back to this as it develops. Yeah. That's absolutely fine. Yeah. Yeah. There's a lot there at all. There's a lot there, yeah. I mean, I went to something at London Health Board Chairs when Kevin Penton presented this, but I mean, there's three things. One is on the Million Hearts and Minds Programme. Get the focus on high blood pressure and the risk factors in the global world. But the important one, I think is often forgotten, but we've already done some of it, is when we engage with employers. So, you know, blood pressure testing in businesses in Westfield is also useful, particularly in regards to men who may not present very early with high blood pressure or anything like that. And I think that's an important one. But also, where it says, engage a diverse coalition of partners with the voluntary community organisations, because people may just have, I don't know, a walking group, for instance. Yeah. You know, which I personally think is more of a prevention space, but we don't particularly advertise them. And it's good for social isolation. It's also good for getting people talking. Yeah. And then just checking in. Well, the workplace kind of situation is an interesting one. It's about understanding the data as well. Because everybody works it and doesn't know. Yeah. But at the time of the day, we're looking at the new investments. Yeah. And then, so that is our bank. But we absolutely need more of a drive. And sitting happily did this a few years ago, whether it was done, et cetera, and stuff like that. But it's absolutely needs to be built into our whole kind of situation. And that's when we're just given. Getting us really, really need to be, because that's, yeah. So, that's what I'm doing. I'm just interested. I can't see any reference to secondary care anywhere in this document. And Barts Health obviously has St Barts and there's a new service. So, it's just where and where is the secondary care disease brought into this? Yes. May I respond to that? So, there is a slide showing the different work streams. There's one on system delivery. And Barts Health are very much in that. The Elopa part of the programme. London Sport are part of the programme. There's a very wide steering group for the whole programme. And Elopa very much in there. Barts is front and centre. Looking to see if we can learn and disseminate a lot of what they do in other areas. But obviously, Barts is holding the contract on effectively heart health for London. They are the London Heart Centre. So, a centre of excellence. So, Barts are definitely there. The leads of that programme are sitting in the North East London ICV as well. As well as the renal network for London, which is more of a South West based initiative. So, yeah. Barts is a secondary care is there. I mean, I guess I would say that the role of Barts in the context of this campaign would be less about their, you know, tertiary heart expertise and more about their role in secondary prevention. And actually that, you know, that they have, you know, along with all other parts of the system, they want to prevent. People needing their tertiary cardiac expertise rather than their, yeah. But I think that, you know, I think that's something that we should feed back into the programme about what the role of secondary care is in terms of secondary prevention in this programme. Because you see, you see an awful lot of people come to your tours every day who would benefit from preventative activity. Yeah. I think it links them to the mate. Yeah, absolutely. Exactly. So, yeah. It just feels like it's a slight missing piece, even though, except it might be hidden in the undergrowth slightly on it. Yeah. What I was going to ask Wax is we do really well on our health checks in terms of the numbers who are reached. I just wonder your perspective on how effectively we use the health checks to get people to, how effectively they inform people's behaviour change and support around the support that people need to change their diet, their physical activity or, you know, whatever. All of those, you know, pharmaceutical interventions on the back of the health check. Are we getting the, are we getting all of the benefit of our good numbers going through the health checks that we should do? Or is there more we need to think about how we maximise that as an opportunity? And part two, absolutely needs to be addressed. So, we talked about secondary prevention. Yeah. Primary prevention is a massive thing. So, anybody who pitches up to the hospital or chest pain, etc. It doesn't have to be. Primary prevention, it could just end up becoming primary prevention as well. But that's something we absolutely need to do. Feels like a good opportunity. We are seeing quite bold. It's just how we maximise on that, that encounter. Yeah. You've only got a look, haven't you, at those, those days that, that day when I was going to school, for example. The number of people, A, who had their vaccines, but also who had their health checks. I mean, you know, and we, we do those events really well. And people actually, they don't just go for that. But actually, the majority of people who attend those events actually have, have their blood pressure. That reason was overwhelmed. I know. Yeah. People, you know, and it's our lesson from COVID is we need to get to the places where people want to go. Yeah. I mean, that's why I said that all the time. Yeah, I know. Yeah. But it's, you know, there's some really good work in the mosque with virus, you know, about council police are involved in. Yeah. It's very good work. It's about when people then have that blood pressure, you know, how do we sort of make certain there's a comfortable journey. Don't be comfortable because it's, it's, it's never going to be easy telling people they need to do certain things. Like lifestyle changes, or exercise, or weight, losing things, or to be on status, you know. Yeah. And sometimes the, the idea is somehow to get across many, I like this one, reading it this far, but the roadmap is about the campaign. And I think it's about all of us trying to get to this, you know, a social movement, a wider campaign, a steady state. So it's not seen as a great traumatising experience. You know, what's on going to, what's going to happen and what I do. Yeah, yeah, exactly. You know, there's, there, there's, there's, there's. Because I seem to advise people there. There's absolutely scope for doing more of that part too. Mm. Yeah. The kind of situation reactions around that, and developing that. But also, making more use of the neighbourhood, and the tent neighbourhood to make sure that we have a ubiquitous kind of situation. Well, that's the best taking action to look at that part two of the health show. Great, everybody. Thank you very much. Thanks colleagues. Thank you. I'll look up about those other things. Snowball instead. Do you want these snowballs? Are you looking for any fish? Oh, they're not allowed to say that. No. Let's take the difference. We can all have a haircut. In England. In England. In England. I'm not sure. Shall we carry on? How do you think? A coconut snowball. Not a choconuts. There's too much hilarity with this, don't we? So, where are we? We're back to the now ICS strategic approaches, I think. Which is great, because people have been talking about neighbourhoods all through the other audience. What you've got is a summary of the neighbourhood programme that is being delivered through the Health of the Health of the Partnership. We have a senior operational neighbourhood group that's co-chaired by Simon Reid from LBN and Jennifer Walker, who works in Newham Hospital. There are three pilots currently, looking at slightly different models so we can do a sort of test and learn approach for how it works, how it can work best. I'm not going to go into massive detail because we've got all the detail there. So it's really just for noting that we're doing this work. We've done some resident engagement, but we are working on how we have some other places have models where they have sort of resident reference groups, but we don't necessarily want to duplicate what we already have. So it's about how we best link in our residents and we're having those conversations in various places and with different groups. There were some recent guidance that came out around babies, children and young people around an MDT approach. And I understand that's on the agenda for the next giant planning group, or if it's not, it will be. So that will be brought in as well. But generally, I think it's also important to say that people will have heard about, obviously, the announcements around integrated care boards and future funding. As it stands, nothing is coming out that evicts the direction of travel that the authorities have set into neighbourhoods and the role that I've been telling, approaching partners deliver those. I'm happy to take any questions, but... And I think it's fair to say that in the discussions I've had, that it's not the implications of the neighbourhood model, it's that we've moved a long way to try to synthesise the geography to make it more reflective of not just where DPs have decided to coalesce, as it were, it's more enabled based. But just on the, if I may, just one of the three examples that we're going to be taking as a sort of piloting. The North-West looking at risk satisfaction for active care approaches to Stratford Forest Gate. High intensity users, what do we mean by that? People keep referring themselves to A&E. So those are the most frequent attendees? Yeah, and half of the population equivalent of Newham is going into A&E on an annual basis, correct? And it was only designed for about 50,000 at most. Yeah, we'll get 450, 500,000 at most. Oh yeah, there is a real impact. Yeah, half of the population equivalent of Newham goes to A&E. So they go there and sort of going to their GP. Is that not true, right? Yeah, part of that, but also accessibility. It's right on the A13. Absolutely. Easy to get to, bus routes, etc. Click up. If you've got to wait six or seven hours in A&E, that's often quicker than a TV wait and a GP appointment. In some practices. In some practices, yeah. But I mean, that is the reality, isn't it? And also, I was talking to somebody, an Eastern European woman, and their behaviour is hospital. Not, we want to turn out great, it's all great. So, you know, but I think it's really quite scary the number of people who go in the hospital on a daily basis. I mean, that's just unsustainable. Exactly. Yeah. Has it been sustainable? We are sustaining it. Yeah. And at the moment, we will continue to, and probably the number will continue to. Yeah. We're not going to get a new one, are we? Yeah. If I may, sorry on that point. So, obviously, there has been deep dive, diagnostic, you know what the drivers are. And given the fact that we're in a financially constrained national government, or national situation, we're not going to get a money from the hospital or an expansion. So, how do you reduce the… So, that's what this… That's exactly what that point is about looking at. How much will it be? Well, how much will it be? Well, I mean, it would need to be significantly scaled to have an appreciate there are. But we're at the stage of piloting, quite a small scale right now. So, just in terms of the modelling, what have we undertaken on different scales of the proposed system model, what will that then be to international? That's the PA report. That's the PA report. That's the PA report. That's the PA report. So, the PA report is, it's predicated not just on, it's on, predicated on greater investment prevention, and in the benefits of this kind of neighbourhood. And the number of other impacts. And quite a lot. And if we did all of those things, then it would have a significant impact on… Yeah, it would reduce the rate of growth. Yeah. It would actually reduce the numbers coming to the hospital. Yeah. Yeah. And that's, that's what we, the best we can hope for. It's a bit like, if you're in Barbs Health, you have a hospital called the London Hospital, which is dealing with, you know, sort of a convenience of St. Elizabeth Lyons, you know, there is, people are travelling, because they've got hospital choice, they're going to the London Hospital, because there is, you know, quite clearly, rather than other parts of London. I think it's probably worth saying that, excepting the constraints, that they exist financially, we are clear as a hospital, that we need to expand the footprint of the hospital, expand the DD, potentially have wards, have diagnostic services into the footprint. And I think that's accepted also by Barbs Health. It's got to be, because the population is increasing, and aging, you cannot, there's not a miracle cure. And it's not just us. You know, you are barking and bagging, most of the growth is on the west of the borough. A lot of that population would look to, you have to know, a local hospital. Barking Riverside. So you can't answer, there are 50,000 people into a total catchment area. Absolutely. And you won't need additional... But then we've also, you know, our neighbouring hospital rips, is also suffering in numbers. Yeah, and they are now being put back until... Exactly. You may even know, you know, the Minister for Health is, you know... But, having said, you know, that's why I think this work is, and the prevention work is so important, because anything of meaning that would happen on a hospital site is many, many years away. Absolutely. So, you know... So that is, that's the risk stratification and proactive care approach. That's the first pilot in a north-west of the borough. The second one, focusing on type 2 diabetes, and where there is... You know, you couldn't do this on mapping, can't we? There's a very high concentration type 2 diabetes incidence. The green treatment of Parkinson's, you know, goes anywhere. Three elements. And I looked at the prevention again. Newly diagnosed and strategic estate opportunities. Now, I'm sorry, I've been a piece of slightly controversial. Do we mean by estates there, the actual buildings? Do we mean NHS estates? Or shared estates, yeah. Because, you know, I think sometimes, and Thomas has heard me at this conversation, and then Jason there, so, you know, in regard to hospital sites, NHS estates is not always the most flexible body to do with. And I think, you know, without committing, you know, by council colleagues, sometimes, you know, we have use of buildings and community space, which I think we've touched on, Jason, haven't we, in terms of, you know, how co-location of services, not just in our libraries or whatever, but also other places, might, just like we can't wait for the hospital building program or the states management there, that we use some of our existing. Well, I think there's huge potential benefits, for example, if you think about the libraries, which we know are, you know, there's challenges around funding model for the libraries. Actually, our libraries would be a brilliant place for co-locating different kinds of services. There's really good health services that would go really well in those libraries that link people in with social prescribing and people in with, you know, digital inclusion, benefits advice, and could bring NHS income in to help meet the financial challenge of the libraries. There's a kind of, there's a win-win for everyone from getting some of this work. Especially around benefits advice. Yeah, yeah, loads of things. Yeah, so I think there's some real opportunities to think about how we can bring the NHS into that library's estate. So, Simon Reid, well, he's the chair. Oh, so if I wanted to talk to him about Pilot 3, I could talk to him. Well, I was going to include... I'm here. Well, I'm sure you were. There he is! It's not like magic! Did you phone him up before? It's not like magic, I was like, I heard you wanted to speak to me. So I dropped everything. You know what? I just rubbed my phone and there... It would be less... No, it was... I was going to take it outside of this thing too. Yes. So you did. Because... About... Custom House and Hawthorneville Quarter and stuff. I just would be... Yeah, of course. My question was, I'm sure that, you know, because we haven't got Carl here from the team, but the song... And there's a joke in there for those who know about the song. What is the song of reviewing learning? The song? Is that what Simon's been called on to explain? Yes, well... So the song stands for... It's in the opening paragraph. Sorry. Sorry. I didn't repeat it. So that's... Or the Senior Operational Neighbours Groups. Right. Sorry. Sorry. Sorry. Are we still on agenda item 4? Yeah. Yeah. Okay. Fine. So, are you able to ask, what was the determination as it relates to the three primers, and what they were focused on? So we're using... It's all data led. Okay. So it's being led... So each of the localities, so there are four localities across Newham, covering the eight neighbourhoods, they each have a data pack. Some of the localities, there are four localities across Newham, covering the eight neighbourhoods. They each have a data pack, some are still being developed, but... And it was also about a coalition of the willing, so it's important that you start in places where people are keen, where private care are keen, where everyone's keen, but they are all... Yeah, they're very much data led in terms of what they're... Which is why, for example, the North East is... Yeah. Yeah. So, so that would be the North East, cover two neighbourhoods... Yep, Green Street, Mount Park. Green Street, Mount Park. No, that's pilot two. Sorry, pilot one, yeah, it's Scratford and Forest Gate. Wait, that's the... Oh, we've spoken behind it. Yes, that's the A&E one. Yeah. Yeah, that's the A&E one. North East diabetes, and South West, I would say... No, because it's... That's about... That's about... That's about... Yeah. Yeah, that's the A&E one. Yeah. I would say... No, because it's... That's about... That's a failing... That's a kind of opportunity that we need... We need to capitalise on now. But each of the areas will have a locality leadership team, will have data that will drive. So it's not to say they will only focus on diabetes. It will eventually be data-led. And they'll all, for example, start looking at high intensity users. So we've got to roll it out in a... I did that before in Manor Park around heart disease. Yeah. Yeah. And my only contribution before I bring some... Not on either or, it's a both and, if that makes sense. So they will all eventually look at all of the different things, because they'll have a team to deliver that. Stage pilot three, correct me if I'm wrong, Simon and Jo, is around the work as the health hub is delivered. So, you know, we're... It's from the start having a health hub that has a sort of multi-agency approach, multi-team approach. Correct me if I'm wrong, Jo and Simon. Yes. That's what we're trying to achieve. That is what we're trying to achieve. Yeah. I think this was particularly related to a building space around, yeah. Yeah. Simon, as you've dropped into the meeting, as if by magic, do you want to add anything at this point? I should note that I'm here for the Better Care Fund. Yes. But what I would say is the work speaks to the conversation you were having previously about how do you make sure that when you found people through health checks, you're doing something about it. And what you're really kind of saying is in the North East, you have a particular population, you have particular needs. Are we convinced as a system that we've optimised our response? How do you work that out? Well, you talk to residents. You figure out what would motivate them, what would help them. How do you develop that relationship with primary care and the whole system to coordinate that response better? It speaks to the performance. It speaks to quality. It speaks to developing new things that align to what residents want to do. And that's the philosophy behind all of the neighbourhood work, trying to optimise something within local communities, rather than just seeing everything as a one-size-fits-all. So, if I may, sorry, just in terms of asset optimisation, you were just reflecting on what was previously around the scale or movement going into A&E in the first instance. I'm assuming that these neighbourhood-based pilots don't ignore the existing asset that residents have become habitually used to in terms of access and how do we equally improve those? because if there are issues of health inequity and health deprivation, one causal issue could be the inhospitability of those places of provision for whatever reason. And I know that in the context of our multi-ethnic, multi-religious community context, inhospitability is a real thing because they may seem or have a lived experience of pretty much a hostile environment, because of language barriers, medical professions can't be arsed, etc. etc. So, these new pilot hubs are going to be a replacement. But it's not about buildings. It's about multi-disciplinary working, accessing our communities, using existing community assets. So, for example, we're having conversations across the voluntary community faith sector. You know, I went to one kind of event and sat on the panel, you know, so it's not, this isn't about buildings. Pilot 3 was about a particular opportunity in a building, but this is much more about people, ways of working, being in our communities, social care, knowing who the GP is, vice versa, you know, it's about building that in a neighbourhood geography. So, if that's the case, that's really hard to be concerned about the pilot three. I mean, having been there on Monday, I can't see where you can get access to this type of provision in a space that's been promoted as a sanctuary for vulnerable residents who have been sold this idea that they're going to have this unique, beautiful, enhanced care-supported space, which is an oasis for them, and then all of a sudden they'll have loads of other people come in. I know, the new health centre is not just somewhere else. It's not just like that. No, no, it's also not just about health buildings. So, for example, this afternoon I was at the West Ham Foundation, the new Becton Community Hub. You know, they've got a fantastic space there that we started talking about, well, what could we do in the neighbourhood model to make use of that, you know. So, it is very much about, not about buildings. Okay, so, getting all of that. So, in the context of the pilots, as they've commenced, what has the North West geography mapped in terms of the different entry points that residents can access? So, who have you mobilised as part of the Commission are willing to be providing that offer? And what does that require in terms of resource injection to bring, not necessarily the professional practitioners more into these spaces, if that's not the primary intention, if I've understood you correctly, it's about enhancing the literacy around health practice amongst the voluntary community faith sector actors. So, what's the resource requirement and where is it coming from? So, there is, unfortunately, it's been postponed due to just making it, because we needed some more data, so, but we are on the 7th of May. Yeah. That's Tuesday. There's going to be the first meeting of what is being called the Locality Leadership Team, which also includes wider stakeholders. And it's really important that we don't build this model, that the neighbourhoods and the people working in that space and the communities living in that space build the model. So, I can't fully answer that question, because that is how we do. And how long will it take to...? Oh, there's the piece of string. Yeah. Yeah. Because in places where they have lots of resource, it could take years, let's be honest. But, so, we have a plan. We're moving pretty quickly, I'd say, Simon, and you, I think, now we're mobilising. Yeah. Absolutely. I would say that, like, with some of these things, it will have a longer lead in time. The North East one on diabetes is the furthest progressed. There are various workshops taking place with residents, with stakeholders. There will be changes to the pathway within three months. And then some of the things will kind of build later. We've also, don't forget, done lots of work ahead of neighbourhoods. So, all of the nutrition kitchen work, a lot of the work, kind of GLL and other providers on leisure. This is all about maximising local assets. So, if you're in the North East, you know your community centre, your youth centre, your library. We want to maximise those assets and we want to find out things that they are motivated to do. That's all taking place now. We will be changing our pathway in a test and learn kind of way over the next few months. North East, a little bit further behind. Capital and estate stuff, that has a much longer lead in time. Yeah. Thank you. Now, I've got Montez and then Jason. Is that all right? And then we'll conclude this item. Is that all right? Montez? Sorry, did I miss that? Is this being tried, this model has been tried elsewhere? Absolutely. Yeah. This is the national model. There has also been work across North East London. So, a paper went, which I can circulate, a paper went to the Integrated Care Board, the NEL one, North East London one, around, you know, to have a bit of consistency across North East London. We had a presentation just last week from Cambridge and Peterborough. You know, this is, yeah, this is the guidance. And it's what's in the 10-year plan as well, in terms of direction. Yes. I was just going to say what Simon began to touch on, which is, although it's taken a long time in many places, we've got some incredible assets here that most places don't have. We've got our community neighbourhoods model really networked with our local voluntary community sectors in place. We've got Well Newham, Joyat. We've really got these active GPs using. referral into, social prescribing. So, there's a lot of things, and all the things that Simon said as well. So, if we've got a lot of the infrastructure in place already, it's about joining it all together and about linking the multidisciplinary working with all of that rich community offer. That's where there's some real opportunity. And this will be, obviously, a standing item to this board throughout. And I think we need to, you know, have this accountability here. Because the recommendation is the Health and Wellbeing Board are asked to know the progress we've made in testing. Well, we've got three sort of different scale projects here, but it's about how we're progressing into neighbourhood working. Because, if I'm wearing my ICP hat, I mean, the Voluntary Community Faith Sector have been, and it's nodding, I hope I'm correct on this one, they've got a survey on about the engagement across the whole of the Nell Burrows, and that was brought up at the New Homeless Forum earlier on today, to get partners from the Voluntary Community Faith Sector involved. Note the ongoing rest, the continuing rest, around dedicated resources to manage programmes, capacity-related systems, and what we're going to engage with the Voluntary Community Faith Sector. There's a role for all of us, but that's the part of that interest. But it is about how do we make certain that we have some demonstrable sort of good practice, not just from the good pilots, and they've got an LGA thing I heard about the Cambridge and Peterborough models. It's about how do we, even within North-East London, make certain there is a more redistributive model. In other words, we don't almost have to have the Tower Hamlets in some powattas where they've got more money per head, as it were. You know where I'm going. And I think it's important that we keep stressing that as well in our discussions. Is that okay, everybody? Yeah? Anything else? No? So we're noting notes, and you'll come back. Thanks very much. Thanks very much for the hard work, both of you and Doug, all the partners. Now, where are we on the agenda? Sorry, if I may have just got more time to comment on these integrated neighbourhood food process. Just noting on the, it's the mental need put on guard. Sorry, I don't understand what that means. Is that five years or six years? Just, just bear with me. Right, we're in a really pressurised, amplifying spring era for the council, as it relates to transformation and saving money. And I appreciate how long this is spring. But, what I'm not understanding is in an organisation that we have pushed for six years, to manage and document the range and scale of our voluntary community-based sector network across the borough, and that data exists across different service areas. What is going to take so long to pull that all together and solve a proposition in relation to that? I'm going to finish it. Right. And, if that hasn't been done, or if that's been repeated, why can't it be done quicker? Because we've got to start demonstrating resource savings and transformation and a shift in the health equity requirements of our population, because we've got a national government landscape with this early intervention and prevention. We're hearing about the pressures on A&E. I mean, this is supposed to be a solution, one of amongst the number, and this feels just really slow and clunky. And I'm not saying that that's because officers' colleagues have been slow and clunky, but it feels slow and clunky. I don't think the slow bit is the voluntary sector bit of it, the mapping one. We've got that, we've got that. Yeah, we've got all that. Yeah, I think it's getting health and care to work in a different way. Yeah, and I think it's different parts of it that are slower, and so, because actually we're moving pretty quickly on some of this. As Simon said, the diabetes one is ahead, the high intensity users, we've got the first locality meeting on the 7th of May. So, but then if you imagine that then you've got to roll that out across a number of neighbourhoods, you've got to work with primary care to get them on board. So we're not talking five or six years. We haven't got time to talk five or six years. We're talking one or two, but we're also talking one or two for the whole model. So parts of it will happen before. So I think it's, I think it's just how it's, because it's such a complicated thing, it's difficult to see the totality of it. But I think maybe the Nell paperwork might help some of that, because it's got a bit more of the overarching. I think it would be worth just saying, there is uncertainty right now, given the announcements around the NHS of the last week, and that's still to be released, and that will have, I think we'll get more clarity around guidance. Because it also involves changing how themes work, which then, so it's like a dual rule kind of running as well. So they're the complexities, but we don't want it to take five or six years. We want it to take one, two, three, maximum. And that's why I think we need regular updates on this, because, you know, by that time, we would make, again, hopefully we'll get some more clarity around the future direction of the ICP landscape. But it shouldn't, all of that should not be stopping these pilots and more of a rod now, for the very reasons. It's not stopping it. It would be really clear that it is not that whatever happens with the ICP, it would be really clear that this is not stopping what we're doing. This will continue it. What would be really useful, the reference of that paper that suggested we'll hold? Yeah, anyone? No, the Nell. Is there a visualisation in terms of how it will...? Yeah, I mean, I'm absolutely in a big fear, and I can escape from different parts of the system, but the real challenge we have in North East London is the sheer immense pressure that wouldn't work by the end of the day. Yeah, yeah. Integrated neighbourhood working is the good models of care, bringing people together to make that journey seamless for a patient, and we really struggle to do that because we just don't have the capacity to be able to come together to be able to have a conversation about that. Nor the resource, nor the people power, sorry. And, you know, in five years, ten years, we've been trying this for two or three years, and my challenge back to anybody involved is, I think, the first thing we need to be able to work together, we need to somehow learn how to work together and find the capacity to be able to do that. If we're seeing 500, 600 people a day near my A&E, near my A&E, they will not be able to come to have a conversation with primary care who are dealing with patients who they should be seeing the next day rather than two weeks down the line, or sickness or whatever else it is, and we really are on the back foot here. How we get onto the front foot is a $6 million question. I haven't been able to answer that. All of this stuff is pumped around you in some way, shape or form, and to do this on thin air is extremely difficult. And if I can just come in just before I bring rocks on, is that, you know, I go to a practice where there's a practice nurse, there's people, you know, located there doing stuff within the medical arena, you know, to take pressure off GP, for a certain extent. But then we've got a complicated landscape where, you know, testing has to be taken off by omelands or something, you know. And that seems to be getting worse, you know, they're sort of like, so the GP can't do this, so this has to go there, and then you're waiting for results, and that's the cardiologist thing, by the way. You know, BP testing 24 hours and ECG testing. And I just think the landscape is not held by so many different moving parts from our residents, who we ultimately deserve it. No doubt, it's multifactorial. We can pick on anything. No, that's just an example. It's a good example. And, you know, there's many others. My clear point is, the perspective is that, yeah, it's a great solution. There's just no capacity, and, you know, the announcements around 50% of this, and 75% of this, and scrapping that completely is unhelpful. And, yeah, it might work in the Shire, it might work in Fireplay or wherever in a different country. It's not going to work in, that doesn't even know its population, really. It's 350 in this pack, but actually, GP registered is well over 400 in this pack. That's why the Jets are not here, the whole thing. So we very quickly need to get up and, I think, try and find the capacity to be able to do that. There has to be some kind of double running. We can't just be fighting fires all the time. There has to be some... Each partner involved needs to pull aside some capacity to be able to move this forward. Otherwise, it's not going to happen. Thank you. It may look very well, my name. So, is it being done well anywhere in London, or by identity of an environment that needs or Manchester or Birmingham? Yes. And if it's a case of twin tracking and major determination and seeing the amount of twin level that actually something's got to give, and in this instance of how what this is, only the need to be altered an hour each week from this person you are being allocated. Sorry, I'm now a lead date safe, but I'm just trying to understand how we... We're all right. It's that... Simple is good. There's very near examples. So, there's a lovely social media post by Lord and Wally about the networking that's happening in one of the happening... Yeah, there's a handy one. ...situations, which is, you know, integrating their team. Yeah. And so there is lots of good local examples that can be done, but it's just about different parts of the system running. But it's also about... It's also about... For every one of you, we have many who wouldn't even think about finding any time. Yeah, so I think... Do you know what I mean? It's like... So, yes, it's happening everywhere. Yes, it's happening... Some places are ahead of others due to various, you know, programmes that have existed in the past, because this has often been the direction of travel, but under different names. Yes, we have dedicated resource to do it. We probably don't have as much as we would want, but that's the reality of the world we're in. We've got a lot of information which shows what it looks like, which shows... So I'm happy to share that. And if it would help, I'm happy to... You know, I'm sure we can talk to you in more detail about actually what it looks like, and show you some examples for other places. I think, fortunately, you've got a commitment of all parlours, and this is really important. There isn't a single partner who is working against this, because they don't genuinely believe in it. Yeah. We believe in it as a hospital. We put it as one of the major pillars of what we think is our emerging strategy to develop and know what it is. So, I think everyone's working towards it, but we know from the PM Consulting piece of work, we've all managed through them. We're in a good place, but we took a very long time against it. If it was simple, we'd have done it. Yeah. Yep. And I know Elks are not represented in the room, but I think a similar message from them, Jason, that they're after this. I don't think it's... They're after it. It's worth saying, they're also under enormous financial questions. So, like, it's... I think Wax's point is right, that this is not... We can't be kind of polygamish about this. This isn't... Yeah. This is... We're trying to do this in a system that's under severe strain. Absolutely. And your point, Sarah, that, you know, our primary care system is red-winted as well. Primary care is absolutely critical. And we've got... When we sit around the table and talk about this, we have, you know, Wax and Rema, and, you know... Absolutely. We've got the best. Yeah, exactly. Which is what I was trying to say. I'll give you the last words. That's all right. Absolutely fabulous examples. And Joe's really into that bit of work that happens. It doesn't... For me, they don't always happen in that neighbourhood kind of situation. And neighbourhood is an ambition, and, you know, it's a plan. Yeah. But, yeah, we must have lose sight of the good things that are happening. Exactly. And absolutely trying to scale those kind of situations up, so I mean, for us scaling up really well, x, y, and z. So, yeah, it's about bringing that order. It doesn't have to always happen. It doesn't have to go by the script book. But, yeah, so there's, there's, it's multifactoring. There's lots of things that people have. And, obviously, what do we need to find out of doing things? Yeah. Thanks for that. Good, good conversation. So, we'll be noting, but we're bringing this back. It'll be a standing item. And I think, you know, if we can have more background, particularly about where things work well, and building all existing networks, etc. It should be imposed on us, because there's no piece of against what's happening happening, as Tom rightly said. So, it's just how do we pay, sir? We do it well, and sustainable, given the fact that all the practices are all under. Yeah. I was trying to be positive in terms of resources, that we've got buildings that may be useful, and I think Jason picked that, God beloved, about, you know, we don't have to wait for the estates thing, which has been, in the past, one of the major blockages. So, anyway, thanks very much. Now, Julie, you've been very patient. On item, to be much about the agenda, I've heard what you can do, an update. And then, just warning, Simon is for an item that's not on the agenda. Not on the agenda. No. Not on the agenda that's public. On our agenda. No, not on the agenda as public. So, Simon is here. Just in case you feel left out, item nine is to better clarify. Yeah. It's definitely on the online version. Yeah, it's definitely on the online version. Oh, it brings you back. It brings you back. See? Yeah. Sorry. Simon C was here for something, I said to Neil, it's like, we'll have a long wait, because it's not even on the agenda. Yeah, I don't know how, I don't know how that would have happened, actually, that's very hard. It's alright. It's alright. It's always the gift that keeps on giving. Well, I don't know how, Julie, can you, can we just start your item before it gets to you? So, I'm. No watch, no update. It's from 21 to 34. Yeah, so thank you colleague. So, this is just really a simple paper, just setting out some of the work priorities that the team want to focus on for the next government's year. It will build on the work that we, presented last year. So there won't, there will be pieces of work that will be following through. But just to draw your attention to a few items. One is that we, we've been awarded some money from, uh, Newham Public Health to, um, actually encourage, um, communities to access the smoking cessation service. So we'll be working in the Northwest quadrant of the, the borough in Stratford, Maryland, Forest Gate, and West Ham. And that's quite exciting because we, we, we're particularly going to be far, focusing on, and, and, and also using kind of high football areas. So that, that's, that's a small, small piece of work that we're doing, but it fits into that early intervention agenda that we've all been talking about as a way to manage demand. Um, there's work around, um, improving perinatal and mental health services. As, as you, you may recall, we buy into something called community insights system, and that's, um, a data driven, um, uh, piece that we use to build our evidence. And it's been really instrumental in the work we've been doing about promoting awareness around maternity services. So we're doing a little bit of a deep dive into that community. The, the next item, which is around access to, um, primary care services. So one of the things we've been mindful of is actually, and also just picking up conversation about the number of people presenting at Newham Hospital is actually, that now there is, um, there should be the opportunity for patients to be able to see, their GPs on the day that they, um, contact them. And this is a piece that hasn't been very much publicized. So one of the things we want to do is work with me and collaborative and, um, and, and to actually look at how we can encourage residents to try and access, um, um, GP appointments a little bit more confidently, so that they don't work up at, at, at A&E. And then, um, we, we're gonna do some work on, um, so we've been doing quite a lot of work with, um, disabled people. So we've been doing some work around improving, understanding, um, and cancer screening awareness amongst learning disabled people and autistic people, and we want to build that. But, we also want to do some work around increasing awareness around sexual and reproductive health, because one of the things we were doing around cervical screening awareness, and that's a screening, was actually many of the people we spoke with, residents, were, were quite offended, I think, in terms of saying, well, why are you telling us about this? Because our lifestyles don't need some of those services. So really it's about breaking down mids, and, and being formed. Is that the DLD community as well? Yeah. Yeah, very much. So, you know, we've had women saying, I'm not sexually active, why do I need to have a cervical smear? So it's just trying to break down some of those sorts of, um, barriers and misunderstandings. And we've also done a lot of work around prostate cancer, with, um, um, African diaspora then, as well, which I think is quite interesting. I think, but, some of the things we have to be recruited, service development as well, um, going forward. Um, and continuing to do work. And just on that one, Julie, sorry, but if we're talking about the, um, my correlation between post-growth cancer in men, and black African communities, then, this, uh, not just the stigmatisation, but the late presentation, and micro-vac, there's a real issue there. Yeah. That's right. That's right. Um, we're going, so I'm, I'm wishing through, because I know Simon's going to talk about better care fund at 752. Exactly. But I'm really happy to, or say, sorry. So it's not that I don't want to discuss anything. I'm really happy to have an offline conversation. But, um, so yeah, with diverse communities continues. Um, I think we played quite an active part on the health equity board, and also the diverse communities forum, which has been great. And then, um, the 15th of March, we actually held, um, uh, an event with residents reflecting Newham's diverse communities, talking about community safeguarding, and Councillor Anne Easter, who co-chairs on the health, um, Health Watch Advisory Board, came and chaired the event. And we had Shola Akhawape, who's our, um, the independent chair for the safeguarding adults board, who would sort of go into top and tail the event. And we had residents sharing their experiences. But what was really brilliant was we also had public health presenting the data. And then we had, um, Claire Solly, who was the, um, director for safeguarding governance and other things to talk about, um, to talk about some of the work that the, um, that borough has done in the background in terms of accepting referrals, um, and how to feed, how they're feeding back to refer, referrers. So that was really interesting to see how systems change at the back. How does it actually feel for residents? So that was quite an interesting, um, piece. We've been doing some work around the well new website and Holly, who you might remember came last at the last meeting. We, um, did some, did some work around that. We want to pick up the conversations with the colleagues around the, the website and making it accessible. Um, and then part of the work that she's continuing to do is, um, is around the, um, accessible information standards, because, um, we really want to empower, um, primary and community healthcare providers to think about how people access services. We want to understand the, how we can embed the video relay relay service that is available, which, um, deaf communities can use, particularly in emergency services. Um, I'll work with the health and care partnership continues and that's been fun. And, um, obviously complaints and advocacy service, we've been collecting and supporting so many of our different communities, um, in, in terms of managing their complaints and, um, and, and how, how, how to resolve those complaints. We have very good success rate. And, and one of the things we also wanted to do is actually, you know, given the number of residents that have long term conditions that require medication, actually just a small thing, what happens with all those blister packs. Yeah. And so we want to have a conversation with community pharmacies about, you know, how can we recycle, reduce the waste that's generated. That's the thing. So actually having a conversation with community pharmacies is actually about creating a bit of a systemic bridge to, um, can we reduce it? There's other stuff, but what I wanted to do was just a little bit of a, a run through it. And I'm sorry, Tom, I didn't mention the work that we're doing with new hospital about, trying to, you know, we're going to now start working much more closely about, looking at some of the perceptions around residents using new hospital, and how we counter that with all the work that colleagues have been doing. So, I actually thought, in fairness, I thought that Newham University Hospital was, the reputation was better. It, do you know, to me, I, I don't hear as, I don't get as wrong. Do you think we are? Yeah. Yeah. Yeah. I mean, you know, I'm much better than we were four or five years ago. Absolutely. Against quite a lot of metrics, we are in the hospital in the room. Yeah. And I mean, you know, I recently had a friend who died with you, and they said that, her family and friends said that the care that she received was exemplary. Mm-hm. And I, I just think that, I don't hear the bad things anymore. Yeah. Yeah. So that's a sign of my, sort of, important conversation when, we saw you, Tom, last time. We used to get quite a few cases, people known, as, you know, evolved as it were on the council. Yeah. Speaking of the older generation. It's like, as old. Aging well. Yeah. Over. Right. After all the definition of family care involved in the lunch. Which is... Our autumn. There's a lot of ... Obviously, of the dental, as an above, and the family care, which is the exact same. Yeah. But dentistry, we're still not cracked in there, has it been. We've had to report, gone to scrutiny, we need to bring it back here. The, the, the dental, and other, the populations. One of the things, yeah. But also, the very real point you made about, pharmacy, technique is something that it needs rather work work program yeah unless yes otherwise the loose side doesn't start yeah okay okay on that one yeah so thanks very much for the work dear ian but then you and your team do it's really sort of diverse range of activities we just know that one there's no island in forest gate you're not touching me we're just not going is on the best care fund 2025 uh the submission and the new narrative plan now we've got simon ready to give us a narrative or to expand the narrative uh i'll try and keep this to about 40 minutes if that's okay this is all ironic banter for the minutes it's ironic banter um so um well the conversations i've been i've listened to today talk a lot really about what we are doing in a joined up way as partners and so we talked about kind of integrated neighborhood teams that's really about kind of relationships and planning for certain communities the better care fund wraps up all of our joined up integrated work um it is a section 75 which is an arrangement between the council and the nhs where we can pool funding in newham it's a little different from other areas because we made a strategic decision a while back to just go well we don't exactly know where various different priorities will take us where opportunities will emerge so we said we put all of the community health all of adult social care and all of public health into a section 75 agreement only certain elements of it have delegated uh responsibilities but it it has the totality of all of our money and that allows us to kind of focus on various opportunities as they emerge and on an annual basis the better care fund asks us to pull together a plan that outlines how we're meeting certain national objectives what you have in front of you is the plan um it describes how we're focusing on some of the the nhs focus points around the shifts the three shifts and such like it outlines how we're doing intermediate care and i'd probably quite like to bring a paper back on intermediate care or do a double act with joe on what we've done around intermediate care because i think that highlights how neighborhood working isn't the only thing that's going to address some of our challenges it's more about how we work together in a joined up way and like wax said but seamlessly for residents uh and we've done some amazing work in that place in the last 12 months really so what you have in front of you is the plan uh and uh you've also got some finance reports that kind of underpin that kind of stuff i'd just like to highlight um that our section 75 is way bigger than the better care fund over the last few years we've expanded it uh to include health inequalities and some of the health inequalities money over the last year or so we've started to include cyp things just because it's one place we can bring all of our financial kind of uh joint working together keep it smooth keep it simple and keep it kind of low on admin so it isn't money that's driving our conversations money is an enabler the bcf is an enabler uh it's the doing the right thing that really kind of drives us and the rest doesn't get in the way so um the national team requires the health and well-being board to sign off the plan if you are all comfortable plan with the plan that's really the uh the ask for today okay any questions uh i noticed that on the template the health and well-being board chair i must admit because i saw it go through in terms of the submission and i just assumed that we would talk about it um i apparently have to just digest it more but thank you for that summary yeah it might be worth simon just because most of it is continuity the overwhelming amount of it is continuity from the same from year to year it might be worth just touching on what if any significant changes there are shifts within the template so yeah maybe to highlight uh for the mayor and everyone um usually they give us three months notice to produce this on this occasion they gave us about three weeks notice and so the engagement with u.s stakeholders has not been great because we haven't been given the time to do that um jason is right most of this is continuity so of the hundreds of millions in the better care fund a lot of it will go on adult social care and packages in relation to discharge and various things like that in terms of the focus points for this year i wouldn't say anything has specifically changed what i'd say is we are bringing in the health and well-being board 50-step strategy into how we are demonstrating we're doing prevention how we don't see prevention in a small thing in a small way but we see it in that whole 50 steps wider determinants of health uh kind of piece uh we talk about how we are doing hospital to home and hospital to community which is more of an evolution of what we are doing and again i think uh bringing a paper on intermediate care so that's short-term care as a step up uh to keep someone out of hospital or a step down from hospital and how we're doing that better than we were before okay yeah i just wanted to get some assurance in terms of um point of continuity and outside of the inclusion of 50 steps as the kind of conceptual framework and anchoring to what we do as a cloud-based faith-based partnership what in a material sense is there newness based on learning from these board meetings particularly given the amplification that we've placed on health inequity and issues of disproportionality so a big change in the past municipal year for this health well-being board has been going to the heart of disproportionality and racial inequality in healthcare and is that something that manifests in this iteration or application not really because this is about where the resources go and those conversations are informing how the services are themselves are operating so it's it's it's just it's it's not it's not what the focus of this submission is really this is a funding that's the focus of what they're doing yeah yeah yeah it's a funded submission yes it's the national template that we need to work towards yeah so for each of the department health yeah it's quite top driven and yeah so far the better care fund capacity is around templates uh there's capacity for step down it's about things like monthly capacity has got on a number of new clients so you know it's it's about how we we're we're doing this you know but uh what a lot of work on re-ablement services but that that those things are this is this mentioned about 25 26 something we've we've said throughout haven't we that we should not be um doing something putting in templates over optimistic it's about what we've done to make certain am i am i talking rubbish at this point i'm right i hope i'm not no no i was nodding this you are not making sense um rather than not talking rubbish yeah there's that there's a some of this is predictable but it's not assuming that we're not doing some transformative work about re-ablement services so do you see what i'm saying this is a data submission but it's based on quite sound modeling around where we're going to be in the projection of change yeah like our short-term work and again i i think it's probably timely that i bring something back uh on that really splits into three areas and they are all all three transformational we have doubled the number of people going through re-ablement that's older people uh going through a service that gets them back to like being healthier than when they went into uh then when they came out of hospital so they can live independently that is a massive achievement and we've established a mental health step down and crisis support the feedback from residents on that has been phenomenal and the amount of money it's saved health has been amazing as well and we've because we're new and we have such a homeless challenge and speaking to the mayor's point on equity we established a step down in a hospital service and again the feedback from residents has been incredibly positive but doing the right thing has also saved the hospital a huge amount of money in terms of delayed discharges so these are things i can bring back and jason's right um this is about kind of ticking a national box what we are doing in those spaces are huge amounts of kind of work and we can report on some of that a project by project okay yeah i think that's a suitable balance isn't that but i mean it's got to be approved and this is the the body in law that has just two sign off and then ultimately the mayor but you know so it's presented to us but but there's a load of work behind that and i just picked on that one about re-ablement because i think that's not necessarily captured in the way this is yeah i think simon's point is right it'll be good at some point for us to focus on someone bring back some of that some of that reading works yeah yeah so do we just note that or we must agree enough no it's a noted report okay no and agree i think we do i think we have a minute agreed yeah please i think i'm going to sign it on i think i'm going to sign it on well thanks everybody now is that everything yeah just a date of that meeting which we cannot agree on it it's tentative yeah it's tentative for the 16th of july that sounds about right like oh it's summer holiday night well no no no no just because i think it's just um you're aware one of the earlier efforts that um is worked for in the head of the union council meeting council is the democratic services schedule for the committee meetings my general feeling is given that this meeting is taking place in early 8th and then for our next meeting to be in july it's way too long okay and i think that we should look up to room in the first week of june because we we do these every two months or every month these three times every two months does that feel still right no yeah yeah and if you can do yeah if you can speak to a first week of june then probably we'll probably go we'll probably go in september and then we'll go back in the middle of august world that makes sense it was june and september otherwise two would sleep then can we go first week of september at some stage because we've got vacancies we've got four vacancies we've got the chair of the strategic strategic representative group representative newham schools and then two reps from the voluntary community in the paid sector that's a good point really i mean i just think you know no no no well that's is the strategic reference group still existing yeah because that was that like popular structures for the ccg i don't know i don't even know what the strategic reference group is it probably doesn't exist anymore do you clarify strategic reference group what that is is no one knows what it is it can't exist yeah do people have um uh can i ask what people's views are about our approach to recruiting two representatives from the voluntary community of a sectors um do we do we could do expressions of interest in it can i just clarify where did this come from because this is the first time i've seen this list in terms of addition we've always been there yeah it has been exactly reference at some point maybe years ago yeah yeah yeah but i did raise it but i don't know about these vacancies i have raised it so the vacancies those vacancies have always been there for ages it's just i've been eagle-eyed today today yeah i did just a couple of things from my perspective i don't understand what a new and place of partnership is if the board members represent the place of leadership i'll unite after my role as the mayor and give them an opportunity yes it's not us right okay so in terms of newham is abby but she's not turned up she doesn't come to these i know she's on there but she hasn't been to one of these she doesn't she always declines so then let's just remove that because if you've got jason as the direct corporate director of health and adult social care that should be sufficient but laura yeah um obviously wackas i'd be quite interested in getting young people involved yeah this all feels really adult and then is there um when it comes to the voluntary community and faith sector is there something about following the principle that i'd do too um are they willing to manifest agency if i use those from our special education or disability groups or boards what was the voluntary community base what is your thinking there inclusivity well yeah but you right we've got two places yeah representatives of the new york community sector right and we live in a peopleist society absolutely but i'm not talking i don't think both should be from i think they would find it quite difficult so when we did it for the partnership we did it we what we did as jason said is we asked for expressions of interest but in the in the information that we sent out we said that we were particularly interested in and we listed sort of four key areas which included disability included young people so we did that and then actually that wasn't for here we had we had a number of nominations and we got all of the people who had nominated their organizations together to work with them for them to come up with the way and how they wanted to be represented so whether it was two for a set amount of time so it took a bit longer but it did make it still worth it yeah yeah but that sounds more equitable to me yeah i just thought so the principle is that we want to have an inclusive board absolutely the principle is that we would want to give preference to those that are marginalized minorities in this space and that talks to disability elderly voice particular ethnic groups gender trans even i was because we are increasingly picking up issues now the great community experience perhaps yes that doesn't come forward so maybe we we try that approach yeah and actually say we share with you you know say this is you know we are particularly interested in x y and z and see who comes forward and to do a process where people maybe do it for a year absolutely so so there's a different chance for different people to yeah i noticed that the older people's reference group were looking for um representatives i've nearly put my thought well before you i thought no i'm not checking you're deep enough got yours no no no no well i was sleeping from may 26th oh okay go on the older people's reference group oh she's a planner she's a planner planning ahead there might not be a vacancy what was i've been saying about ironic so you happy for me to work with joe on that point i think we have reached at the end of the meeting thanks for everyone's contributions