Transcript

We will meet there. Are there any apologies for absence? Remind you that the attendance there is a meeting in subject which is live webcast by the City Council website so people will be observing online just to let you know. Are there any declarations of interest? No? No declarations of interest. And can we approve for minutes of the previous meeting? Yeah? No amendments? We might do introductions now. Okay, so I'm Councillor Karen Pickering. I'm your chair for tonight and we'll go this way. Good evening, chair. Good evening, everybody. I'm Councillor Asher to Joel, Vice-Chair. Councillor Stephen Bonham. Councillor Zuffar Haq. Councillor Liz Salvey. Councillor Jenny Giovanni. Councillor Adam Park. Councillor Vidantster, Executive Member for Health, amongst other things. Royal Power Director of Public Health. Katie Jordan, Governance Services. Tessie Whitton, Governance Services. And if we can go over to the seated area. I'm going to start with Rob, because I know who you are. If you could introduce yourself. Yeah, hi, I'm Rob Melling, Mental Health and Improvement Transformation Lead, National Partnership Trust. Justine Hammond, Associate Director for Mental Health and Aid. Thank you. If we can go over to the back and then I'll come to the... And then we've got our youth representative. Yes, I'm going to ask you for the rights and participation officer and rights and participation team. And there are some members of the young people's council and the extent of it. Thank you for those. Chair's announcements. I just want to thank all of the officers and the exec members, members of the commission, for all of the work that they did last year. I have been appointed as chair again, as of last night. So thank you for the work that you've done over the year. Are there any petitions? No, Chair. Questions, representations or statements of case? No, Chair. Okay. We'll hand over to Rob then with the health protection. Thank you. Thank you. Just give us, as it's become custom, a kind of brief run-through of some of the health protection issues that we're currently looking at. Get this to work. So, there's a number of issues I just wanted to highlight. One of them is around ongoing discussions that we're having with UHL around safe discharge for residents in care homes and making sure we've got tonic procedures for notification of care homes of when people are being discharged with potentially infectious diseases. And there's some work going on about that and a few concerns about communication between UHL and care homes and infection prevention control, which we're working on. Flu vaccinations, uptake of schools remains pretty poor. 27% of schools, school children currently having flu vaccination. And as I'm sure you're aware, this isn't, this is around protecting older people in the wider vulnerable community as well as protecting vulnerable children in schools as well. But we have seen that drop off quite considerably. Primary schools performing better than secondary schools. There is a new procurement process going on around the school-age immunisation service, which may present challenges and opportunities for the future of that contract when the new contract starts on the 1st of September. So, watch this space around that. COVID and flu vaccination rates out in the wider public. We are concerned that quite a few of the impact of some of the savings having to be made by the Integrated Care Board over the next few months are going to impact on some of those services that are particularly important for the city. Because there are services which are trying to address some of the really stark inequalities as people are aware of in relation to uptake of vaccination and other programmes as well. So, for example, we know for this year the funding for the roving unit, which goes around our community, is offering vaccinations and other services, has been significantly cut. So, we're going to be working with quite a reduced service around that. But there's a wider range of services as well, which we have considerable concerns around, given the savings targets that ICBs are facing. New vaccination season starts from April. There's a smaller cohort, but there are still cohorts for the over 75. Immunocompromised and care home residents have started, and our comms are working with ICB and UKHSA comms around promoting those vaccines as well. And we've got some information around, we've concentrated on TB, the last commission meeting, and we have some good news around some of that. We've got some new staff in place in the TB service. We've got a record number of latent TB tests that have been carried out last year, and some additional funding to maintain that for this year. And we've got this emerging new strategy. And it's fair to say a real increased attention and focus on tackling TB, given that we do have the highest rates in the country. And there is an emerging Midlands TB control board being developed, and I'll be meeting with some of the key people around that as well. School vaccination programme, we're commencing on increasing vaccination uptake. Again, there's some really, as we'll see as we go quickly through the slides, there's some really stark inequalities in relation to some of the school vaccination programme. And we also, we're bringing back in the future today some of the work we're doing around supporting voluntary sector organisations to support us with community vaccination programmes. There's a project called MIST where we've funded three voluntary sector organisations to support some of that work, and we'll be evaluating that and looking at how we can build on that in the future. So I'll just very quickly run through the slides for that. Has that moved on? Not so far. There you go. That's just the, as we've seen before, that's the TB rates comparing the rates in the city with the rates in the country as a whole, and then looking at that compared to some of our similar cities as well. So we can see that we're significantly high, and the trend is increasing in the country as a whole, as we saw last time. And we can see some of that, of the trends across Leicester over the past year or so as well. Here we can see measles cases. As we saw, we had a really big uptake of measles in the city at the beginning of last year and the year before. We've had a few sporadic cases notified since then, but actually the good news is that they're just suspected cases that haven't been confirmed. So we get to hear about these, and then the UK Health Security Agency investigates them, takes swabs and so on. So it shows that they've got a grip, effectively, on cases that are suspected, but there's nothing of any concern there. And then here we can see some of the MMR, so this is the measles, mumps, and rubella vaccination rates. We can see that there has been a slight improvement over the quarters. That actually belies a huge amount of work that's taken to actually increase that just a little bit. There's a huge amount of work going on in relation to that. That's becoming some improvement, but it's also a reminder that we just need to get much, much stronger grip on this and put more resources into it and not less. And unfortunately, we're in the position, as I say, that we're seeing potentially a decrease in resources and the concerns that I have around what the implications for that might be in the future. COVID rates have come down. They're remaining kind of bubbling along, but there's, again, nothing particularly that we're concerned around for that. And then the last slide just shows the difference in flu vaccination rates across LLR. You can almost replace flu with almost any vaccination programme and any screening programme and many of the other services and conditions which are affected by social conditions and deprivation and so on. But you can see there that the uptake in the city is pretty much half of what it is in the county for both of those. And there's, as you know, there's lots of reasons for this, lots of explanations, but it's unacceptable. It's unacceptable that it's so low and we need to really rethink across the system what we're prepared to do to address that. So I'll leave that for now as it is. Happy to answer any questions. Thank you, Rob. Are there any questions from members? Councillor Hark. Given that we're committed to getting rid of health inequalities and looking at those slides, does it mean the money is not going to come and that inequality is just going to stay as it is? So why don't we just tell the truth to the public to say, actually, it doesn't matter. We can't change what's happening in the city because the rates that you're quoting on there haven't really changed. And when you start putting less money in, it is roving and actually actively trying to get to these people to actually vaccinate them. The figures aren't going to get worse. They're not going to get any better than what they currently are. So why are we just to actually tell the truth for a change? Because I think the public deserves that element of it. It's a very good question. I disagree, though, that we're not telling the truth. So over ten years ago, the MMR rates in the city were higher than England. So there's nothing inevitable about this. There are challenges and there are difficulties. And there may not be new money, but how that money is allocated across the system is what's important. And if we're facing inequalities like that and we're not addressing the needs in the city, then the question needs to be asked. We need a different distribution of funding, of resources, of staff to actually address that. If that's our priority, and everyone says inequalities is our priority, and everyone commits to narrowing the gap, then we're failing. We're failing in doing that with the resources that we have. So it's not necessarily about new money. It's about what is our priority of how we spend money across the system to address those inequalities. So can I ask you, are you confident that you'll get the extra whatever you require, so it is going to be a better, more level of playing field in the future? Because obviously the resources are currently going elsewhere, and you want to redirect them to target the areas that you want it to. Are you confident that's going to happen in the next 12 months? So we will see improvements to those figures? No. Councillor Jarl, and now I'll come to Councillor Dempsey. Thank you, Chair. Thank you, Rob, for the presentation. I've got a question. I think this is a recurrent subject matter now within the Public Health and Health Integration Scrutiny Commission around the flu vaccination uptake, particularly for our younger age children going to secondary school. And I personally think it is quite worrying that we have a very disparate, you know, uptake across the city. One of the questions that I think I've asked over time is, what are we really doing around our engagement procedures, our engagement structures, and our engagement protocols? Because we need to recognise, you know, so to sort of leverage on Councillor Hath's point around inequity, one of the biggest drivers of inequity is, you know, poor access. And in Leicester, where a language is a barrier, a huge barrier to access, we need to be very intentional about how we work with our communities. And, you know, I know that at the last meeting, Councillor Dempsey did say that there was very intentional engagement work being done across the city. But how much of it, really, are we going back to reality check to ensure that we're not getting the same constance? It is very poor. I mean, unless I'm mistaken, I don't think I've seen the figures hit 70 and above. And we really need to start to look at how do we sensitise communities to trust that these vaccinations are really about prevention, and not about this, you know, false misinformation that seems to be spread via a range of media. So, for me, it is what are we doing as a city council, and how are we engaging with our ICB partners to actually pull that programme through? Thank you, Chair. Thank you for that question. So, first of all, I'll be a bit more upbeat now. So, first of all, we have a fantastic team within City Council of Public Health, led by Mary Hall, who presented on the TV work last time. And we have new people in posts whose specific role is to work with communities to get over that message around vaccine and screening programmes. We also have our whole Community Wellbeing Champions programme network, 500 organisations and so on. We also have a fantastic team within the ICB, who have the responsibility for delivering this work, who do an amazing amount of work on this. So, this isn't to criticise the existing effort that the limited resources are able to apply to this, but it's a plea to say, if we really want to make a difference, we need to see a sea change in the amount of effort and resources that's needed to change the direction of where we're going. We're going in the wrong direction for all sorts of reasons, everything that happened during COVID, the various hesitancy, people just getting fed up with all the vaccinations. We've got the complexity now of what's happening in the United States and all the conspiracy theories that are being actually supported at government level now. And people get their messages now in their phones from all over the world. So, we can't operate in isolation. There's all these complexities going on. But we are working extremely hard to try and address this. But at some point, once the ICB reorganisation has settled down, once we have a bit of a better vision about what might be happening around some of that, we need to regroup, regather and refocus our efforts to continue the fight to try and make a difference to this. And we will do. We'll certainly be there trying our absolute best. Thank you. And Councillor Dunster. I mean, this is something that is particularly close, I think, I hope, to everybody's heart that's sitting in this room. But I'm not sure. I'm probably, oh dear, I'm probably the oldest person in the room. Which means, maybe not quite. Well, you might be the same age. But I remember, because I grew up in a very, very impoverished area. So, I remember diphtheria and children disappearing and never coming back. I remember polio. I remember children in calipers because of polio. And I remember that we were all, at the very first opportunity, we were all vaccinated. And that's all there was to it. Because everybody was sensitised to the danger. And that's the issue. The danger for your own child, for your own family, for other people and other people's families. So, there is a massive piece of work that needs to be done here. There are a number of complexities, as Rob's touched on. And do you know what? Not all of them require huge amounts of money. Now, I know the world, everything you do in this world needs money. But, you know, not everything needs huge amounts of money. And this is one of those things where you've already got quite a lot in place. But if you've got a lot of things in place and you're not seeing that step change, then you need to go back. And you can't just keep doing the same things. What's that phrase? If you keep doing the same thing in the same way, you'll get the same outcomes. So, we need to be looking at what we're doing. And we need to be changing it and be more engaging. Just on a declaration of interest. This is just more a little pet thing. I'm in, you know, suppressed, failing the suppressed. I'm meant to be getting a COVID injection in the last six weeks or two months or something. Nobody's ever contacted me. I've got no idea how to do it. My doctor doesn't do it. No idea where to go. I'm not a stupid person. Nobody's sent me a text or anything else. So, there you go. So, some of it isn't to do with money. Some of it is to do with how we engage, how we get the information out. You know? So, that's just a little bit of an irritation. There's two other things. Can I very quickly say? Sorry. I know that this issue has got nothing to do with the issue that we're doing. But, hey-ho. This week, I want you all to remember that this is Black Maternal Health Awareness Week. And when you look at the data, it is scary. And I have got a whole load of information here. Black women in the UK are three times more likely to die in pregnancy, etc., etc., etc. It is not a good picture. It is a scary picture. And so, I will be sending this out to all members. And I hope that we get this message out far and wide. Maybe you could think about putting it on a website or something, something, such a thing. And the one last thing that I want to say, and then I'll shut up because it isn't my meeting. And that is, I do genuinely, and this is a genuine comment, I do genuinely feel concerned for our NHS staff who are having to deliver in a very, very difficult situation. And it's all very well, as all being critical, but at the end of the day, these are people, with all due respect, who have got life, who have got families, who have got mortgages, HP repayment on their car, whatever. And they may be about to lose their job. So, let's just all cut a bit of slack and recognise this is a very, very, very difficult time for the NHS. Right, I'll put it. Thank you. I was hoping that the, I mean, I'll just say this. I was hoping that the influx of measles last year has hopefully left a trail that people do want to vaccinate their children, because I know there's been reluctance. But the influx of measles last year, hopefully, has sent a message loud and clear. Councillor John. Thank you. Well, I was actually going to say something similar to Val. In the 1950s, when I was at school, you were all lined up outside the school nurse's door, sleeves rolled up, jab, and off you went. And it seemed to me that there was no child in that school that didn't have an injection, whatever it might be. So, schools seemed to be, to me, the place where we need to educate families. You know, a letter home, I'm sure this is done by headteachers. You know, next week, we will be having the, whatever it is, injection, and your child will be expected to attend for it. No question. There were no questions asked in the 50s. Everybody just did it. Also, I think there's an awful lot of work that should be done. Reading through all of this this morning, it seems to me that we miss a trick. That we miss a trick with mothers who are expecting children. That's when the education should start. That when you've had your baby for the next 10, 15, 20 years, you will be expected at various points to have your children inoculated, or to have this done, or that done, or whatever. And it seems to me, reading through this, we've got all these wonderful workshops for all sorts of different mental health, this, that, and the other. But what are we doing to educate women when they first become pregnant? Thank you. Do you want to come back on that, Councillor Dempster? Sorry, I'm not being funny, but also the men. Well, the men, sorry. Sorry. Sorry. Just had to say that. Sorry to the men. But you know what? You just have to step up, take your chair of the responsibility. Yeah, absolutely. But it is about how do we get these messages across, isn't it? And, you know, you could argue that there is something about, in those teenage years, what is it that they learn, like when they're 14, 15, and they go to classes, and I can't remember what it's called. But at the end of the day, that's the age when we should be saying to them, you know, all about vaccination. And that's it. Yeah, PHSE. And that's when it should start, isn't it, for boys and girls, because at the end of the day, let's get in there. We have a real problem in terms of, what's that one that they have meant to have from the 15? HPV. Yeah, I mean, the uptake on that is really, really, really scary. And when you think of the outcome, if you have that, if you have that HPV, the outcome's fine. If you don't have it, you could end up dead before you're 35. That is a really, really scary outcome, isn't it? And you think to yourself, well, I don't understand why these people aren't having it. Yeah, but they're not. So there is a huge piece of work that we need to do. And just to build on what Councillor Joanne said, I've got a young child that's at school, and it comes through the newsletter. Now, not everybody, and it comes through the dojo. So not everybody clicks on that newsletter, because they know it's a lot to read. And a parent has to give their permission as well. And it took me three years to get Taya to do her vaccination. But she was proud when she'd done it. But that's me giving permission, reading the newsletter, answering the dojo. So there's a lot put on parents. And like you, I was lined up at school, and we had the BC jab. Nobody said anything or any permission. It was just done. And so I'm hoping the influx of measles encourages people to have it done this year. Thank you, Rob. And, oh, Councillor Sahu. Thank you. I just wanted to touch upon something else that you mentioned about the impact some of the lack of funding is going to have. And you mentioned about the bus, but you also sort of alluded to other things. And I just wondered if you had any more detail about what those other things are. No, not as yet. So there's a process that the ICB are going to have to go through in terms of their plans. So the target for the running cost savings is 33% savings for LLR. So they've obviously now got to go through a process of working out how they're going to make those savings. Presumably then there's a consultation process. And then by Christmas they're supposed to be implementing that savings plan. We're hearing some concerning things, which I'm not going to say in public because they may not well be correct. But we do have concerns about some of the stuff that's maybe seen as a bit of an add-on, a bit of a kind of extra thing that they're doing with us in the city to address the inequalities. My concern is it might be seen as an easy target. But we're having conversations with senior officers at the ICB around how we can make sure that the implications of some of this, it won't just fall on the community and the ICB, it will fall on all of us. It falls on social care, it falls on public health. There's lots of implications for changes to the service. So we want to be able to discuss that with the ICB as well. And I think it's been incredibly difficult for the ICB because there's been precious little kind of guidance around what an ICB is going to look like in the future. And it's, you know, it's all very rapid in terms of their targets for the savings and so on. On top of that, NHS England is going to be deleted and brought into the Department of Health and Social Care. So it's another huge structural change. And a lot of these things cause a lot of concern and obviously it's people's jobs at stake, you know, as Councillor Dempster pointed out, which, you know, is really important and troubling. But it also means there's a huge amount of distraction from us all being able to get on with the job that we actually want to do, which is improving the health and well-being of the city. So I can't give any details on that, but maybe the ICB colleagues might want to talk about some of the process at a later stage, you know, some of that. Councillor Hatch. Sorry, I was just going to recommend, actually, can we have the people who are going to be making these decisions come to the next community meeting and at least let's hear what their thinking is and to make sure that the city doesn't lose out, particularly with the whole point of the inequalities. I'll make sure that our voices are heard, because otherwise there's a high chance it will be too late. So I'd rather do it sooner rather than later. I think working with health inequalities with people that are disadvantaged is difficult, but it doesn't mean we shouldn't try and keep knocking on that door. So with those recommendations, I'll ask the Commission to note the report, and we can move on to Dr. Janet Bowley-Williams and Justin Hammond to present the Children and Young People's Mental Health Referral Update. Thank you very much. I'll kick off, if that's okay, Chair. The presentation and paper are submitted, so they're in the pack. I'll just draw on a few highlights in terms of successes and challenges, if that's okay. Then I'll hand over to Justin, who'll give us a bit more of an update around referrals from the wider mental health system, if that's okay, and then open it up to questions and comments. So I just want to start by saying and reiterating, as I did last time, that CAMHS is only one element of the mental health offer across Leicester. And we are really proud of our self-referral route into mental health support. That isn't something that's replicated up and down the country. And we also have a triage navigation service that, with a few exceptions, actually provides triage for all our mental health services. So I just wanted to start off on that point. We've got a slide on our latest performance data from March 25. So they're our main KPIs, so they're the key performance indicators that we are measured against. And you can see there, we've got a bit of a mixed picture, but I don't want the committee to lose the narrative at the end. There are lots of things that affect our delivery against KPI, but from a generic sort of CAMHS perspective and our CAMHS access team, which is our assessments into CAMHS, we're fairly strong on our assessments with the longest waiter only at 15 weeks against the 13-week routine performance. Our crisis and home treatment performance is generally really strong, consistently high. We do have some exceptions, and most of those relate to families not being contactable. I just want to assure the committee that we follow that up. We don't just try and contact a family once. If someone's been referred in a mental health crisis, we follow up, we follow up, and we actually do a cold call if necessary. That might take us beyond the time limit that we're judged against. And the children's eating disorder team, since COVID, we've had a significant increase in referrals. That's sort of levelled off a bit. The one-week urgent time frame, as it says at the bottom there, sometimes if a family's referred and they're not available in that first week, we're only talking small numbers each month, so that can drop our performance down to 50%. So I just wanted to give a bit of context there. Neurodevelopmental assessment and diagnosis continues to be our most significant challenge. So you can see from the slides there, when we're talking, the reason we've brought this into the presentation is that for secondary school children, our CAM service undertake our neurodevelopmental assessments. So we're talking autism and ADHD. They're not mental health conditions as defined, but the way our services are set up, our CAM service currently do those assessments for secondary school-aged children. As people will be absolutely aware, autism and ADHD, and particularly ADHD, has really become part of the public consciousness in the last decade, in a way that it wouldn't have been 10 years ago. We're seeing a significant increase in referrals. This is replicated across the country. We're not an outlier. We're probably in the middle of the pack in terms of the numbers of children that we've got waiting. We have been doing everything we can to innovate our pathways as much as possible, but we need to remember that certainly for ADHD, if we're positively diagnosing children, the usual treatment of choice is medication, and that's controlled drugs, and we need to be really robust in our assessment, because this is a lifetime diagnosis, as people know. We have escalated it locally through our health system, through our local MPs, and at national level. The government have responded with a national ADHD task force, and they are proposing that they will produce an interim report nationally in the spring. We're yet to see the report, but we wait to see what guidance there is. The bottom line is, we do not have the capacity to meet the current demand, and you can see there there's some significant rates in the system. I'm being deliberately brief, so that we've got time for questions, if that's all right, Chair. So, I just wanted to hover on a few success stories, and I think this probably is a bridge to some of the previous conversations that we've just been hearing around reducing inequality of access, particularly to mental health services. We've got a really positive story about our Play On programme, which is a partnership with Leicester City Football Club, that we provide supervision and support to local mentors that are employed by Leicester City, that provide emotional and mental well-being support to children and young people that wouldn't ordinarily access mainstream mental health services. And in particular, a significant majority of the cohort of young people that are accessing that are young black men, and that's really important, because that cohort of young people isn't always accessing our services in the traditional way. I won't go through the other partnership success stories. You can see there on the slides that we've got some other really positive examples of work that we've done in terms of working with the police to produce some short videos around knife crimes, a really topical area, and also some work around social media awareness. So, I think I want to stop there, if that's okay, and hand over to you, Justin, if you've got any additions. Thank you. So, as Paul mentioned, we've got a triage and navigation service, and that's our entry point into all children's planned support. The crisis offer, as I've explained previously to this committee, comes through either NHS 111 option 2, which is an all-age offer for both children and adults, and also through the CANS crisis line. The children's referrals, we've had just over 8,000 going through triage and navigation this year, and approximately 16 a week are coming through as self-referrals. So, that's children going onto the website, reading the information, agreeing that actually they would like to see someone or speak to someone, and so self-referring themselves through that service. So, that's just over 787 since the 1st of November 23 through to 2024. As previously we've discussed at this committee, there is also the referral route through the GP to triage and navigation, and we've done separate briefings with some of the counsellors here as well. Unfortunately, that position hasn't changed in terms of the number of referrals that are being sent back to GP for further information, so that still sits at around a third of those referrals. The majority of those are because the lack of information isn't correct for them to be able to be triaged, which again we've had previously discussed. However, we've had four meetings now with the local medical committee to talk through their issues and their concerns and why these referrals are getting stuck. Unfortunately, due to collective action, they no longer use the PRISM form, which is a standardised referral route. The LMC, as part of collective action, advised all GPs to stop using PRISM forms wherever possible and instead to go back to writing a letter. And so as a consequence of that, the referral then becomes whatever the GP puts into that letter. So it removes the standardisation and makes it more complicated, if you like, to ensure that we get the right information through. We'll continue to work with the LMC on this, but as it stands, over the last year, we've not seen any change in the number that have been sent back for further information to come back through. So I'll leave it there and take questions, thank you. Any questions from members? Councillor John. Thank you very much. And Keith, welcome to Leicester. So in a past life, we were both part of a different trust. So my question is around the seemingly lack of, I don't know whether to use the term engagement or awareness now, the part of the LMC to understand that if you take away standardisation, then it becomes a very subjective process. And so people, as you say, doctors will put in how they have assessed the patient, and then you have this back and forth coming back. So I'm just a little bit surprised that the number of returns has not triggered any sort of review in terms of how they then go back to, look at can we standardise referrals, because if we take one of the biggest underserved demographics, so the black community, you would have a lot of disparity in how people, you know, a GP would refer, or how the patient themselves, or their family, or support network, would represent the issue. So there's concern for me in that we then begin to insert unintended discriminatory practices into a system that should be serving and working for everybody. Thank you, Chair. Would you like to come back? I can't speak on behalf of the LMC. We're working as hard as we can with them to try and help educate. Unfortunately, collective action means that GPs have a list of things that they could choose not to do. They can't go on strikes, so this is the next best thing for them. The LMC guide them. The meetings that we're having with them, we've explained. We're trying to get a better content to the letter to try and help the information that goes into health triage and navigation. But it's non-enforceable from an ICB perspective, so all we can do is ask. And so the work we've been doing with them is to try and help them understand the impact of the information not being correct in the first place, and then forwards and backwards of requesting further information. Can I just make one more point? Is that all right? At the last meeting, we did agree with the minimum information that we required for us to be able to make that decision, which was agreed. And hopefully that will then go back to the GPs. So that was going to be my question then, because whilst I sympathise with you when you say you can't control the LMC, but I think it is just critical for us to be able to have the confidence that the ICB is representative in its position around ensuring that there is equity in how people are referred and how the access patients have to a system that is already overworked and overloaded. Otherwise, the referral fatigue becomes such that you would have lots of, you know, unfortunate cases. So it is, you know, you just said now that you've given a minimum expectation. But then how do we then, as counsellors, how do we gain assurance or how are we assured that they will work to those minimum standards and not work outside of them? So how are you going to really check, you know, that ask you've made of them? Thank you, Chair. We do our best to try and educate the GPs. And there's over 5,000 referrals that have come in appropriately. So that's about 5,000 referrals that came in first time around. We can't enforce. You know, we can do as much as we can in this position with GPs, but we can't enforce. Hence why I've brought to you also the numbers of self-referrals, which is a far quicker route for that young person to get support. Nearly 800 of those have done that route and immediately get through to where they need to. We are equally frustrated and we hear your frustrations. I'd have to come back to you. I think we're looking at around 11, but I'd have to come back to you to confirm the age. I'm going to go to Councillor Jarno. I'm just interested in the number of referrals to CAMS through the youth courts. Having sat as a magistrate for many years, quite often we had a report from the youth offending team to say that this child has been referred to CAMS. And are they fast-tracked, young offenders, to CAMS? Or are they just put into the melee with everybody else? So we have one of the specialist teams for the young people's team who work with looked-up children, adopted children, and young people through the youth courts. So we do have clinicians that work specifically with that group of young children. So they would go directly to that team. And do you have an approximate number of young people in that system? No, no. I'm afraid. No. I mean, we can... We will have that data, but I haven't got it up there to hand, I'm afraid. I'd be quite interested to see whether... We'll perhaps have that data as well. Maybe we could get that. Thank you. Thank you. Councillor Sardin. You know... You know I'm not going to be happy. You'll know that. So my understanding is that self-referral you can only refer for certain things. So when I looked on that big list, there's a big list of things you can't refer for. So, yes, you know, young people can go through that line, but there's a huge lot and often the more serious and more concerning conditions they can't, rightfully so. So I think we need to be mindful about over-promoting the self-referral route as a solution when the big chunk of stuff really still needs to go through a GP. I've spoken to the GPs about the... What did you call it? Prism. Well, about Prism and the collective action. Collective action came to an end on the 19th of March. So there isn't collective action anymore. So it's a bit concerning that we're now literally in May and you weren't aware of that. And I've also spoken to a GP and they are using Prism. So we're also a bit of an impact, I would say. We're really needing clarity on exactly what is happening because there's 8,000 referrals and a third, I think you said, was being returned, rejected, whatever you want to call it. But when you actually put a face to each one of those and a distressed family to each one of those, it's really, really upsetting. And what really concerns me is we met summer last year and we're basically a year on, 10 months on and we're no further forward. And I acknowledge there might be some collective action thrown into that, but they have used Prism. The collective action has come to an end. You know, we need to be we need to be moving with this. This is really, really concerning. And the fact that it feels like collective action can't do anything even though that's even ended. Plus the fact they're still using Prism. Plus the fact they can't, young people can't on the whole refer to some of the really more worrying things. And we have 8,000 families potentially here who, to me, I say are in crisis. I know your legal clinical definition isn't, but if you're a parent with a child taking them to a GP for something to do with mental health, you are really worried. So, I just don't think it's good enough. Councillor Sahu, can I just correct the dates? So the dates, the numbers I've given you is up until the 1st of November 2024 when collective action was absolutely wedded in. I've not given you dates, I've not given you data up until today. So the data I've given you is for a full year effect. So that's within collective action. Meanwhile, we've met with the LMC four times. We are continuing to do the work. When we come back to this committee again, hopefully, the position will have changed because as you've rightly corrected me, collective action ended in March. But at the point of the data that I'm providing you with, collective action was absolutely in place. If they're now starting to use Prism again, then that's great. But I can only go on the data that I was given from the service, which was to give you a full year effect of the dates previously, last time to today. So I am very passionate for this area. You know this when we've met with you. And we want to get it right and we're desperately trying to get better outcomes for these young people and we want this to work and we don't want this moving forwards and backwards with information. We want that referral to be done once, done well, form completed and through we go. And that young person then gets to the service. And we know for the 5,000 children that do go through immediately, they land in the range of services that are most appropriate to them and aren't, as we saw previously before triage and navigation, sitting in a waiting list to go to CAMHS, to get to CAMHS to find out that CAMHS was a completely incorrect service for them. So we're getting there. I'm disappointed that I've not been able to come to you today and say it's better. But I can't fix this at this stage until I get the next lot of data and then we'll see whether things have changed. We're committed to do webinars. We're committed to do training. We've got the LMC on board, which is a much better position than we had six months ago. But this isn't moving at the speed that we want to. So I do appreciate your concern and feedback. Just to clarify for that sector action, I've got all the data. So collective action, this sort of thing, started last year. It was up to practices to decide which bits they would follow. Most practices continue to use PRISM form to refer. Collective action was made with ten options that practices could choose, all or none. So they didn't all choose to do that. So the PRISM form is a referral route for a myriad of different things. I think there's four or five hundred different services they can refer through to from dermatology through to mental health. On each choice, they can decide if they use the PRISM form or not for every single subject area. So it wasn't a blanket approach for the practice to decide that they will or won't use it, yes or no. They chose on each individual case. On children's mental health, a number of those practices chose not to use PRISM and instead to write the letter. I can't give you that today but I can come back to you with it. If we can find it, I will try and give that to you. Thank you. Councillor Hatt. Okay. First of all, thank you for your presentation. I was slightly concerned that you sort of, I sort of got the impression that the self-referral was referring to everything but it's obviously limited and that's the impression you gave me. And the fact is there's 2,666 families almost still waiting. And the time scale that you're talking about 176 weeks is over three years and almost four years is the longest wait for the city for the neurodegenerative it's on your papers. Yeah. And this is not something new. This has been going on for a good few years now. And I've spoken to with lots of families in my patch certainly who've ended up going to private providers to try and get a diagnosis and get support and get the necessary help. There is issues with that as well. And you know, I realise you've got issues with the LMC. I'm more than happy and I'm sure some of the other councillors are more than happy to act as go-betweens and talk to those, talk to the LMC on your behalf as well because we should be we're all working for the same outcome and the outcomes have to be for those families and for those children. These have life, you know, they're life restricting issues for lots of families and I think that the LMC should understand that and I'm more than happy and I'm sure Liz is and some of the other councillors here would all be happy to help you and help LMC to deal with this problem. I've spoken just the same way as Liz to several GPs just now. I've also spoken to some other consultants as well. They're just not using prison for these. We need a list of those GPs and those surgeries that are not using prison for their referrals to you because you might not be able to do what we can do. I will certainly be naming and chaining them because they're putting children's lives and their families at unacceptable levels of stress and pressure that they don't need and we need to be highlighting that and they need to be moving themselves from those GPs to GPs who are doing a proper job and able to look after their patients correctly and that's what we're here to represent. We're here to represent the people of Leicester and if they're not getting a good deal from their GP surgery they have the opportunity to change and they should be changing. I think if I may come back on that if that's okay that from the trust perspective that has been one of the challenges in the way that has been described in terms of the differing response from GP practices and having to navigate how that's appearing in different services so it's been a very hard and changing picture as been described to understand the impact of particularly the prison forms across a number of services and how we collate that information to understand a picture of what each individual GP surgery may be doing and what decisions they're making so that offer of support would be fabulous but it has been a very challenging place to understand the impact on different services. Can I just add while I was on the board of the CCG if some of the GPs weren't using prison for their operations or for LPC or for UHL they would be called up and they would be under serious pressure to get their prison act into order because of the wasted lists so whatever help we can give we're happy to help and we'd rather you come to us rather than come back in six months or a year's time with the same figures again and again and again because it just isn't frankly acceptable at all. I just want to check with the youth rep whether you wanted to say anything because it's about children and young people and I can see you nodding away and agreeing with a lot of it so I just wanted to ask if you wanted to say anything. I agree with a lot of these points that I've come across that I've found but I appreciate your experience. Thank you. Thank you. Councillor Dempster. Thanks. Thank you. I've just got a little bit of a confusion in terms of tone so I noticed it says MD conditions are not mental health conditions so I thought well what are they? Anyway, okay. Treatment of choices medication isn't that isn't that what happens nowadays in medicine? I mean I just feel that there's a wee bit of a different tone here from if we were talking about diabetes. There's a whole range of treatments for diabetes and I think there's a whole range of treatments I've just forgive me I just looked it up on Google apparently there's a whole range of treatments in terms of ADHD so not just medication CBT and also if you have ADHD you're more likely to experience a mental health condition we talk about anxiety depression I don't know about the suicide rate I didn't have long enough to play about on the Google and I'm not that good on it anyway so I just was a bit concerned because it did feel like a bit of a disparity between when we're talking about diabetes and when we're talking about ADHD thank you I think I think for us it's important to differentiate what's a neurodevelopmental condition and what would be considered a mental health condition so conditions such as anxiety depression psychosis eating disorders sit within that mental health definition there are lots of neurodevelopmental conditions and certainly in terms of people with autism they will often don't particularly like understandably the term of disorder and the medicalised model of some of those conditions so I think in terms of being more neuroaffirmative and seeing that this is a condition rather than necessarily a disorder I think that's where the tone and the language comes from to try and differentiate those out so in terms of I think that's what we were trying to say there is a difference I think when Paul referenced the medication for ADHD whilst you're right there are other treatments for ADHD many young people and families want medication as one of the options within there and that was referencing the importance of a robust assessment process so we're very aware that due to the way people have gone to independent providers and I'm sure we've all been aware of some of the controversies around that so that need for that robust good assessment is needed so I think that was just highlighting that given that it's then a lifelong condition that we're treating with medication I'm totally in agreement with you I would have thought you know yeah but I don't understand why it's a particular issue for ADHD I would have thought that any medical condition any giving out of medication is a serious matter but I do not recall of me attending the meeting and I have done this before I did lead on public health for four years before I just don't remember this tone when we've been talking about diabetes or high blood pressure or anything else and it just doesn't sit comfortably with me and probably because let's just be frank about this there has been some difficulty in under diagnosing of ADHD in the past because there were a number of practitioners who thought that it was just poor parenting and if only the parent was firm and consistent their child wouldn't have a problem I think we've moved on not massively not massively I must say but I do think we've moved on a little bit in the last 25 years but I'm concerned that progress hasn't been great enough for the families as well as the children the families that are suffering I think we apologise if you're concerned about the tone I think you've misunderstood our tone because that certainly isn't what we're saying you know we are very aware of the increased risk that neurodevelopmental conditions put children at and we are very aware of the needs of those young people thank you I've held my tongue a bit I'm one of those well I'm a guardian special guardian and paid £650 for an autism assessment which the GP then won't recognise and what I'm hearing from others and I can hear it's frustration I can hear your frustration I think with ADHD there has been an under diagnosis really going on and just getting the diagnosis is just the beginning then it's another three years I've been I've been four years and I've got so frustrated that I've paid the money to get an independent for a GP not to recognise it so I can't get any further with an EHCP or anything like that and when you think as Councillor Sahe said the families at home that are trying to cope with this you know they're coming into social services because they're at the wits end but I hear your frustration as well I hope that the government task force comes in like the A team and tries to you know but it's brilliant news that we are thinking out of the box at the back of the net with the Leicester city and the community which might bring some of the more people who are not seeking advice are there any other points yes yeah if I may I think this is it's helpful to probably land this in the context that looking at it from a health perspective is only half of what's happening there is tremendous work that we're heavily supporting in terms of the send agenda and inclusivity so there's just to recognise our partners that are working closely on that in terms of enabling schools to be neurodiverse inclusive and ensuring those families are getting that support at that end in education and in social care so whilst we're talking very much on the medicalised element in terms of assessments and ongoing treatment there's that whole piece of work there as well going on to enable people who are neurodiverse to be more included within society and there's a lot of work there with partners as well so just to recognise that it's sort of two halves of a coin really working in tandem I mean we haven't even touched on schools yet you know a lot of the parents that I know their kids are being excluded they're losing their education the schools don't have the capacity to deal with very different behaviours temperaments they're there for average joe aren't they so the teachers are just as frustrated we're working with the city at the moment to do a piece of market engagement to see how many providers we've got across LLR that provide support you may have been aware of ADHD solutions that was a main organisation that folded in December since then we've done an awful lot of work with the city the county and the Rutland local authorities to identify the range of organisations we've got appropriately in place that can support parents with strategy with toys with all the other coping mechanisms that isn't about medicine but is about actually helping the family to get through the next stage the next day the next week the next month we've also got funding that we've already put into the city that was going to ADHD solutions so that will be funded through for another year and we're hoping that by the end of doing this exercise which should come to a conclusion by the beginning of May that we will then have a web effectively of where these organisations are we've also got volunteers that will work in for ADHD solutions that are doing webinars and one of our clinical leads Dr. Louise is doing some of the her own child's got ADHD is also doing some webinars to help families to understand different ways of mechanisms for coping so I didn't want you to think that this is all we're doing while we don't have much money we are doing a whole range of things can I just bring Councillor Bonham in and then I'll come back to you since this does cut across with the work of the CYPE Commission could we consider possibly in the next year's work program for a joint meeting to look at ADHD in terms of young people with education and other fields as well thank you I think that's a brilliant suggestion Councillor Hack I just wanted to also say thank you to LPC and some of the staff because I know lots of families who are getting into the system are being really well looked after so there's a huge positive to gain from that and also genuinely the help required for the LMC that's an open offer we're happy to help with that because I think there needs to be external pressure to make sure that these things are done and also as the chair mentioned these private providers can you actually give us a list of the ones that you can there's got to be a way of actually because if you go to a private provider for any sort of services at Spire or Nuffield or wherever you'll get accredited with an NHS staff or whatever it might be there's got to be proper accredited people where parents can go to that they will be able to get into the system then the GP will accept their reports so let's do that as well because you've got to think out of the box you can't have 2,600 families with the stress and the worry and being excluded from school because the schools don't have the wherewithal to deal with some of these children under these conditions thank you councillors so let's just a quick one sorry so obviously there's the 3 year or 3 year wait time for the end of the assessment so is there any I know they can't do meditation until they're being assessed or whatever but is there any other support that is required why are they waiting for that or do they all come once they're being assessed so you know where family are waiting to be assessed do they be providing any support or not help to cope with that yeah so everybody who is waiting is given a robust list of services that they can access and as has been described unfortunately we have lost one of those providers so there's obviously immediate action to plug that gap but yeah everybody is given support they have an opportunity to escalate back in if there's any escalation in their need in that time so yeah they're not just left on their own there is support around them as well councillor demonstrably wants to come back in yeah thanks I'd be really interested to see the list thanks okay if there are no more questions I think the recommendation to get together with children and young people and I think you know some external pressure from councillors might help okay and list of GPs those recommendations thank you we'll move on to item nine systems pressures on the Bradgate mental health unit I haven't got any names but I've got the Leicester partnership trust and IC bill to present thank you who shall we start with hi chair I think we're starting with myself so I'm Tanya Hibbert the executive director for mental health services at Leicestershire Partnership Trust and I'm responsible for the adults and the older persons mental health services through LPT I think the first item on the agenda is with regards to the Bradgate unit and winter pressures and then I think the second agenda item Rob and I will be presenting with regards to community mental health support and the cafes if that's okay so I think in the pack there was a paper that we've written detailing some of the activities and what were the practical things that we did to help support the whole system of LLR particularly through the winter period some of the data goes up to January some of it February just because of the timing of the data and the paper being released in the validation process and this is particularly for our adults so this is data around our six acute adult wards at the Bradgate so during that period of November 24 to January 25 on average there were about six patients who were waiting in any one 24 hour period waiting for a bed on some occasions on nine occasions this did increase to ten patients waiting for a bed we talk about in the paper OPAL and I realised we didn't explain that so OPAL is what's called the operational pressures escalation levels and it's just a way of standardising levels of pressure to be able to have a common definition it's what acute trusts to use it's what the NHS uses and mental health is no different so OPAL 3 there's four levels of OPAL which signify levels of pressure OPAL 3 is severe level of pressure and that was maintained at 96% of the time we do seem to live in OPAL 3 most times throughout the year but we escalated to OPAL 4 which is when we put in additional levels of support we asked additional levels of support from partners as well for three days over that winter period so you'll see in the graph we've just shown some activity levels around demand for our beds and we've shown a graph on the bottom of the first page with regards to flow and we did see as we do see often over winter our length of stay can increase and in December we had a particularly challenging month where our length of stay increased to 66 days on average so we did experience some reduction in flow over that winter period and that has an impact on admission so what did we do what actions did we take and I'm pleased to say it does feel like today we're out of winter for this last year but we are already starting to plan for winter as we go into this new financial year but what we did part of the further investment that we did receive from our commissioners thank you Justin was some additional mental health liaison practitioner support and link workers that help with our mental health teams that are based in UHL so we help support with patients being admitted for mental health assessment either because there's a dual diagnosis with a physical health condition in A&E or in the decision units or on the wards across any of the three sites so our staff will move to support those patients wherever they are so some additional investment helped because that meant that we were able to offer additional shifts for key periods of time so that we were able to assess patients more quickly and if bed need was identified we were able to then hopefully pull people out of those environments into the mental health wards as quickly as we possibly could that was one thing that helped with flow another thing that we did going into winter we reviewed that OPAL framework as I described to see whether we could do anything more whether it's as robust as it can be that also coincided with the national review of OPAL levels that happened in December so across the country we're all asked to review what our local frameworks were and realign them with what the national requirements were and again it's just to strengthen our governance arrangements and make sure that we're being more proactive well as proactive as we can possibly be in identifying pressures heating up and what we might need to do in addition our OPAL scores have a framework of actions associated as well so as the pressure increases our actions increase to try and help de-escalate which means we get more patients into beds and get more flow happening. We just mentioned in the paper that our PICU ward and whilst it's not particularly in the figures our male PICU which is called our BEV award has had to undergo a period of extensive refurbishment so we did have to decant out of the BEV unit at the end of January and as a result of that we have had to block purchase with a private provider the one that we could get as close as possible to Leicester so that it was less inconvenience as we could possibly manage for our patients and their families and so we did commission some beds now our patients are still there we have that oversight of those patients and we go into those wards and help support that private provider for our patients there. We also did have to use some acute beds because of capacity so where we used you'll see on the top of page three about our PICU use that was because we had to commission those beds because we had to close the unit for the extensive refurbishment required but where we said about some acute beds being needed in that winter period that's been because of demand that we were unable to accommodate within our own LPT beds so we had to buy that capacity in addition. We try very hard to prevent people and anybody going out of area but we have to do that at times because of demand but we have tried to mitigate that this year as well by working with a local private provider and commissioning some block-looking beds which means we had sole access to a number of beds which we paid for for a period of time and at least that meant that we were able to keep people a little bit closer to home with their family and their support services and also for our community mental health services makes it easier to help with that discharge planning as well so we did do that on occasions as well. And the other thing that we've just mentioned in the paper is around our clinically ready for discharge and the last sort of table shows the number of particularly city patients that we had that were deemed clinically ready for discharge. Justin does chair for us an meeting every week with our partners and our local authorities which identifies the number of patients who basically don't have a medical need to remain in a mental health bed but usually due to housing issues or more complex packages of care required sometimes people can stay longer than they really need. There is a national target around that. It very much can help with our flow and you can see that the average number of adults that we had clinically ready for discharge was around 18 at any day over that period of time of winter and about 40% of those were city patients as outlined. We are one of the few systems that are deemed to manage clinically ready for discharges more robustly than in other parts of the country and I do pay a huge credit to Justin regularly for that and the great relationship that we have as a system to try and help move our patients through and get them the right place, the right care as quickly as possible and we also undertake every week what's called a little mini-made. It's a terminology used in the NHS and it's about how multi- professionals come together, housing, local authorities, mental health practitioners to proactively review the needs of patients on the wards who are near and discharged to try and get them that support identified as early as possible so that that planning can take place and people can be moved on more quickly and the last part of the paper just explores that there were 13 occasions where we did use bed and breakfast for some patients, again people that we knew it was only a matter of days before they were going to be able to get that package of care or whatever it was that they were needing so they were risk assessed and there were an average of six days for those 13 people. Again, that did free up 80 bed days of availability for other people who were poorly and able to use those beds. So I think that's a summary of the types of measures and processes that we put in place and actions that we did to help maximise flow over the winter period for our mental health patients at the break-out unit. Thank you. Are there any questions? Councillor Sahil. Thank you. Can I talk about OPAL? So it says that your OPAL score of three was maintained for 96% of the time on the break-out unit I'm assuming. So the clinical risk for OPAL three is high so that means that for 96% of the time during the winter months the clinical risk in that area of the break-out it was high. So even though everything that you spoke about that you put in place didn't mitigate that and didn't bring it down. So what are you looking to do to put in to make it less usually so it's not about high clinical risk? Yes, absolutely. It's more about the pressures risk than the clinical risk because we have patients who are waiting in sometimes for beds. The new national framework actually means we're in higher levels of OPAL than we were before and that is now a new national benchmarking. We're not an outlier on that and I don't know if at some stage there will need to be a realignment because it doesn't feel that the OPAL is perhaps working as effectively as it could if we're all constantly in level three or level four and never in level one or level two. I think it's the first time nationally that it's tried to be standardised in mental health. It's been used in acute trust for many many years so I think there's possibly some learning about that. It is about the number of beds we have available, that's what it's a reflection on, also about the number of people waiting and it also takes into account how many people are clinically ready for discharge and a few other categories as well. that's how it's, that's how the algorithm works in the background. So it is, if we are regularly at 99% bed occupancy levels. We did change two wards around in March time, so just outside the timing of this paper. We had a significant dormitory eradication program on for our older people's wards that started in COVID. We were fortunate to get some capital monies for nationally to do that work completed in January and then that meant we were able to do a review of some of our other wards. We switched two wards which gave us five extra beds at very little additional cost and that has certainly helped from the end of March onwards with our occupancy levels. But yes, it is difficult to be able to bring our occupancy level down below for our acute beds below about 98%. We are regularly at that level. And I think it shows in our national benchmarking, we are spot on average with what we would be expected to be providing as an acute provider for adults. So we're not under with the benchmarking that came out last year, but we were pretty much spot on what we would expect per 100,000 population, weighted population as well. I think it just shows the pressure, the constant pressure on beds for mental health. So you're not concerned by being at that level for so long? That's a worry to you. It's not an ideal position. No, it's not. I would love to have beds free for patients regularly. We do struggle. I don't think I know of any trust in the country that has beds available like that. As far as I'm aware, I don't know, Justin, if you see any more national data, I've worked in other mental health trusts and having acute capacity infrequence to have beds just available regularly. Thank you. Councillor Clarke. Thank you, Chair. Thank you for the paper. Quite a few questions are raised coming out of the paper in terms of understanding generally what the baseline is. I don't really get an understanding of what a steady state is at the appropriate unit in terms of staffing levels. What the impact is of the financial impact is of a private provider coming in and what financial burden that puts on the service. And again, you say that the bed and breakfast places have created some or relieved some pressure. But I don't know the cost of that. And yes, you say you've received some investment monies. I don't know how much that is. You know, what is some investment monies? So I feel there's some questions that I don't know if you'll be able to answer today, but would be good to hear the answer to. I don't really understand in terms of how patients are presenting themselves as well. What are the, you know, what are the diagnoses coming through? It's a bit like the question that the cancer dempster raised earlier. You know, how many are coming voluntarily? How many are coming because of a section? Does this fluctuate throughout the year? There's no kind of pull-up, for want of a better word, around some of that, which leaves me kind of quite an empty feeling in terms of this paper, to be honest with you. I think it might be, might reflect a need to push to do some more work. Similar to Councillor Bonham's point around children's services and CYT, there's an adult social care impact here as well. Declaration, my wife's a social worker, and so I kind of hear, you know, firsthand some of the issues are presented there. I do wonder whether there's a task group around this work that might emerge, Chair. I think that mental health has exploded since COVID, and to operate at 96% all of the time must be very stressful for staff as well as the reorganisation that we know is coming. So I think that would be a good idea to work with adult social care to see what can be done. Just in terms of, you know, filling in some of the gaps in the paper would be helpful. Yeah. And it might be a further, you know, further paper to come forward with a bit more detail. May I come back in, Chair? Yes. Just to say, you know, apologies if that was your expectation. I thought we answered the question for the paper today, but if you would like, I mean, I think what you're asking for is more about the sort of day-to-day running of the wards. No, no. Can I just interject there? I think at the last meeting I suggested that we look into winter pressures because we've had acute UHL, the paper UHL, and there's nothing at all around LPT. I think you say that what I'm looking for is more than, but there are some basic things in there around, you know, financial impact and impact on patients and impact on staff that I can't see, and that was what I wanted when I suggested that this can come here, and I thought I was quite clear when I said that last time, and it's that level of detail that really put some colour to the narrative that's here. there's a sentence that drops off actually, it says the Opal scoring process is a fully automated, it's fully automated, and in retrospect we have seen that it reflects a similar, I don't know a similar what. So for me, I think, yeah, there are some literal gaps like there, but also some gaps in some of the detail that I'd like to see. Thank you. So we've put those into the minutes, and I think Councillor Dempster wanted to come back. Yeah, thanks. Yeah, unfortunately, I do feel the need to make him a couple of comments. Just picking up on what Councillor Clarke had to say, because I do feel quite concerned. Step down beds, you know, really important, great idea, blah, blah, blah, blah, blah. But in practice, and I think this is the issue that everybody needs to remember, what does that look like? Because I can tell you what it looked like, because my friend who's dead now, she died of COVID in a mental health facility. One day I got a very panicked call from her, it was about 11 o'clock in the morning. She was a very, very poor lady, she'd been in mental health facilities since the age of 16. She came out at the age of 18, she went back in at the age of 19, and spent most of her, the vast majority of her adult life in mental health facilities. And basically, she'd had a phone call, she'd not been in a local unit, she'd been sent up north to another unit, and at 11 o'clock they phoned up, they went to her and they said, oh, you're moving. Yeah, great. No, no discussion, no questions, no wheeling from fire, you're next to skin, nothing. When are you moving? Oh, within an hour. You know, you could say that my dog's spoiled, but I don't treat my dog like that. Never mind a human being. And similarly, the idea of bed and breakfast, I'd fit for the sake of six days. So, you completely, I mean, I just find, I don't mean to be horrible, I just think, to get into hospital nowadays, in a mental health facility, you have to be pretty poorly. You know, you don't get into hospital if you have a mild dose of flu, you have to have like double pneumonia or something. And it's similar with the mental health service, you know, you're a bit depressed, you don't get taken into hospital for two weeks respite from life, do you? You've got to be pretty poorly. So then, just as you're recovering, because let's be frank, it's bed, bed, bed, bed, you're out the door, you're disrupted into something like bed and breakfast for six days, and then, guess what, you're out of there, into something else. Maybe I've got it all wrong, but I really need to have more information in this report to help me to recognise that we are treating these people like I would want to be treated if it was me. Even if I take it on that very self-centred sort of level, which isn't very nice, but it just does not feel right. I understand about the numbers, I understand, oh, isn't this, you know, 96% and da-di-da, blah-blah, we're not level four, at least we're not level four, we're level three. That this is human beings' lives, very, very, very vulnerable people, many of whom are very isolated. They don't have lots of mates to care for them and advocate for them. So, I just think, I really would like to see more detail in a report that gives me the confidence that there is some acknowledgement of the emotional welfare and the emotional cost every single time somebody is moved. there is a cost. It's not about, oh, great, that's a freed up bed. It's an emotional cost to a human being, and I would really like to see that in a report. Thank you. Sorry. I think we've got one more, Councillor Hutch? No, no, no, that's okay. I probably should have put my hand up. Apologies. You know, Councillor Dempster, I appreciate what you're saying there. And, you know, every life is really important and matters. I think, you know, we're not trying to hide behind some statistics here, because you're right, this is all about people. And I was on all the Bradgate wards last night going and speaking to patients and staff. And it's, there's some very, very difficult stories and sad stories to listen to. And you are right. But when we, it is a real challenge when you know the poorly stories of the people who are waiting to come in. I recognize that. And then if there is an option for some person to go to a B&B after their risk assessment, and usually it's because somebody is not needing mental health support, because they're waiting for something else. Because it's only a matter of a few days, it means we can get that next really poorly person in. And it is a comp, it is hard for the clinicians making those decisions. It is not something that is easy to do. And I think my team do it with real great humility and great compassion. And if we didn't have to, we wouldn't. But yes, I'm very happy to bring some stories back, give a little bit more detail about those particular patients and how we do that. I think I just wanted to also mention that with regards to our out of areas, we are one of the better performing trusts in the whole country. In fact, we've been asked to give talks to many other trusts across the country of how we managed to have so few people going out of area, and that might feel a bit counterintuitive from what you've heard tonight, and you might think, you know, how can that be? But the fact that we have, we manage our flow pretty much at the top end all the time, you can see, you know, 98%, 99% of occupancy, but that we managed to do that that keeps fewer people going out of area, which yes, as Council of Clark says, has a significant cost. And our cost compared to many other systems is much, much less. And we've been seen as one of the best, one of the better national performers for having fewer people out of area. So it is a constant challenge there, and there's a fine balance to all of that. I think Councillor Dempster wanted to come back. I just have to say, that is an absolutely classic point in terms of the NHS for me. I remember when my friend went literally, I think, I don't know, a couple hundred miles away, and I hold my hand up, I wasn't very chuffed. You know, it took me half a day to get to see her, and half a day to get back from seeing her. So, but on the other hand, I hate to tell you, and I'm sure it is so much better now, because I mean, this was like three years ago, COVID, middle of COVID. But the unit she was in was so much better. She'd been in the Bradgate unit. The unit she was in was so much better. She so wanted to stay in it, and I so wanted her to stay in it. But she wasn't able to, she was brought back to the Bradgate unit, her mental health went June, and then she was moved, yet again. So, although I understand that people instinctively think it is so much better to be closer to home, do you know what? That is not, situations with human beings are much, much more complex than that. And it's not the greatest thing to be close to home sometimes, if it means that you're in something that's not meeting your needs. Sometimes, if it's going to meet your needs, then do you know what? You just have to swallow hard and be 200 miles away from home, because that is actually, it's a bit of a trade-off. But the idea that it is always in a person's best interest to be near her home. I would have travelled to Scotland to see my friend, so long as she was in the best place. And bringing her back, I know, was on somebody's data sheet, as a, oh, isn't that good, because she's not far enough, she's not far away now. She's near her family, she's near her next of kin, isn't that great? No, it wasn't great. She'd have been much better left where she was. Sorry, it's just, it's just about how we craft stories. And sometimes the crafting needs to be more subtle and more complex. It's not just a sort of like two and two equals four when you're dealing with human beings. I'm sure you, you would agree with me on that one. Sorry, I just had to say it. Rob, did you want to follow on from that, and then I'll come over to you? It was a slightly different point, though, if you want to. Oh, OK. We'll go over to Councillor Hatt, and we'll do it in order. Yeah, I just wanted to say, Vice Point, you sent 13 people out of, to a nearby place. I just wanted to know where that was. And on the point that I made, I remember 20-odd years ago, a parent coming to me and said to you, can you help me? My son is in a mental home over in Gravesend, and it was taking him the whole day to go and see him occasionally. But what I never understood, and I, you know, we've always campaigned to get services here locally, so nobody's sent away so far. Why should there not be services in a place like Leicestershire, when you've got the best part of a million people? You're in the East Midlands area of four or five million people. And so the population is there, the need is there, so why are the facilities not there to match? And why hasn't there not been any investment in order to, I mean, if you take those bed and breakfast cases that you had, and you were to add them as beds in your hospital, you would be an Opal 5, and you would, you would be automatically in trouble, because you would need those beds, so you were minus beds, and you put them in bed and breakfast, effectively, as a step-down scenario. Does any of these Opals further up the chain, trigger any extra funding, or is there any, so what's the point? If it's not going to change anything. Mark, I'm in, Chair. It does change, because, as I mentioned, but I probably didn't make it clear, when we have a definition of what level of pressure we're at, we do have actions at the back of it, which means we do do additional things. It doesn't release additional money or resources, you're right, yes, but it does mean that we will have more frequent meetings with, say, local authorities, to help with some of our clinically ready-for-discharge patients, that they could move faster, quicker into the accommodation, or the support they need outside a hospital. It means we could pull back on getting more people onto the wards to do more things, rather than being in meetings and things like that. So there are some very practical steps that we take to try and help provide more support onto the wards to help being able to get people whatever care or accommodation that they might need outside. That's the type of things that it does. So we've got a contract at the moment with St Andrews in Northampton for the PICUs, because that was the closest PICU unit to LLR. Thank you. I was just going to ask about the Mental Health Wellbeing Recovering Support Service, which I understand it was as part of the, as we talked about earlier, the savings targets that you have to look at and so on. It was announced at the Mental Health Collaborative last week that funding for that will no longer continue, which is a significant amount of funding. I know it's about £400,000 a year, seeing, I think it's seen about 1,500 people a year, delivered by P3, the third sector organisation. Now, I know everyone has to make these really difficult decisions about funding programmes, and, you know, it's not something you'd want to do, but have you considered the implication for that on pressures on further up the chain? And so, for example, at Bradgate, which may end up costing more money than a preventative service might actually save. So it's actually more related to outside of that. Probably what you just, I apologise for putting you on the spot. No, it's not coming on the spot. It's just because it's related, in terms of the prevention bit for people who end up at Bradgate, or coming out of Bradgate and getting that community support. So at the moment, the ICB has an £11 million gap in the funding that we will get for 25-26, and where we need to be. And so every decision that we are looking at and considering that have not been agreed at this stage, these are proposals. The scheme for the city, you're right, is funded 90% by the ICB and 10% by the local authority, which is just under £400,000 for the ICB and £40,000 for the local authority. Likewise, for the county, that's a similar position. So the total aggregated effect is nearly £900,000. So the proposal has gone forward at this stage. That service will, contract comes to an end at the end of October. And at this stage, as part of a number of savings, that is one of them that is being considered, but that hasn't been agreed. At the collaborative on Monday, yesterday, we shared all of the plans to be completely transparent about every single line of funding that we were proposing would end, to try and mitigate as many, or to try and limit the number of impacts on services, to try and reduce the number of impacts that would result in redundancies. But as you've already mentioned, as an ICB, we'll be going through that ourselves towards the back end of this year. We have not received the level of funding that we received last year, so the government took 9% before it came to us. So to pick one service and to focus that one service in this meeting out of context of everything else that we're having to do is a little bit difficult, and I can't talk to say exactly why and how. What I will say is that we're doing quality impact assessments and equality impact assessments on everything that we are having to be considering at this stage, but no decision has been made. And the information that was shared yesterday was to be transparent with the collaborative of all 30 of partners around the table to show where we've got to. But that decision has not been concluded. Thank you, Drissar. I do appreciate that. And it wasn't to put you on the spot, but it's just how it relates to the pressure that we're talking about with Bradgate. And I suppose if the decision hasn't been made, it's just a plea to say that you will be considering the impact of that decision on more expensive services because ultimately the saving, and this is a lot of money, and I know we've been through exactly the same in the Council on Public Health, but the savings in the short term might end up costing more in the long term. So make sure that's considered as part of the impact assessments and so on. That's all we can do. Thank you. Thank you. Councillor Clarke. Yeah, just briefly, just coming back to the two things, I suppose there's the lived experience bit, and then there's the presentation of the data, and we'll just come back to the data. It would be useful to have trends, really, because we've kind of got a year in isolation here, so don't really understand, you know, again, you know, what the baseline is in terms of understanding, you know, where we are and going forward if something like this is going to come back next year to understand, you know, whether there'll be improvements or not. So I can't compare January with September. It'd be good to compare January with January. I understood, and we've made a note of that. And I think the population density in Leicester, I mean, we've seen there's a good argument to widen our borders, which is bigger than some of the cities that are bigger than ours. So I'm sure that has an impact. Thank you for the presentation, everybody. We'll go on to Rob Mellin now, and he's at Neighbourhood Mental Health Cafes. Chair, thank you. And hopefully what Rob's going to talk about now helps a little bit around pressures and beds, and with Rob's question just before as well. But can I just check? I think we sent you a presentation. Are you all right to... I'm just wondering who's able to share that, if that's okay. Otherwise, we'll just have to talk to the paper that just checking the presentation's able to be played, if that's possible. Thank you. I'll try. That's been a good 10 minutes, isn't it? No. I'll pick up... I should pick up most of the points in the presentation, but there's just some more data in the presentation that's in the accompanying report. So I'm here to talk about the Neighbourhood Mental Health Cafes. People may have come across those, which is a scheme that has been focused on increasing crisis alternatives nationally. We've got a very collaborative scheme here in Leicester. We use mental health investment funding to really increase our voluntary sector offer locally. You'll see on the screen there are a number of organisations. There's nine different voluntary sector organisations in the city who operate weekly neighbourhood mental health cafes. And I think what we've got there is a mix of very local and some national organisations that have had a footprint in Leicester for a while. In terms of the offer itself, it's about having an open access offer for those individuals that are experiencing mental health distress in the eyes of the beholder. So very much about what someone's experiencing, taking that at face value and having that ability to walk into a venue and receive one-to-one and group support of people if people want that, or a quiet space to take some time out and away from the issues they're experiencing. In terms of the locations of the offer, it was great to work with Rob's team in particular and Council of Dentures as well at the time to make sure that we have got cafes that are located in areas with high deprivation and not only that, we've compared that with the urgent data sets that we've got as well in order to make sure that we've got locations where we've got high need, but also represents the diversity of the city as well. So the locations are seemingly quite accessible for many of our local population. And I think one of the features of the cafes has been about working with the local providers to ensure that we've got both insight and intelligence on the local community. And whilst we've got a consistent service specification that we, I guess, underpin the cafes with, it thrives based on the ability of the local organisation to understand the people walking through the door. So the organisations actually really represent the community first and foremost. And then the cafes are a feature of that community, I would say, in terms of the understanding that they can provide through their offer. And that's through coping strategies. They look at risk and safety planning with individuals. People are provided with the decider skills, which is an accessible way to provide psychological self-help and coping techniques with individuals. And I think what we've started to really see is that the recovery workers within those cafes have got a really diverse skill set. The expectation is quite high because actually the next person walking through the door could have a complete myriad of situations that are going on, experiencing, as I said, either a mental health distress or those wider determinants that are having an impact on the mental health and wellbeing. So we do a lot of work with the cafe providers around training, around raising awareness so they've got the skill sets to understand and either signpost or provide that immediate support. So that seems to be growing as well. So we're seeing the, I guess, the resilience in those cafes to do some incredible work growing and growing each time we meet and provide the meetings. Yeah, we could move on slightly if you don't mind. So on screen, you can start to see some of the contacts that we've had during N2425. So you can see that we've had around about just over 3,500 people accessing those local cafes and we can see that and you'll see that within the report we've sort of been able to collect information from those individuals to understand what some of those experiences and some of those distresses have been and we've got a lot of people that have suggested that one of those primary features will either have been anxiety, depression, Oh yeah, sorry. Yeah, there we are, there we are. Sorry. Sorry about that. So you can see that across the months there that's given you an idea of the contacts of the cafes during that 12-month period. You can see that we record and try to ensure that we understand who are first-time visitors and who are repeat visitors because some of the impetus behind the cafes is they're there for that support in those immediate times of concern and what we're really, I guess, expecting the cafes is that we can find alternative support for some of those issues that they're experiencing and the majority of that has been through in-person support but what we've seen is we've also got cafes that can provide phone support and text messaging as well as online. So if people cannot travel we're seeing that we've got a growing way of, I guess, having a digital way of being able to contact those cafes for those people that can't travel across the city. And that's been something that we've been developing because that hasn't been a straightforward offer to provide in terms of having just that range of different providers. We can see that in terms of when we break down the usage by locality you'll see on the screen that we've got various usage in some of our different neighbourhoods. I think, just to make some observations around this data, we've got certain parts of the city where we've got very, very active local organisations you'll see in New Parks that's linked to Team Hub who are a very active voluntary sector organisation very trusted by the community. But we've also got a very trusted organisation within Ayers-Monsau but that cafe hasn't been open for that same length of time. But we are seeing that we've got increases in that usage all the time in that area by being local and having that access. So I'd just like to sort of point out that some of the usage here may look lower in some areas but some of the cafes haven't been operating for that 12-month period just for some clarity. Thank you. So this is, we collect the data for the whole of LLR so we've tried to break this down so I'm not sure of the full picture that this gives here but we've linked this back to I guess how our neighbourhoods are organised within my team so in terms of the focus of some of our neighbourhood leads and where they focus on so the patches may not align to potentially some of the natural alignment that you might work within but we can see that we've got an east and a west and a north split there and we see that we have got really good access from that city east perspective so coming round from Rushy Mead and going through Bell Grave into Thurnview Lodge and those areas there so we can break that down for a further bit of detail on that if people are interested and would like that so sorry it's not broken down. I think coming on to our gender and our sort of demographic profile you can see there that we do collect in terms of our gender profile and we've got more women that are accessing our services than men. Typically we know men potentially in a cafe offer from conversations and some of the co-production work it may not be the ideal offer for men and there's some work going on in terms of men's mental health focus to try and better understand what the need is. From an ethnicity perspective I hope people can see kind of in the report they can't quite see on the screen there what we've tried to do is look at our ethnicity profile in comparison to the JSNA and I think that is positive we've got some areas to work on so we can see that we've got good alignment with the population in the city overall we can be doing more work around support to our black and African Caribbean population which is just under the local level and we've engaged in a partnership piece of work with the African Heritage Alliance to be able to support how we can continue to increase that footfall that's coming through the cafes and also where the location is but also we've got a bit more work to do particularly around some of our other ethnic groups that perhaps aren't represented so much in the cafe data so there's a bit of profiling to do there in terms of who those individuals are, what those communities are so that we are ensuring that we've got maximum access for those communities and then from an age profile we can see that much of the age profile is quite consistent particularly from a male perspective around individuals that you might see through sadly through some of our suicide prevention stats and figures we know though that we have got some work to do around particularly our younger adult age group around 18 to 25 because we feel that the data at the moment perhaps isn't showing that they're being representative in the cafe usage and we may have to consider what the offer looks like from that 18 to 25 age group we have got a university offer but actually what we know is that that might not necessarily capture those individuals that are not in education employment or training we know that there's a younger population in the city that perhaps we're not accessing so we've got more work to do around that age group and I think that's what some of the data is telling us here and again trying to work through that transition period as well when people may have accessed or started to wanted to access children's services what that looks like if they transition through to adulthood and how the cafes can provide support to them thank you we've tried to introduce as much data collection and tried to make this humane in terms of how much we can ask people the cafe offer is dropping so of course collecting information is important but we've always tried to be mindful that asking people a barrage of questions who are in some crisis and distress isn't always ideal however I think I can't say enough about the voluntary sector organisations and their approach they are providing us around information on disability you'll see here so we can start to see that we have got individuals that have got a disability profile that are accessed in the cafes we've probably got some more work to do around actually understanding the fuller picture on that is it a physical is it a mental health disability which will be interesting for us to really work through and I think in terms of how accessible our cafes are as well are they in locations that people can access if there is potentially physical disability by nature and then we've tried to introduce a question around neurodiversity and we have started to do some work around mapping what training needs we might have across our recovery workers within the cafes so that again we've got a better understanding of how we can communicate and make sure we've got a fit for purpose offer for people that have got those neurodivergent needs and that's pretty much about both the environment and the type of support that people need so it's been great to collect that information and it's quite consistent actually again with population levels of neurodiverse needs across the city thank you yeah I don't know how much time we've got chair but I'll keep going and tell me to stop if I need to again from a demographic perspective really trying to understand people's employment we know that those carers within the city again we've had a change in terms of provision and making sure that we've got an understanding of not only people's employment status but a bit more detail in terms of their occupation we are starting to see we've got an older population which is really interesting in terms of retirees and particularly those individuals anecdotally that are bereaved that are attending the cafes because they're at the ability not at the ability to cope with perhaps that loss where that person was the person who dealt with the bills who dealt with the household issues and actually we've seen that start to come through in the case studies we receive so it's been great to see that actually the cafes are not only just picking up an adult age group but an older adult age group as well including carers and that's been fantastic to kind of see come through the information I've talked about some of those presenting needs I think we've identified the top five within the report but I think we've got people that have got a multitude of challenges that are going on what we are going to do as well as we're going to amend our data collection for the primary reason for presenting at the cafe because at the moment we collect up to five challenges that might be experiencing and again I think what this does is although it gives us a kind of a profile of what we are seeing within the cafes actually there's some really critical needs that are here that even though they're not showing as high when you start overlaying them actually the needs that individual becomes greater so I guess we're not resting on our laurels to go actually it's just depression that we're seeing I think we're seeing some of the different challenges they will be exacerbating someone's depressive symptoms and so we've got to get to I guess ensure that we can try to support individuals when they come along into the cafes and not just it will be about depression for example and we've had a recent you know presentation on gambling concerns for example which again is a bit of a hidden need from a wider perspective at the moment so that just gives an idea there thank you and then we again we try this this is challenging about where someone might have gone where they might have gone instead of attending a cafe so it's anecdotal and it's based on the person's feedback so again we'd always we're collecting information because it's interesting to know whether people may have alternatively gone to A&E sort of GP support but I think again it's taken at face value we can't track those journeys through it's great they've got to the cafes but this I guess gives us a level of understanding about where someone might have gone it's not you know 100% accurate from a you know where they might have ended up but it's positive and it's encouraging to see that people are coming to the cafes which may be you know diverting away from primary care time for example into an environment that's set up for mental health support and if that's the right place to go to actually that's a good alternative from that data slide there thank you yeah word of mouth from a community development background and from working in our neighbourhoods trust in cafes is absolutely imperative someone telling someone else where they got support and that being received positively can be very encouraging to our communities and we know that that word of mouth is really important however this is telling us also we've got more work to do around referral sources because actually it should be part of the pathway and we can we can and we have got an escalation point within the cafes if someone has got distress we have got a direct link into the mental health hub we have got a direct link into the central access point so what we don't want to do is I guess prevent that early intervention happening we want to make sure that actually if someone has sought advice from GP there is a route into the cafe they can get that support quickly when they need it across Leicester people don't have to just go to their one locality but we've got to do more around that referral pathway and make sure that it's as good as it can be. Thank you. Chair I'm not sure how much time we've got this slide gives an idea of the support that people were given so we understand from providers what work was undertaken with an individual and of course the numbers are all different because everyone's needs will have been different but I think it's really again encouraging to see that we've got lots of one-to-one support we're trying to give people that tailored support that they need in relation to their needs but also we know that we can see lots of people being sign posted onwards and we are trying to utilise the other support mechanisms that are across the city for example the food banks you know vital sources of support it's been great to add that referral mechanism in there for things like that to cope with people's I guess very basic needs of being having access to food there's a couple of case studies that we've introduced here I won't people could walk through this at their own time what I'd say with this one in particular is that the signage and the awareness of the cafe being there was the reason that this individual had a positive outcome so the A-frame board the poster whatever you know sitting on the side of the street and someone actually you know it being visible there was support in the side meant this young lady actually walked through the door and started her journey it didn't resolve the issue at the cafe because actually that's for some people that's impossible but what it does is it actually as I said intervenes early starts that that's that support mechanism going and actually this is a really positive positive outcome for this yeah for this person in particular from a health outcome perspective and and I think just just in terms of we try to collect impact and feedback from service users themselves and this just gives an idea of I guess the importance of actually it could be a turning point for people walking through that door in terms of getting their life back but that genuine scheme that can be about starting that recovery journey just by having you know a chance conversation walking through the door and having that open access route so I've gone for a long time there chat I'm really sorry I think I would just say that I think it's a system I would want to say it's a system scheme so whilst LPT you're seeing here is kind of the logos on the corner what I would say is that it's been enhanced and supported by the local authority I can't say enough for our voluntary sector partners and how they've embraced that and also our co-production group as well we've got people who've lived experience and co-production partners that are supported with products with materials with everything else and I'm just I think we've got work to do still but I'm I think we're we're heading in a direction that's positive in terms of trying to redirection about potential traffic to the system that we can't cope with sorry thank you thank you Rob and am I right in understanding that wherever possible we train local people because I know in Ayers-Mansur there are two local people who are already part of the tapestry who are trusted in that area so when the cafe closes doesn't necessarily because it carries on in that community and they're people who are trusted and talk to each other one of the things I noticed is there's quite a lot of repeat visits and which is a good thing but then when you want to bring new people in how do we move those people on or don't we it's a great question and we grapple with that all the time chair and because what we've found is that for some people it is that safety net and people value the not only the connection from an isolation perspective that they value the connection socially with with others we work really hard with the cafes because what we've also got is other schemes that people could be connected into to continue their recovery afterwards so for example airs montal is a great example because not only does the they have the cafe but they have another grant funded program that enables people to walk into other support mechanisms and that's either through counselling or that's you know through their other schemes to the gym so what we're trying to do is work the cafes to have a very balanced view on repeat visitors and almost trying to find the balance between a safe place to go when you're in distress because it's the right place to go but equally a step in the right direction to other support so it's a it's a really it's a really it's a million dollar question and it's a really great question and and we're trying to to find the right balance for it councillor dempster i have to say i think this is an absolutely brilliant project you know we do not just because we worked one in together quite early on um but i mean it's just fantastic and that whole thing about certainly the one in my ward because i represent um new parks western park and the one in my ward is with team hub in new parks absolutely fantastic absolutely buzzing and of course the people go to the cafe but then at team hub there are all sorts of like craft groups and just just different coffee mornings and stuff that once you know that somebody's face and you know the layout of the building because you've walked in because of the cafe you are more likely to then go to other things in the building you're going to have that little bit of confidence and certainly i'll give a shout out to the guy in in new park gary and gary's virtually always in team hub and so if you go in and it's uh it's uh the cafe but then you go in another day there's gary and so you you're still going to have that that level of confidence and the other thing that i've got to say is this project didn't get off to the greatest start as i recall i don't know if you remember that rob but it did get off to a great start in terms of engagement with me and then and what they really had thought of were great places to start and and i i clearly had very different views and and you know what you listened and and we worked together and that that that was just so good because that that is the whole the whole way that we are going to improve services when especially it's the best way to work anyway especially when you've not got all loads of money is make the best of what you've got work together get that joined upness and this is a great example of early days working together listening because the local authority have a real expertise in working with local communities and the nhs were a bit slower to the you know to the game really with that and but you know you've you've you've i think you've come on miles and you've learned and we've learned from you you've learned from us and it is an absolutely brilliant project and i i would really like to see us sending this presentation out to all councillors definitely um councillor sahu i think what i and you may have this data already but on the demographics um we had the chat um in a few months they were talking about suicide strategy um yeah yeah number one was white males so you may have it but what i'd like to see is we've got males and we've got whites those white people could be all females um you know and the males may not be white so it would be really good if perhaps we could take that suicide strategy and then sort of link it in with the brilliant work that's happening at the mental health cafe and really focus in on some of those key um people or groups that they've identified that they're at risk and see if we could really sort of direct them into this because it's the outcome has been fantastic yeah um rob yeah i just want to absolutely echo uh sentiments as uh fantastic and um i also wanted to thank you for the some of the some of the quite difficult conversations that we had when we were deciding on some of the the second round of cafes with pressure from some of our colleagues in other areas of llr whereas when you look at the the presentation about where people come from um and you've got three and a half thousand people coming from the city and three from russians i think i think we're right i don't know you couldn't possibly come up but i think it illustrates the level of demand from the city and that you've reflected that in terms of the delivery of those cafes in the city so thank you councillor clark again yeah very well presented and um uh yeah and very impressive i think i was quite sceptical it's probably because councillor temps was quite sceptical at the time i became quite sceptical um as to what they you know um but you know you've demonstrated you know real success with you know some really good quality data that you provided this evening um i think as councillor sorry says there's probably some um you know some interrogation that would kind of that might reveal some other other things we might look at but i take your point about not wanting to badger people in their hour of need it has to be done very sensitively but just you can't some having a look at some of the data that we already hold and cross-referencing would be um would be really really useful um there is one bit of data that is missing and that is how much does it cost and i only ask and i only i only ask because you might be able to um you know look think kind of monetize you know what what you're preventing as well because of that and that might be an interesting figure to come up with um yeah no problem so each of the cafes on an annual basis receive um a 30 000 pound uh grant um for provision of the cafes and that's to provide um up to six hours of um office six hours of cafe time per week so the scheme in totality across llr i think is um 626 626 000 um and that um we've got 16 providers uh we've got 25 cafes and 44 sessions um a week so um we've done some you'll see in the paper we've done some modelling around um other midlands based um cafe schemes because we're not the only one in the in the country um and in terms of um a period of care if you like through the cafes it benchmarks it benchmarks quite well in terms of being low in comparison to other areas i think it's works out at 77 pounds um a person in the in the city which is uh i wouldn't be the expert but i think from other schemes and programs we've delivered in the past around about 100 pounds mark i think is can represent quite the value for for money um again there'll be more schemes uh than that council clerk that operate across the country but we've just done a um a bit of baseline work around the black country covensham and warwickshire and berling and solihull um which are quite comparative population wise as as well so um yeah so that's where that's where we're at what i would say is we haven't had an increase so um the uh again um the volunteers are responding fantastically um uh in terms of um how we operate the the scheme financially um and so yeah we're we're we're really really pleased with with how it's stacking up i guess from that perspective i think it does say about value for money not not just in monetary terms either um if they repeat visits to that cafe they're building their own network in the community as well um so i think it's brilliant value for money councillor clark oh sorry i looked at you and said councillor clark why did you not answer councillor how what i wanted to say is first of all congratulations to the team because it's absolutely fantastic and to the executive for actually being able to deliver this on such a scale and and actually engaging with local communities and getting help to those people because each each one of those individuals if anybody falls over it costs us 10 times the amount and it is it's it's it's better for them better for for them for the rest of the population and actually it works all the way around because it's in their locality and the fact that you're using some really good sort of local partners voluntary sector is really useful and it helps them support other people apart from this in other work that they do as well so it's it's a win-win all the way around um but just a slight worry is this money going to be ring-fenced and is this service going to carry on with a little bit of an increase because everybody's national insurance costs the rates have gone up and all the costs have gone up is this going to carry on and is the icb committed to making sure this is going to be funded for the future anybody want to take that again back to my earlier point yes we're committed yes we put it all in the plan the plans have not been signed off yet so yes we're committed but i can't sit here and say yes absolutely everything's happening because until our plans are agreed um it's in our plan to be continued it's something we're really proud of it's something we've invested in it links to all of the new outcomes it links to neighbourhood working all of the outcomes that you've heard today but i cannot sit here today and tell you categorically that it will be funded until the all of our funding is signed off from an icb perspective so our commitment is yes but i can't say categorically on anything at the moment until we get through the next few weeks thank you um i've just got a few questions myself so we're looking with the mental health unit and the stepping down is there any referrals that are feeding into those cafes and um the neurodiverse bit as well especially with um not particularly with school children obviously but with parents who are really struggling um is there any cross referrals going on so there's a um there's a work stream that's focused um on the inpatient pathway at the moment in terms of supporting around that discharge piece so we are um working um with the team at the the bracket unit to consider how the cafes could become part of someone's um plan when they're when they're moving on from from the bracket unit not only that we think about community mental health teams how does it become kind of a core offer for anybody who's in in distress within that what we need to ensure is that we've got a really um strong way of being able to hand people over um who potentially have been um supported by the inpatient services or any of the mental health services because what we need to ensure is that the voluntary sector again i think goes back to my point are the right organization the cafes are the right um support for that individual however what we're confident about is that as a place to go to in a neighborhood when you're in distress and then having that escalation point means that even if the work can't be completed by the voluntary sector organization actually there's a there's a there's a pathway there's a route for that individual to be escalated to the right support so what we're trying to do is to work with and it's not just within the cafes but think through from a neighborhood perspective how do we create a much um clearer offer for individuals when leaving that actually could support people um to go away and continue to recover well um in that community so having the right connection so we are starting to work that through chair and i think it's important that we're on a journey with that because again for the voluntary sector organizations we have to ensure that those staff are also have the right skills and that we're not creating um i guess undue harm for those individuals psychologically if it's something that's beyond their their skill set so you we have you know so it's important we just need to step through it and get the right get the right um process in place for that to happen and my next um question was going to be about um some stats on on the people who deliver to do with support and all of that but i think you've answered that but um i think targeting the isolation with people who are stepping down or parents that are at the end of their tether it's in their community so they're going to get their own support network hopefully as well as having those talented individuals that take all of that on board but like you say they need supporting as well so we have over the last 12 months developed a uh psychological framework for voluntary sector staff so what we've been thinking about is that it's really important that we maintain support the maintenance of the recovery workers mental health and well-being we've extended that not only with the cafe providers but to our grant partners as well because what we're really aware of is that actually having a healthy resilient workforce with all of those skills is really important because vicarious trauma can have a significant impact on individuals and what we want to make sure is that whilst these cafes are thriving in terms of support what we don't inadvertently do because we have got local people working in those cafes is have a negative impact on their very mental health and well-being so we've introduced um um that framework for organizations and we've also introduced time within the cafes to make sure we've got debrief time for individuals so they can debrief before they they leave that that cafe scenario to try and make sure we're looking after those staff as well so um that's been a really great addition this year i think thank you and do you think we'll get 25 cafes we've got them what 25 is that 25 sessions or 25 cafes no we've got so we've got um there's i think there's just over 40 sessions per week across llr total so the 20 the 25 cafes at the time came about because that's how many pcns we had back in 2021 so we mapped a cafe against each pcn to make sure we had a footprint but it's gone beyond it's gone beyond that because the pcns from a geographic geographical perspective don't quite align um but we've managed to be able to i guess extend the provision um through having more um more sessions per week delivered across six hours so we've we've actually gone to just over 40 sessions a week across and that are so it's it's it's yeah it's it's sort of met that expectation thank you are there any other questions okay uh thank you rob and thank you justin and sorry tanya and thank you for everybody coming tonight that's the end of our session um thank you for all the work over the year thanks