Transcript

Good afternoon and welcome everybody. Welcome to our new Sea of Honor, Mr. Maurice. Good to be here. Thank you very much. I'll see you there. Okay. Do we have apologies for the current joint summit? I can do any declaration of interest. Any questions? I don't know if it might have. I've always, in fact, I'm working out of technology, although it might be something, even though it is sort of like, potentially you're going to get the meeting. They always might be. You know, without the emails with everyone. Okay, I'm going to create public health declaration. No, I'm trying to do that. And before minutes of the last meeting, we have the 20th and March. Has anybody got anything? I don't know. Okay. Okay. I'm going to try to push this aside. I'm going to just as well. Sorry, my apologies for not many of you. And unfortunately, my father will not take you rather. So thank you for letting me come today. And I just make a few gently brought comments by the paper. They didn't say questions. First of all, I wanted to thank formally the council. And see here for the additional resources that are not into our social care to get the way to get down on safe. It's not a easy thing for you guys to find money. But you did. I think everyone has to never happened to say any for that. It's an ongoing problem issue. The goals in terms of making sure you have to start. I think when you were a part of that, it should never happen. I'm just going to do a few areas then. I commented last year about the safeguarding and a good verbal rapid building process. That's continued this year. Has a major benefit. It's been both being financially cheap. It's a run system. It's a quicker process. But more importantly, you get the learning out more rapidly. And if we're going to engage with the learning reviews from that for a serious instance, the mind market is important to get the learning out as quick as possible. And being able to do that in three to six months rather than a year or so. It's really not going to be quick. We spent quite a bit of time in this last year reviewing self neglect. And you might as well might not be aware that. I'm just looking to an amazing podcast. One on financial important scams and one on what's called executive function. So, one's ability to cognitively process information. And although they are with the ship products, they use nationally. Although it's a country and by many people. Really important is their self neglect. I think often we have a view that people deliberately self neglects. They call what they do things and we wonder. And I think sometimes we just underestimate the impact of people's declining cognitive function. So, for example, by using the podcast. And if you had met my mother a few years ago, we did for what a spryly young lady. Very capable of very articulate. But actually, if she got a packet of having the fridge. She'd be able to read the cell by day. But not understand what the cell by day meant. So, if she ate ham beyond the cell by date. Which puts her at risk with food poisoning. Is that self neglect. Or is that actually because of her cognitive function. Executive functions, you might pass many mental capacity tests. But not understand the new ones of the cell by date. And therefore could be perceived to be self to get it. And so, I think in the next few years, we've been thinking about it a lot more. The new ones as a new complex is around mental capacity, mental capacity stress. I do not buy any yes or no. They are complex. Hence the reason why I wanted to do that work. We also took on a fair amount of work reviewing and continued to review the exploitation strategy. In the last year, there have been a dramatic review of the rust sleeping issues in the county. And that's been taken further forward with an assurance of now, which includes people with lived experience of rust sleeping and bodies involved in that. And that's gone down really rather well. And kept that community really quite being a secure handle. So involved in those practices. I also mentioned last year, the development of the calm process, the complex handle of this management process. And again, I want to thank the council for and other members of the board for finding the additional funding to continue with the calm process. And just to pause what do you mean by the calm process complex handles risk management. The most complicated, risky time people often fall through lots of little holes in the system between agencies between people people. They're often the most difficult people to engage with because of their lifestyles because of their situations because of the complexity of their situations. And the calm processes are nothing really quite remarkable work in this area that really agencies together and finding innovative ways to meet with and engage with some of these people. The ideas of having appointments and meetings with people in coffee shops, tea shops, other places, not just expects them to turn up at a normal place of it. It's really right to be commended and the engagement with some of these people and the impact is had on their lives. I think it's really like profound and quite significant. And you're one of the few councils in the country. I think that's invested in doing so well in this area. So, I think it's important that I chair has said, I think for jazz, we have the same problems, but we don't have the same solution. Thank you for that. I mentioned last year, finally, that I believe starting is going to be an issue. You have made, I believe, moves towards ensuring that social care staff and getting slightly more paid and we were getting before to go contracting. To me, I think the biggest risk we have in the adult care arena. It's going to be the next few year, lack of nurses. And I think doctors will have plenty of. It's going to be increased number of medical schools up down the land medical schools that we have bubbles in size. And there's already some evidence in the system that, you qualify doctors are struggling to find placements. If you talk to your level universities and universities around, they are really struggling to recruit people into nursing degrees. That's going to potentially be a quiet problem, but of energy being put into how do we retain staff. If actually people don't want to come in the profession in the first place, as we increasingly have more and more adults with complex needs and an older population. If we don't have the workforce at all. If that's going to become a real problem, I suspect to be safe about involved in the land in two or three or four years time, it's going to be best by that problem. It's clearly not a local solution. But the question is, you know, during the pandemic, we had that sort of clap for the NHS and there was a spiking number of people applying to those things. And since then, there's been a, you know, this may drop off. That would be something that will affect us all and unless we can do so, let's turn that around. My final thoughts are, I've done one CQC inspection in one of my book authorities, Mr. Berkshire was one of the pilot for science. And I think they had a, they were well prepared to see CQC and for my observation, I believe the Bureau was so in a very strong position to be expected. So you've got many happens and I'll be there to answer questions on the inspectors. I think I paused that, but we didn't take any questions and that makes me so. I've just got one question. The process is something that we can look into further to see how it's working and maybe have some case studies. If that's possible, it just gives us a bit more of a new science on what, why. For September, it's more traditional briefing paper with some case examples of real life individuals and how it's made difference those people's lives. Yeah. Okay, you do have some questions. Yeah, thank you, thank you for the report and really good. And just wondering about this. There were three, was it very safe counting with you, it's the only one we're kind of generally this kind of. And German lessons that you can learn from those and things across the game or anything that you think is really relevant to us. It's important that it all came out of those. Sorry, I'm sorry. So the chairs, the song. The issue that's coming up. Yeah. So it's professional curiosity. And that's actually not so bad. That's come through the nationals. And so I think that's recently done so nationally. That's something that's emerging as a. And locally, I think we're seeing a similar pattern. There are two other areas as well, actually the national, the national review of all songs just really published cloud. I think two weeks ago. A special curiosity, certainly collect and still mental capacity. The national three views. I think it's not always even good, because I think we're finding that there are different issues around the application, the mental capacity. I think the basic level of assessments, the quality is better. But it's the more important issue, like big, long bookies was just giving earlier about the cell by day on the hand and that book, being able to act on decisions. So I think that's different issues around the same legislation. Also, making sure that everything purbs mind every thought to slow the making, they've got in personal. So that we need to make sure that professionals are still taking that into account, we very much come from a culture where say, closing the valve, you're, it's done to you to make you say for all the comps, whether you like it or not. And it's much more these days, we'll be looking at what the person wants that famous quote by judgment be about. And there's no point making people say, what we're going to do is make them literally put as well. So it's about trying to get that balance. And then the other thing, multi agency working in information sharing and that's, that's like a calm, kind of in the farm frame I come in. If, if somebody is subject to a same kind of inquiry, we'll be sharing information and we'll be working together, but it's making sure that we're doing that in other situations as well. So that's, it was from the learning of the process that we introduced that company. So that's our main areas, we're currently seeing that we've got. I've seen them. I have pretty good confidence that most of the council staff. A reasonable, good understanding in the meant past year. I don't have the same degree of confidence. In the health and social care sector outside there does seem to me, we commissioned a lot of work, a lot of work is in the private center. Yet most of our understanding and what we understand about it is in the main health or the main social case does that make sense because that's what we know in the most. And the further it is away from us, the less observation is of it. Yeah, and the less understanding and that means application is new ones and those sorts of things. And it's much harder, you know, the training. Often focused on the main social care health care agencies, not the smaller and smaller private center lot because they have lots. And as much as invested in that, in those sorts. So, that's the biggest reason to say it's only in the other floor, I'm sure. Yeah, someone was considered to have a clinical capacity, but different interpretations of that. Some people thought, Oh, I'm in there, but that is not what we mean by having. There's so many subject nuances, so is it more kind of getting out training out to those smaller agencies that we work with, somehow we do that as a basis party trading party changing attitudes. So maybe for me, capacity is all about consent. So how many of us have some consent for an operation in the hospital. Anybody would do it fully involved, understand anything. Let's be honest, but I was trying to have that moment, just do it. Yeah. And so it's really interesting when you start thinking about capacity and those sorts of terms, informed consent, do you really fully understand all new ones of the strategies of what's going on. Yes, we understand most of it, or couldn't understand most of it through to us, having no understanding. And I think the problem is we've started to realize is that mental capacity assessments should not be binary. Yes, or no, you have all your. You might well be able to make lots of decisions about lots of things in the lives, but not in other areas. Finance is another one, isn't it? Many older people, you start talking about complex singing plans and whatever the investments. And it's completely over. Yeah. And yet organizations get them to sign at the understand what they're doing and what they're investing in and all that sort of thing. And they do not have the capacity to make those decisions. And this is where we're going into starting to understand that world much more. And therefore, it's not just a let's all do a two hour training program, it's understanding how we personalize it in the way Sarah mentioned so that we actually does the person makes sense of this or not. And of course, in the rush of the moment of trying to care for lots of people and the loss of pressure. That's when assumptions get made because it's easier to quickly make an assumption, rather than actually find out. You might give it an example of why God's father started to care for you. I'd say he's got mental capacity over respect for people who understand. But maybe because we've got a returning to have that activated to just in place, they contacted me and said, what, what to put on the respect for and I said, no, he understands that decision. Don't need to have that. I think it's that so the new one was isn't it. So we've been the year saying there's a presumption capacity. And people have really taken that on board. And so what we're getting now a lot of the time is in the notes has capacity. No, we're saying the puns are taken, and we're thinking, oh, no, there's reasons to doubt that people have just got a perception of capacity. So that's one of the reasons that's coming up when we're realizing, yes, we gave the training, but maybe we, maybe we're going to explain that bit fully. So it's just all the time. What have we said? What have people understood by it and what are we getting in practice? I don't know, certainly at the end, but so I know a lot of adults are similar. Yeah, I'm a doctor clinician. I'm going to make the best interest decision. Yeah, again, I think I'm going to be good. I mean, it's a problem with the term. Because the best interest decision. Technically, it assumes that you've understood what the person wants. But professionally lots of people think, I know what they've got the person, because I know that this is in their best interest, as I mentioned. Yeah. And so it was still coming to that middle ground. Yeah. Let me manage all of that. And Sarah Sprite, one is gone that way, another good to go that way. And actually, it's a much more subtle than he wants. But the take that point further is that, if you were to know all the influence of what you have done, then you will go to the next thing. Because if they told you and said, I'm going to be with them, I'm going to be with me. But the problem is, you could don't read that. That's what she wanted to do. And then I've been getting on a setting. You're my professional career. I'm also dealt with that. I'm a man who tattoos as well. You tell everybody, well, you know, this has been aphasized. Do your liver in five years time, you get cancer. It certainly could. Yeah, you have to think of what they are coming for and the benefit of getting what they are, what, what they want without writing that. At the same time, but giving them enough information. Actually, it's an idiosyncrasy that he could do in any local energy. But statistically, you're not. Yes. And it's safer to have the every second, then not to have anything. But you could die and wasn't around to buy any groceries. And so, we've not allowed, we encourage people to do that, don't we? But you don't have to sign that. And this is exactly it. And in the signing for it, sometimes we all head to one direction or another direction. I'm trying to make it so much more so. Thank you. Can we have a question? Yeah. Just a couple of other variations on this. You say violent and graphic facilitator and magic recording. You just give me a little bit more. If you want to talk about magic, it's engineering. It's when you're talking about learning lives and getting new. And then that graphic facilitator. Take into account the basic way people actually live. As an example, we can. We have had a number of other issues. And that's because actually I was in the right room. And unfortunately, three of them have been found. And the results of the infected. I'm not sure that they have to be taken to account what they're doing in other areas, but it's just across the board and we are very close with people actually. We did that right there. So the graphic recording in this event. And it was a joint event with people with live experience. And the same person that we used to do the animated podcast. Basically able to take the 10 minute 12 and draw cartoons and animate it, which is very good at them. It's very, very broad as we're having our meetings and produce these graphic works of our art with cartoons and structures and graphs in them, and it becomes a visual representation to the meeting as opposed to set of minutes. And particularly useful often when you're working in the learning difficulty field. Or when you're working with other people with lived experience as a way of capturing their thoughts and their feelings and a summary of the day or events. And we found to be very useful. That's why we're recording it here. Rather than just being a 10 pages of minutes to be signed off three months later. We did that on our website, but the actual freeze that they produce without event time. And then we used it to have to develop an option camera for ways that people just see through that. She's different from that. And we did go back and with the people that participated in that then we share them updated songs where the work was going. So it was, it was a mechanism for record and I think it's been used across the car. We've been using building together the same facilitator it's an organization does that but it's really quite powerful, easy for some people to invest in. That's fine. Really to do with learning the life index, life index. We did share the findings from those reports, and I don't report that the use that have been done on people with a learning disability and we did share with that group some of the learning that had come out of them. We use the event to actually understand better their experience whether they have similar experiences and what the issues are they face and then in the final report that came from that that some of the issues that they had was around. The issues that came around the work around the increased use of telephones or appointments of GPs in the hospital they thought they really struggled about the sort of timeframe that those appointments are given sometimes there's three hours windows and they're waiting for an Africa to be with them and not always have an Africa. That was some of the issues that came out and I think some of the professionalism of the way people treat them in some of the situations came out there and closing was an issue that came out. I was in there as well into for some of the people and I can find more specifically some of the areas that came out around them. Yes, so we just gave that and got some actions that we were based on that. Thank you. It was made for me to do with the section 42 information wrong and there was another that was a section 42. I didn't know this thing was quite quite that meant. It was not. Yeah, I was paying attention to. The level of relative duty to make an inquiry was when some criteria and then person can support me. There is the risk of these threat and the result of the codes for the family. They're able to protect themselves against the risk of that. So that's what section 42, we should have put parents after it and being technically I shouldn't have done it before. We do. Another British isn't. So that I'm going to explain what we did. Things that are likely to be discussing around mental capacity issues that are quite not black and white. We need to know a thought about sometimes like more complex and therefore. We just turn the wicked issues, things that we're trying to do. They're not wicked. It's in a sense that we're bad. They're wicked in terms of like problematic and complex and then it's not so. Yeah. Things change quickly in those areas as well. But the complex really complex ones that took me complex. I was wondering what really was going on. And I said bridges and actually it was a previous chair. Wasn't it still like this chair. So you came up again. A number of issues that the board has in terms of. I let somebody else ask questions. I'm not going to go to the meeting. I've been to a year. I'm not going to go to the meeting. It's crazy careful to clearly run it to be you. They are up and running and trying to find their role within the system. But say that you're having a board. Is set up under the care act with the statutory responsibility to do certain things. So actually technically the integrated care board should be responding. Sits underneath. The state is on the apples towards that make not parallel but underneath it. The state body board that I had the people to chair on. You're wasn't on the half. The care act's responsibility for holding all of those agencies together. But at the same time integrated care board is really trying to bring together many of the health components on it. So sometimes. Sometimes integrating health means. We're going to carry out these how to read primary secondary care or community hospital care. So we're interested in a much greater level of integration than that. And actually not just the integration of the care of the main, the ball is on to respond. But the main statutory agency, but also the community agencies. So just this morning. I met with the people responsible for delivering feedback. They're not helping and they're not working with them. They're not any mate, but they divide a huge service to the community. And the ball has responsibility for everything. So, and. Over time, we'll have to find effective ways and we are finding effective ways of working with the actually big. They're just finding their new feed them open and then. To. I don't know whether it's going to be that many more years, whether there'd be further integration. So we were generally really motivation. And I just have in terms of application where it's coming really. We go back to the complex office management framework. Every one of those organizations signed up to it. So when we get a case and we have a few cases and I would like to engage with a service and one of those partners. That gives us the vehicle and we have used it to go back and say, we need you. We need you around the table. And so, you know, it's going to be very tricky. We now have somebody that tends from mental health at every car meetings and then we'll identify the right person from the pool. You have drugs, who should be there. So, by signing up to these policies, we can hold them to account and make sure that they deliver around the frameworks that they agree to them. And then we can ask questions if we're hearing issues without partnering organizations. From Bling's, we can ask them to present. And you know, this is what's going on with regard to this particular hospital award. But I don't think we can award them to come together and ask that. Yeah, assurance or otherwise. Thank you. Thank you. Just kind of following on actually. Back on the stage and then. I was on health over you and scrutiny. We were. Really shot. At the last meeting of the last meeting, but one with the CQC report on the. I don't think we should have a chance. Because to many of us, you know, we do attend health and wellbeing meetings that are sort of familiar with the. And our check service is that kind of came out of the. So, your set of safeguarding, where they're warning signs. Particularly particularly inspection around the. Mental health in patients with a tip around the wheel and a lot of concerns from start. In terms of this organization culture. Was that something that you have spotted or. So, you know, we were. Aware of problems. In that sector. It's over a year ago. And we've been having a regular update reports. From the trust. After what's going on there, the staffing levels, how they're managing it. They're doing to recruit new staff. Because they were having the staffing problems to run this unit. A lot of dependency on agency staff. And so we've been receiving those quarterly. So, I think I got to say, one of my colleagues, and then we were looking at what was happening in our operation. By infection 42. So then we have a sort of conversation about it. There's something that we need to be writing on the board level. You know, keep them fast. That's what you contact us. So people come to us and then we start doing what they're doing to address those concerns. The only thing is the information that's being paid to it. So, you know, we're going to be 100% on top of this. But that was a great example of how it worked. So we, we, we don't do like another CQC type thing and go and inspect the chair, but we, we recognize an issue. And we, we the board, our chair, so I have been certain that I want you to assure me that you're doing something. Tell me what you're doing. And I will monitor that now. What has to take the reports on face value. I think there is something they've been considered reports and demonstrating the dash and it's taken the issue seriously. But it's never pleasant on your own patch. When a part of the system is in trouble to put it. You know, it's worried, isn't it? Because at the end of the day, they all people in your citizens and your neighbors are talking about in that system. But one to have those sorts of problems about stepping again or culture was a big part of it. People should culture don't want to deny that. And that needs to be addressed. I think it's been addressed. But again, it was a lot of it was about stepping. I'm back to my comments. I am not an issue for that. We have a problem in our society, not this infrastructure. The jobs that we expect people to do. For some of the most working with some of the most vulnerable citizens in our society are not perceived to be. The jobs that the brightest in the best in our schools aspire to do. Yeah. If you're going to three A to A level in the local best schools, you possibly think that if you're a science A level, I'll be medicine. That year apparently not thinking I'm doing a nursing degree. Hopefully you might be thinking about becoming a social worker. You know, that's not that high of their eye. Whereas I think we've got to try and change some of that and sort of recognize that it's not always about paying anymore. It's about actually how we recognize the social welfare value and all these sorts of things. I mean, it's interesting. I was talking to the Prairie Vice Chancellor, which is just in the day on this on the ICD people board. They can fill the paramedic courses 10 times over. They've always been a paramedic. Is that because of TV and 999? I think it's something that I see with me. Because to me, it's still shift work and it's still pretty gruesome time at work. But the nursing courses across the country are really struggling to recruit. Maybe that's because who wants to go to university, have a £50,000 debt and come out working as a nurse on expounds of the year. But the amount of your sort of issue. I think that in combination with the demand on that, I think particularly with that, I don't think they've gotten that definitely people are much more aware. And so we get more referrals and people's expectations are high as well. A long time ago, something difficult is that it is difficult, but we do always know one of the agencies. If there are issues to be a update that's been in our meeting. So there's the opportunity for agencies to raise sales with their issues going on. So when we did have that, that gone, the same question was, we raised that to the board. Obviously this is what we're doing about it. I mean, there's lots of information, lots of interesting conversation around it. Some of us are in politics for the reasons to make life better for nurses and to reduce the odds because to recruit them for those professions to be more valued. We are in the difficult place. And I think, you know, some of the kind of bullet points that pick up on the kind of learning and improvement from the calm process. But also, if those are improvement, it's like there's a risk built in within systems for those who come on the process, you know, continuity and consistency. You know, your relationship with a social worker, your relationship with your social prescriber or whatever, and we, you know, are really challenging. For the individuals, I know support individuals. I'm a part of the Department of Work and Pension, which people to upgrade is to be really really difficult. I hope this doesn't sound too political or political at all, but I think it'd be reasonable to say that we are society in quite a difficult place. In terms of caring for vulnerable members of our society. We are struggling as a society to know how best to care for an increasing number of very old people with capabilities. I don't think that's actually any political parties thought I think all political parties are looking for solutions. We need some very serious leadership in these arenas. I, I passionately hope that people start to read some of the books and materials are right on these things. I spent a lot of time with this. And it feels like people don't look for proper solutions as well as they used to do. We were always knee jerking, but we do need some very serious thinking as a society as to how we're doing for some of these things. If we don't, I think we're going to have a few more years of what you're hinting, you know, we're looking at things and thinking but it's okay is when it's not that good and there must be risk and we're constantly managing ever greater risk, rather than reducing or getting rid of eliminating the risk. And that's not just about money. It's not just about resource. It's about attitudes. It's about thinking things through. It's about how we work. It's about good quality leadership. But boy, at the moment, we really do need it. And I'm coming back again. I cannot give enough praise for people like this, they have to manage in this world. I used to be a systems rights and social services 30 years ago, and it was a dog or cocaine. And if he was a journey with me, you know, when I was versus social worker, I think the things that I was able to do. I was encouraged to do that, you know, it was part of the good practice, whereas the problem is we've had so many years of cuts, cuts, cuts that would now just was so limited. And it was a time to now that limits. So let me get into talking about professional curiosity. I think professional curiosity is all lack of it. It's a by a father of everyone be constrained by the system and the structure and the funds if that makes sense. You stop believing in call that you can do, imagine some good things because you don't think the system will allow you, even if the system will allow you does that make sense. And then the cycle, you've got to change those cycles. That's not just political that is the societal change we're going to have to have. If that you, you take on to do these jobs that looking after the global people, my nephew is 30 incentives, very vulnerable, can't speak. And we had a couple of same part of issues, not the system. And one of them, very simple. The care was using household wise, instead of baby breaks up. And that is just a communication. Thing you think, fair enough, there is cultural issues, but that towards is a simple thing. If you know a household right for a baby boy, but, but we have a few issues and I think it's the retaining of these that now he's got some care is now who are absolutely fabulous. I know him inside out, and people on his complex issues, but he's very complex. I know he was fired out, but you could go and sit next to him and wouldn't know what needs to be done. And sometimes people are being pushed into these jobs without the exact training, because it takes a long time to build up the relationship with some. It's like somebody to go in, and to know the difference between some white ones and something. It's quite seriously profound, isn't it? Yeah. And we had a section. There's an 18 currently question for just last year to be not. And she went to Sheffield General Hospital, because she had in growing eyelashes. So she was going inside and so she went into the general hospital to have her eyes. She was dead 16 that 16 days later, because of malnutrition. Because nobody knew how to communicate with it. Yet you could communicate with it, just started knowing how to communicate with it. Now, you know, what is going on in our society in the 21st century. And there's a lot of reasons why there's sorts of things happening in the college jumps on there. And it is all these very small subtle things you're describing as to how you communicate the other sorts of things. That's my question. Yeah, that for me is what safeguarding boards are about, working with the like Sydney South and others, to actually to how do we try and prevent those things because the children will never stop them all. But how do we communicate, talk about these sort of things and try and drive on thinking that practice. And as well as the nurses that you said that real concern about nurses coming through the system, people coming into the system, a lot of the people who are working in the system are sort of pensioners. But they haven't resigned because they enjoy the work they're doing, but often they're absolutely like I'm an engineer, and I'm still working. And so, so, so, for that, I, I enjoy the work that I do. And, and, and, and after I was born, then we got good to say a county who would be my master's wife, I would have gone. The people coming through often haven't got the skills because I didn't get a deal. They're two pains and they were multiple, just been through the things that it was, you know, and then go and I've been no concerns about being keyword for that will be the site to represent it. You can go home and sort of like the other side, it's a real concern in health and surgery there, about precisely where we go because we are not working the most vulnerable in society. We've got to have when we get access to the community to the language of course, you know, not go and tell the access to the community. When we do go to where the people are. Of course, you're absolutely right. We support, but basically, we're always one step ahead. We're always making sure that, whether you walk this site, whether you go in this site, you'll follow right on the go, this site, it's a constant thing. A lot of people love it, but a lot of people are getting all of the expanding staff. So tell them stuff, but start with with abilities. So again, oh, and, and, and, but they can't work, and it's, it's hard for the cabinet members and cabins to afford the best companies. Obviously, you mean, they don't respect, and we panic is when you are spent, because it does not look funny, then he's supposed to shake out cats and needs more delay. Basically, for the people within most, to support them in most issues. And by the way, I'm one of those pensions. And I think down very, very good. And my, seven, nine in terms of the year, four, there are the, the age codes. But we now have more than seven, the 40 amongst those 18, 64 age. So, everybody is growing up down moving further, but if we have younger people who have that issue. And as you said, we're not going to have to start to be able to cope with what is coming. Yeah, one of the fascinating things that I would say driving. That's really good. I'm sorry, I'm not too big, and you want to have a lecture. And it's a growing field. So, a few years ago, we wouldn't really be talking very much about coercive control and domestic abuse from the same sort of where we are today. And rightly so, we're talking about those sorts of things. And rightly so, we're talking about violence against women and girls. And rightly so, we've got whole new areas that we're looking at that we didn't look at that many years ago. And whereas I think child safety to children and family safeguarding has matured. You know, when I started my training, there was no such thing as child abuse. It was an unaccidental injury. Child abuse only became examined in 1980. That meant physical assault. And then we thought about sexual abuse and then we thought about emotional abuse. And over 20 years, we change our understanding of who the perpetrators were and what was going on in that room. I don't say it, but it's still more relatively in its, well, in its infancy, you might be, if you don't say it's a bit late with me. And so I think you're absolutely right. There's going to be all sorts of spikes on some of those graphs, but they're very different over a relatively short space of time. If suddenly there are new things that we consider a safeguarding issue. I think we've had a really interesting event here about a whole range of issues of society that we're going to have to consider. And they're going to be very complex and very difficult things. And I hope I'm still saying here, I'm still going to go to your tea time. Thank you for the extra resource. I'll get you now. We do try to engage in the prevention models. I mean, it's a healthy Worcestershire. Interesting today, especially we have with the food banks is even in their approach, they're recognizing that they want to exist anymore of part of what they need to do with racial, but they've got depth. The vice in their centers as well. So I think there is that peak. And I know it's massive, but there is that you have to keep that eye on what those early interventions and prevention, what we need to do. And I think we do want to build a relationship to your services as well, I think. Because a lot of the people that we get to those complex needs. All the ones we've had that for over 18 in terms of the first of the calm where exploitation, the physical and the need. So we do, you know, there's no. We'll be. With the various issues. They are going to be able to look at more trauma and more practice and recognizing that those, those adults that are coming to us, you know, if we look at most of the ones that have been having this, there's probably lots of those indicators on there. I think that's the time to go, we're all working. So, for instance, the food bugs, and not just food, I'm just saying more. The people who are running food bugs and looking at ways they can help these people to stop them coming to food. Yeah. Well, you know, can't just really get you ready. Not you can't, but you can also get the additional help. Yeah. And to stop the safe garden issues coming down the line. One of the managers this morning said they had a gentleman coming in and he came in and talked for quarter of an hour. And at the end of the quarter of an hour said, I'm not going to give you my voucher. I didn't actually need any food. I just wanted someone to talk to him. Yeah, I mean, these are sort of the concrete issues that we are having to sort of wrestle with. I mean, if you want to jump in on the careable learning disability, so I'm really fascinating feel isn't it. When I was at medical school, first of all, you know, we were being told that that field would disappear by 2000. Children and down syndrome won't be born anymore, pregnancy would be terminated. But we have a whole new generation of children with a little difficulty, caused by oxygen asphyxiation and birth, and surviving through premature value situations that we didn't have to go home. We had lots of people that we've got people now rightly in the positive way, the living much longer. The problem then is that often their carers are becoming extremely ugly. You know, we got 70 year olds still caring for a 50 year old. And what happens when that 70 year old has to do. They picked up the care needs of a 50 year old that's being cared for by a normal data for all those years. And that's what you're doing. And you're, and we're commissioning that service and read this isn't I mean, just very hard. So yes, there's an awful lot of things to celebrate. But some of the celebrations have a hidden cost to as a society. And the science society actually understand that we are on the meeting of the special sheets, you know, absolutely, the only in the in a checks that you can have children for financial year 28 weeks and still get the line. And the fact of the matter is they will be dependent. 50, well, close to their life. They won't want to develop their ability to read possibly even speed. But we have the ability to keep our life. And we have the ability to keep our life. And we have the ability to keep our life. And we have the ability to keep our life. And we have the ability to keep our life. And we have the ability to keep our life. And we have the ability to keep our life. And we have the ability to keep our life. And we have the ability to keep our life. And we have the ability to keep our life. This is not any political view. It's not, it's just, it's a society thing that we need to start thinking about and having to open up conversations about in our communities in our societies. Otherwise, we are going to have lots of people struggling on the margins and all sorts of ways and feeling very unsupported and cared for. And I think that we can do better. If we are doing better, I think there's so many positive things we can talk about. And harmless works really well. Yeah. And last, and then Lynn. Yeah. Tough on boy. So all these. So, you mentioned staffing is something like the big issue is the overcome years. And you said that, yeah, political parties, never really got this. We've got a good mix of it. If you were. You can't buy minutes as well. What would you do? Well, it's kind of the first couple of things that you do to change the whole kind of area to kind of help. Start thinking. Many of the situations we have, when we recognize where we are, we would often say we wouldn't want to start from here. And it just strikes me that. We now have a department for health and social care. But that department for health and social care has the help it's still potentially driven. And the social care, they're politically government driven. I suspect that. Yeah, that. Certain politicians are looking at major review of the system coming down the track. I think there has to be. Well, there has to be a pretty serious. Room branch. Review of the way health and social care is constructed and organized and delivered. And I think the local government has led the way in terms of cutbacks and there's no more. You can't cut your organizations back any further. It's magnets to think you can. But there's clearly some evidence I think that you can pump lots of money to the NHS and doesn't always hit the front line. And there's a awful long way between NHS England and your hospital bed or your GP or your front line nurse. And I think how that's configured and constructed will be the game for the next five years who whoever's in place will have. And then let's hope to get it right. That's fine. Thank you. I'm going to pick up on the. The beginning report about type of abuse. Yeah. Physical. Financial. Yeah. Understand. Then it refers to organizational. Yeah. So what does that look like? Well. Yeah. So those types of abuse are given to women from a subject and guidance. The organization is mainly to where you've got care provider. Because they care. We've done silly hair provider to where the systems and the policies are causing problems. So maybe you haven't got good quality assurance. You haven't got the right training for staff. Then errors are happening because there's distance of process on property and things because that organization. So, it's quite difficult to only get from it, let's see. The mission. So how the tools work it is. We'll look at when we're getting a lot of the collective admission around one provider. So we start to think actually on this identity. So, for example, a nursing home that doesn't have a dementia friendly environment. Yeah. Yeah. There's no sort of governance around it. But they're caring for people with dementia, that's a good example. Or it could be, you know, sometimes it's just a fear medication or more and more and more coming in. Actually, there's something good of training. Yeah. Thank you. Thank you all for coming today. But, you know, chomping in with cancers, chat to you about it or share thought more than happy to sort of. Have to be there. I'm just going to lunch. I'm going to ask you item. Yeah. Yeah. Thank you. We did provide a paper, January 22, lots of details, some updates or any changes in particular. So that we've worked really closely between finance and operational stuff. So, welcome Richard, which of your support with those finance conversations. Just to note in the pain does the pain, but she had cancelled data is included. It reports to as one, I see the set of data to NHS evenly. You will be able to see all of that NHS data on publicly on the website. But the I see me did give us a set of graphs that we could provide you with. Unfortunately, that PDF document hasn't been provided to you that I refer to when I talk about the graphs in the paper. I think you are going to send those graphs so that it wouldn't be to locate them. By the website. And if there is any questions that you've got in relation to those graphs, then absolutely share those with us when you perceive them. We will ask our ICD colleagues to report back on those queries, but they're not the local authorities. However, I have thought having met with the ICD long through the graphs and explanation in the paper for years that. Hopefully that is helpful. So year on year you will see that we've had an increase in continuing healthcare and just very simple terms without going into the data. So continuing healthcare we refer to as someone that is in the seat of fully funded healthcare. So they will not make a contribution. You know the cost to a lot of social care, they have a sign that would help me. When we talk about joint putting in, that would be someone that is not eligible for continuing healthcare. And, but there is an element of their care that is health responsibility that isn't met through a different health service, such as district nurse, for example. And then when we provide care for the health element, we would charge the ICD for that element if they're not different in another way, as part of our package of care. Also funded nursing care is another type of health funding, which is purely for those people in a nursing home, where there is a contribution from health towards that nursing placement or the nursing element. So then the type and bash track funding is your other one where someone is attempting to apply rapidly deteriorating condition. Used to be talked about in terms of six weeks till potential end of life, that isn't the case, it's about a roughly two rated condition. So there are different types of funding schemes and it very much is about assessing what is a social care needs and what is a health need. If they've got more than 50% of health needs, we would be expected to have a primary health need. And a lot more detail in the original paper on that, if that's something that you want to refer to. But from a financial point of view, year on year, we've got increased income from continuing healthcare so post a project back in 2020, which was for fair and transparent care where we had a huge focus on those funding schemes as well as section one while seven and then we hugely increased that income, you know, we took with four years on how we continue to increase. So the work that we did is absolutely embedded and it's a local authority. We absolutely remain focused on ensuring that we are not funding people that should have health care that is free at point for the bring the spring individuals that's not right. And for the councils challenging budget that is also not something that we want to see happening. So we have, you know, a huge focus on continuing healthcare as part of our operational procedures and as part of our financial savings management. And we work really closely with our colleagues in the ICB and the pair of this year together through the partnership board that we created back in 2020 and through operational working groups. And we absolutely have this really good partnership working with the ICB. And in fact, they would have joined us today, but, you know, we wanted to take me focus on what the local authorities position was and not the ICB. So we did to climb up that they absolutely will answer those questions if you've had any. So, from an operational point of view, you'll see in the paper, one of the key changes that we have is we know I'm going to have a boat continuing health care. It was quite small. We set it up a number of years ago, never with an intention to have it forever, but we recognize that the complexities around this field required some expert staff who would day in and day out. Work within this area of social work with health colleagues have additional legal training to really help us. Support families to access into really health care and doing when we thought that was appropriate. And that has really, really helped us along the way. That doesn't mean for all those years are why the social work teams have not carried out from the back work. They absolutely have this was a very small team that just did continuing health care work. So we've drawn that back out in terms of the main teams or having a part to play in continuing health care. We've retained one social worker and I think we have agreed to fund social work on behalf of the local authority because they really recognize the important of that partnership relationship. So we're really pleased that we've secured that from industry, particularly the time where we were we're locating our resources. So, that has been diverted to what we now have is an adult neurodiversity team. And that leads in very closely with young people and some of the complexities of young people coming through into our social care. And it enables us to work with people with autism, ADHD, any other type of neurodiverse conditions that quite often when we are seeing it are eligible for continuing health care, but are not in your seat a bit. Or they have been eligible for a number of years, but appear to be receiving care reviews, and not be eligible for continuing health care. Some of these young people and the complexities of their needs have got packages of credit cost thousands of hours a week per person. So, we are, we will still retain our focus. If working with that home or people, and in our wider social working and wanting to really closely that we continue to receive our income oscillation, despite those operational challenges. So, with the investment that we have in our social care and where we've been, so that our resources, it wasn't an option to help us. So we had to decide which, which area of work we wanted to focus on in the next few years and not the new way global students that we focused on. So, we're doing a lot of close working relationships really by your level of transitions that we've seen left. So, we are starting to complete those checklists with continuing health care as people are approaching 18, and that has resulted in a significant number of younger people again on very high cost packages of care, quite often placed around the country. So, there are people who are honestly be responsible for, but we are now in dispute with, and we've got some really close working with our legal teams in terms of challenging those eyes can be in terms of them following the continuing health care framework, which is a national framework that shouldn't be applied consistently whether you're in worship or anywhere else in country. Because if not, those people are going to get out of social cares, but get 18 with their existing packages that will be, you know, extremely expensive, but not necessarily be the best way to be the outcomes of that individual. And, or they have needs that we would need to be owned with above the local authority responsibility, in line with the care, and that is very different in legislation that will be applied in terms of children. And when young people at the age of 18 are considered for health care funding that's called continuing care, but it's a different set of criteria. So you're working with people and growth chain to be looking at the opportunity with health care criteria, but you can start to map out whether we think people of that age would be eligible as they reach our group so it's really important for us in terms of people's needs and outcomes as well as how we condition the services for that cohort, as well as how we then, you know, have accurate forecasting without financial accounts colleagues in terms of what's likely to be social care responsibility, what's likely to be health, what's likely to be coordination with both. Okay. So that's just a bit of a flavor for some of the work that we've been doing in terms of those changes and challenges. I'm sure you'll have some questions about them. Why not just like things as I said, which is here. We have to say any operational questions, kind of certainly with any in relation to the data that we will offer to our last meeting. Thank you. Thank you. Thank you. Thank you. And the table one of our 14 start doing and the actor, and the very good thing is getting down, but it's still 1.5 winning wondering how we get that down for and what the issues are around why there is such big difference between the budget for now. Yeah, thank you very much. So it's kind of that way. Likewise, I get to say we got three million pounds more in the. It's very difficult to forecast CHC because it's entirely dependent on the individuals that do come in, so when we are known to find we can understand what is the recovery element of funding we receive. We also have. The individuals in cases that we will. So it's kind of. It is important to have there are. There are cases we would have high competency into speed levels. So obviously attempting to resolve things before then. Again, when we're working with our local partners in the ICD, the model that we have for those to speed levels, you know, it really gets past the level of dispute with myself in direct to it. So it's very difficult, just once before that we normally resolve those, but actually there will be cases where we would have, you know, a lower level of competency, whether, you know, an illegal team that applies us to that as well, because it isn't. It's not a set of evidence of the person's needs. Yeah, sometimes it's a challenge on the process, following the framework. Actually, that's much easier. I think we can say, you haven't followed the process, and we have to go back around the full assessment of health and social care need. So, yeah, we've all been very careful between reaching them ourselves where we have those confidence levels because we can't count on the money and spend it. In case we don't get the money and just sometimes it's, you know, it's just a balance in that sort of weather, you know, where that level of confidence sits. And it's interesting to keep this conversation, keep in the office and you have to fix this system. A lot of it is, or rather, how do different systems are coming up, has become almost fighting would be NHS, no open up on CB saying, we think we should, you should pay for it. No, we think you should pay for it and you end up having a lot of time spending, hopefully getting to resolve that before it does get. But it's still safe, there's a lot of time in that but going to fight me over who pays for what, it's something connected. There is. But you will see from the paper, those numbers of disputes are very low. So that's really good. And we are launching into some additional training jointly, and funded by the ICD this week up no budget for that. The colleagues in partnership for health and social care staff has actually decision making should be at that first line, you know, the nurse and a social worker, as an MDT should pay that decision. So you get it right first time. They get that right first time. So those systems benefit. We don't send them to all those dispute processes. We don't end up with that data defense to our organization. Individuals don't have to go to have peer appeals processes, which take more nurses and more social workers, regional appeal panels and so forth. So decision making that that's where we want to be. We're in a pretty good place locally with those. When we have to go to dispute processes with other areas, we have much more challenges. And hence, we have our legal teams act with pre-action. We've got the rich pre-action notice that is recently with one authority, which has led to the completed the DST. And on Friday, has led to the taking was health responsibility for the beginning of the individual at the cost of the media portal of the year. So, you know, these things are worth investing our time in. It's really, really important for us for the chief management, but yet we need decisions to be really accurate on the ground. Yeah, one last point. I mean, how do we compare with other areas and community of councils? 90B think we're doing better than others. It depends whether you're asking a question from a local authority perspective or from the ICD perspective. We would have different views on that, weren't we? So the ICD might say, and they'd have said, for example, that we're very high on the Bachelac. There's too many people coming through Bachelac, so they're eligible for that. But then, with a rapid need to deteriorate in condition that three or six months later, they are still funding and they have to carry out care reviews. You know, they need to then focus on the work around the health professionals making those eligibility decisions, not the local authority. We're quite an outlier for joint funding, according to the RSPB. So, in the local authority perspective, we have lots of people in funding in most of the year from parallel to both people in the region. Now, that could be the health of funding too many people. It could be the people that should be in eligibility, which we sit kind of in order packing, quite a good position for eligibility. It would sit in the region, but it could also be the other areas, and of course, in pairs differently. The best systems are set up differently, which means that they have very few people joint funding, because they have a pulled budget of care and support resources that meet the needs of those individuals. So, the system is set up differently. So it's very difficult to compare, but you will find, you know, we will provide the graphs and it is a published information where you'll be able to see the, you know, the NHSE data across the country as well as regional conferences, but you'll also know in the paper of those six. There's six areas that they've only found that, actually, we are very positively supporting people with help from any of those types of funding in a therapy chair and relationship. And our proportion is higher for the situation is a therapy chair as well. Thank you. Thank you. You have Adrian on any way. Thank you very much. And thank you for the report, only when we come to 46, that being, you know, not quite the same, but, you know, we have to, when we are able to be the future, certainly. And therefore, then, yeah, they have to wear to have a commercial. So, we just have a large lot of criteria is, and whether you're happy that obviously our legal services are on the issue, are very the collecting to make sure that you get back my balance, and that you can easily collect. So, continuing healthcare framework is the legislation that the framework that we're working to. So that's the national framework. All we are required to do is apply framework to follow the process. So we're absolutely confident that when, when we are carrying out that decision support for assessment without help from itself part of the MDT, that we are applying the framework and gathering all the evidence and we individually contribute to that. So, there will be occasions where we are not part of that MDT, and then we'll be challenged in terms of why we haven't been invited to that. So, the MDT might not involve the social worker. And then let's say someone comes out of eligibility as a result of that, the funding request comes through to the local authority to pick up and we say that we work with that VST. So, again, and it's not that they're not part of the framework because you will be requiring two professions as part of the DS community to be a social worker. But we work really closely with our own ICB to recognize the value of a social worker there as part of the MDT, which then prevents those disputes happening at a low to stage. These three cases wouldn't have been our local we've built. And so when we're trying to then have those conversations that can be really difficult around other areas following a similar kind of dispute level process and ensuring that we are inviting them and then a part of that DST. There is also a major issue around the definition of optimal means within the using healthcare framework. So that's a judgment for, isn't it? So if we have someone that has got a number of behaviors that are quite challenging and quite least there might be some other people within the setting to the staff. It could be argued that they're not at that optimum if there's been a recent change in medication, for example, and that causes the process and means that there is no responsibility or the health of that building or a period of time until they're getting to be settled. Another example might be that they just move from one setting to another. And then they won't accept a checklist because they'll say that person is a period of unsettled. So these are the types of challenges that we will often accept to start with. After a period of time, we will then start to escalate through the legal process if we think there are delays being caused unnecessarily to make a decision about things responsible for things in that person's care. And that has led to, you know, threats of J.R. and reaction matters, etc. So that's just an example of three of those very high cost cases that we've had a challenge. And, you know, we can't provide more details on that because there's potential for individual identification. So, I suppose what we're trying to say to you is that they are ones that we don't back down on. And, you know, generally have that success. Sometimes we have to fund some legal costs to support that, but we will balance the cost to the local authority here in legal costs versus the potential outcome. But not just on that individual case, that will set a standard for us when we have similar issues, because the framework that we've been working was a revision in 2018. It's been what we've been using for the real decades. So it shouldn't be that difficult to apply the framework and reach for the Greek position on it. Because I guess my area is in there in between four days, seven, we've had a lot of development going on, and we have more people that we need from learning and, but obviously, even to take over care. And quite likely seven, but as long as it seems to be collecting and it was understanding. And it's positive, as long as evidence to how you've graded it, and that should then start that full assessment, instead of some visibility. It should be the same, it should be the same, it should be the same international framework. Thank you. Thank you. Thank you. Thank you. I mean, this is about from a Robin Finn to. I think it's a bit of a bit of a technical issue, but I think it's a bit of a technical issue, but I think it's a bit of a technical issue. It isn't always as black and white, which is the nuance and the potential for the dispute. In fact, I thought it was a dispute can arise to treat the two of our ideas. This look quite often when people are placed out of county and funded by a local authority in a different county to where they live. So they can we dispute between two ICB's is to whom is the responsible commissioner in the framework, you'll see the guidance around responsible condition and how that's applied. So, there will be times where we are waiting for a nice big bill to reach a position on who is the responsible commissioner, so that we can then work with the correct I see the. So is there a difference between how local authority responsibility work. And then I just respond to work. I still don't quite understand so somebody. But in the example we heard that there is somebody was living in the. And move into Worcestershire. How do the account abilities changing for what. I mean, somebody in Birmingham is in receipt of continuing health. And then moves into it. There are so many complexities to it because it depends on where they've been assessed in the first place, whether they're in what type of care and support they were seeing. And where the last accounts or tax pay, such as the ordinary, ordinary residency issues in terms of which local authorities responsible and then I see the to I see be there should be a continuation in their care. And they should transfer then to the local I see be that local I see this and accept that person, but where we often find those challenges is whether back to the framework if someone's deemed to be eligible. So, and the other I see the looks at that. And says we wouldn't have deemed that person to be eligible. One of these cases is where this is taking a long time to unravel the local authority position on that is that we don't care who funds it. It should be the continuity of care for the individual. We should be able to recharge while they agree responsible commissioner to whoever the original fund in authority was. And it's said in a care act when we're in dispute about somebody's ordinary residents because of our complexities to it, but we would, when we consult with our I see be over that expect them to be working with the other relevant ones. The legislation that sets up I see big is, did it fully take account to see a to be or we are we using different legislation within the care. We're using this scenario, we're using the framework, not the care act so the health care button to get the, it's the until we help them. Is that the same framework that's been on the show it's been on the issue. Yes. So the difference with this group between I see big so we have a was the show resident that is supported by local authority, but we then place them for care outside of county. Do they become within another I see big. Yes, so you should be. The dispute between I see being in because to the other I see be might have a different view of the system. The same work for who responsible or relative to between the framework. I can get some more information from the ICB around that volume. That's not, you know, we have a social care we're not involved in any dispute between the ICB's will be informed that there's it's been around responsible commissioners within the framework with the I see being. And obviously from our perspective, we'll be wanting that to be ironed out within the 28 days that we need a decision made to agree then who's going to them that person's care. And when they don't make a decision within that time, we would expect one of them to take responsibility of the commissioner and continue to pay it for person is eligible while they have that will speak in the same way that local authority would. If they're moving between local authority areas of random water dispute, whether they're going to retain responsibility or has responsibility to an authority area. And there are so many complex little to some of that decision made, if it would be very difficult to explain that in the panel. There's only one making it simpler. What would happen to make it simpler basically? You can do an average of the jobs where you do. I think it's important to say that 13 cases with work locally, we've got 7,000 people that we've been here. So, this is a very small number of people. It's in the paper to demonstrate. The time and effort that we would have on some of these faces because of the significance of the sums of looking. Both of the local authorities financial positions and the individual person should not be paying the contribution to care. Because it isn't just about the between or it is at the heart of this could be something they all of that themselves. Let's not forget that there are also should happen if, and then they have above the threshold, there would be came that full amount of that. So, actually is the wrong of the individual, the lion, the patient in any of this process, does that come the first time that they refer to. They will be part of the CFT, which is the decision support or assessment. You would a nurse and a social worker with the individual, their advocate, their families, anybody that has got to know a significant amount. We've got two of the individuals currently school, they will be part of that BST. And there will be a lot more information about regional paper in terms of what the decision support tool is, et cetera. The ask of us today, this panel was around the changes and the savings, not the detail in terms of what the framework says and what the process was. There will be a lot more details on the previous papers that we've brought. And then, as I said, it's your question as well, when a family doesn't accept the decision, there is an appeals process that is read by the ICD. So they can appeal the decision through the ICD. And then going forward possibly next time we have this panel, we have more information because the ICD will be set up a little bit more. So we'll be able to get more information then and include it in this report. Information on one particular area, but worthy of the ICB's input is to to our input. And any questions. Who is that? What was I still about? It's not really an operation. Yeah, I mean, as I said, I mean, the ICB is we've been working with the ICB since 2020 when we set up our partnership board, which is a joint policy that has gone through the ICB's. Processes, I would have been in that board, since 2020, attended by the strategic director of the ICB reps, data reports, data analysts, as well as parents. So, any issues that need I now in terms of how this process functions and what can we do to remove barriers and blockers. I'm adjusting that partnership board successfully. They will continue and as resources start to shrink. We will still need more challenges, won't be in terms of, like I said, people who have been in CHD for a decade, have received care reviews and then come out to have an inability and therefore, you know, we absolutely need to make sure that we're supporting those individuals in those meetings. All those decisions to find them, because we will inherit or they will be carried at your cost of their children support. And that's fine, if they're not eligible for it, but we would want to see them significantly changes in their need for their parents. It's quite often we could come out of age ability, but then we'll be told that the 5,000 have to care. So, it's still required, there isn't but job ownership, you know, the Commission services for that individual, but there needs some change. And that you will be referred to as a management team. And what we can't do is provide fantastic photographs for the prevents all those who is the incidents. And then the ICP say those things are happening to anyone, but we expect a number of into the productions as part of, you know, really look at its portion. So it's really making sure that the needs are still recognised years later, and that we're not in a situation where we need to be well managed and then they say they're eligible anymore. And that's a little bit of the cases that we're going to always continue to need to put effort into maintaining the information. I'd be surprised if we're starting to do the 10 years and then we're going to use it, because we just 10 years ago. And then we're going to use it as part of the process. And then we're going to use it as part of the process. And then we're going to use it as part of the process. And that's another big challenge because some people will see this diagnosis now. So if somebody is diagnosed with and health condition, that should automatically mean that it's a help me. One with dementia that requires a significant amount of care and support as a result, well, you know, it should be free, because the person's got dementia, but it's about what type of care or quantity of it, the quality of it. To you, the unpredictability of it all that would tip it into a home condition, as opposed to a social competition. It's very much a normal diagnosis for the next year. Yes, it would automatically at the diagnosis point, but then being some of the energy, which we go through those assessments and then need to become a nature that we would say are only available. But, you know, social care is responsibility, because it's about being the person, you know, as healthy as they come late and it's like this, I can get at the point in which, you know, they will be deteriorating quite rapidly. How did you, for the question, somebody doesn't want that care, but they leave it with you. And they have social care in the sport or health care in the sport. And we're going to give it a little bit more and more and more. We are working with someone, you know, regardless, we will go relationships with people, but people are able to go back to the back conversation. We have repeat there earlier, then, you know, are able to make decisions about what care and support is able to have the capacity to do. So, then that local authority cannot, you know, go any further into being what we would want to be doing is providing excellent advice and information, particularly if it's financially driven. So, I don't want to pay for my fair, you know, how do you want to work on it. I just don't want to have care, but there are many people that come through our doors daily that, you know, are referred by other individuals, neighbors, police, you know, all sorts of types of scenarios and yourselves. Yeah, but there are any reports about people, but they do have one to engage. So we will look at whether there's any safeguard the evidence that in terms of stuff neglect and we've got enough procedure. There's no reason to doubt that someone has got the capacity and they're not basically the people at risk them, or the other things that we can't intervene. But, you know, we, we work with those people on the face by face based listening sometimes that means, but when people grow very high in time before. So, we get to the door, that's the case that I had recently, sometimes they don't want to care because they've got a neighbor who's looking after all, but the neighbor then passes away and then they need to get a solution. And then when you step in and explain this is what we're here for, it won't doubt that it's, it's how many of us present share is, but absolutely, when there are people that refuse parents support because they are reliant on other people. We absolutely would be trying to encourage those parents to receive an assessment and support lighting through was to show some patient of care is in readiness for when they're unable to deliver care anymore. So they've got the contingency plan, be able to spend where they need to go to. It might just be over her mail themselves and they just prepare it for her and what to do and come through our look for a door. So we will try and put them with me together in place. Before closing the case in that sentence. Thank you. It's been so long last. Yeah, thank you. What are those numbers. Are these people they really should not have a decimal. Okay. A lot of numbers, they're not really, you know, if these are cases they are people. Sorry. And then, so, so, so, so, so, you should protect the grass to follow through to paragraph 21 and you refer to adult near where the diversity tip. Is that specifically around the agency or it's a new team generally within adult social care. So, the advanced social work professional host is now funded by the ICD, but it's in the local authority that will have been advanced social worker and a social worker and that they will be as she specially staff. And then the rest of the team that used to do continuing health care is just small number of social workers at the central base. Okay. So, did you add on your own diversity team, a new thing, yes. And I don't know where was that decision made and this is actually something for such a future scrutiny for us to understand what the whole new team is doing. Yeah, absolutely. I would say that the name of the team is new, but this would be previously, you know, the liberal adults team. So it was the result, new people, they would have been supported as a part of the continuing health care and the liberal adults team. It's a term that we want to have going forward. It won't be it's people who need some social work support intervention that don't, they're not an older person, they're not. They haven't got a mental health need that meets the right here, especially for mental health services or learning disability services, but we wouldn't want them to fall through the gap. And I was previously known as our vulnerable added team, but we recognize that most of the people within my team had neurodiverse conditions. And then we have the new autism act responsibilities and we've got the autism strategy for the local authority about actually how do you want to make sure that we've been really to those people and really help them to promote their independence, our problems. And so skilling some social workers, particularly around that would be the best way to go home. Other people are on their other level of abilities are on the route to that, but because we've already got a vulnerable average team, we've repurposed that results to create the other neurodiverse teams. So absolutely, we've been free, you know, that's a really great new service. It's fun because if we're taking the, you know, people who were previously able to respond to a lot of, so there'd be a cohort of people that would work with anybody that now skids under that team. There was also a number of people that dispersed into the main teams that had autism, that were scattered for a disability and older person's team, or in mental health team or learning disability team. So there's been a lot of people who worked for the local authority of those teams into one area, where we can never fight some special training and support the families and individuals to achieve better outcomes within that service. So they're not new people that we would be open the doors to, they would have sat in on the areas before, but would centralize them, because that's a more cost effective way of delivering the service, but also, you know, it was just to upskill a smaller number, what we have been to continue with health care a few years ago, while we work through some of the kind of delivery and the training and then. So, we have a little place on where I was working. Absolutely. The service is got a brand new manager, running the service, so we've never done a forward plan. Okay, we'll move on to eight and seven. So, you want to pay attention to the service. I'm going to see this for the end. And then, and then, hello. Oh. Sorry. Okay. Okay. Thank you. Just to welcome my colleagues. You've got pretty calm here who's our principal, so she woke up, and we've got. And we're currently issues are direct payments need for social care, but what far more expert them mean to, um, answering operational questions, but just as a bit of an overview to start with them. So, again, an update paper on the previous paper, around direct payments, where we again have any other projects, some real focus, a couple of years ago around how we can improve, since the by the pilot. And to improve the numbers of people who wants to receive their parents support arrangements that has no budget by the driver payment. So, um, the personal budget is, is that some of many that we can offer somebody in many services to direct payment, but not at all. And you will see from the paper, for example, you can't have a direct payment to purchase residential. You can't get on a student services. So, we put the link in for the 22 paper, which again, we've been lots of operational detail in terms of types of direct payments that we offer, and what improvements we made. Just a little process, a couple of years ago. You will see from this paper in terms of we've got data, but it is disappointing that our statistics on direct payments that remain pretty started. Now, that is because we see direct payments quite regularly week on week where it's no longer appropriate for someone to receive a direct payment. That might be because they've got into residential care. It might be they've got into continuing to have their funding. It might be their pass away, or it might be it's now too much for the person that used to manage their direct payment is no longer able to, and they want the local authority to commission those services in a fully supported way where they don't have to manage that. Or use an organization to support them to manage it. We continue every week to have new people receiving a direct payment in the same way that we see people. So overall position month on month might not change, but it's important to know it's not the same people as two years ago. There will be a lot of change of activity within people who jump off from people who started on a different climate. But it does remain below the national average around direct payment and a huge amount of work has gone into looking at, you know, other local authorities that have higher levels of performance, you know, what are they doing differently. In some areas they do have spoke teams they've invested more heavily in teams that managed that the whole start to end of the direct payment rather than not being part and parcel of a social workers. For the responsibility, there are other areas that decommission quite a lot of services, and then individuals have to have a direct payment to continue with that service data division, et cetera. So where they had numbers certainly bracketly increasing it might be for that reason that actually there is limited choice to an individual continuum with a service without having a direct payment, for example, direct home that's really should be about choice. So, when we are the legal team to make sure that we offer those in all situations, it is generally a lot of choice, and we should be making it as feasible as possible for people to, you know, receive a direct payment and be supported to manage that in circumstance of where people might not have capacity or anyone to help them, you know, the employment at the start will be supported with their own agency to be able to support. So, yeah, happy to take questions. As I said, you know, we've got some real successes within the paper that we want to cite I'll just because the overall performance is changed. Like we've moved from measures just to value bookkeeping, one of the things that we want to find bookkeeping to really push for us to have an important place in existence that are on a register. So that if next week I certainly need to care support and I want to be a person assistant to provide that, we have to stop an adverts and papers which the law received from a one stop shop, you know, on a website where anyone that is looking to work. As a participant assistant to register their, you know, capacity, their skills and training, and individuals can then have a one stop shop that you're looking for a place, for example, for the web and going around our micro enterprises to have an alternative care differently within community has been that's really, really great and it's given people more options in terms of what the way that they can support needs a little bit. But the challenges remain difficult and they remain even more difficult. I think it's important to know in terms of the council position and the reduction of staffing, and some of the federal agencies, except how they reacted on the number of back office staff and support that we have to manage direct payments and support people with those and I know that has work is feeling that now as our lead social workers are working really closely with our finance staff, but then the amount of results does reduce. So, you know, that doesn't mean that we're constantly needing to think of how we can do this differently, more efficiently, but still, you feel to be able to take a direct payment as well. That's the best option for them. So that's just a bit of an only view of where we are and I'm happy to take questions. Thank you. Thank you. Thank you. It's probably an obvious question, but it's saying always higher is better in terms of direct payments just kind of remind me why only one more people have direct payments. First of all, it's a legal duty to offer people a direct payment if their service can be provided because it is seen to provide more choice control, you know, flexibility in the outcomes. The other, you know, common benefit is that it can be and I am going to say can be cheaper for parents or to be purchased through, for example, a personal system. Then it is to have a fully commissioned service through the council, so they can be some financial statements for local authority, the more people that we have a direct payment. But equally, there are other types of services and the arrangements that go into governing those services, make sure that, you know, the money is spent in line with their care and sport and the care act. And it's not issues that, you know, there's too much in the hand, we need to then claim the money. So there are other costs that are involved in managing direct payments as a local authority. So it isn't just about the hourly rate. So there are lots of benefits to having direct payments and the area clearly says that we must be offering those duty, and it's about making sure that the people that do receive those manage those accounts. So it's absolutely not for anyone. And we also need to recognise it was a sheer we have a large number of people. And that's not to say that an older person was, you know, support or without support can't manage one, but it is more difficult without an older people to manage their account in the way that, you know, we have, you know, credit card, you just need to come to all the pay for the money loaded onto an account by the credit card, you know, that can be a lot of people to understand how to manage that. And whilst we do have some mission support services for that. If you say to someone or we just saw all of that out for you, but it's just more about how it works. It's going to be absolutely recommend. I don't want. So, yeah, well, my whole one question tonight is obviously got to go after all the different, absolutely, there's quite an extreme in terms of, you know, sleeping, drinking like four. But then you've got nothing to worry about, so I suppose you can relate it to sometimes it can be how things are managed to be the thing that you almost forced down to that pain but you said you are looking at the count. So, so what is it about one type of effort to go to get so much more. Some of it is going to graphics as well. They're taking spats and we've got a fine old population. If you were in an area that has much higher working age people, when you look at our statistics for the uptake of direct things with young people. So, demographic gaps of indeed is a factor. But as I also said, there are alternative commissioner arrangements for different types of services as well. Um, because I don't know whether you've ever looked at those in particular, how high have you been blessed to show it's a good example. There's a couple of other authorities to do if they can. Then did all contracts with domestic regurgencies to that as an authority, they didn't contract with any agencies. So they almost have to put on the loan to the draft and unless they couldn't do which they needed this both contracts in person. So it's how they set them up. So, that's why I was forcing people to do that. Not always. Not always. Fair enough was my head later that you're provided with any really important space to find out from an operational perspective of what what was actually happening to improve those videos, not necessarily something people would want to do. Exactly. No, we want to go that value interest. Oh, that's what I kind of asked the initial question is sometimes having those great things. Yeah, I think about six or seven years ago they had a big drive to be employed a lot of faculty created a 14. Then they did bespoke direct payments and contacted individuals if he wanted to direct payment, they would give them one stop shot. He's stuck with our team will start to end and then the team put up once they have the good roles. Leveled up, but I am level. So you touched on some with my last couple of people now. I think I have about 19 talks about the style, taking lots of time. So, actually, if you invested in that team, you found some money. And then put it paid for itself in a way, and then you'd maybe only have it provided, and then you would need it, some sort of level. I think you would always need it to sustain it. I think you got to have an ongoing investment to manage it because, you know, we commonly will change the people that were all of these being financial or team records of abuse, you know, that. So I think you would always need it. If that was the route that we would go down, I would want to have an ongoing investment. Question of whether it would pay for itself is an interest in one. Because when you give someone a direct payment, the setting of the personal budget, you're not dictating how they use that. If then you've got to have a personal system at the price that we set, if it's not a low price, it would probably make a considerable savings. But if people use that budget, go direct to a care agency, they can charge about individual there, but the rate that they will charge yourself. In terms of an hourly rate, whereas our framework, we don't really care that we recently introduced, could be a cheaper rate. So it's going to cost the lower ability to buy personal budget, but I don't care. And we still got a duty to offer it. But it's, you know, it's how far isn't it that we would want to go in terms of that investment. And that's how far is to stay with these, but it has been considered by the TDR, the federal paper, and we're, you know, the wider discussions around where we're going to invest out as all the C's. That wasn't normally doing records for half, but we're doing the same. No, no, no, no, no. And how we make it smoother and easier, is only so far new going. So many things that have to be in place around financial control, better, you all play in the facility cars, you know, for the TDR, but, you know, it's never going to be an easy kind of a right. But, but would it mean that more we take it up? But the way you sell them to an individual as a social worker, be the deciding factor of whether that person pursues the direct payment move or not. Yeah, thank you for sharing a few questions, I mean, I'll start with a couple of questions. So, but, but the conversation, I can just tell you, I'm understanding of a voluntary redundancy scheme. It gives the employer a sum of requests redundancy and the employer makes the choice as to whether to agree to that redundancy or not. Why have we or whom has agreed, if actually, this is being undermined, which is kind of what paragraph 90. And the paragraph 21, but the redundant is, that has been agreed, leaves this particular aspect of county council services in a challenging position. I think any of the redundancies across the council are going to have an impact, which is what the paper says on the delivery of our service. We are reached a position where we haven't got excess plans for the room. I'm not big enough, should they leave the council that made it, you know, have, have the slide did that they're only in a bunch of businesses, you know, and it's gone through the relevant process to decide in what areas of the council, they will be accepted or not accepted. But in out of social care, once we know then, you know, where those positions are no longer going to be, we have to then consider. What we can deliver and then what case, you know, in all the areas that I did, social care, yes, direct payments is just one of them. I mean, this, that the impact here is around the finance team, which is not our decision making in. Other social care or the paper director, there is still a service. It is just not a resource to the same degree as it would have been six months ago, but that's the same for many about services across. So what was the decision made, but it's, it's okay, and shouldn't, it should be a plan for managing the vacancy, you know, to managing the gaps that he's taken out there. Every government means that a person is taken out of the organization, and the management shouldn't be saying yes, without a plan to reorganize. I'll take that. I remember that that weren't approved, but there were some that were, and it isn't that we don't have a service anymore we absolutely have a service to manage operational and financial elements of direct payments. So that's what's been at the level, you know, in terms of the number of hours or staff that we may previously have come. So that's about the looking to have service and agreements with our finance colleagues and working through actually, you know, where, where we need to be director of the resources that we've got to manage them as effectively as we can. Okay, so then in the process of next step, so there is a new that it's ongoing at the moment, which that was a review initiative. I can evolve through with any taking now. We review is an operational review, a direct payment, which will be led by. I want to mention the tendency scheme it's about how we the processes and systems that we have in place from the point of someone being eligible for parents support. And then all the guidance and the processes and steps on the system to take them on through the stages of risk, you know, to actually receive the direct payment. So, we are working. And Kelly will be working with people who use those services to understand what the experience is like, where we could, you know, do better from the user experience, but also all of the social work teams. And the service very bookkeeping that we use to support people with direct payment, so that we can see, you know, what, you know, we've got limited resource which across the board actually make that more efficiently streamline as possible. And I don't think until now we've really engaged people who use the services to the degree that we are now. And that's really important, isn't it, because there's the aspects that are barriers for us that actually don't know we're really different to the barriers for individuals. So we want to bring all of that together for this piece of work and then look at, you know, anything that we can do to support people to take the offer and to support stuff in terms of managing the process through operational social work teams. Into the finance team, and then back out again. So, when you say the dosage that we've seen power growth, 20,000. The fact, the exact rate of the needs gives that we've used as actually food. And it's what did it mean. So, in the context of the 35 residents who use direct payment. So we managed to get a thing for these small people, even for the fund to have direct payment. We have got to do to do stuff like that today with what they're involved in asking questions at once. That's right. And while you're trying to just want your barriers. We also have those, again, the groups, which that's a little bit boring. And that's what we're going to do. Thank you. That's a piece of work that will have a conclusion and recommendations. Actually, that's something. I think it could be a little bit of a talk back. And I think in fact, 26, you say, a working group have been established. I think that's a lot of areas. Yeah. Yeah. Okay. So how long did it take to set up a direct payment scheme? Absolutely. I think the person to, you know, get some formula and some other details. I'm sorry. I'm sorry. I'm sorry. I'm sorry. I'm sorry. I'm sorry. I'm sorry. I'm sorry. I'm sorry. A bit of standard time for a standard drop here and prepayment account would be between three to five data set about a count. But there are best. Before anyone have a draft period, they must not be financial assessment first. We must know that they're trying to be should read the figures kind of you need an effort. You know, when they're called to be should raise the system can't pay out of the important, what they've got to pay in. That assessment's got to be done first. And obviously Parkinson's is engaged quickly with over five charging team. That slows it down. Then by the time we established what kind of budget somebody needs. And you've got to sign their direct payment agreement and that's going to be able to launch on the system. Again, if the person happens to be out of busy for a couple of days, ask them to let you know. Once that's on system, then we can all the purchase in enough. When the accounts get set up, so there's your three to five day. Then to receive funds, they have to wait for payment. So we have a four weekly payment to be to make it on. I'm going to be after the cut off day. So they missed that cut off day. And then within the next payment. That doesn't mean the care can't start. But certainly has a personal system in mind. They can start now. But the guidance then is they probably are going to be waited about four weeks before they have paid their first wages. Then after they can be paid, we can click on it the answer. We'll just comparing it to like more than a decade ago and when I had to go through that. I mean, like coming and that's a lot too prevalent. But that was why I share it with all this. And I think it's important to know that people wouldn't be left that risk without having sort of all anxious insights. While we're setting it for direct payment. One of the things we're really working on is people coming through the hospital discharge upgrade. For example, not going to be the ideal time to set aside that payment. But we want to be talking to people about, you know, when you're back home and set it all. And this is the information going to be thinking about what benefits are. And then hold them up at the first point of the queue. They'll already have their arrangements in place. But then we visit in the opportunity to is an event bit to. Changing this to a direct payment. So, you know, it is important to note that somebody wouldn't not receive terms for while we're going through that process. But as you can tell, it does take time. Just to know on the financial assessment process, those have always been prioritised with people with a direct say, payment under the finance service level agreement. We are actually going to do all financial assessment to be service staff. But direct home is have the improvements that we're going to have in that time, haven't they? Make sure that they are prioritised. So it is of course perfect today. But we have to go through all of those steps to make sure that right insurances are in place. The agreements are signed to make sure the money spent are, you know, can support me to not, you know, isn't any of the only in public funds, etc. But the piece of work that we will be doing will be looking at it from the stock point of view. The system is a financial system, the logic system and then all the rest of them. She's a feedback and we will say is that anything that you can do to shave that down anymore. Make that more streamlined. Yes, we'll go ahead and then we'll do it. But we'll do it within the timeline that we can achieve back in right now. And if not, then we'll be satisfied with running this effectively and as we can, except in, you know, what is quite a bit of a pack in terms of our performance. So one more quick question is quick. Can they combine and use all PA and say like an agency as well? Yeah, absolutely. Yeah. Yeah. Thank you. Thank you. You've been working on a couple of people because of the issues of funds or what do they want? We wouldn't go into individual circumstances. Again, that could be personally identified. But if I just talk more broadly, I think over the years of experience where people may excuse them. I think it is more about challenges in terms of people's normal arrangements to access parents for. So there may have started to use cash payments, for example, which is not acceptable and there are payments. We might not have a audit chair of receipts and documents in line with the agreement that they've signed. So that would be classed as misuse. And we have no people to use payments in shops and holidays and things that sit quite outside of private payment agreements. And what we have to be careful of care act is quite broad in the sense of how people can be their outcomes. But there will be things that in the cases on the, on the three loaded account cards that would set up alarm bells for us to review. But if someone has a traditional style account where they've got their own bank account that the money's going into, we don't know anything about that until we carry out a financial or the environment, and we asked to see the bank segments. And then when we see the bank segment, we see things that might indicate issues of funds. By the list of things that they spend the money on, they have to have an entire set of funds for that. If they use an old style, their own bank account. Now we discourage that set up, but the care act is very clear that we still need to offer that as a choice. Obviously, we've got more free payment dirty cards with people and alarm bells that would go off as an indicator. Not a definite, but could be in some of the use of the account, we can set up certain shops and there's all sorts of things. But it's a specific image. We have functionality to block certain money expenditure. For example, I'm making this up. Now, if somebody was to access the account on site, they wouldn't be able to remember the bank. We have an ability to block that. It is small numbers where I would say there is intentional mystery. And of course, there are small numbers that will end up in safeguarding financial abuse. Some of the members of that site. So, you know, what is really important is that we make sure that people are receiving the parent support me that is that we buy them to buy through the direct payment. Another big issue quite often is that non-payment of client contribution. So, if their personal budget is 400 pounds and they should pay 100 pounds into the pot. So, if they could meet their 300 pounds, then we would still provide 300 pounds and they still need to put 100 pounds into the pot to be reduced to the budget. But some people will think, actually, no, I'm not going to make the client contribution. I just spend the rest of the money and I'm going to get less support. So, you know, we need to pick up on those that are really early to make sure that we don't end up with people in a significant amount of debt to the local authority on contribution things that they've now spent. And that does, of course, is the issues that we also manage to show. And then we can talk to our first agent, which is the work very well. Thank you. And then we did have a quick look at our turnover. There's quite a few on that for October, but what we did pick out earlier was the care home is an independent focused on the return on the position, including a focus on the quality. So, okay. Given that we get a very in depth review last winter. Okay. And start baking season and attention, I think it's something that I want to just share that we kind of have returned to impact into that. It's very much of a peak to. Because that's what I think it says it's not because we're going to says what will be happened by that meeting October, so you should be able to see impact of it. And update on how to access the adult special program tool. Let me know if there's anything else and then we can change it. There are a couple of other items there that we can put in. Okay. Thank you. Thank you. Thank you.