Transcript

of Primary Care Network, and Ellen Rule, Herefordshire and Worcestershire Health and NHS Care Trust, and then also I want to mention about Joe Newton, who is from Acute Trust, and I understand it's your last meeting, so all of us would like to thank you for that, and you've been members since 2020, but I'll hand over to Lisa McNally to say a few words, because she has worked with you for a longer time. Yeah, on behalf of the whole board, and obviously I speak for the whole public health team as well, just want to say a massive thank you to Joe, you've been at the centre of things for so long, often behind the scenes, being the engine room for things, and it's been great to work with you, you've been an absolutely indispensable figure in the health and well-being of Worcestershire for a while now, and thank you for being a member of this board, and such a great colleague, and enjoy your retirement, we're all really envious of you, but enjoy it, and keep in touch, please. Thank you, Lisa, for that, and we have a guest, Anna Winchman-Lema, who is Operations Manager, OSS Academy, Worcester. So, thank you, and welcome to all the new members, and the next on our agenda is any declarations to be made? Okay, and public participation, any members of public with us today? Okay, okay, and now for minutes from the last meeting, confirmation, which I believe everyone's had a chance to look at those, so we'd be happy to sign those off. Happy with that, okay. Thank you, and so next on agenda, we have a public health community-led approach, and sponsor is Lisa McNally, and presenting by Lisa McNally. Thank you, Chair. So, colleagues, this is just going to be a really, really quick update on our public health grants program. As you know, for some time now, we've been of the opinion in the public health team, as I know many of our partners around the system of the same opinion, that the power of community to create health is vastly underestimated. And if we can tap in to the contribution, to the energy and expertise that our residents have, and make them part of the team, making the community the front line of health improvement, then there's an awful lot to be gained. So, this whole public health grants program is about making residents' ideas a reality. And certainly my experience over the last two and a half years is I could list you dozens of projects that we've seen have a positive impact on health that I promise you I would never have thought of, and possibly people in my team would never have thought of. But residents knew that that's what their community needed, and all we did was offer them an accessible funding program to be able to make those ideas a reality. So, some principles behind the program. Firstly, public health is often, it takes a, what is often called a deficit-based approach. We traditionally start with what's wrong in a community. And we'll say, well, people in this area, there's too many smokers, or obesity is too high in this area, or this town has got this problem. And, of course, there is some utility in doing that. We do have to still identify needs and put resources in to be able to solve problems, and that's what our residents do want. But it can't be our only approach. And our approach with the grant program is, rather than starting with what's wrong, we start with what's strong. We look out into our community and try to not find problems, but find assets, strengths, ideas, expertise. And in that way, we end up doing our public health work with our residents, rather than doing it to them, and enables those residents to make their ideas happen. The effect of that, we generally find, is it builds place. Places aren't the buildings, they're not the roads. The real essence of any place is its people and the relationships between them. And so, by investing in that, we build community capacity and resilience. Think about it from an individual's perspective. When an individual becomes ill, has she got people around her to go to for advice, for support? Or are we creating a society where, actually, the first and only option is to go to see her GP or some other health service? And can we create more capacity within communities and resilience within communities to be their own source of health improvement? And what we've also found is, by offering grants to communities, based on their ideas, that funding is often more sustainable, because it becomes a critical mass, a potent combination with the energy and expertise in that community. So, what we find, firstly, is we strengthen communities. Everything we do, if there's one common denominator between all of our grants, whether it's the grants in schools, the grants on physical activity, the grants on mental well-being, the common ingredient is strengthening communities and building relationships between them. That picture there is from a care home where we gave a grant to a school to take the kids in and lead the residents through physical activity programs. And I saw, right in front of my eyes, the effect on both the children and the older adults. For the children, talking to their teacher afterwards, they were building communication skills, nurturing skills, social skills. They were learning about different generations. And the effect on the older people was profound. When we first walked in, it was quite a sleepy atmosphere. It was very quiet, not by the end. There were shrieks of laughter. People's eyes had lit up. And, again, the care home staff said it has a visible, measurable, positive effect on their well-being. Building resilience. That picture in the middle I'd pick out on is, that's Pete Martin, I think, is there? And Pete is the most, one of the most amazing individuals I've met in my time in Worcestershire. He's got black belts in about 10 martial arts, so you wouldn't argue with him. But he also has the most amazing insight into young people and the issues affecting them. And just sitting down with him, I, as a public health professional responsible for community safety, learned a whole lot about knife crime and how potentially some of the dialogue that we have as adults about knife crime among young people is actually unhelpful. Really, really insightful. He takes kids, he puts faith in them, he puts his experience into them, and they come out more confident, stronger, resilient members of society. Social. It's all about social. About 160 years ago, Emil Durkheim, the father of empiricism and the social sciences, was telling us that social relationships are fundamental to health and well-being, including mental health. And we're trying, so it's not a new idea, but we're trying to build on that. Everything we do is about fostering stronger relationships. It's about making sure that every single resident has people they can go to in their community for support. And obviously, we know that social connections can not only help people become healthier at any time. They're particularly important at times of stress, particularly important at times of crisis or illness. And another big theme for us is physical activity. We give grants to communities to get, not just young people, but everyone, adults, right up to the oldest age groups, active in our community. A couple of my favorite projects are on there. The first thing is the cycling schemes, the bike buses that we've helped support, and also balance bikes. I don't know about you, but when I was a kid, my parents and big brother taught me how to cycle by putting these daft stabilizers on my bike. And one of them was wonky, so I used to ride around like that. Now they use balance bikes where they take the pedals off. And kids naturally learn the balance by running along and then lifting their legs up. We've funded numerous schools to start these balance bikes schemes. And of course, that gets some cycling. That leads to active travel. That leads to more active communities. And then, of course, we've done loads of Tai Chi in the park and yoga in the park sessions as well. Also, we will be running the With All Fun Run on Sunday. So if you've not yet entered, obviously, it's obligatory for all health and well-being board members to enter the With All Fun Run. So go online and book and join us and Steve Cram and other amazing people to run around With All on Sunday. And can I introduce you to Crunchy on the left and Munchy on the right? And we've been getting Councillor Bell out each Friday to visit different community projects. And a couple of weeks ago, we went along to a school where the school were using animal care to develop well-being, mental well-being, and also, again, nurturing skills amongst the kids. And the BBC came along to film it. And one of the little girls walked in. And honestly, we couldn't have scripted her better if we tried. We didn't get to script her. We didn't get to tell her what to say. But she just come in and nailed it. She said to the BBC TV camera, When I'm having a really bad day, when I'm feeling angry, when I'm feeling upset, I can speak to a teacher, I get time to spend with Crunchy and Munchy. And it immediately brings down their stress levels. The head teacher was telling us how important it was for kids with learning special educational needs. Again, helping them calm, helping them relax, and helping them develop their nurturing schools. There's actually a good evidence base around animals and anxiety, animals and a child's well-being. It's quite a robust finding in the health and social care literature. But there was a school. We said, what do you want to do? They did it. Also a forest school. Also other projects. And we've got Lego mood busters. I'm sure most of us played with Lego. Some of us maybe still do when the kids aren't watching. And it's about saying to schools, we think you know what's best for your school community. We think you will know what will boost health and well-being. And of course, school budgets are accounted for to an inch of their lives, aren't they? So for head teachers and their teams, their business managers, their school staff, to be able to say, I know, why don't we do this, is always a very insightful way to go about things. You can see all of these projects on our insights page. And we'll share the link for the insights page. Sam at the back there, who's one of our senior public health team members, also is a part-time journalist. And she's got very good at writing up these articles for the website. So well done to her, because she manages and collates a lot of this work. And people love it. It's the sort of public health work that makes sense to people. People instinctively know the community can create health. And so often, these stories reach the media. And the media love them as well. They're human stories. They're stories about the place in which we live. And we've got a map. We've got an interactive map, in fact. Hundreds now, over the last two years, since we started talking to you as a board about this program, we've given hundreds of small grants out to community groups of all shapes and sizes and types. And you can go online, zoom in on the area you're interested in, and find out a little bit more about what we've funded in your area. And if you have an idea, if you know a group in your area that you think could use a public health grant, try us. I bet you we say yes. We'll work with that group sometimes to shape the project, to make sure it does have a good link with health and well-being. But, generally speaking, their ideas don't need a lot of work. And the final point to make is that while we offer grants all across the county, we do now have priority neighborhood areas. These are the areas which are, according to our data, being affected by the worst health outcomes. And we're seeing significantly more unplanned hospital admissions from these areas. So, we did exciting data work, a statistical process control analysis, to identify 14 lower super output areas that are producing significantly higher rates of unplanned admissions. And, of course, one of the areas that was experiencing poor health outcomes that we've identified was the Westlands Estate in West Droitwich. And some of you may have heard last week, and Caroline at the back there is still smiling because she led us all on this. It won the National Public Health Team of the Year Award at the local LGC Awards last week. For me, that was an important thing, not just because Worcestershire won a trophy, which is always great, but it was a real badge of honor to this way of working, to trusting in communities. In the Westlands Estate, when we went back after about 18 months, we found reduced emergency admissions. Emergency admissions had gone down in that area while they'd gone up across Worcestershire. We saw significant drops in referrals to children in need, social care referrals. This work has a positive impact. So, what I'd like to do now is, if it's okay, call to the front someone who can talk about one of our projects, if you don't mind, Anna. Are you okay to come up? And Anna is from Oasis Academy in Warnden, which is very near where I live, so I'm particularly proud of this. And she's going to tell you about the work that we did with her on play. Hi, yes, so I'm operations manager at Oasis Academy in Warnden. We're a three-form entry school in Warnden, as the name suggests, and we've actually got a bit of a declining number of students, lower birth rates at the moment, which is having increased financial pressures on school budgets and on the school. So, I think that's important to be aware of those. We're an Ofsted outstanding school, so we're really proud of that as well. Demographic of our school, we've got 50% of our students get pupil premiums, so are entitled to a free school meal. We have 50 children with educational healthcare needs plans, and we have 40% of our children are on the SEND register. So, significant number of children with additional needs come to our academy. Since COVID, we've really noticed an increase in the social, emotional, and mental health needs of children, and we also have a really big need of speech and language. Only about 30% of our children start reception meeting the age-related expectations for speech and language, so it's something that we really have to work on while they're here. Yeah, and so the grants that we've applied for have really helped with those. So, we've actually had two grants so far from the public health grants. The first one we applied for was for some sandpit development. We are proudly an Opal School, which is outdoor play and learning. We've won the Platinum Award for it. We really value play at Oasis, and we think it's really important that children get the opportunity to play. It's really important that they're learning all the curriculum stuff, but play is as vital. And through play, they are learning so many additional skills, communication being a really key one. So, we had six huge planters that were filled with dirt and soil. We used to use them for growing things, but that faded away, and we have turned them into six huge sandpits. I went out there at lunchtime today, before I came here, and on a summer's day like this, it's like they're at the beach. They've all got their socks and shoes off, they're in the sand, they're building sandcastles, they're burying teachers. The sensory element of it is amazing for them. So, if you ask the kids, what's your favourite bit of lunchtime, lots of them will go to the sandpits. There's some children who will only play at the sandpits. That's the only place they want to go, is to the sandpits. It's open in all weathers, so they get to experience that play in all different weathers, in different environments. They love it. Not only is it important for them and it's fun for them to play, but it does support those other things. We also use it, our pastoral team uses it, takes children out there. Children can, lots of children talk better when they're like fiddling with something, when they're doing something. So, kids might be out there building a sandcastle and be able to communicate what they need, talk, regulate themselves. So, the sandpits have been a massive success for us. They're absolutely huge, they're great, we love them. The second grant we applied for was to develop a sensory room. With the number of children we've got on the SEN Day Register, a lot of them struggle to regulate their emotions, which means that then they can't access education in the classroom. Having a sensory room has enabled us to have a space for children to go when they need to regulate. So, we've bought lots of things like sensory tiles, so they can do a bit of a sensory walk and just calm themselves to enable them to go back to the classroom to access that education. And it's been, and again, these are things that we wouldn't have been able to necessarily do or do as well without this funding from public health. As you mentioned, school budgets are tight, so this has just enabled us to do something extra, which has been really important. Brilliant. So, if you stay there, I might have some questions, but I'll, what a great story. School staff having an idea, and together we're able to make it happen, and you can see the impact. And so, yeah, I mean, two things. Firstly, next time somebody asks how many people are in the public health team, we're now saying 603,000, because every member of the public in this county is potentially part of this team. And secondly, I just want to say thank you to the Health and Wellbeing Board. Each and every partner, from the ICB and NHS trusts through to voluntary sector schools, you have all supported us on this. It's not a traditional way of working, maybe, for public health, but you all got behind us. And, yeah, let's keep going. We're getting a national reputation for this work now, so let's see what we can achieve in the next year. Thank you. Thank you, Lisa, for that presentation, which gives us overview about public health department and the community grants, how they've been working. I think the fundamental here is that we engage with the community, get the ideas from them, what works for them, and that we reflect into the projects. And so those projects have been working, and congratulations on LGC Award. And thank you, Lisa, for sharing that information about how those grants have helped the children. So we'll go for questions. Any questions for Lisa? Hi, Lisa. Councillor Bowen of Children and Families. How do you evaluate schemes? Lots of different ways, Councillor Bowen. So the first thing we do is we go back to the school. Usually we put a six-month time frame on it, and we gather evidence from the school about what impact it's had. Sometimes that evidence is in the form of data, sometimes information. Sometimes it's in the form of – we often ask schools to make a video with the kids to show the impact and to get, whether it be teachers, kids, parents, to talk about the effects. So it's a mix of quantitative and qualitative findings. For the bigger grants, like Westlands, there's a more formal evaluation where we actually dug into the hospital data and the social care data to see if we can see if it had an effect. And, of course, in Westlands, that's exactly what we found. We do try to keep evaluation proportionate to the size of the grant. So, you know, we don't ask, for example, a school to do lots of questionnaires. But, yeah, sometimes qualitative, sometimes quantitative. Thank you. Any questions? Hi, Chris. Yeah, I just want to sort of echo this. I had the privilege, and I used that word quite deliberately, for about 18 months, wasn't it, being on one of the bodies that does this. And it was absolutely one of my highlights when those meetings came around. I think something that is key is the application forms are really, really simple. So in the same way that the feedback is really simple, the application is really simple. And I'll be honest, unless you were completely off script, you had to work really hard not to get the funding. We would go back and we would say, OK, we hear what you're saying. It doesn't quite match. Can we talk about this? And when it was completely out of scope, we still didn't say, no, we would be, have you looked at this funding that's offered by the county council or whatever? Because someone had come into the system with an idea and we didn't want to lose it. And I think that's what I loved about this. You know, we live in a world where you have to do multi-page applications with years' worth of evidence. And then you have to prove that, funnily enough, that was true with all the feedback. And instead, this just released people to do what they do best. So, OK. Yes, thank you, Chris. Any other questions, please? Yes, Simon. Simon Adams, the chair of Healthwatch, Worcestershire. I'm particularly interested in what you've done at your academy because one of the big things that parents raise with us is the availability of sensory rooms for the increasing numbers of young children who, you know, are having difficulties to cope with. And I just wonder how the learning, assuming that it passes the evaluation, right, that Lisa will eventually do, how does the, I don't know who, because I wouldn't say how does the council roll out because it's an academy at the end of the day. But how is the learning from that taken and then rolled out to the rest of the county? Yeah. Can you? Yeah. So, yeah, thank you, Simon. So, when we see really good ideas like that and come to fruition and we learn about the impact, we share it with all of the schools, whether they're academies or not. You know, as public health, the children at the academies are our residents and, you know, it might not be a local authority maintained school, but we, they're as much our kids as any other school. And so, we share via the insights page, we share via head teacher forums, and in some cases, we actually write up evaluations formally. So, there's a whole raft of sharing the learning. And we have seen that happen. We've seen schools go, oh, we could do that. Or a voluntary group in one town has copied what another voluntary group in another town has done. So, Worcestershire is learning from itself. And do the schools presumably talk to each other about this? Absolutely, yeah. We, in head teacher forums, the head teachers are constantly chatting with each other, and rightly so, whether you're an academy or a local authority school. And we value other people coming in, especially with not so much the sensory rooms, with Opal. We've had about six or seven other schools across Worcester come and see what we do because we were one of the first ones to implement it. So, likewise, with the sensory room, if other schools want to come and look at what we do, or what we've managed to achieve through the grant, absolutely, we would welcome that. And we're more than happy for people to come and reach out to us and have a look. Flame of sandpins. Yeah. Thank you. So, Sarah, yeah. We've been doing the grant mapping for a while, and we're getting better at it. And absolutely, yes, we're doing lots of analysis now. It is about capacity, but we now know, and I wrote down some of these insights, we're reaching out through our contacts. So, we know, for example, in our schools, we've had a lower uptake in Redditch. So, we've been talking at head teachers forums. We've mentioned it at district collaboratives. We're talking to our partners. A lot of what we do, which I think has come across, is this isn't a funding pot where you just apply. This is about an approach for us to create connections. So, actually, we're able to reach out and say, you know, a youth district network, can you tap into this? We know, stay connected. We've had less of an uptake around the loneliness and isolation in Bromsgrove and Witchaven. Youth a little bit less in Bromsgrove. We know from our mapping, obviously, and our work in general, that it's the reach into the rural areas. So, I hope that gives you a bit of an insight, and we will do more around it. But hopefully, that gives you a feel for we're really starting to understand these. And we're really starting to understand the themes that are coming out. So, sensory areas in school are our third biggest uptake for sensory spaces and well-being spaces indoors and outdoors. We know that physical activity is the highest type of grants that we get across everything, whether they come to us to do loneliness and isolation, that physical activity is a vehicle for that. So, yes, we absolutely have analysis, and we can share it. We love to talk about grants. Thank you, Sam. Just to add to that, I'm a big convert, Sarah, in the concept of maps as data. I come from a very empirical, quantitative, sort of professional background, and what this has shown me is the real value of mapping as data. And I think one thing that Sam mentioned there has particularly struck me is rural areas. We need to encourage more grant applications from rural areas to address groups that have specific health needs, like our farming community, for example. Thank you, Lisa. Thank you. So, I would just like to add to the same point, because when we look at the factors, so in Worcestershire County, we have some areas which have unmet needs or deprived areas. So, the focus for us has to concentrate on efforts there, going out, engaging with the community so that we can run some projects there, bring them up to the speed, and then that would reflect the whole Worcestershire County. So, we can only be healthy if we have everybody else together with us and then make them healthy as well. So, thank you, Lisa. Thank you, Anna. Okay. So, next we have on agenda is NHS update. This is update on recent ongoing NHS reorganizations with ICB and NHS Joint Forward Plan. So, sponsor and presenter, David Mihafi and Simon Trickett. Thank you. Thank you, Councillor Bell. So, I'm Simon Trickett. I'm the Chief Executive of Everettshire and Worcestershire Integrated Care Board. So, you'll see the paper is split into four sections. I will cover the first two sections, and David will do section three and four, if that's okay. Thank you. What we set out to do, recognizing this was a new cycle of Health and Wellbeing Board, if you like, with a lot of new membership, was to provide a bit of context, particularly around what's happening in the local NHS and then where we're going to focus moving forward. And then adding to that, as you alluded to in the introduction, we are now in the midst of reorganization of how the management of integrated care boards work. So, I'm sure we'll be having conversations down the line with scrutiny committees and various other regulatory bodies who are checking out the detail of that. But it is important that the Health and Wellbeing Board understand what's happening and understand the strategic impact of that, really. So, that's the first part of the paper. Section one describes, on pages 16 and 17, a series of changes that will take place over the coming months, really between now and the end of next March, to how integrated care boards are managed. So, this is linked to the government's new 10-year plan for the NHS, which I think they're going to publish before the summer recess, so at some point in July. And as part of that 10-year plan, linked to the spending review outcomes of last week, they are looking to reframe how various parts of the NHS work. Certainly looking to reduce management costs and running costs, so that's a big driver for us. And you'll see from the paper, we've now been set a target of reducing our running costs, management costs by 50%. So, we'll be spending, on the 1st of April, 50% less on managing, running the integrated care board and running services like continuing healthcare, safeguarding various other services that will interact with partners on the board. So, that was the challenge that we were set in the middle of March. I think all this started. We've subsequently been working with various other people across the geography to try and work out how we can best achieve that. And you'll see the paper describes a proposal that we're currently now talking to HS England about, whereby we wouldn't merge the ICBs, and I'll come back in a second to why we wouldn't do that. But we would share management and leadership capacity and run two ICBs, run Herefordshire and Worcestershire Integrated Care Board, and the same team would run Coventry and Warwickshire Integrated Care Board. So, keep the two statutory bodies, but have a single team sat behind them doing all the work, and the net result of that would be a 50% reduction in running costs. That 50% across Herefordshire, Worcestershire, Coventry and Warwickshire equates to £23 million. So, this is a lot of money taken out of management to be available to put into frontline care, and actually, it is a lot of jobs that will be lost through redundancy. So, I think we will look, in Herefordshire and Worcestershire, we will have to make somewhere between 150 and 200 people redundant as a result of this. Clearly, we haven't got the detail and any specific detail of the structures yet, but we will be working that through over the summer months. So, to come back to, I think we very specifically are saying we don't think we should merge the two integrated care boards because one of the aims of the government's 10-year plan will be to get much more alignment with the local government devolution agenda. So, one of the things Councillor Bell and colleagues will be doing over the coming months is working through plans for a unitary council or two unitary councils in Worcestershire, but also for Worcestershire to partner up with other local authorities in a strategic mayoral authority who will have an elected mayor. I think the policy aim nationally is that the integrated care footprints would match the mayoral authority footprints, which does make a lot of sense. I think we're recognising here, as in Herefordshire, as in Coventry, well, as in Worcestershire in particular, there is less clarity at the moment as to what those mayoral footprints will be. The local authorities have got work to do to work through how they want to form their mayoral authority footprint. So, in light of that, it's not worth pushing on emerging integrated care boards. This is an interim arrangement that can allow the savings to be delivered and a holding pattern, if you like, whilst we wait for the local government reform agenda to move through. So, really important to point out, that's the end destination and we'll be looking to work with a new cabinet and the leadership of the council as that journey continues over the summer. So, that's the ICB changes. We will still be here at Health and Wellbeing Board. We'll still have an integrated care partnership for Herefordshire and Worcestershire. Councillor Bell, we'll probably still be asking you to co-chair that with your colleague and counterpart from Herefordshire. Nothing changes around this. This is all internal back office changes to reduce the cost. So, that's the first part of the paper. I'll probably do the second section and then maybe we can stop for questions before doing three and four. So, just wanted to give some headlines in section two, which is pages 18 and 19 of your pack, just about what the NHS has delivered locally during 24-25, this being the first meeting of the new financial year. I think my summary is we've made good progress in lots and lots of areas, but there's still so much more work to do. Actually, I think we can be proud of some of our efforts to bring down waiting lists, to improve GP access, and you'll see in the report the most recent data suggests residents of Herefordshire and Worcestershire are more satisfied with their ability to access GP appointments than any other area of the country. Which, of course, is something to be celebrated. But we all know, and I get complaints and you'll get comments as members, I'm sure, of people that can't get what they need from their GP practice. So, it's a good example of where, yes, we're doing fantastically well. I think we're offering 29% more appointments now than we were before the pandemic, but actually there's still a lot more work to do. And you'll see through the bullet points, we can point to similar improvements in things like dental access, mental health, how the NHS uses the digital app and the shared care record to share information. They're all fantastic developments, but in all of those areas there is also a hell of a lot more work to do. So, I'll probably stop there if that's okay. Happy to take any questions on Section 1 or Section 2, and then I'll hand over to David. Thank you, Simon. So, David. Okay, so go straight into the next section. Thank you. I'm David Mahaffey, I'm the Executive Director for Strategy, Health Inequalities and Integration at the Integrated Care Board. So, Section 3 of the report really focuses on what we're focusing on improving in the coming 12 months. And I think, as Simon said, it's been a challenging year last year for the NHS, but some good progress made in a number of areas. And the coming year will be a challenging year for us, but with some confidence that there are some of these priorities that we can really make good progress on. So, for example, you would have seen on page 18 of the report the large reductions in very long waits for care that people experienced in elective care. Really quite significant reductions over the last 18 months, people waiting longer than a year, longer than a year and a quarter. So, we want to continue that push, but we want to get back to the old measure of 18 weeks. So, move away from waiting for a year for care and get back to measuring waits for 18 weeks and looking to get that number back up to 60% as one example. And 67% of patients having their first appointment within 18 weeks. So, two kind of key measures there. We're really pleased with the progress we've made on cancer care in the last 12 months, but we're looking to stretch that performance further again in the coming 12 months. So, for example, people with a suspected cancer having a diagnosis confirmed. Last year, we were at just under 79%. We're looking to increase that to over 80% in the coming 12 months. And people whose cancer care is actually started after a confirmed diagnosis. Last year, that was 70% within 62 days. In the coming 12 months, we're looking to improve that to over 75%. And there are a range of other targets that we're looking to improve our performance on. Ambulance waits for people who have dialled 999. For example, largely, we achieved that target in this part of the world. Category 2 responses there. They're called to people with an urgent life-threatening condition. An ambulance arriving within 30 minutes. Generally, we're 25 to 28 minutes. We're looking to maintain that. But the one area where we do need to improve significantly is people waiting for longer than four hours for treatment in the ED department. And that's an area of focus for us. There's some other areas that are included in the report around dental, mental health, learning disabilities, and autism services, etc. So, those are the key areas we'd like to focus on. So, I pause there before going on to the final item just in case anybody wants to ask more questions. Yes, please. Thank you, David. So, I think we can go take some questions because it's quite a lot of information for us to on the service first and then the key targets. So, any questions, please? Yes, thank you. Andrew Wilmot. Thank you very much. Malvern Hills District Council. You're taking a huge chunk, 50%, out of part of your organisation. And to date, you seem to have comparatively good results. Are you confident that that can continue after the restructure? That's a very good question. I mean, I, so alongside this reduction, there are going to be changes as to how the wider NHS works. So, the biggest element of that being the NHS England is being abolished by the government and absorbed into the Department of Health and Social Care. So, there is a good proportion of that 50% we will deliver by the lack of the need to service the NHS England infrastructure that we currently, our teams spend a lot of time feeding information into that. So, whether the Department of Health will really adapt to that new world and stop asking for so much information, who knows, but that's part of the theory. Secondly, they are asking us to be more of a strategic commissioner. So, lots of our staff are pretty heavily involved in, like, day-to-day operational work. They work with Mark's teams on helping patients stuck in hospital. They work with the A&E team on helping to bring ambulances in that are waiting outside hospital. It's pretty hands-on, but actually what the government are now asking us is to be much less hands-on and to be much more strategic commissioners to use the data, work with Lisa and the team to use the data. So, yes, it is a big chunk, but actually it's going to become a different job as well, and we will have to adapt. I think the other thing I'd say is what we want to make sure we do is to retain the improvements we're making. You are right. The NHS in this part of the country is far from perfect, but we have made some good progress in recent years. We want to continue that journey, that direction of travel. So, I won't be willing to compromise things that make a difference for patients to hit this target. I think there's a conversation to have as we're going through the next year or two about how we get down to this new spend level. And I think your colleagues in NHS England and the Department of Health are happy that there's a flexibility to that approach as well. So, we are going to have to balance a lot of common sense and pragmatism across this journey, and that would certainly be my intent as we head into the summer months. Yes, thank you, Simon. And, of course, we are looking at different other views as this forward plan says, you know, shared care, records, so that we get information better among each other, organizations, so that will help in efficiency. So, and NHS England, yes, there will be a lot of mobilization of resources to deliver that. But it's a good reset for us that, you know, when we are talking about 18 weeks and that's for us to go back to where we were and then have that standard practice to go forward. Thank you. Any more questions? Thank you, Simon. Yeah. Yeah, I just wanted to pick up on Simon's comment, because for Healthwatch, I work in the region on things like cancer, for example. And what I observe is that Simon's team play a much bigger role in the provision of services here with our providers than is the case across the other parts of the system within the West Midlands. And, in fact, some chief executives from trusts across other parts of the West Midlands have privately questioned with me, well, when we lose our ICB, what will we actually lose? Right. And I just want to, I thought the paper might have identified, because there's going to be a need for our providers to step into some of these roles that Simon's been fulfilling if the patients are going to continue to receive the level of services that they are and the improving services that we see. And I'll come onto that in the second part about patients' responsibilities, because some of those waiting lists, I know of patients who are getting a knee replacement in a two month, three month wait, but that's because they're fit enough to take advantage of some of the offers that Simon's commissioning in the private sector, for example, and don't need the support of HDU and what have you if they have a surgery. So I'll come onto that in the second part, but I just thought, just mentioned the part about, from our perspective, if Simon doesn't have his team, there could well be a gap in what we see at the moment. Yeah, it's a good question, Simon. Undoubtedly, part of this is a more responsibility and accountability for the NHS trust sector locally. They are going to have to step up and own a bit more of this themselves. So Jim Mackey, who is my boss, in essence, the chief executive of NHS England, he says, we've got to stop blowing the lines and be clear, is this a provider problem? Is this just, you're not organising yourself properly? Or is it a commissioning problem? You're not commissioning, and you've got to be clear, it's one or the other, it's rarely both. And actually, I think that will become much more apparent. What we don't want to do, though, is just drop the ball, do we? We have got, that's what I'm trying to emphasise, this transition, and we make sure it's safe and sensible and pragmatic. But absolutely, Simon, we will need a lot more ownership from both of our local providers of the big agendas. And Ellen's here, we'll be looking to lead that for mental health and community services. And Jo's team at the hospital will be looking to take on that responsibility, I'm sure, for lots of the urgent care, cancer, diagnostics and elective services as well. Thank you. Any more questions, please? It's really more of a comment. Obviously, I work very closely every day with ICB staff. And I just want to, didn't want this discussion to pass without a note about them personally. This must be a tough time to lead a large team of professionals, a lot of uncertainty. But still, I turn up at meetings and my ICB colleagues are there, you know, still full of the same enthusiasm. They've always been all wanting to do the right thing for Worcestershire. So I just wanted to put that on record that, you know, my ICB colleagues, on a personal level, are working right across your organisation and working through a difficult time. And obviously, you're leading them well and keeping them focused and motivated. So I just wanted to put on record my thanks to ICB staff just for keeping going and keeping being the professionals they've always been through a difficult time. Thank you, Lisa. Thank you, Lisa. So we can move forward, David. Thank you. Yeah, thank you. And thank you for that comment, Lisa. So the last part of the report then is focusing on the Joint Forward Plan, which is a rolling five-year plan that we first published in 2023. It's designed to have three specific purposes. The first of which is to describe how the NHS contributes to the delivery of the Health and Wellbeing Board priorities. Secondly, to describe how the NHS, that's the ICB and the NHS trusts, exercise their statutory duties. And thirdly, to describe how we will deliver our annual planning priorities, which I refer to in section three of the report, those kind of six key areas. So with regard to the first of that above, the contribution to the Health and Wellbeing Strategy, the Health and Wellbeing Board was first invited to offer an opinion on the plan when we published it in July 2023. And it gave an opinion on the plan, which we published in the document. And then the statutory guidance and the statute itself asks us to bring the plan back each year to the Health and Wellbeing Board, each year it's refreshed, to ensure that that opinion remains valid, or if the Health and Wellbeing Board wants to change that opinion, to reflect the changes. So that's one of the asks for today, is to look at the Health and Wellbeing Board's opinion on the plan. So the full plan is included in the reports packed from page 23 onwards. I do apologise for the 90-odd pages that's included in it. And I say this every time, this is a really big, important plan for us. It covers everything we do in the NHS, and we try to condense it down as best as we can into sections, you know, three or four pages on each key area. But there's no getting away from the fact it covers a lot of ground. So apologies for that. But I would like to highlight that there are no absolutely fundamental changes to the versions that the Health and Wellbeing Board has previously reviewed. We've updated the report to say this is what we achieved last year, and we've updated it to say this is what we're going to focus on again next year. But our key focus on this plan, as described in the title, is about getting upstream with a focus on prevention and to deliver best care in the right setting when that care is needed. So that strategic objective hasn't changed at all. So the essence of specifics in children and young people or primary care may be slightly different, but it's still driving towards that same objective. So what you will see in the supplementary paper, Agenda Item 6, was a suggested wording for the new opinion. So asking the Health and Wellbeing Board to review that wording if they haven't already, and to either confirm or request any slight changes to that wording. So we can then publish that opinion in the plan when we put it out into the public at the end of June. Thank you very much. Thank you. Thank you, David. So just to confirm about the agendas, everyone has received this statement, which is there, about NHS Joint Forward Plan aligning with Worcestershire Health and Wellbeing Board strategy. So everyone has had a chance to read this. Okay. Thank you. Any other questions to David? Yes, Simon. I've got one, and I might sound like a stuck record. At a risk of sounding like a stuck record. And that's around co-production with patients and the public, particularly as this requires such a big shift in terms of mindset for patients and the public about how their health service will operate, both from the point of prevention, hospital to home, analogue to digital. They are all for patients we know, a massive change in mindset. I often point to the point prevalence audit that's done about whether patients only one particular time should be in a hospital bed. Are they in the right place? I often question whether that could be a shared decision with the patient so that we could actually find out whether the patient thinks they're in the right place as opposed to what the NHS thinks from a clinical perspective about where they are so that we can sort of judge the gap, if you like. And every time I ask, I understandably get told by David that that's just not actually logistically possible to do that in the time that the point prevent audit is made. But I just use that as an example to say that I guess I would like to be reassured, seek assurance, that that commitment to actually investing in co-production to make these changes possible. Because otherwise, I think if you don't take patients with us and the public with us, they won't be delivered upon. And I use the example around prevention, for example, of actually reducing demand in the longer term. So I'm really looking for that assurance because I'm afraid I haven't read all of the 90 pages in detail. I have picked up, I have read the pages on engagement with communities and what have you, but just looking for that assurance around co-production. Thank you. Thank you. Yeah, thanks for that question, Simon. And we did indeed talk about whether we could make a joint decision last time. And I did go through several conversations with people who are responsible for filling in the forms. So the point prevalence audit, just for people's understanding, we do an audit on the third Wednesday of September every year, between 10 and 12, in every care setting. So every bed, every acute bed, every community bed, every discharge pathway, every care home where the person is not having their normal care package, if they're having an escalated care package. And ask a series of 10 questions about whether that's the right care setting for them at that particular point in time. So the logistical challenge is when you're doing that in 2,000 care settings, the time commitment to make it a joint decision in each instance is challenging. But nonetheless, I did take Simon's suggestion on board last year and I went and spoke to people about it. The biggest challenge I got back was actually it's a clinical judgment that people are making at that decision. So are they clinically in the right care setting, not socially, emotionally, do their clinical needs justify an acute bed, do their clinical needs justify a community hospital bed. So those two elements combined were the key factors as to why we haven't been able to implement it. But to address the wider issue of co-production, it is something that we talk about throughout the document. So the section on children and young people, for example, talks about co-production, the section on learning disability and autism, the section on primary care, and the section on commitment to carers talks about co-production. I think Simon's challenge will be every section needs to talk about co-production and I fully take on board that challenge and we'll make sure that we pick that up in future refreshes. Thank you, David. Simon, are you happy with that answer, but I can add in a little bit from the acute setting side as well, because I do have experience working with elderly patients at the front door. So, of course, I mean, you know, the evidence shows that we have challenges in the intermediate care and this is not something this year. This has been possibly going on for the strain for the last 10 years when, you know, the acute beds were, the intermediate care beds were closed. So social care and the intermediate care so is under strain. So when we talk about make those shared decisions to have someone come out in the community, so there are so many other factors where they are going to go, who is going to look after them, are they safe to be at home? And, you know, every time an elderly person or patient goes to the hospital, there is so much more added to their co-morbidity. So it sometimes just doesn't become a simple decision for us to say, yes, we can discharge you and then you are OK. But, you know, there is no care for them outside to stay in the community safely. So there are challenges and I think one factor is linked to another. So once we have to sort of sit down, look at everything and then put it all in context, then only we should be able to, you know, address these issues. So I think from the elderly care side, we are in quite a lot of challenge in the acute care settings. I absolutely appreciate that. Thank you. Now, I want to come back to you to say I absolutely appreciate that. I mean, we've done a lot of work with the acute trust on discharge, which and with Mark from the council on discharge. It just demonstrates how complex an issue it is. But I think the comment that was made about it's a clinical decision, right, and not necessarily an emotional or where the patient wants to be, is the mindset change that I'm talking about, and I think that will be even more profound in our community hospitals when we come to looking at the flow in the community hospitals than it is perhaps in the acute, because they are very much seen as a refuge by people. Yeah, a couple of things. Yes, I feel sorry for David and Simon. I think you've got a real challenge in terms of co-design. I was at a meeting a few years ago. I'm not going to say which one or who was there, but a very senior member of the local NHS when the trust was challenged on co-design. And there was a very brief rabbit in the headlights moment followed by, well, once we've come up with our plan, we do ask you what you think of it. Now, I know you've got some staff who are really, really good, who get this, who want to talk to people, who understand that their decisions are improved by broadening the input, but also you're a big organisation, it's a hard culture to turn around. So I just want to say you have our sympathy on that one. I think there is a really fascinating question under all of this and this strategy, this whole shifting upstream, which is that the definition of health is changing. So we need to change it within the thinking of the NHS, which is a little bit of what's been talked about here, so that people realise that health doesn't start at the GP surgery or the mental health support unit. There's a whole swathe of territory out there where huge work is being done in health prevention before anybody even touches our health services. But, as was alluded there, we also need to help the public understand that. So that sometimes not having a prescription is not a bad thing. Sometimes actually not having this wonderful bag of tablets, it might be better to join the group that's walking by the river each week. So I think the more we can have those discussions in public, and I think co-design helps with that, the easier it will be to navigate this because everybody's going to have to move to a completely different place because the current model's unaffordable and it's just going to blow up, and we all know that. So, but, you know, best the British. Thank you, Chair, and good to see you all. Thank you for the opportunity to bring our summary of community safety work within public health to the Health and Wellbeing Board. I think it's been about two and a half years since we last brought a full community safety update to the Health and Wellbeing Board, but Paul and I have been on a number of occasions since to bring really specific updates on important areas of work, like domestic abuse and drugs and alcohol, and we'll take the opportunity to give you brief updates on those as we go through the overview. I'd also like to introduce Simon Wilkes, who I'm sure a number of you have already met previously. Simon's here in his role as our lead for trading standards, as one of the County Council's functions, and as far as I understand, it's the first time we've been able to bring trading standards to this particular table, and it's a really good opportunity to understand the role and the impact they have on the health and well-being of residents across the county. I think a really important thing to start with is that we'll talk about a lot of real positive stories throughout the paper, but none of this work happens in isolation, so none of this work is just carried out by Paul's community safety team or by Simon's trading standards team. The success in all of these areas is a result of all of the excellent partnership work, which includes all of our statutory colleagues around the room, but also some amazing VCS organisations, a number of which we'll refer to throughout, but it's a really important point to make that a whole range of really significant statutory legislation is discharged by these teams, and it's a real team effort across the county. So I'll kick off with the first point on the paper, which is around domestic abuse. As I say, we brought a paper here a couple of years ago when the domestic abuse statutory duty was pretty new, and we talked about the new range of responsibilities that that placed at the foot of the local authority, the County Council in particular. And it's amazing actually to be sat here two years later to talk about so what, so what has that changed and what are we achieving as a result? Part of the duty around the statutory duty around domestic abuse, blimey, how many times can you say duty in one sentence, was around conducting regular needs assessments and the development of a local strategy. And our most recent needs assessment, and often I understand needs assessments can carry with them an element of so what, an element of we do the analysis and then what do we do differently as a result. Our domestic abuse needs assessment that was conducted was finalised in 2024, but obviously took place through 2023 and 2024. It commended the excellent services we have on offer in Worcestershire, but it also highlighted a number of gaps for us as commissioners to consider and think about how could we do stuff slightly differently. In particular, it talked about communication between organisations, so victim survivors were having to tell their story multiple times and be re-traumatised as a result of that. But it also indicated an inequity in services across the county. So individuals who were experiencing domestic abuse would have a different range of services on offer, depending on where they lived in the county. And quite frankly, from our perspective, that was unacceptable. So that was one of the things we needed to address really through the commissioning of services latterly. The second bit in general was access. So the access to excellent evidence-based service provision that is timely at the point of contact for individuals who need that support in that moment. And I'm really, really pleased to be able to sit here today and say, using our domestic abuse grant, which we receive annually from the government, I'll note that we only receive a one-year settlement. So every time we get the grant, we make decisions for that coming year. It's really difficult to forward plan. But we've been able to use our 25-26 grant to commission a brand-new additional service. So in addition to our substantive DAS service, our domestic abuse advice and support service, which is delivered by West Mercy Women's Aid, we've also commissioned a brand-new community-based domestic abuse service, directly listening to the feedback from the needs assessment from people with lived experience of DA, ensuring that people have timely access to service provision within their district, within their local area, regardless of where they live in the county. And that feels like a really huge step forward. That service went live in May. So more information will follow over the next few months about that. But a real significant step forward. I won't labour the point much more on the needs assessment itself. But what I will talk about is, it was an upside-down needs assessment from a public health perspective. We normally lean very heavily on the quantitative, don't we? We throw out lots of pie charts and graphs for everyone to have a look at. The DA needs assessment, unapologetically, was completely opposite. We focused very, very much on lived experience, the voice of the victim survivor in Worcestershire. What does it mean in Worcestershire? What are access to services like and how are we going to make stuff better? And that's been really important in delivering the changes that we've been able to deliver this year. Moving on to the second part of the paper, which is drugs and alcohol. Again, we attended, I think, about two years ago now, actually, and gave a really substantive overview of drugs and alcohol in Worcestershire. And we focused really heavily on the Dame Carol Black review. You'll remember the government at the time commissioned Dame Carol Black to review drug and alcohol services across the country. And following which, the government published their, from Harm to Hope, 10-year drug and alcohol strategy. But with that, what was really important is it brought with it additional funding for local authority areas. And we're now four years into these drug and alcohol grants. It's increased year on year. And this year, we're receiving about £2 million in total to supplement our drug and alcohol service provision. And that funding, alongside the work of Paul and his team and our providers, Cranston, Mags and Emerging Futures, has really enabled us to turn things around and make things better in Worcestershire. We've had good drug and alcohol services for a long time, but we've really been able to respond to the government's call. Two of the things that we were asked to improve, based on our local needs assessment, but nationally, in utilising that funding, was to improve access and was to improve quality of drug and alcohol treatment services. What we've been able to achieve, I'm actually looking at my notes to make sure I get these numbers right. It's quite incredible. In May 2023, in the year preceding, just over 1,900 people had accessed our drug and alcohol service provision that year. Looking back from May 25 to the previous year, we've had 3,300 people attend that service, which is a quite remarkable turnaround. We've seen unmet need for alcohol dependence in Worcestershire go from being worse than the England average to being quite significantly better than the England average. Now, access is only part of the story, but it's a real significant step in the right direction that we're getting people through the door to a service that we knew was excellent. The second call was to improve quality, which clearly is of fundamental importance. And one of the measures of quality is around continuity of care. This concept of continuity of care is about when an individual is in prison and they're using drugs in prison, is what proportion of those individuals, upon leaving prison, go on to engage with our community drug and alcohol treatment provider. And in Worcestershire, I've been involved in drug treatment services in Worcestershire now for about 10 years. It's something historically we've really struggled with. We've really struggled to build those relationships with prisons. We've really struggled to drive those numbers forward. What we've seen since 2021 is an increase in the proportion of people who go on to successfully engage with our community treatment, increased from 18% to 67%, which again has gone from being at the poorer end of the national average to better, significantly better than the national average. So again, a quite remarkable turnaround. And that stuff isn't rocket science, but it's taken hard work, it's taken determination, and it's taken really skilled workers from Cranston to spend time in the prisons, get to know how that system works, and sell the concept of community treatment to people who are being released from prison, which they've been really, really successful in doing. The benefits of that, again, I won't labour this for too much, but there are many, many benefits to increasing access to drug and alcohol treatment and for keeping people in treatment following their release from prison. The first thing is it reduces the risk of drug-related deaths. So often people can become opiate naive whilst they're in treatment, and then when they come out and start using drugs again, that can lead to drug-related deaths. It makes them quite vulnerable. So we can manage that change, can't we? We can manage that change as people come into treatment. We also know that people who are engaged with treatment are less likely to be disruptive out in the community. They're less likely to be involved in criminal activity, involving theft. Around 42% of acquisitive crime is linked to drug and alcohol use. So by increasing the number of people engaged in treatment, we can significantly impact those figures. We also know that people who are accessing treatment are much more likely to engage with the NHS in a more positive way. So rather than reporting to A&E because of an injury or what have you, they're more likely to engage in GP services and preventative care. So really important that we've been able to start to turn those two things around. I'll move on briefly to trading standards. So Simon's team, as he reminds me on a monthly basis, have responsibility for discharging approximately 300 pieces of legislation on behalf of the County Council, all of which are linked to keeping populations safe. They have a really wide range of duties linked to the weights and measures, to food safety, product safety, fair trading, amongst a whole range of others. They undertake really regular strategic assessments to understand where to discharge their resource within the team. They have an incredible bunch of staff members, trade and standards officers, and they will flex that provision based on the findings of their strategic assessments. We talk about in the paper a really important piece of work that's gone on. We reference how the seizures related to illicit tobacco have increased year on year over the last few years. But a real point of progress, I think, in the last 12 months, 12 to 18 months, has been the increased or the reintroduction of closure orders in Worcestershire. Closure orders enable the team to build up an evidence package based on a particular shop that might be selling illicit tobacco or engaging in underage sales. And it enables the team to work with their district council colleagues to close that particular premise for a period of three months. And it's an asset that has been underutilised in two-tier areas across the country for a whole number of reasons. Lisa and Sam referenced our grants programme earlier in the conversation, and it was a small amount of public health money and the PCC and the district councils that unlocked the team's ability to utilise these closure orders. As you can imagine, based on previous conversations, we accompany those closure orders with a whole raft of media press releases and comms and all sorts. And the hope is that as that work expands, it acts as a deterrent for that work to continue. Moving on to CONTEST. So CONTEST is the government's counter-terrorism strategy, and it's based around the four P's. From a public health perspective, from our Ports Community Safety Team, they focus primarily on the Protect P and the Prevent P. Prevent is all about work focused on preventing people becoming involved in terrorism. It includes the delivery of the channel panel, which Paul can discuss further if that's of interest. But all I wanted to really mention around Prevent is it's a really complicated area of business, as you can imagine, and is potentially subject to significant media coverage. The team are subject to an annual Home Office review, which looks into how our Prevent strategy work and how our channel panel are performing. And in the time that I've been around this piece of work for the last three years, Paul's team consistently exceed all of the requirements around that piece of work. And it's reassuring to hear, but it's a real testament to the work of Paul's team that they're able to consistently deliver that outstanding service to Worcestershire residents. The Protect duty is slightly newer. So this is related to Martin's Law, which some of you will have heard in the paper. And this was in direct response to the Manchester Arena bombings from a few years ago. The Protect duty of the Martin's Law has recently received royal assent and is now law. And we're all now subject to a two-year implementation period. The duty's purpose is around developing a much more consistent approach to making buildings safe, to making buildings and events safer from terrorist attacks. And it applies to a whole wide range of settings, which will affect it all. It applies to education settings, health settings, food and drink establishments, sports grounds, et cetera, et cetera, et cetera. It distributes venues into two categories, so a standard tier and an enhanced tier, depending on their capacity. But venues are now required by law to show they've taken the required steps to ensure public safety. So do they have plans for evacuation and evacuation? Do they have ways of communicating with staff in the event of an emergency, et cetera, et cetera? We have a page on our Worcestershire County Council website dedicated to the Protect duty, so I would recommend anyone who may be a landlord for buildings within their organisation to have a look at that. Finally, youth work. So youth work is another statutory duty placed upon the local authority to ensure the availability of recreational leisure time activities, or to you and I, ensure the availability of youth work provision for young people. As a public health team, we've led on the commissioning of this now for five or six years, and we took a real revised, or the team took a real revised approach to this in 2023, and we started to work much more closely with our district council colleagues, understanding that they really know their communities, and we've worked with them to develop an offer alongside their youth providers, alongside the young people, that is much more flexible based on the needs of young people within those particular districts. So we invigorated the setup of district youth networks. There is now one of those in each of the areas, attended by health colleagues, school colleagues, youth work providers, who will discuss what's going on in their local area. They'll have the views of young people at the forefront, and they'll flex their provision based on those needs. Again, we can go into more detail on that if it's helpful. I'm conscious that that's quite a whistle-stop tour of a number of important topics, but I'll stop there and welcome any questions. I've actually got a couple of areas in this that I'd like to ask about. The first one, in terms of domestic abuse, and I think you may know what I'm going to say, because I think I asked you about this in the briefing previously, but given the issues noted in paragraph six, particularly around the under-reporting of domestic abuse and how women find it difficult to come forward for all the reasons that you've set out, is there scope for public health to basically train staff within the council who are working with families, vulnerable families, to train them in the work of Jane Monckton-Smith, who's recently made an OBE criminologist from Gloucestershire University, because her work, which is absolutely groundbreaking, is particularly good at identifying potential victims of domestic abuse who are struggling to come forward for all the reasons that you've set out. She's identified eight stages of domestic abuse, so it's a great tool. The other part of that work, which is particularly important, is she also sets out a framework for working with perpetrators to prevent re-offending. So it's really asking about, you know, is there scope for developing that, particularly for training social work staff? I'll give a really brief answer, and then I'll pass over to Paul if he wants to add anything from there. So I mentioned that we receive a domestic abuse grant. One of the services we commission is to a provider called Sarah Wigley Training. The training course involves three modules that people can opt into as much or as little as is relevant for their role. Module one is all about exactly the things you've just mentioned, and we have, since we spoke at the last briefing, I have shared the information about Joe Monkton-Smith's work with our colleagues who have shared it with the provider. Module one is all about it's for anybody, anybody working with the public, actually for anybody in Worcestershire really, to help them identify the signs and symptoms around domestic abuse. What might you be looking for when you visit a patient or a service user? It's very much an introduction to domestic abuse. Module two is much more about an intervention. So what? What can I do to help? How can I be an ambassador for domestic abuse? How can I support any individuals I might come in contact with? And module three, actually, is very much around working with perpetrators of domestic abuse. Just before I hand over to Paul, I'll just add around the perpetrator work. We have historically funded a programme called DRIVE, which is its sole reason for being, is to work with perpetrators of domestic abuse. This coming year, or this financial year now, we're working with the PCC who are now funding that service. Paul and his colleagues are very much linked into that commission of the DRIVE service, which is now funded by the PCC across the whole of West Mercia. As far as I understand, one of the first police forces in the country to have that option. So hopefully that allays any concerns around that, but I'll hand over to Paul if you want to add anything further. Thanks, Anthony. Thank you, Councillor. Multi-layered question, actually. There's a lot to it. Coming back to your original comment about reporting. I've been in this environment since 1994, when I ran a domestic abuse team in Hackney in London. And consistently, right up to today, the issue is trying to get more reports. This is one of those few areas of crime where more reports say good thing, not a bad thing. And I've literally just come out of the Domestic Abuse Partnership Board. The reason I look slightly punch-drunk is I've spent three hours chairing a meeting this morning. And one of the issues we discussed is trying to enhance the reporting in of domestic abuse cases for people who might not even identify that they're the victims of domestic abuse. We've talked about reaching out to GPs, training GPs. We've talked about enhancing our existing training so that we can work to a greater extent around the impact on babies, so children up to the age of two. I'm aware of the Jane Monkton-Smith eight-step... I think it's eight steps to domestic death, isn't it, yeah? I'm not familiar with it, hands up. But we can certainly consider it as part of our process. I'm confident, because it's constantly reviewed, we have a robust training regime in place. We are always looking to train more people. We've made it available to councillors historically if councillors want to come along and get involved. We also have other ways of reporting domestic abuse so that partners are aware of what is going on. So, for example, the police, if they attend the domestic abuse incident, and there are children present, they will report those incidents into what's called Operation Encompass, where an update is sent to the children's school, if they're in school, or preschool if they're before the school age, to be advised of the fact that the child has been what amounts to the victim of domestic abuse, because now children who are witnesses are regarded as victims under the new Act, the 2021 Act. So, in terms of that picture of domestic abuse cross-partnerships, we're confident that we have the means to engage with partners. I think we're still short of encouraging more people to come forward, and we're always looking for ways to do that. One of the discussions that I had earlier on was we have what's called a lived experience advisory network, again, dropping out the 2021 Act, a requirement for us as the Domestic Abuse Partnership Board to have an understanding of the victim's voice. That network of domestic abuse victims across Herefordshire and Worcestershire, we commission it jointly with Worcestershire, feed back to us the views of victims in terms of our strategy, in terms of some principal areas of concern, housing, children, and it's a very, very valuable resource for us. One of the proposals I made today was that we look from West Mercer... sorry, West Mercia, from Worcestershire County Council's perspective at assisting them with flagging the availability of this network in conjunction with work that's being done with West Mercia Women's Aid around champions for domestic abuse. So bringing forward more people to be champions across the county so that we get as strong an outreach as we possibly can into communities for people to understand that there are services around domestic abuse. They don't have to go to the police if they don't feel that that's the appropriate route for them. they can go straight to support services. We talk about the housing availability. We talk about the sanctuary scheme that we have that will target, harden individuals' properties so that it's harder for a perpetrator to come into the property and assault the survivor or engage with their family, engage with the kids. So a real spectrum of things. I don't know if I answered your question if that's the problem. Just on the point around children's I wonder if I could just bring Sarah Wilkins in just for a moment to talk a bit more around Operation Encompass. Thank you. Sarah Wilkins, I'm the Assistant Director for Education for the Council. I'm here on behalf of Adam Johnson the Director for Children's Services this afternoon. I think on the point Councillor Bowen about the linking the under-reporting to who can we provide training to, what can we do more of. The feedback and the discussion about Operation Encompass is such an important one in terms of that information sharing which happens, so there are around about, I want to say, 4,000 or more reports made out to schools in the course of a year and now into this sort of low thousands for early years settings of what we call low-level incidents. And our training, our training availability for schools, and when we say schools I mean all schools in Worcestershire including our independent schools and all of our 500 plus early years settings in domestic abuse is, the take-up is exceptionally, exceptionally good. what Operation Encompass and that information sharing process enables and we have evidence of it is that early conversation so the school will pick up something and it's limited what any school would know about an incident but it picks up the opportunity to have an early conversation with the child and with the parent and from that you can stimulate the access to support and information. It certainly, you know, we will know that it continues to be an underreported matter but Operation Encompass is a really good method by which information sharing at the earliest stage enables the child and the family to access support. Yeah, I just want to recommend to the whole board taking some time to read the work by Jane Monckton-Smith which Councillor Rowan highlighted. It really resonates in terms of, you know, when I've had the real displeasure of reading through, for example, domestic homicide reports or just experience of incidents and experience of domestic abuse either as a psychologist or amongst people I know. It really resonated with me. It takes the signs, the stages right back to pre-relationship. You know, the history of right through to the development of relationship, the start of coercive control, triggers and escalation and it's, for me, it underlies if we could all, all of us involved in health and social care and beyond community safety including medical colleagues, nursing colleagues, voluntary sector colleagues, social work colleagues, if we could all be aware of this and learn to pick up these signs, we could prevent more. We could offer support for. It's so difficult for women and, of course, some men to reach out for support around domestic abuse. It can often be difficult for people to recognise what they're experiencing as domestic abuse. And this framework, I think, is absolutely fundamental and indispensable for all of us. So, Jane Monckton-Smith, it's definitely worth a read as Councillor Bowen says. Okay. Thanks. So, it's around prevent and particular paragraph 28. And there's two statements in there I just want to look at. The first is about the Home Office saying it's inappropriate to share statistics. And the second is the increase in right-wing referrals. So, just for context, National Prevent Strategy was launched in 2006. At that time, I was a member of West Midlands multi-agency public protection panel. and as a result, I was one of the first people trained and briefed in Prevent. Now, at that time, the caseloads were approximately 80% Islamist terrorism and about 20% extreme right-wing terrorism, ERWT. And I personally did a lot of work particularly with young white males and diverting them from the English Defence League. Now, that proportion of caseload has not significantly changed. October 2024, last year, head of MI5, Ken McCallum, said that the caseload now for MI5 is about 75% Islamist threat and about 25% for ERWT. Now, the reason I take issue with those statements, first of all, it's mainly around, unfortunately, this government over the last year and the Home Office actually over a few years has politicised counter-terrorism and Prevent. It's started to creep into the training and it uses the term right-wing and far-right threats for putting forward a political narrative. This has an effect on referrals. It dampens the ability, not the ability, the willingness of professionals to refer in terms of Islamist threat and it leads to them being oversensitive to right-wing and making more over-reporting right-wing concerns. So, while the government might use Prevent as a political narrative, this council and this board really has to avoid that and this is particularly important in the light of the Casey report yesterday where Dave Casey highlighted in terms of children at risk of sexually being exploited by group-based abuse local authorities in her words shied away from addressing the ethnicity of perpetrators. We have to avoid that in terms of this issue because there is a danger that the same thing can happen. So, can I ask that the Prevent strategy is reviewed so that it looks at the threats as they stand based on evidence and data and avoids over-promoting phrases like an increase in right-wing threats which aren't backed up by the data and actually focuses on things as they actually are because that's how we will keep the public safe. It's something I've been very passionate about for 20 years. I've done a lot of personal work on it and it's really important we don't make the same mistakes with this as local authorities have in terms of sexual exploitation. Thanks. Thanks, Councillor Bowen. Really important point and I think it underlies the importance in this sort of work at getting the cons right the report right and the terminology right and I think for us where I was learning on this I think and what would be really useful I think is maybe what we should do is take an action to meet with you because it sounds like you've got a lot of relevant experience in this with myself and the experts in the team to go through both the data side of things to take a look at that and also look at the way we word things because the last thing we want to do is either desensitise or oversensitise a particular element we require in order to be effective a balanced approach to this so absolutely let's have that conversation I think and look at how we can restructure a report like this I think it's obviously well meant everything we write we try to keep to we have a lot of guidance coming from government you're right and we try to follow that as much as we can but I think you're right that also taking local opinion and local evidence and insight into this is going to be important so we'll get in touch with you and set that up thank you so next on the agenda for us is better care fund and sponsors Mark Fitton presented by Mark thank you okay thank you thank you chair thank you thank you chair Mark Fitton I'm the strategic director for adults and communities at Worcestershire County council before I delve into the business for the day really for health and well-being board members just to give a fairly brief rundown of what the better care fund is for those of you who don't know but essentially it's amount of money that is afforded to ICBs and local authorities to initially it was the main driver around integration of health and social care services in that sense but to jointly plan to meet the needs of the population in a joined up manner rather than singly on our own so that's the sort of sense of what the better care fund is and I suppose you may look at some of these reports and think why on earth are we getting quarter three out term report from last year now at this point in time in that sense and I suppose there are many difficulties in relation to aligning the returns that are required to make by NHS England and the cycle of the health and well-being board and because of that what happened some time ago was health and well-being board devolved responsibility for the planning and the reporting on better care fund to a group we affectionately refer to as ISOG which was an integrated commissioning executive officer group so they're the ones that really drive the plans and the decisions and reports and then what has to happen though is the reports have to come back to the health and well-being board for that formal sign-off which is the national sort of governance around the whole process so that's just a bit of background in terms of what we're being asked to do today the two reports that you've got as I've already said really is it's a quarter three out turn from 24 25 largely speaking the report talks about the report is for noting the return has already been made from that point of view to NHS England and the sense of the quarter three from last year was that we was at that point in time potentially reporting an overspend on the better care fund budget just to give you some sense of the budget 75 million at that point in time and the overspend at the quarter three out turn was in the region of about 360,000 so that's the sort of first report that in many ways you're asked to note as a board because the return has already been made and just to say in terms of that overspend at the time a lot of that pressure on that budget was as a result of demand in the system and what we refer to as pathway one activity and that's about transferring people from hospital beds back to their own home and supporting them in situ which is one of the priorities for the better care fund what you've also got in front of you as well is a sign off of the better care fund plans for 25-26 it's a one-year plan the budget now stands at 85 million in terms of better care fund and essentially what the plan has been put together is to address the priorities of the system which essentially are around flow what we mean by that is how people move through the system particularly from community to acute hospitals and beyond it's also around the urgent and emergency care agenda there's another priority there's some work around making sure that we prioritise prevention in the system as much as we do treatment in that sense and also again a focus on reablement getting people back on their feet as much as can in that sense to maintain living at home for as long as possible so that's the task really in hand it's more of a governance process than anything else I can't be more flowery than that about the process in that sense but it's to note the 24 25 quarter three out turn and also to sign off the better care fund plans for 25 26 and just a final comment if anybody wanted to look a little bit more in terms of the priorities for the better care fund 25 26 on page 173 of your packs you've got a better care fund narrative plan and that just gives some narrative around actually what we spend the money on and what our priorities are in that sense so I'll leave that there chair