Health and Wellbeing Board - Thursday 23 November 2023, 1:00pm - Wandsworth Council Webcasting

Health and Wellbeing Board
Thursday, 23rd November 2023 at 1:00pm 

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complete.
if, if we cancel thanks, sorry for the slight delay, that's all good good afternoon and welcome to this meeting, I am a Councillor, Graham Henderson, and I am the Chair of the Health and Wellbeing Board, and I shall turn off the volume on this because I've got loads of notifications coming through your mind, iPad which is kind of irritating I'll just finish this preamble then alternate off
members of able, would I, I will now call your names in alphabetical order, please switch on your microphone to confirm your attendance once you have confirmed your attendance, please return them to switch off your microphone.
I say that board membership in alphabetical order.
at E J Carter.
present heading thanks high Mark Craig on present council age Aug Groveley present.
Jeremy this is at present.
Stephen Hickey presence.
Nick or Nicola Jones, if he or she is on that, and he's actually Hanna X and thanks sorry, I haven't got eyes in the back of my head, but I think it would welcome.
Shannon Cato.
Good afternoon, I'm here virtually excellent OK, thanks, Chairman, Vicky Kenny.
nor he had Arianne Javier President X thanks Mike Procter.
sent apology is what our shadow good afternoon present in person excellent, thank you cater Siamak for try.
OK thanks Kate and Councillor Kate stock.
excellent thanks a lot, so please carry out when you are speaking, if you can actually referred to the page number at the top of the agenda pack and the power of a number so far are members of the public, and indeed myself, I think we can follow the discussion.
please also indicate if you wish to speak in the normal way by raising your hand once I have invited you to speak, if you could turn your microphone on and enter.
when you are finished and turn it off.
we do also have a number of officers who were present at the meeting, who will introduce them, as well as other when they address the board Kelly, also welcome Chris offshore across the Independent Chair of the Safeguarding adults Board is here too.
present the board's annual report welcome Paris outskirts in person.
thanks.

1 Apologies for absence

right, so if we can ask of the substantive agenda, apology is, I understand apology for absence had been received from Jamie that a Michael Jackson, Philip Murray and and a pop of each E and any other.
again I prompt excellent
SF n o further apologies.

2 Declarations of Interests

that was a declaration of interests of any debt issuance either pecuniary of or registrable were on an register of interests, please declare an interest quoting the item and paper number in which you have interests and describe England nature of your interests, including whether or not
do you intend to take part in a fat item, and can I ask of, or any declarations of interest?

3 Minutes of the meeting held on 28th September 2023

the excellent good, so now we can move to the minutes of the last meeting which took place on the 28th of September of this year.
first of all, other minutes of the previous meeting agreed, and can they be signed as a correct record any comments on the accuracy of the minutes?
I, in which case I will take it back.
as I can are agreed, OK.
the rate
thank you and good progress so far.
I do like to propose with the board's agreement to slightly reorder the agenda.
so we consider the south-west London mental health strategy first on the agenda, I know the mental health to us did have been a difficulty.
in volunteering some and socially senior to come along to the meeting to talk a bit of a slush, unfortunately, Philip Murray, as has been indicated, had to give his apologies, so I am festival wow, are people concerned with that.
OK x, and so if we can move.

4 Wandsworth Safeguarding Children's Partnership Draft Annual Reports April 2022-April 2023 (Paper No. 23-376)

to any item which, on the original which and was this, a sex southwest under the mental health strategy paper number 23 3 7 8 on page is 89,138 and it is a report about a south-west London and St George's mental health trust, Deputy Chief Executive,
to be presented by Amy Scammell, who is the director of strategy in Transformation and Commercial Development who is joining us off urgently so?
I welcome Amy if you would like to give a brief summary introduction of the paper, thank you very much.
hello, thank you very much for.
including me, and for changing your agenda around, we really appreciate that today C, and my name's Amy Scannell, I work at Southlands St George's mental health trust alongside Philip sends his apologies, and you have, as you've just described to the mental health strategy for south-west London in your pack, it begins on page 89, I believe so just by way of introduction. Back in January 2022 the south-west London integrated care board recognised that there's a great deal of sort of
interest and prioritisation around mental health, and at that point they agreed to commission the development of a new south-west London mental health strategy. This developed over a period of time and involved a number of stages and those stages are outlined in section 3 of the cover report. Essentially, we did and quite significant amount of data analysis and review, looking at population health data and looking at service and performance data, we identified innovation and some best practice. That's going on around mental health and mental wellbeing crossed six boroughs, and in south-west London we engage with our local population
including those who live, work and study in south-west London, across our boroughs, and we then brought everything together and synthesised what we felt would be a vision, statements and aims and some themes, and we tested those back out with a there's a range of stakeholders. I would say over several sessions in this time last year really it was October, November time last year and you'll see that we've developed the strategy into a number of sections. So the cover sheet outlines. I think it's sections 8 to 10 a vision, six aims and four themes, and then you have the document, the actual long strategy document which has been published following onwards from the cover sheet in your in your pack, the strategy in itself, I think it's been extremely helpful in in creating a sort of
focal point almost for mental health work in south-west London. It's really helped us clarify a number of challenges and opportunities, and it's really helped us come together to think about what we want to achieve over the longer term. The strategy itself is for a five-year period, but within the document we include aims and ambitions and goals. If your outcomes 4 x 5 years and 10 years, recognising that a great deal of the change that we need to see will take longer to come into effect, and the last element which I think is important to note is that the strategy was overseen in its development by the south-west London mental health partnership group and every place in south-west London has a representation into that group and then the strategy itself was approved by the South West London Integrated Care Board at its meeting in May just this year, we're now in year one of delivery. There is a lot to do and we have a clear focus in this first year on children and young people's mental health and, in the beginning, on governance and of structures in place, to enable us to work in a collaborative way. So I'll stop that. Thank you very much for including this on the agenda. I'd be really delighted to take any questions or and any comments many of the committee members. Thank you.
thank you very me, offering no questions or cup comments from them, so what?
Abbey.
thanks hi any Muslims Abbey, I'm the voluntary sector representative, thank you very much for a really interesting over put one of the things that just came out quite clearly was with regard to social prescribing and how people were very poor at, but there's a real struggle to get kind of long-term funding for social prescribing by telling you things you know already.
and particularly around B also is just the sustainability, knowing with mental health, obviously you're not unlikely to be able to make changes over a really short timeframe that doesn't need longer term investment, so it was really kind of a, I guess, a plea from the voluntary sector that we want to play our part and people can because of the variety of things on offer,
do some really helpful work, hopefully to help promote better mental health and wellbeing, but that the funding needs to be done in a way that actually gives some surety and sustainability towards programmes, and too often people have asked to do things for either free or for minimal funding, and that's obviously just not.
that is not possible for a lot of voluntary sector bodies that was so yeah, more the kind of a comment and a bit of a plea, really, I suppose, as part of the social prescribing element of the strategy.
thank you very much, maybe I would entirely agreed with everything that you've just said, we really committed to developing a more sustainable model for funding into our voluntary and community sector partners, supports around mental health, and so we started that discussion and I will just now really they were at the early stages but I'm really hopeful through particularly this NHS planning round will be able to make some strides forward and then absolutely be great to come back and have a further discussion with yourself and other voluntary community sector representatives, so thank you thank you.
uncle codes or protocols.
Councillor MC, thanks, Councillor Henderson and Amy. Thank you very much. I think it's a great strategies have been is really well written. I just it was just a question for me because I know we're doing a lot of work now that's probably started in the last six months together across south-west London. All we have to cancel emergency care ends of on of mental health and whether we can do things differently. Do you think the strategy accommodates that or do you think there's gonna need to be a refresh to to recognise that work? I think that's a great question and I think this sort of strategy in itself is it's not just trying to break some mental illness, it's trying to focus on mental health and emotional wellbeing and resilience more broadly, so we're trying to cover actually a really significant span. I think what you probably all have read within the strategy were very focused on prevention and early support work, and I think that is the major thrust of the work within the strategy, notwithstanding that the work that we have to prioritise, at present, absolutely right, so rightly so, on urgent emergency care needs to come into this. I think we have a number of outcomes and metrics and the strategy that speak to those and that might more acute part of our pathway, but actually over time we would want to be sort of moving much more into the preventative and early support agendas. So I don't think it's outside of the strategy. I think it's not the main thrust of the strategy overall, thanks me,
Jeremy
yeah. Firstly, I've got a couple of things. So firstly, only work in terms of working with the community on community led admin and initiatives. I well I welcome, particularly where there's references to the work in south London lessons and work which is driven by communities, and I'm probably just mentioning worth mentioning. Yesterday there was a south-London listeners' assembly hosted in the Borough of Wandsworth that and that was a really excellent example in action of where our communities are coming together, so I just wanted, I suppose, to understand how we're gonna drive out any comments and how we would drive that forward. That's my first question and keep very much great Christian from definitely something for us to consider. I say the one not with London mental health partnership delivery group which brings together all the places in different sectors. Mental health and across our system has started some work around and I guess. Community inclusion and development co-productions, service user involvement, carer involvement and and the south London listens programme told me that you refer to here is absolutely part of that work. So we see their south London lessons programme as a real foundation on which to build, and we also, of course recognise that there are many groups and community groups of BCC partners that are operating outside of that and we want to be inclusive. So I think there is quite a lot of work for us to do this year and next financial year to create a sustainable framework. A bit like Abbey has mentioned to think about how we include all partners, and we really adopt a sort of and assets vessels, strengths based approach to moving this work forward, so I think it's very early days, but I think that's absolutely the right direction of travel and we're really committed to that.
you have to walk.
thanks I mean, and just to reiterate.
I really will well-written document and I've seen it in a number of times already, but just I suppose one comment I think it's important for us to at yesterday's south-west London I see be there was an in principle paper around moving finances towards primary community and mental health services, so I think there's a really important principle that we know funding needs to go to.
frontline services in the community to support you in that prevention, particularly.
I'm and then my second questions kind of.
linked to that because we are seeing unprecedented demand and for mental health services and more complexity.
it's a weird question, how do you, how do you get the headspace to deliver on the strategy when actually you're also kind of firefighting real increase in demand?
not entirely sure I can answer that mark, but thank you, that is entirely the right question, and I think it comes back to case point. Actually you know, how do we balance, where do we, where do we include are urgent and emergency care elements, and the and the prioritisation of service users who are presenting to us now in crisis and distress alongside starting off work which may come to fruition in three or four years' time. That's the challenge, I think, for us as group of system partners
my sense, from a personal perspective, is that we need to start off the work around prevention, early support, community development DCSC, kind of partnership working.
in small contained steps, probably this year and next year, and then build on that as we move into years 2 3 and 4 of the strategy. That's not to devalue that work, but I think it's about doing the work in the right way and being very engaged and very inclusive, and I think we do have to recognise that we don't have any additional leadership resource around mental health that we can put into the system at the moment and we know that capacity is stretched not only within our borough teams but also within our broader ICB system team and some of the providers. So I think it's balance and we aim to set priorities for the mental health strategy delivery on an annual basis. So we will be looking around March time to reset, to review what we've achieved in our first year and to reset priorities for or to set priorities for year two. I would really welcome colleagues to be involved in that process and to give us feedback about what you feel is important. We can then link that, I think, to our NHS planning round, which is currently underway at the moment, operates normally October through to March each year, which looks at where we spend on our mental health and if you are the NHS pound and how we try and tie that up into the prioritisation
thank you
backup?
thank you very much Chair, thank you, Amy my name's workers Shah and I'm a general practitioner in Wandsworth Amy. I just wanted to start off by saying thank you very much for this very comprehensive looking documented, I take pleasure in reading through it. There are many areas of mental health that are amenable to technology and innovation, and I just wondered if you were in a position to be able to articulate your
plans for perhaps a digitally enabled delivery care model.
I may need to come back to the committee with more detail on that, but thank you very much for the question. What I would say is that we've begun in conversations with our digital leadership group within the south-west London, ECB and our digital teams, both within South Muslim St George's and also more broadly, South London and Maudsley, who cover the Croydon element of the system. To think about what our pathways need to look like and how we can support our service users and carers in a more digitally enabled fashion. We already have some significant programmes of work, so we already have sort of, and a sort of air contact to contacts and contacts operating through digital media. We have a number of services that operate technological based treatment interventions, so that might be talking therapies, interventions, and we also already have quite significant amounts of self-help and resources that one can access online, but I think that's not the same workers. What you're describing, which is ensuring that the digital offer is embedded through our pathways and can be used as an alternative.
full support in in the majority of cases, I think there's still more work to do for us there
thank you very much.
back hauling in a man.
the question Nicola
hi, folks, hello Amy, and thank you for this. You know, I think this is great, I've seen in several different forums now and read it more than once, and if there's some really great stuff in there, but I think if you asked your average GP and quite a lot of other people in other sectors, they would say the big things that affect us at the moment and that we see affecting our patients is her long waits in EDI, which we had long conversations about the other day. This is really really huge issue with both the people in E D who are getting less than a positive experience, but also all the other people in Edie who I've kind of feeling the effects of those long wait
the other thing I think people would say is about the
the way that primary care manages to access emergency surgeries for people from JH and get support for people who are in crisis, and there's lots of things in place there, but I think there's work to do to knit that together. I think that people would say that there's a higher acuity in the community and therefore lots of different health and care professionals are managing that, and I'm thinking particularly about GPs, but I think it goes for lots of other professionals. I think we would all be concerned about the inequalities and the physical health outcomes for people with mental health issues, and I think that's probably well catered for in your strategy. But it doesn't actually mentioned primary care delivery of that, which is really where a lot of it happens. So I think there's something there about identifying where this work goes on and where more needs to be done and where it needs to be spread to other agencies as well. I think people would say things about waiting times for A&E HD and CAMHS and all that stuff, and I think they will talk about eating disorders and need for reinforcement in that area. So those are the things that I think are kind of hot topics,
and I really really agree with you that we should be shifting the dial on prevention and making that much. You know strengthened part of what we do, and I think that's what this, if I'm understanding correctly, that is what this strategy is trying to achieve, but I think all those other things, a bit like what Mark was saying, it is like it's not just the headspace to think about this when you're doing all that, actually we still need to sort those things out, and so it's not really a question. It's just a sort of an observation on what we're trying to do here and say I really really support it, but there are lots of other things going on as well. In the more immediate and shorter term
Anthony O'Connor, I entirely agree with that, and it does feel as though the the mental health space it's quite crowded, isn't it in terms of the work that we need to do and the work that we're trying to progress, and what I am really heartened by, as I think some of the work that we've seen most recently, moving forward to talk about the urgent emergency Karen and I'm, and health and emergency departments is has been really really positive financially or we should really thank our key acute trust. Colleagues, for the their leadership and their work within that, and I think there's a further conversation at the urgent emergency care board tomorrow. I believe around that as well, so so I think there are areas that are progressing forward. I think the challenge is always going to be the capacity, so how do we prioritise
between the short term and the immediate and the long-term and the strategic. How do we prioritise pensions that are system level, priority across all six boroughs and also take account of tailoring and health inequalities and local need, and how do we work best with partners such as herself in primary care? So maybe there needs to be a more collaborative discussion about where we put our energy or strategic and transformational energy and mental health, and we could start that now to be really clear for April, I think, for the next financial year, so it'd be really really happy to commit to that, and I know colleagues also would be
thanks.
some.
thank you, I thank you very much Amy for the strategy and I know colleagues in public health have collaborated with the south-west London and St George's on this, I had three comments of a general nature, I think which are more for all partners to be thinking about and the first thing is that we're really welcomed in paragraph 8 the focus and recognition of the wider determinants of of mental health because we all know that the quality and the access to good employment, housing and other services or impact on the incidence and the prevalence of mental or mental ill health and as partners will be aware in once what we are doing a lot of work around mental health.
firstly, we publish the mental health needs assessment last year and this year we're working towards a public mental health strategy that will try to work with partners to pick up on some of those elements and start really thinking through how we can have a partnership approach, depending on all the different levers that we have to impact on those wider determinants, and obviously prevention can't be overstated in all of this and has been mentioned already, and we welcome the fact that that is a strong thread thread running through through this strategy, because I think we all have to remember that whilst we've got the current pressures until we can focus on prevention and to try to reduce the the incidence of mental ill health, then we will continue to kind of just firefight with you know, limited and finite resources, and then my last comment really was on the first year delivery plan in relation to children and young people and really to just say that we know that in order for us to have a comprehensive preventative approach around children and young people, we need to focus on providing a whole healthy environment. So including everything, you know, the environment at home earlier, setting schools and other places where children and young people will be and one of the areas that we think needs more focus around. This is an increase in mental health support teams in schools, which I know I'm not necessarily your responsibility but responsibility of partners across the table. So we can try to increase the coverage in our schools and colleges, which stands currently at around 60%, and moving more towards 100%, so that all schools and colleges in once we've recovered. Thank you,
thank you very much in and then I would entirely support that, and it's fantastic to hear that you guys are working on a public mental health strategy, so we'd be really keen to to support and participate in that, whatever we make sense, the mental health support teams that are really interesting service and actually that has the work. What you have just described in terms of coverage is also voiced by partners in other boroughs, and I think that is something for us to think through. So have we got the right support for children, young people and their families to stay in that school age bracket because there's also children who are maybe not in school and we've got an increase, and we have an emotionally based school avoidance coming through the pandemic. So there are a number of pieces of work that I think we really do need to focus on for children, young people's mental health. So thank you very much
f thanks on coach coach lock Councillor, that thank you, Chair, high dedicate stock cabinet member for children. Actually, I think Shannon has stolen by questions so really are, I think, might put just just reinforces from a children's services, an education perspective that the point that Shannon has just made. We really are seeing rising social, emotional mental health need within our our school and really welcome the focus on early intervention and prevention, certainly from local authority precepts. But that's perspective. That's what we're focusing on
as well, and we're making some investment in terms of place to be in social workers in schools, which also has turnover I can wellbeing benefits in relation to social workers and schools say I was really pleased to see the focus on on schools in the strategy and support what Shannon says about yeah. Expanding those mental health support teams within our schools thanks
thank you countless fantastic, and if we could, if we could connect clearly it's really important, isn't it to connect what we're doing at borough level and with individual organisations up to a more strategic business, probably a lot that we could learn from Wandsworth, for example, maybe that would also support working at system level or across other borrowing saying be great to pick that conversation up from by thank you.
George Councillor, privately I just first and foremost it was gonna, see, I say your emphasis on prevention, that's that's excellent, I'm I'm fully supportive of that.
I wanted to ask you about people would present themselves to accident emergency with mental health problems, a lot of people who were a percentage of them but end up in A&E, and some of them also regrettably, also end up in police custody when in effect they've not really committed a criminal offence. It's the the the mental health issue. That's that's that this led to them, and I see in the the the people you've put. You want to see reduced presentations to A and E for people known to mental health services, except for physical health issues that that's great, but dir do you accept that that sometimes, when you have these people who are turning up at A&E when they've got an existing mental health issue or they're getting arrested and put into police custody that often what's happened is they appear to have lost contact with mental health services and the the that? This is one of the issues that that needs to be emphasised, that the continued contact with people who've get mental health issues so that they don't lose contact, because that's what's then resulting in them, ending up in A&E or police custody,
thank you, yes, there I mean, there are a range of reasons why people may come through the accident and emergency route with mental health issues, and pass are part of the work that we're doing within the trust now, but it's also a national programme is to strengthen our community mental health services for adults with serious mental illness, to mean that there is additional investment, broader, multidisciplinary team, working, greater emphasis on our CCSC colleagues and their involvement and the provision that they can offer and also peer support, because it's enormously important for our community teams to be able to hold people in the community to prevent deterioration and relapse and to be able to identify signs and offer support at the earliest possible point to prevent someone going into crisis and and significant distress, which then of course, exactly exacerbates what you're describing, which is a presentation to A and E or at the more acute end of our system, and that doesn't help recovery and it doesn't help the our services work in the optimal way. So we really fortunate, under the national programme from NHS E that community services have had significant investment over the last three years and so were better able now to provide additional support. Ongoing challenges exist in in deploying that support, not least access to a an appropriate workforce and we do have challenges in workshops, workforce shortages, both in terms of clinical roles or new roles that we're developing. So is an ongoing piece of work to make sure that we are providing absolutely the highest quality and the best care to people who are already known to mental health services to prevent that crisis completely agreed.
thanks to Audrey Mary Tomic, I think you have another question.
yeah, thank you, thank you s chat, so I'm just so in the context, really of the increased demands, and I think that's come across in the discussions, I think, just where a social care point of view.
I know colleagues mentioned the voluntary sector as well. What doesn't come across so clearly in the strategies is our approach to moving resources across the system
you know, we're reflecting, so clearly there's the ambition to shift to prevention and community services, but at the moment the mechanisms are not so clear and it doesn't come across clearly so be helpful to understand how are we going to make that happen, thank you.
thank you, you may have asked me a question. I can't answer. I think thank you very much for the question and I would entirely agree that there is more work to be done to look at the mechanisms of shifting resource, and since it's not a, it's not a quick thing to do and it presents challenges, doesn't it for us, so if we want to move our resource from our acute and urgent care element of mental health provision into more prevention or community support, we have to do that in a way that we can meet that resource safely and that we can not destabilise services and people that need immediate support when they're in distress and crisis. That's very challenging. We also do want to commit where we are, where we feel this is the right thing to do. It is putting support into non mental health sort of NHS providers because we're not always best placed to deliver the care and support for prevention or early support, and the same will be true for social care. I don't think, Jeremy, we have a mechanism for doing this yet, and I think that's something that I would invite partners to work through with us over the coming months for this for planning for this financial year that comes 24 25, but during 24 25 as well, for 25 26.
thank you Chair.
it says that this is the paper that keeps on giving, isn't it?
I just wanted to ask you about workforce, there's obviously quite a bit in the paper about the struggles to retain and recruit, and just generally because the NHS, particularly in this sector.
but I was thinking, particularly with regard to training and making sure the workforce is kind of culturally appropriate.
I I worked with people with learning disabilities and autism and we know, for example, mental health conditions with people's autism is, by the way, going to be disproportionately affected, I think seven in 10 people who are autistic of mental health condition and I being honest don't have an awful lot of faith that when more students are referred to mental health services they're gonna be very good at understanding where they're coming from and being able to cater for them very well.
let alone, if I'm talking about someone who's a black autistic person or white one and so forth, like this was kind of compounding the issues that they face, so I just I'm sure it's something think about, but I was just kind of just have a quick scan through again about where your priorities lie with regards to not just getting more people working with the mental health but making sure those people are the right people who are trained well and can understand the diverse needs that are going to be put in front of them with people who aren't always able to maybe communicate in a way that you know other people would understand, for example,
thank you, yeah, I absolutely so it gets there in numbers and key tenants to the work that we're trying to move forward around the mental health workforce, the first is recruitment and retention, so hold.
trying to ensure that we can fill our vacancies and where we can really positive at the moment, because the senior vacancy rates come down in key areas and that that's really great news, but also retaining staff so being able to offer development and leadership work and different career pathways so that people want to stay within our organisational mental health more broadly, there is a core piece of work, the second is that we're doing a piece of work thinking about cultural competency through our ethnicity and mental health improvement programme which many of you will know about led by our Wandsworth community and empowerment network.
and that work in itself helps give us a springboard to think about cultural competency and links into our Trust-wide anti racism programme,
for example, in broader work around health inequalities, and I think there's also further work on new role development and being able to genuinely I guess, offer opportunities into our community. So it's in my trust covers five boroughs in south-west London, our boroughs are hugely diverse. There's a huge amount, passionate enthusiasm for the NHS and for mental health and mental wellbeing, and actually we need to be out there, I think, and engaging with groups such as yourselves to work through. How do we encourage people to come and learn about health and care to think about, could think about volunteering opportunities to knowing more and also building those connections between our workforce and a broader group of services? So I think it's a much more developmental pace as much more strategic and there is more work to do that.
Stephen Lee, on behalf of the Health Watch, thank you very much and you know excellent piece of work, so thank you.
this is the first year of implementation as it were clearly the agenda moves on to implementation from strategy this year in my mind there was a two really big things in Wandsworth, one clearly is about Springfield the opening of that and that's been really you know there are very, very good but the other thing which this year I think is supposed to be about is about the redesign of community mental health services in Wandsworth I mean this is personal development year.
I wonder if he will give us a bit of an update on where that has got to in your mind and I am and the wet, where are we in terms of developing new models and then planning for implementation?
yes, thank you, and you know, you're absolutely right to say. As I referenced earlier, there's been a national programme with additional investment into community health services for people with serious mental illness that adults and older adults across south-west London. We have taped to were taken, a phased approach to implementation, and we have waited until this year, 23 24, to involve and include at both Wandsworth and Martin borrowers, and the benefit of that is that we've had some learning from Sutton, Kingston, Richmond, Croydon that were able to apply so Stephen. We have now the funding to support the expansion into Merton and Wandsworth, so that's all in place. My understanding at the moment is that there are operational groups in both boroughs, the ones we're specifically looking at the model that already exists in Sutton, for example, deciding what how that might be appropriately tailored to fit within our Wandsworth landscape. Remember, of course, in each borough we have a different range of providers, a different range of leadership groups in a different range of priorities, in some cases and trying to fit and look at that model, and see how we might need to adapt that for Wandsworth and also to build up our voluntary and community sector provision so that that's a core part of our service delivery in the new SMA model. My understanding is there is a partnership group in place, and I'd be really happy to circulate details of that further. If that's of interest to committee members,
we will.
just to cover them. There is a partnership group in place, we can get the details of that. I think, also just to say that in terms of you mentioned them hit like Wandsworth is at the vanguard of all of the them hip programme and that we, the programme on the ESA, often the ICB so we've already started with community hubs, those community activity and mosques across two sites. We have just started a family placement crisis programme. So instead of going into an in-patient, you go into a family and you are supported by that. Family and services support the family in kind of caring for you and dealing with the crisis and, as Amy said, there's programmes around culturally competent
organisations, but also coercive, restrictive practice as well, so that's within the community kind of programme with an M hip, I think it's just worth kind of making sure that we're tying all the strands together.
absolutely Karim OK and are difficult to hold a conference but months or to do three weeks ago, which was extremely well attended.
so I is certainly ongoing work any further questions I do have one or two myself of.
I was actually quite struck, Amy I I appreciate I, Philip, is the money man, so he knew him AP rather sought a better place to answer this, I was quite struck in paragraph 60 of the main report, it says that the level of NHS financial spend on mental health is lower in south-west London than other areas of England.
and you may mean or may not be able to answer this, but have you any idea why at ease and what can we do to rectify it, because I mean demand really is, so going through the roof, I had a meeting earlier this week with officers and essentially into health him office services, local authorities as I've increased by 28% on pre pandemic.
absolutely phenomenal increase, so I think there is something you can comment on
thank you, Chair and I can come into Little's poorly known as not just doing it with comments, a little and say Yes, in south-west London.
the analysis shows that we spend 10% of the ECB, and so the health budget, if you will, on mental health compared to a national average in England and 14%, which doesn't sound much, but actually, when you're talking about.
tens of millions of pounds hundreds of millions of pounds. That's actually quite significant amount, and I think, to be honest, Mark May Mark Crumlin may wish to add to this, but I think sometimes these these kind of investment levels arise historically over time and actually they can reflect differences in historic commissioning between borrowers. They can reflect different ability of those those borrowers. Originally when they were primary care trusts or clinical commissioning groups to be able to invest in certain areas, and they can also reflect how funding allocations to an ECB area or two smaller or as they were, clinical commissioning groups or primary care trusts may have been set. So we, we recognise that this is a real challenge in south-west London and we're really pleased that are ICB has recognised that this is something they wish to tackle and when Mark Harriman earlier referred to having a and, in principle paper at the ICB
most recently to think about shifting resources that is part of this movement, it's part of building a case for change, I think, around where we want to move resource from and to and what the system benefits, the broader benefits would be of further increased investment in mental health and wellbeing, so it's the beginning of a journey but I think a very positive conversation that's already started.
Mark
sorry, it's almost as if we've designed it this way, so actually Sarah Blow specifically talked about south-west London, being benchmarking not as well in terms of mental health spend, and that was one of the the the tenants of the kind of in principle paper to shift it around. I think him is absolutely right around. The mechanism is what we need to do is find the mechanism, and the paper outlined some options to do that, so we need to do that piece of work and I do think historically you know where we were CCG's before that we were PCT is there. As you know, I, the ICB, is an amalgam of six different borrowers and different six different kinds of levels of investment, but it is something that we need to address over the coming years.
OK, thank you.
I mean, I know it's early days George so I touched upon the issues concerning the police and many people with mental health finding themselves involved with the police, clearly the Met police is a new strategy of right care is fairly early days I just want to on the the extent to which the strategies or takes into account that particular initiative,
transport apologies, are you referring to the right care right, parsonage test, that's most recently come in with the Metropolitan police?
yes, yes, that's fine, sorry, I just thought was confirmation. I'm thinking about the right thing, yeah, so the strategy was actually put together before Right. Care Right person was introduced and and indeed sort of widely communicated within London, I think I mean are are experienced by Cameron personally is very early at the moment, but in early indications indicate that actually we were managing to work in this new system and actually the relationships are working well and we're not seeing and coming through any of the I guess, significant risks that people were most concerned about, so that's very positive, and we continue to need to monitor that on a, I guess, a weekly basis, so the strategy doesn't directly refer to that because it it proceeded right kind of right person, but I think in terms of the premise of having the right health and care professional support, someone who is in acute mental health distress and ensuring also that we intervene as early as possible to prevent distress and crisis and to support someone's recovery journey. These initiatives are aligned so actually part of what we will need to do as we move forward is evaluate the impact of Right Care Right person, but also think about some of the learning that we have from our implementation of of that.
of that policy and how that's working for us, so yet they're not directly aligned, but actually I don't think he there is, I don't think this contradiction, I guess I would say.
OK, thank you on us, or any of the questions I will sum up briefly, first of all, thank thank you very much Amy for presenting all it is an extremely comprehensive paper setting out mental health, so actually I think we've had a very good and wide-ranging discussion.
I think what that really emphasises to me is the importance of continuing dialogue, not just at meetings like this. We were safe formal reports, but clearly on an ongoing basis, and I think quite clear from the comments from Jeremy Moll whole range of other people. These are subjects we don't need to come back to and certainly of into to make the strategy a reality, as Mark said, to have an implementation plan which actually works for the borough. So I thank you if it comments I mean I certainly is. I have very pleased, as was Shannon to see paragraph 8 of this rhetoric is looking at the wider determinants of mental health. I think that's very important as all other good stuff here, and I think that's simply incumbent upon us to turn that into a reality. So thank you for coming along, Amy it. I can have a fairly short notice stepping in, and I do thank Philip for his paper. Thank you. Thank you very much
great OK, well, I'll have to Romeo it's simply because mental health is yeah.
truly big issue, and certainly in terms of demand and the pressures we're facing, it's absolutely essential we we actually get this right, so can I thank Members of the Board again for your contributions, which I think were extremely well-informed, however, we now move to what was item 4 on the original.
and or ones of safeguarding and children's partnership draft annual reports.
from April 2022 to 2023 answer paper on 23 as 0 3 7 6 on pages 13 to 40, it is a report, I've a Wandsworth safeguarding children's partnership and it is to be presented what a Beth Kelly, the head of participation and community engagement who is attending virtually so I welcome Beth and them if you can give him a brief overview of the paper, thank you.
thank you very much, hi everybody, Amber Kelly and work in Children's Services, and I am head of participation and community engagement and also Wandsworth Safeguarding Children's Partnership business function comes within my remit.
so you will have in your packs the draft annual report of Safe the Children's Safeguarding Partnership from 2022 to 2023.
I wasn't around at this time, so Madeline Armstrong is also here online to help me if there's any questions from before my time that I can't answer so forgive me if that does take place within the report, the report is the activity of Wandsworth children's safeguarding partnership for that time period but it also touches on the future of the Safeguarding Partnership as we've just gone through.
a large restructure refocusing reimagining of the Safeguarding Children's Partnership, and it's worth saying now that it's placed with me because we have a real desire and ambition to ensure that this Safeguarding Children's Partnership.
and all the members of that across the whole multi-agency partnership have a greater closer connection to children, families and communities that we serve, and so being within my new service is already enabling us to do that better.
we have in April of this year, although I know we're reporting back, we've created some new priorities that you can see on page 32 in your packs.
and our overarching priority for the future for this year and going forward is around anti-racist practice
and a real focus for us is also hearing the voice of the child, so it was really really helpful actually to come after Amy, because there is so much that we've already talked about this morning that connects to the work of the partnership and my service, so we'll definitely be getting in touch with Amy about how we can connect.
I think it's it's worse saying, and I know that every year the this annual report comes to the Health and Wellbeing Board, I'm not sure how it's been presented before, but the partnership worked together to respond to incidents that happen that impact on children and their families and also to to bring our collective expertise and ideas together to ensure that we are working preventatively to increase the safety and wellbeing of children across the whole of Wandsworth and also responding where where where we know through our
multi-agency data that there are issues, gaps, trends, themes that are telling us that we need to respond differently, or you know it more innovatively, to increase the safety and wellbeing of children, so we work together to respond where those needs that are changing but also we have a plan of work and a set of priorities that you can see that where you know there's a real we'll have real machine going on throughout the whole of the year.
so that we can work together to achieve our priorities, the structure of the partnership were separated into different sub-groups, that all report into the Executive and each subgroup has responsibility for delivering on our priorities, and we have a very complex multi-agency dataset that tells us how we're doing and we're progressing against our priorities.
I'll leave it there and leave some space for questions
thanks a lot for our over report, any questions or comments.
Stephen
thank you very much and I've had a very interesting report, but I hope I I have the sort of advantage or disadvantage of reading it back to back with the adults paper which we have next and, and it struck me reading Adults' paper that was for the adults annual report that there was some type of material there which I didn't see here I wanted to just raise that and that was analytical if you like.
in the adults report. There isn't there's a source section, which gives talks about numbers about what sorts of abuse happened, what settings they were. You know what the issues were and also gives a flavour by case studies of individual cases which bring it to life a bit, and I didn't unless I missed it quite CV equivalent in this report and I just wondered whether, looking forward, it might be helpful to include in the annual report a bit more of a flavour of what what's going on here? You know, and thank you
yeah, I noticed the same one.
I thought the adult there's some lovely infographics, aren't they and the adults report that I noticed and case studies, which I don't think in the history of the the Safeguarding Children's Partnership annual report, from what I've seen going back?
through the different years that's T, that's been the case, but now sort of now, it's in my world, there'd be much more kind of creative.
child focused examples that we can give you, so it's really helpful and next time and in fact this is a draft, so let's not let's not fix it until with added some case studies in because that's a really excellent point and I completely agree.
wrong.
for just two to firstly acknowledge that there was the safeguarding anti racist.
a conference this week which was incredibly incredibly powerful, I think one, and it kind of I left thinking.
in my ivory tower, I forget how hard some people's lives are in our communities and then in certain parts of our community, so we should we firstly should commend Wandsworth for holding that event, and we should do more of the same really, and that's something that I want to take to the ICB.
but in that also a ethnicity really came through and and ethnic backgrounds, and and I suppose just in the in the Safeguarding report and it's along the same lines, does that kind of level of detail which informs where we should be had, you know where we should be really looking in supporting in our communities and that's just maybe one thing that I think we could develop over the next year or so.
if you haven't already got it.
yes, then we thank you and agreed also we in one of the things that we're doing as part of our reimaginings of transforming the Children's Safeguarding Partnership, is creating a new multi agency dashboard that will really tell us more about children and families that need our help but also about the impact that we're having in their lives and that's really difficult to measure for us we are done if you saw in the report we've just.
we've employed this year an independent scrutineer and too young scrutineer, so two young people who are gonna work with us across the whole of the borough and help us to connect better to children and young people and really find out from them what kind of impact we're having on their lives as a Safeguarding Children's Partnership and all the different work streams that we're all busy working on as they are they meaningful in any way have they seen any sort of impact from all of this activity that we're doing and we would really want to report that in all different innovative, creative ways with our young people so next year you'll see it not only presented very differently but
yeah, I'm really certain, we'll be telling a very different story, and the conference that happened this week is the beginning of that, so we've set up her new.
anti-racist practice subgroup of the Safeguarding Children's Partnership, and that's the first time we've ever had a group of this nature and we are working with partners across health, police, community and voluntary sector and our young people to make sure that all of that discussion,
that took place on Tuesday at the conference and everything that our data and our activity is telling us with following through across all the different agencies, so it's the beginning of something different.
more innovative, more creative, more connected to children and communities.
in fact.
thank you partner. I also wanted to comment on Tuesday's conference, particularly really about thanking partners in the fact that kind of there clearly is a shared commitment to that vision, which is anti-racist and reducing disproportionality. So I'm really pleased to see that and I think the partners he came, please south, of a real openness and willingness to have challenging conversations, whether it's on stop and search or health inequalities. So hopefully they're definitely does seem to be that that commitment to progress the the conversation, which I think is really important, and it's good to see it reflected here as well. So I guess my question really Beth was just then you've got kind of a different set of partners or more partners here at Health and Wellbeing Board. I just wonder if you thought about kind of how the work of this Board and the partners who attend here, whether it's the voluntary sector or GPs, at how that can also kind of support that that strand strand of work of the partnership.
thank you, Councillor stock, yes, though I referenced it slightly in the introduction of the cover page, which is that with.
we're being courageous and were working at pace and were pulling all of these new ideas and ambitions together, we really need the support and momentum of our partners to help us really make the impact that we want to have, and so particularly with the anti-racist practice subgroup that will be taking forward this work and holding our Safeguarding Children's Partnership to account, you know sort of overseeing all the work of the partnership we really want.
as many different communities and communities of practice represented there, so if if, if you could help help us with that and some of those challenging.
conversations that we are having and sort of dose of vulnerability that we all have in our different agencies and organisations, we're really trying to sort of break down those barriers of defensiveness and, unlike haven't done Tuesday, being really open him and ready for challenge and then what comes next to know what we're gonna do differently, so it would be wonderful and we would be so appreciative if we could have ideas about
partners that we haven't thought about, including in this work that could join us, that would be really really helpful and welcome.
action Fund.
thanks to you for giving the opening address of our conference, unfortunately, I wasn't able to put him in the end, but I have heard it is only went off very well indeed.
any further questions or comments in relation to the children's paper.
if not as own does the Health and Wellbeing Board note of the report?
thank you Beth for coming along and.
Good to see, I see you again some time,
OK thanks.
now MIT is on to press on to the next item, I actually forgot to ask the Health and Wellbeing Board to actually agree the actions in relation to the mental health strategy, which are simply.
can you formally agree the recommendations in paragraph 1 to note and support the strategy and be identify ways in which partners can contribute, I think we've actually sought done that in the sort of discussion, so it is really just a question of formally noting supporting the strategy, so my apologies for at more haste less time.

5 Richmond and Wandsworth Safeguarding Adults Board Annual Report 2022/23 (Paper No. 23-377)

OK thanks, so I think we can now move to Item 5 Chairman and Wandsworth safeguarding adults wood annual report 2022 0 23 paper number 23 0 3 7 7 page is 41 to 88.
and so to a report by the independent chair of the Richmond and Wandsworth Safeguarding adults Board, and it gives me considerable pleasure to welcome Christopher Shaw Cross, who is the independent chair of the put ward, to introduce another report, welcome Christopher
but my area, thank you very much, it's been very useful being here since the start of the meeting, because a lot of the the mental health strategy and the discussion about the public health mental health strategy and clearly children's partnership and being at the Health and Wellbeing Board is key to us ensuring that we work together as partners on the Safeguarding adults Board to protect people from abuse in Wandsworth.
as you know, because the report has been here before, we have an excellent joint arrangement with the London Borough of Richmond, obviously because the director and adult social care and other services work across so we have a very good strategic partnership, working with Richmond and with Wandsworth, but what we've been doing more and I'll come on to this bit later, in terms of our new strategy, is trying to ensure we've got sufficient focus on the needs of people, whether living in Richmond, but in particular because you're concerned here today with Wandsworth, is the needs of people living within Wandsworth and whilst there's lots of similarities, there are always lots of differences. So I very much resonate with what the previous speaker said in relation to children's partnership, wanting to look much more at what's happening within local communities, and I very much welcome the comments from Stephen from Healthwatch about our data, because one of the key tenets of the Safeguarding adults Board is making Safeguarding personal so I always like to try to highlight to to bring to people's attention how we are actually impacting on people in different communities, so what I want to do is just talk a bit about what we've been doing at last year what those issues were as partners and whilst we talked a lot about the local authority having the lead role which they do, the board is about that multi-agency partnership and about ensuring that all our partners, so the ICB the police local authority but broader partners such as the NHS trusts that provide different services whether it's Richmond or Wandsworth, our community sector voluntary sector and, crucially, Healthwatch will have a key role to play as well in trying to ensure that we get out the message to different communities, about how to safeguard themselves and how to keep safe and to try to engage more with communities about what that means to them.
so in the annual year 2022 to 23, we did see a decrease in the number of concerns that were reported to the local authority who manage those on behalf of the board, which were seen as a positive area because we had seen during the height of COVID and just afterwards a high number of concerns coming in which, from my point of view, is good because people are thinking about safeguarding, but sometimes it's not really within the carer criteria, but it does give an opportunity, in the sense of that triage, for people to be signposted to other services that they may not have known about and were hoping to look more this year about how we're doing that and what the effective outcomes are for people because, crucially, it's looking at the make-up of the people who are being referred through once people are referred, if they don't neat require a service, they may go on to an investigation and inquiry and what was positive is that there was an 11% increase in those people who did need more interrogation, support making Safeguarding personal with them, but how to either stop the abuse or to make them feel safer living in their own home or indeed in other situations, the types of abuse that we saw.
we're not that dissimilar to last year, so neglect, which is of concern and majority, is happening in people's own homes. Self neglect, quite a lot of better understanding from partners about referring self neglect as a safeguarding issue. Financial abuse on the increase this year scams an area of concern and physical abuse. One of the areas that we are concerned about not seeing reported is discriminatory abuse that links back to children's work on anti racist practice, and this is a national issue in terms of people, not recognising that financial abuse, maybe because somebody is being discriminated against for other reasons, for learning disability, for their raised for the ethnicity and for other reasons, and we're hoping this year to create more awareness about recognising that so that we can understand what's going on and where to target more help with different types of communities. I've already mentioned the majority of abuse happens in our people's homes. 16% nonetheless are in care homes and 8% in hospital, so there are people from Wandsworth, because obviously, at the hospital sites vary, but I want to emphasise, is that this doesn't necessarily get reflected nationally, and we have to really look at what we have locally because some borrowers will have Councils. County Council have huge amount of residential care homes and therefore will have huge amounts of
abuse reported. So what we look at and we're guided by NHS Digital, who we refer our data to who are very clear, do not you're not comparing like with like we obviously will compare with Roche with Richmond, but there are differences but understanding what's happening locally to make sure there is a much higher quality of care provided and looking at who who is going into people's own homes what I would point out and this has been a system area further down on patient 19 in my report, but I think it's 12 in yours I've got a big x where 65% we didn't record who the alleged person was
which would then help us understand what's happening in people's own homes. Is it familial abuse? Is it's strangers going in? We do know about those care providers going in, I'm assured, and so hopefully I can assure you that the systems that were being used have been changed and therefore this year, and I will come back to report, we will be seeing that are recorded. However, the positive side to that is is that in terms of people who were asked or what are the outcomes so making, Safeguarding personal is very much. How do you want to help us feel safe, and this can be very sensitive when it may be a member, somebody's family, going in possibly taking money from them, and people individuals say Well, I don't want my son to stop coming back, but we will have to have a conversation to say, but if we don't have enough money then you're not going to be able to pay your bills and we need to work towards helping you to have that conversation,
and if those are 80% of people did express positive outcomes in terms of what was happening when, and this is principally the local authority, carrying out those safeguarding enquiries and in terms of the outcomes being met, 94% of those were met and for the reasons some are met, we do look at that may actually be possibly sadly, the person has died from natural causes or, in fact the person has moved on, and there's no need to continue that situation and one of the other key areas. Obviously you would want to ask, I think, is what's the outcome of all this activity? Are we reducing risk? Are we removing risk, and 95% of people do have the risk reduced or removed and where it's reduced or not removed, then the local authority with partners will set up a plan to work with the individual and family to monitor what is happening should it be too high risk to continue
and 84% of those people felt safer after the safeguarding process that they went through
in terms of the people with care and support needs. We haven't actually identified. There are complications about that, not to do with the local authority, but how it's documented, but we do know that this year Lincoln back to the mental health strategy, there's a rise in numbers of people with mental health needs, so we want to be looking at that. The vast majority of people are older people, which does reflect the demographics both within Wandsworth and Richmond. Although we know in Wandsworth, there's a much younger population coming out higher proportion of people from black and minority ethnic groups, so we're wanting to focus more on the cohort of people aged 18 to 65, although it's a very high proportion over 65. But we know about those and have plans for that, and one area that we have been looking at to learn from from the Safeguarding Adult reviews that we've had, that I will come on to as well is transitional safeguarding, working with our children's partnerships. I'm really pleased to hear about the mow more comprehensive approach from the Wandsworth children's partnership and I've now noted I will get in touch with the Scrutiny who obviously I have a similar scrutiny role, but it's a bit softer than the strict scrutiny role children's have to look at. What better can we do together this year around transitional safeguarding? So those young people from 18 to 25 and for the first time this year, we're looking at the numbers of that cohort of group and although the numbers of people who come forward to safeguarding our small because I'm sure you're familiar with care and support, the Care Act doesn't always relate to the children's act and the types of needs that people have, so we're wanting to look at prevention, particularly amongst those groups of young people who may be about to be homeless, have substance misuse issues and typically mental health issues, and we've had
a few sars around that which we're learning from, so that will enable us to then look more in terms of what what's happening in local communities as well.
I mentioned learning disabilities because the need to safeguard people with learning disabilities, people who perhaps don't have capacity, although many do is, is a significant national issue, and the ICB has a responsibility to look at the learning disability mortality reviews and we have oversight of that because the National Health Service determined that people with learning disabilities,
dying younger than people in the usual way or the usual age, and therefore every death is looked at and in Wandsworth of a 14 LA in that year that we're reporting on. I am pleased to say that the ICP oversight determined that there, when there was nothing untoward, in that there was some learning because they always look at learning, perhaps around of the implementation of some of their healthcare procedures, but that by and large people were effectively engaged, so that is very positive as well. In terms of our providers, there is a good story to tell see. QC assure our providers and
by and large, there are very few that needs.
it requiring improvement and there are some who are good as well and outstanding, so that's very positive, but obviously things change quite rapidly, that was last year when our this year, so we still want to ensure working with our commissioning ecology, colleagues, through ICB and through the local authority to ensure safeguarding and standards of care within care homes supported living and home care,
is is sufficiently looked at to be improved, because again, it comes back to some of those issues will be in relation to safeguarding for care providers going in and needing to ensure that the safeguarding
remit is fully understand and we're very conscious we've had for report thank for mental health and workforce that the adult social care workforce is a challenging one in Woking I know and slammed from Wandsworth and Richmond, it has been well maintained and there's a lot of support, but over the years that's likely to change particularly around increased demand, I want to just now come on to what we're doing this year because there's a key strike strategic opportunity for us here we are required to have a strategy every year but in fact most boards have a five-year strategy, our five-year strategy ended in April,
so we're carrying forward our existing strategy, because for this year we want to have far wider engagement discussion, consultation with community groups of previous speakers have spoken about engaging better with people with lived experience.
with service users, and that's something that I'm really pushing for our board to do now. The irony is, in a way our board is made up of all of you, of all the NHS providers that will be reporting here, who are all talking about needing better engagement. So what we want to do is to provide more support for people in their consultation to ask more about safeguarding how do people feel safe, what more can be done, what does safety mean to different people in different situations in mental health? It could be basically when somebody is admitted to hospital to those mental health wards how they help to feel safe on those wards. So what more can the board do to enable people to do that? So really welcome any of you with your local communities, to help us frame those questions, to have better engagement as well, to shape our priorities for the next five years and for our business plan for next year. I've mentioned Safeguarding Adult reviews, which are very important for us to learn from, and I'm looking at. I'm pleased to say, because actually I don't think it's a question of being pleased or not, whether we have safeguarding referrals that become a safeguarding review, because actually, I think the more referrals we have, the more that shows that people in all our multi-agency
remits are looking at, should this become a safeguarding area, so I probably would say we should have more coming through, we did have one come through last year in Wandsworth and determined that actually it was more a specific issue for two healthcare agencies rather than a multi-agency review, but we will always ask those agencies to tell us what the learning is and how they've impacted on on the situation that they've
reviewed we did have a review that was actually carried out by Croydon because the person who was placed by Wandsworth this was a transitional safeguarding person who was as referenced in the report, Madeleine in in Croydon very sad, a transitional case with mental health issues, homelessness support and so on carried out by Croydon and there was extensive learning for Wandsworth children's partnership and ourselves in transitional gardée.
safeguarding which both our Executive and the children's Executive have had assurance on the learning coming from that, but that's there are also issues that we need to go forward, loaning around that with people very complex, physical and mental health needs and listening to the voice of the person which I I think is probably a theme coming out today and a theme that we want to look at going forward for our new strategic approach next year.
I can stop there.
fine thanks, Lord Christopher, or it's suddenly a volume in this report, I think you've covered it.
very, very well, indeed, any questions or comments from members of the board.
backup?
thank you very much indeed, Christopher thank you is a great report and I I really enjoyed listening to your description of the report and all the great stuff that has happened to bring this to this point. I had a specific question which was when board members have a disagreement in respect of how a case or cases are managed that could be through professional differences or different professional agendas, or maybe even a lack of process by one member of the board you've developed what's called an escalation policy, which I think is fantastic and it's a very farsighted as far as, in my opinion, my question really in respect of this escalation policy was how is that working out?
well, my answer to that would be that I would, I would say, that it's working out positively, because nothing has been brought to my attention that it's not working out, however, I think if maybe you think actually I ought to ask, is it working out because it is the Executive that will be then looking at where there are issues and how to intervene on that, so I will take that back as a point to note that we should be scrutinising that. Thank you. Thank you very much
any further comments.
Stearman
yes, I am y y y y, you kindly mentioned Healthwatch, but I have to confess I have slightly guilty feeling that in Wandsworth we in Healthwatch are less engaged actually on this issue than maybe your colleagues in Richmond reading the report, so I really wonder whether it would be useful to have a discussion outside about about this and whether or not just Healthwatch but the ones with Care Alliance which which is the umbrella organisation within within which Healthwatch sits.
might be used more actively to promote messages because we reach not the the carer allowance because, which is the voluntary sector more generally, Israel has established communication channels, so there may be an opportunity there that we are fully using at the moment.
if I can come and say I very much welcome that and I think that there's huge opportunities, Sarah and developing through the care allowance, as well as because Healthwatch has such a key role indeed, if I may say, Kingston, Healthwatch was commissioned across London to develop expertise on people with lived experience and to set up a group across London, so I'm sure Kingston Healthwatch is contacting local Healthwatch is as well around that chair.
I've realised I've forgotten to just highlight or dodge your attention to an issue that was not an issue but that we cover particularly in Wandsworth around Wandsworth prison, if I may just say because it they have done a reporting here and I just wanted to let members of the Board know that Safeguarding Adult Board have some responsibility for prisons within that area, but it's not the same in terms of the assurance that we're expected to have with health services, social care, services and so on. It's arm's length and very much to be there to provide support, and I'm sure you all know that that there have been issues at Wandsworth prison over the past two to three years we have tried to make engagement and I'm confident we're making more effective engagement. Now there has been a lot of change of personnel there and one of the issues has particularly been the inspection reports around health services going in which are commissioned through NHS England. They have now hugely improved, but there has equally been concerns around the safety of people there in terms of self-inflicted harm and deaths, and I'm really pleased that we've had a really fantastic discussions. In response with public health in Wandsworth, Shannon has been involved and his key lead on prevention of suicide and we set up a meeting to try to engage with the prison to enable them who were very keen to have that advice from public health, on those strategies and obviously the role we all know all the staffing issues and key problems there,
and what we are looking at is perhaps setting up a local criminal justice forum to look at what we can do because it obviously impacts on probation and the courts and police, and no doubt children's partnership as well says anything more, we can do to provide better advice and support for those people within the prison but equally those because it is a remand prison people coming out quite quickly back into their communities so that may well be support issues too.
yeah thanks thanks, Lord Christopher with him, and the Nelson mentioned it, I was actually going to raise the issue of prison, so thank you Mark.
just to say, thank you for the report, it's fantastic, and I think the the statistics really help kind of helps kind of paint a picture of what's going on and the cohorts of patients, I suppose my question was just around, I'm really glad to hear you talk about transition because I think the transition between childhood and adulthood can often we can often see some.
very complex needs arising there and I do think over the coming years we're going to see a and even more complex cohort of patients, whether they be older adults or indeed children, I suppose my my question is is around the link to kind of inequalities and I think it's it's kind of in there and there's some ethnicity information there, but I suppose it's whether
are there particular geographies that we are seeing more safeguarding issues arising from now they're more pockets of our particular communities, where we think actually safeguarding issues, there's there's more work for us to do with those communities, so I suppose it's more about whether we have the background kind of targeting information at our disposal and again we can look at where we prioritise our efforts going forward.
yes, that's a really helpful comment and I am conscious that the public health have very good data on health inequalities, you know where the areas of inequality disadvantage or and so on, as indeed is the ICB in terms of those health inequalities in different way, so I mean our dataset is that actually pretty small compared to what public health will have, so if there is an opportunity for us to look at where are the referrals coming from or are they geographically based and looking more at those care and support needs?
and linking in with the other datasets that people have, so we could look at that on a multi-agency basis that would be hugely helpful and obviously I haven't really mentioned community safety, but those community safety issues about where there may be are gangs, cocooning issues and so on where we're developing our relationships to look at that data as well, so yes, absolutely that's a really good point, thank you.
OK, thank you any further questions.
I think Christopher or your introduction was extremely comprehensive and very useful, because it is obviously a very detailed report and I'm I'm sure when you actually answered the other questions that people would have otherwise had so.
thank you very much for the report and work you do so, it is very important and we certainly value your work and work colleagues as well, so thank you for that, so can the board agree the recommendation in paragraph 1?
which is rather on it's to note that the Old Safeguarding Board is assured that the safeguarding partnership is working effectively to raise awareness and prevent abuse as far as possible, where safeguarding interventions are needed, these are undertaken in accordance with the London multi-agency, safeguarding and local procedures and standards.
learning from SAAS is promoted across the partnership, are people happy members, happy to agree that OK, thank you, thank you very much and I thank you all for coming to the meeting thanks excellent OK, so I think we can all move on to Item 7 the better Care Fund Quarter 2 update paper.

7 Better Care Fund Quarter 2 Update (Paper No. 23-379)

23 0 3 7 9 on pages 0 1 3 9 2 1 5 2, it is.
a report by the Director of adopt them public health and Lynne Wild, the associate director of health and care integration, we will introduce a report with Brian Roberts, head of health and care integration in attendance, to answer any questions, so overdue little thank you.
thank you, I think we've talked often in this board about the better care fund, and this is just and how we're doing at quarter 2, which may sound like a long time ago, but at the time passes quickly and so really what we're doing is just to say,
on the whole, we think we're doing OK in terms of using the funds as we planned, and in achieving our metrics.
and I don't know whether Brian wants to talk or or whether you want to explore, indeed any further detail on
any issues around the metrics at, I think one thing we're pleased about is that we are on track with everything.
it doesn't mean it won't change as, but it's it's a good news story for now.
and I think the other thing to highlight is that the better Care Fund as a mechanism for integration, has supported us as a system to work well together, and we have really good partnership work across one once were specifically with the ECB, so just.
thank you him points questions.
Mark
I promise I will comment on every paper.
just to say that they are absolutely echo Lynn's comments around.
good joint working. I think what we want to do with the BCF is actually really dig deeply into it as a as a partnership to make sure that in the changing face of the cohorts of patients that we're trying to deal with that, we are reflecting that in the way that we fund things, so it's not about reviewing it necessarily financially, it's more about, have we got the right schemes in place and the right services in place, and I know we've done a bit of a review across south-west London and I think just locally we are keen to kind of work together to make sure that we are spending the Wandsworth pound in the right way.
excellent.
then, if oven
commented.
soon.
it's just really a sort of as of interest I had, and I compare the the BCF in terms of its bureaucracy, and I seem to recall some years ago the what it was a real issue and I just wonder if that's still the case, I mean things like annual Re. Annual reports were not aligned with the normal financial year. If I remember rightly and things like that and the amount of paperwork that this creates, and I just add interest, really so is that still a real concern? NB if so, is there any way of sort of trying to encourage those
with the levers to actually do something about it, because there was it, that suddenly was a huge bureaucratic overhead to all this.
and then the distraction from the real point, which is the collaboration.
no, this day, a huge thank you.
that's the good news is that remember this year was a two year funding yeah, I do it, and but this year as in past years, although NHS E were quite pleased that they've given us longer time longer time was instead of four weeks I think we got six or eight from the time of publication, the the the the templates. You can see that they're clunky, they're tricky, and some of the asks require us to together quite complex information and put it together at system level.
but it's getting better, and I I hesitate to say that because we have had two weekly reporting, but Brian I think it's now gone 2 monthly, so wow we get one less report.
yes, thank thank you just to just to add to that I think so so some of the timescales have moved forward, so actually we haven't more time, so so last year we can have cause to point actually we just move to scored 3 and then we finish the year but I I think so so there is a massive bureaucratic exercise here but actually there is,
there is, there is some good output, which is actually we we, in terms of the demand capacity, work, some of the other work in here and some of the joint planning. It does mean that your partner sit down and work through some of those issues in a very candid way and how and how those issues can be solved. So so, while it's bureaucratic, I think as a system Wandsworth uses the opportunity to have those advocates, have those that those forms to try to just try to solve issues in health and care services as effectively as it can. I think I think that that would probably be the takeaway here
thanks but.
4 over questions.
she has won and is on the page, on 40, what an e typo under paragraph 6.
on reablement, the assessment of progress against the metric Platt, and it does actually say that the data are not available to assess progress on the you'd proportional older people who were still at home 91 days after discharge from hospital into reablement rehabilitation services, I just wondered, why are we making any progress on developing that data on the face of it it doesn't sound too complex, but perhaps I'm missing something.
thank you for your question, so so this is an annual indicator and what it does is it takes everyone who.
who leaves relevant services in a planned way in quarter 3, so October to 2 December 2023, and contact them by telephone 91 days later to see if they are still at home. So it's it's a big manual process that happens once a year, which is why we can't ascertain progress. However, we know that our our outcomes for the success of re-ablement, which is an ongoing measure which isn't measured here, but we know that over 80% of people end up leaving Ray-Ban in a planned way, with less or no needs. So so we can. We can point to the good things about and the ongoing things about reablement services, but this one indicator is is captured once a year through a very manual process, which is why we can't necessarily say how we're doing it
I think I think that that explains why I thought that.
it was perhaps easier than what it actually was or any others
letter.
well, thanks for the explanation Brian, if there are no.
sorry, further questions, then coming, moved to decision and does the health and wellbeing would agree the following two recommendations, as set out in paragraph 1 of the report?
first of all, to sign off the better Care Fund plan, the quarterly review for Quarter 2 as set out, and secondly, you to note the MBC effort, demand and capacity plans and assumptions for the period November 23 to March 24 can we agree that place extra, thank you good so,

8 Health Protection Annual Report 2022/23 (Paper No. 23-380)

making good progress item 8 is the Health Protection annual report for 22 23 lots of annual reports at this meeting paper number 23 3 8 0 on pages 153 to 182, it is a report by the Director of public Health, and I am honest ash and of Epsom and calm the consultant in public health will introduce the report and there's one I think you're with us urgently.
thanks Chair good afternoon everyone, so I am a doctors spokesman consulting public health, the Health Protection Board Wandsworth Council and.
I just give you a brief summary, assuming MP everyone has read the report, so this report for 2022 23, I liked the work of the bolstered public health team Health Protection Team over the last 12 months also showcases the key successes, challenges and the priorities going forward and gives us the time for reflection into the post COVID world.
in particular, the the post COVID recovery work that we have been doing, the Health Protection bug is quite a significant piece of work and it is an area of book dedicated to the Director of public Health from the secretary of State for Health and who is responsible for the
local authorities' response to health protection matters, including local authority role in planning for and responding to incidents they present a threat to public health, but as we know, it is all a collaborative work working with partners within and outside the Council to make things happen and to gain assurance around that.
the work spans around a few areas, which definitely includes infection prevention, control, outbreak management, also immunisation programmes for children, adults and seasonal vaccination, against and on cancer screening programmes, including emergency preparedness, resilience and response, extreme weather planning, climate change, sustainability and air pollution.
if I may point out towards a few key successes, general successes, I had already included a few successes on an additional onto the report, but I think, looking at the the previous 12 months in terms of leadership and collaboration, now we have got very good relationships with UKSA.
great Kingdom health security agency, with our south-west on ICP colleagues with the NHS primary care voluntary sector organisations to make things happen, which is the rule of health protection system leadership.
we have courtesy or a robust systems and plans in place which have been jointly agreed like immunisation plans and so on
we have done a lot of collaborative pieces of work, for example in bus with the connecting health communities, Mary Mary Dubbo, and I work very closely on that and enter our part of the steering group on cervical cancer screening in Wandsworth to help reduce inequalities and of advice had been quite a resilient team during the past.
a couple of months and during COVID to deal with any reactive challenges, which is also one of the challenges, the the reactive nature of work, but we have got medications, please be proactive planning and put in place initiatives and protocols as a peace. Also, another challenge which is again inherent within the system is you've got an assurance function and not a delivery function, so we have to work with partners and stakeholders to make things happen, to make things easier, as we have developed joint plans like immunisation plans, the jointly agreed plan with our NHS partners, including the south-west and ICB resolution Leeds,
moving on to the next 12 months, the key priorities for us are, we have developed a number of plans which have highlighted like immunisation against a screening, climate change and inequality which are being implemented, so moving forward is to to make sure that these are implemented.
in terms of system leadership.
there are a few things that we are doing. The south-west London infection prevention and control strategy, because one of the things and lead it from the COVID. This no strategy that exist and the roles and responsibilities of different organisations within the system are not clear. So we have got that a task and finish group happening, which is looking at the strategy, which is collaborative, a piece of work that is happening across the system in terms of our input to other strategically suburb, so definitely Joint Health and Wellbeing Strategy. We've got a childhood immunisations and other plans in place so it just gets squeezed. Screening is one of the key priorities and there are also severely surveillance and monitoring systems are in place to raise and scan what is coming up and to keep an eye on things that are happening and participation in campaigns, and also, lastly, I just mentioned. We are leading on this year on the angled out for public health support for Wandsworth which is focused around childhood immunisations. So I'll stop here for any questions and thanks for listening to me, thank you.
thanks to this.
amendment number 1, any comments or questions short.
J, can I just ask a question about the the vaccination work that you have been doing on page 1 6 for you talk a bit, the them are them, them are campaigns and a the statistic there, you've got, is just slightly less than 14% of.
children don't have the them, them are a vaccine or a 24 months, and then that drops you expand sorry, dear to about 24%, with a two doses at 5.00 years, and I appreciate the NHS is pushing these vaccinations or a very prominently, and so too are or are ones with the work that they have been doing to promote them in their campaigns, and I I was personally slightly surprised at that figure because I would have thought that most parents would be very keen to see their children
vaccinated. This is, is there any particular reason for it, anything that's identifiable
thank you. Councillor Cook clearly
there have been a number of reasons, yes, as we know them, and while vaccination across London is not hitting the target and,
I think it has been it was he impacted due to the Covid, having said that,
they have been a lot of issues with the Wakefield report that that had an impact on that and Andrew because of that we see a lot of vaccine hesitancy amongst appearance, but we've got a plan in place, we, we have been participating in the national campaigns and localising them locally with the Edwards out for public health report we are also doing a lot of engagement work and also gaining insights into that.
I was with his costume peculiar peculiar issues as well because of for being in an inner London Burrow the the
the population transition and mobility is quite high as well, so I think there are issues with data quality as well, so I think it's the combination of factors, but I think it's an hour.
priority list as part of the Joint Health and Wellbeing Strategy as well, and we are looking into that, but I think, yeah, these are multiple factors that we need to resolve across a bit of system partners, OK great thanks.
yeah, fine.
just a quick follow up on is I was going to ask a similar question, George, I am semi, might understand if certain demographic groups, who are particularly a reluctance.
to submit either themselves or their children to vaccinations, what more can we do to actually get to those particular groups and admits it really is a major challenge and I am not suggesting it's straightforward or easy, but what do you think you actually need to do to get it to some of those particular groups who do appear to be reluctant?
for whatever reason to take up vaccinations for themselves or for their children
that said, I I think that's a really good question, I think this was another thing I wanted to ask of this committee as well if there was support, so I, I think, in terms of fixing hesitancy and disengagement.
from the Paris perspective, and it could be social media or other things.
what we have been doing with our NHS partners is doing some webinars for parents and weighting them. The uptake has not been that great for that, but I think we need to do more, are raising awareness about the importance of them are and other childhood vaccinations. There has been a vaccine fatigue because of the autumn winter vaccination programmes and COVID it in in in the past couple of months and ears, but I think it is do to raise awareness and to do some training and vagueness to be able to do some interactive work to be able to answer their queries.
we have done this profiling and we exactly know which areas, so I think it is more in areas and deprived areas, certain communities where the uptake is really low.
and so we have mapped it out and I think the we are doing targeting a targeted messaging around that as well, but I think it's more then the make-up brushes, the behavioural change state of things and hopefully the the Director-Public Health report will will help us come up with some recommendations are going forward in terms of engagement because we are interviewing parents, we are doing the Sylvia appearance, we are doing a survey of adolescence and also our partners GPs,
so it will give us some understanding of what, additionally, we need to do are worrying about what we are doing.
thanks Elizabeth happy am just following on from this had some really interesting anecdotal feedback from one woman who works for creative arts charity, in fact, I see I see on Monday about how a health bus came to her workshop for new mothers who have got like you know, she's the they're Endaf, they're going to have in possession for a reason and actually going to where the people are, who've got lots of hesitancy for lots of understandable reasons and actually,
working where they are and delivering messaging to them in their own backyard, of course, of a range of things the way they came, particularly to talk about.
flu vaccine, but also we then got on to them and are then gone to breastfeeding lots of other, you know, public health messages, that you'd want to try and push out, and she said it was really successful because actually people were able to ask the questions that they wouldn't normally dare to ask you know in a in a safe space and you were taking all that kind of all that expertise into a place where you would expect them to go to the Dr, you were taking it to them and that was a them, and certainly I found
the charity I run with regard to COVID vaccinations, kind of bringing the doctors into our site to run COVID vaccination clinics with our disabled students was way more effective than expecting them to go down to the Antrim Seafield or into a walk-in centre, so I just think that that approach of going to where the people are and taking the time to understand some of their fears and and being able to kind of talk on their terms was something that was a really positive.
positive thing that you've been able to do, I see those health buses mentioned and just say, I think, more of the same as it was kind of the the request from from the voluntary sector, because I think once once that investment is made people will not get a chance of people being able to come round and then once you build the trust that way then they're more.
amenable to them may be following other public health messages,
Mark
and just along the same lines, I think one of the things we found during COVID was sometimes the health professional isn't the right person to deliver and encouraged reports, people within their own communities and so actually going through faith, leaders, community leaders etc can be quite a powerful kind of lever in encouraging people to eat.
Isabella me, I saw comments on Mila and I think thank you very much, I think, excellent suggestions. We are already use the help us for a COVID and flu vaccinations B. We did consider that for the unmemorable explanation, but I think they are for her delivery of the vaccination, but there are some licence issues split with the now unnumbered bypass, but hopefully we'll get that in the future but at the same time we have got some health promotion material and we have got people on on the bus who do increase awareness but,
as suggested, I think, make approach making every contact count approach not only from the clinicians but people who are out and about in the community, absolutely something we are looking at, we did develop Mahmoud on COVID work or vaccine hesitancy, but we we are looking into having a broader module on and childhood immunisation as well, but definitely a dig on both the suggestions thank you.
excellent thanks, and if I were only answering my apologies, Elliot, yeah, thank you, Councillor, I just wanted to highlight to the boat that this is of increased poignancy at this present time will GPs have been notified of an increasing incidence of measles in the community from NHS above, so this is this is verging on a sort of local crisis and within London in particular,
it's been a sequence of events, the reduced uptake of them them are probably going back about two decades and then, obviously, with the pandemic, this whole vaccine fatigue has kicked in just to highlight to the board what happens in primary care maybe it might be of use. We in Primary Care send out invites to have children immunised. We go through this phase on multiple occasions and when we decide we're not making any progress, we then involve the health visitors, so it is a collaborative approach and any
public health are very much involved in work with us on this, but these falling figures are despite all these efforts, and I certainly commend the efforts of the MMA campaign and certainly use some novel approaches, use social media to try and increase that.
one one thought that crossed my mind, and obviously there are many potential barriers to it.
is that as a routine in pretty much every school across Wandsworth in London and the nation school nurses go in to schools and offer flu jabs as as maybe quite a novel approach, good public health discuss or let us know if they've considered the possibility of almost having one?
consider almost think about opt-out option of will also often them, or if you're not on the list, I it's just an idle thought, but it's something that might be a game-changer in a situation when we seem to be losing, despite our very best efforts.
I just thought I'd put that out there. If that's OK, Councillor
yeah, I mean I can carry out.
as well as the at that interest, helping you that you are, you have a problem, we've all got a problem because they actually come up with any suggestions or solutions as to out of approach.
sorry.
0sorry, the NHS, in addition to stating what I think is pretty much the obvious that we have a problem here, have the NHS actually come up with any suggestions or improvements that GPs can actually take full, it's it's not that it's a criticism or,
it's a, it's an alert just to raise our awareness that, despite our best efforts, measles is on the rise. This is a public health issue. This is, and nowhere is, this is something GPs really need to be attuned to. We, you know in this world of consultations and deciding who to bring in and not if we're not aware of the fact that some child coming in with a rash that you might otherwise just want to see face to face might be coming into a surgery packed with people with a measles rash, you know, there's there's not a herd immunity anymore, so you know the. This is why it's raised to us. I mean, for our part, just on a very small perspective, from a much bigger sphere of existence where we're launching, are we're adding it to our Facebook page, we're going to involve it at our patient participation groups, so we're doing little things, but I don't think there's gonna be a game changes. We'll carry on doing what we're doing. We carry on having those opportunistic conversations with patients, but it's all chipping away, which we've been doing for for as long as I've been a GP,
on Kenneth angst, as Simon OK round the corner and I was just as part of the NHS.
so I think actually just isn't one Shay Shannon and one that you know we do have an immunisations team we are.
continuously trying different things, whether it be community outreach, etc we are working with primary care in terms of whether we can do things at scale, I don't think there's a magic nirvana out there, but it is about us coming together and thinking, particularly for those that are resistant, how do we get into those communities and how to bring it at switch?
no one are absolutely right.
Stephen
on page
it's on the same subject, page sorry 1 6 1, of the pack, it lists some of the local barrier barriers to to him, immunisation include two which caught my eye, one is a financial disincentivise action. I just wonder what that was, and whether that you know is that whatever it is, it is that addressable because we've got some financial disincentive, so that sounds quite bad.
and the other one was issues in data recording inaccuracy, and I from memory this goes back, aeons people argues, but a lot of time arguing about what the actual numbers are, which is that they're the starting point of all this and again you know it or are these issues being addressed as my real question because they the long-standing,
if or if I may, come in on the
detail side of things, so I think that is definitely something that has been addressed and, as Mark said, there is a immunisation southwestern immunisation team that we work closely with.
and and they have gone into.
and there is the lead, who is a visiting practices and looking at the detail, quality and.
and and we have identified issues, and there has been a big sort of improvement in those practices where they have gone in and we need to change and develop now a guidance due to improve the uptake so definitely that has been addressed at is being addressed at this level but also I have highlighted that at at the other London Network meetings and south-west round of meetings as well, so it is a big thing which NHS England is looking at.
and the NHS
in terms of the this incentivisation, I think it's the shortage of resources because of so many immunisations happening at the moment, I think, like the autumn winter programme, because there was a COVID variant that came up and that it was fast-tracked so that it pushes other things down the priority list so the roving team we've got a finite resource and in terms of asking the rubbing team to do now switchover to this, so I think that that is the one of the issues that when we meet up with our NHS colleagues,
we we we do come across, but definitely I think was the autumn winter programme is is almost dear, then we will be focusing back into are working more closely with the practices, along with our immunisation colleagues in the NHS going forward, but I I do take Dr Dougie's point on.
that we are doing the same thing again again and is not making improvements, so I'm I'm really hopeful we'll get this.
online surveys that we are doing and we will have some British information, and we will be able to make a change going forward as part of the and without ProPublica's report, and they are just to add to that there was a hackathon at part of the immunisation week that was held back in summers the which had a lot of stakeholders from Southampton,
and immunisation team NHS H R C H and all key stakeholders, and we came up with a plan to look at them them, or so it was hackathon for them are improving uptake, but one of the thing was how to counter the social media campaigns because there are a lot of anti campaigners against them in marriage stuff so we we did come up with a plan and if there are pilots happening across south-west London to do to help with that so hopefully we will see some change going forward.
we have seen an uptake in them in more figures lately, but I think it will take a bit of time.
whether it is a national issue, we are grappling with.
thanks, salesman Guth, for on 0 for comments.

9 Work Programme (Paper 23-381)

so Comey, please, and out as the Health Protection annual report for 2022 23, thank you, and I thank you is mindful of the presentation and I have the ONS's et cetera, great so we're almost on the also item 9 is the health and wellbeing board work programme pages 179,182 a reporter from Jeremy as a director and Lynn
in Wild will introduce newydd please thanks,
thank you Chair, I think we know this is the forthcoming programme really exciting for February and lots of items.
we don't yet have the dates for the rest of the year, so when we get dates will will put forward what the rest of the plans are, as if I do encourage members to consider items that would be of interest to us here and then, finally, just to do a a little plug, I know that there is a train strike, but I can't delay this workshop again, we delayed it last time on the same basis, so we're going ahead with our Christmas seminar now.
and intermediate care, and I hope people can can get there, so please try.
just somewhere, I think at least one person, also a pertinent question, as to whether it will be available with urgently.
no one's OK.
no, because it is not practical in the sitting, and I think what we want to do, the point of our seminars is to can generate that in the room, discussion and the networking.
rather than content, otherwise it risks just being us we can talk at everybody endlessly and not just go to sleep, we want we want real engagement from partners on how do we make this work in our local system Behan on I completely completely agree I mean that is the purpose of the seminal,
just that sort of practicalities which may preclude people from being able to adapt, OK, we will see how that goes, but a thank you for putting the work into organising loser seminar class and of course, potentially we have another interesting one in February, which is more strategic as well great good as well, can we please note the work programme,
but suddenly, I would certainly welcome members of the Board to actually contribute ideas as to what is actually getting onto the agenda.

10 Date of Next Meeting

right excellent, so Earth 8 8 of the next meeting is scheduled for the 29th of February 2024 are unique, they let me have it once every four years, if, if at all, can I just simply thank everyone for the participation I think you've covered all of them are very so tricky issue is ones which I mean a whole.
family or, and by that I mean the public health, the NHS, everyone is of the voluntary sector, really needs to contribute to tackling it is Parliament's task, but I am certainly very grateful to all of you for the work that you actually to aim to try to improve the health and the health and wellbeing of residents in Unsworth and again, and I think Christopher Health coming in a person sitting through interact and I'm going to eat the other present presenters in the papers, so with that I'm all concludes meeting. Thank you very much indeed.
and can I also say I don't know if there are any members of the public actually listening to this, but if there are, thank you very much to them as well.