okay we're now live thank you thank you very much okay i make it at six o'clock so uh welcome to the adults health and social care scrutiny board on thursday the 10th of february 2022 let's say it's getting a bit lighter staying a bit lighter for a bit longer so it does make you feel a little bit better even though it's absolutely freezing so let's get on to the main items of the agenda tonight so uh substitutes nominated for this meeting and apologies for absence i don't think there are any substitutes and we've had no apologies is my understanding no no substitutes all members are present and correct chair fabulous that's uh super well welcome everybody welcome uh a guest as well so members interest to remind members to declare their interest at the real relevant time so thank you for that item number three admission is to the public it's not recommended that the public be excluded from the meeting with the consideration of the item on the business of this agenda uh anyone uh viewing us on youtube uh you must welcome and uh hope you enjoy the discussions um so we we don't have any minutes from the last meeting because he was so short since the last meeting and and even though diane's a superstar she's yeah she can't without minutes as quickly as that so we'll uh we'll expect to see those at the next uh at the next meeting so we've changed the agenda realm slightly uh so item number four now is nhs priorities and operational planning guidance 2022 and 2023. uh welcome neil welcome anna it's always nice to have you here and this so uh neil do you want to lead on this yeah thank you chair um so i'll just sort of give a sort of a brief summary of the paper that's been there and clearly people will be aware of the um announcement this week of the elective recovery so i'll touch on that a bit as well and bring anna in to sort of help so um within the paper the guidance that was issued just before christmas um comes up with 10 priorities which is around workforce uh responding to covid elective recovery emergency care timely access to primary care mental health services population health management ill health and and health inequalities digital technologies and use of resources and the icb collective system working i suppose the key point which is in section j um is people be aware that the uh integrated air boards will now be set up from the first of july subject to legislation being passed rather than from the 1st of april people will have seen numerous recruitments going on and clearly rob webster is appointed as chief exec designer and kathy elliott as the chair designate um and clearly structures being put in place to mobilize that going forward um so there are ten items there there are brief summaries um within each one of those but i just wanted to touch on a couple in a little bit more detail um so this week there's been a a plan for the tackling the curving 19 backlog of elective care um some of the priorities that have come out in that aren't a lot different to what was in the original uh planning guidance that came out in december however what it does help is manage expectations of recognizing how long it will actually get to get our waiting list back to pre-covered levels so a lot of work has gone on particularly in the last 12 18 months which i'm sure anna will be able to touch upon and some of the priorities around elective and particularly cancer care we are actually performing above a lot of our peers in this moment in time so the 62 day wait for cancer care we're in the high 90 for achieving that already and that has been a priority for us as a place over the last sort of 12 months as we go forward but there's clearly a lot to be done and the elective recovery does uh rely on a certain amount of workforce and the plan recognizes the pressures that the health and social care workforce has been under over the last two years hence it manages the expectations out to 2025 for us to get back to similar levels i suppose one thing to elaborate on particularly around the elective care side of things is there will be significant investment particularly in diagnostics and out of hospital diagnostics of which our partners across west yorkshire have been working upon that for some time and to sort of separate uh elective and i suppose emergency care uh workforces to enable people to be more productive um some of these take time workforces i think the the paper i lose to doesn't grow on trees and it can take 12 years to train a consultant in seven years for a nurse so they are nationally um expediating the international overseas recruitment and they're creating a significant amount of additional roles and new roles which a lot of hospitals and primary care and mental health providers are taking advantage of so there's a lot of work to do in a lot of in a short space of time um but to recognize that within calderdale we are in a good place with regards to our elective recovery our urgent care responses um our access to primary care and our continued investment in primary care and the continued investment in the additional roles which we are starting to see benefit of with social care prescribers but also the investment in mental health standards and priorities for our children excuse me which we've seen and reported to the children scrutiny over the last few months as it is so sorry that's a bit of a whistle stop but there is quite a lot in there and i wanted you to be open to questions um that hopefully we will be able to answer and there's there's quite a lot to go on anna is there anything else to add from a hospital perspective no i i just think you've covered that really well dale um i'll just reiterate the comment that you made um that we have a lot to do but we have um during recent months being able to make progress around our elective recovery so um we are have increased our activity we know that we definitely want to develop our plans to be able to address all of the all of the priority areas we take this very seriously i think the fact that we've been able to maintain our elective activity during a particularly difficult period during the recent wave of the pandemic and during the winter period as well means that it gives us optimism that as we start to see hopefully a reduction in the numbers of impatience with covid um that will help us again around our capacity um it's currently a very key area of our focused work and planning to develop our clear trajectories for our um way to address of the backlog happy to take questions i would just comment i think colleagues know i'm not the operational lead so there may be questions you'll ask me i can't answer but i will certainly take those away and be able to come back to you with fuller answers if i'm not able to um respond to them this evening since as you always do anna so thank you for that it's nice i've got council hutchinson first of all please uh thank you you know not surprisingly i've got a couple of questions if that's all right first one at the risk of sounding like a stuck record i've been trying to explore the workforce plans across west yorkshire for over three years and it's been like banging my head against a brick wall um though there have there are no plans that anyone is willing to discuss with us um so my key you know an understanding of the gaps that exist in the workforce was described back in 2018 and then conveniently shelved and i've not no one has been able to provide the joint scrutiny board for west yorkshire with a clear understanding of what the workforce gaps are and whether any measures are being taken to actually deal with them so my question there is whose responsibility is it just to tackle the gaps in substantive staffing at primary amongst gps mental health acute care community services for a start and what can be done at local place level calderdale and trust level but principally what can we do to make sure you know the west yorkshire integrated care system will cover a population of 2 million people it's big enough to have a local workforce plan to develop the workforce that we need rather than seeing the provision of our of our medical services continuing to shrink so that's that's my first question so i'll stop there and indeed i'm looking towards that i might be able to answer that i'm hoping so so so i think we recognize across western auction this is a hugely complex area um covering multiple members of providers of different sizes um and i think that's been recognized in the structure that the west yorkshire icb is putting in place and is looking to appoint a director of people which predominantly will you know have a big remit of bringing um the work that's done in places and providers together so that we can have that coherence plan i think all individual organizations have plans and anna will be i'm sure able to talk about chft plans and we have over the last couple of years created the environment for providers to talk to each other to understand what the needs and the gaps are so you're not robbing peter to pay paul so particularly with the primary care investment in the additional roles we've we have been encouraging and we've seen success um in in our providers working in a collaborative manner because we recognize there are finite resources in physios in occupational health and gps and all physicians so those conversations are now starting to take place and you've got to remember that they didn't used to take place providers used to be their own organizations that have their own responsibilities there's never been a remit for you to work at scale to work collaboratively and they're now starting to see fruition so the work that the west yorkshire association of acute trust does mental health providers in our primary care are all starting to have those collaborative conversations to ensure that when we have the conversations with health education england about the number of gps the number of nurses that need the true number is submitted to treasury to fund those places and the university places available so it's hugely complex but i think that has been recognized as a priority in one in the west yorkshire strategy thank you neil and the second question uh sorry i mean i would like to point out that it didn't always used to be that organizations didn't speak to one another before the purchaser provider split before the fragmentation of the national health service into numerous freestanding uh organizations there was a national responsibility to produce the workforce that was required at national level that has that has been lost in recent years um i would like to know where we are on track with actually recruiting you know we heard we found out a couple of months ago that calderdale has one of the lowest levels of gps per header population of anywhere of anywhere in yorkshire apart from possibly hull um and so we're badly provided with gps numerically i would like to know what we're doing locally to redress that problem you know and what whether we've had any success what what the figures of gps are actually doing within calderdale whether they're going up going down or in terms of full-time equivalents thank you for that sir anna do you want to comment on that because i know you're going to comments um earlier so in terms of i think um councillor hutchinson's question there was particularly around gps and primary care workforce or i think probably neil would be able to respond more fully too than i would but i did have some comments just around the overall local response around workforce planning and the question that you raised prior to that around what are we doing um neil referenced at the work across west yorkshire and on a people plan so there's definitely work going on at west yorkshire level but one of the other comments i would make you you reference that some um the need for organizations to work together and certainly what we have across the west yorkshire association of acute trust is an approach around providing mutual aid working together around recruitment to address where there may be strengths or weaknesses in workforce levels that's a really key feature of our work working across the hospital providers i think the other big emphasis particularly over the last 18 months coming out of the pandemic is about making sure we're doing everything we can to support our existing workforce and to retain that um for our local population so big emphasis around well-being around working patterns and about providing opportunities for development locally it has been a big emphasis and also you'll know we've been recently you may know we've been recently very successful through international recruitment schemes that is helping to fill some of our very important roles in nursing roles locally as well so there is a lot of activity being undertaken um so i know that only partly answers your question councillor hutchinson neil jones coming on the other pass yeah so the primary care thing um i think we've touched on this briefly in the community paper before in the the number of gps per head is just one barometer of how how good or how successful or how effective your primary care is it's not the definitive thing so we have been under that barometer for a number of years um been uh under doctored and we've done numerous things to attract them with apms contracts and unfortunately not been successful i think we're the advent of our primary care networks and there's more collaborative working we are having different workforce conversations um as a place we're one of the the highest and best for gp training but after that gp training our retention is quite actually poor so what we are trying to do is work with our practices who are independent organizations around their structures to be able to attract and retain some of those people but also we've got some fairly innovative practices that use other roles and other specialties to see it so we have one practice within uh calderdale which is nurse-led so you won't even know you're not seeing a gp so there are other skills and there are other ways to meet patients needs and that's what we've been good at in calderdale over the years and we need to build on that initiative and work with it and retract the train gps as well thank you neil collin you might have another point to make as well yeah thank you thank you um i did want to explore what's going on in terms of uh elective diagnostics i mean i don't i don't think we should be referring to this as the covid backlog and with more than four million people were on waiting lists before covert occurred the nhs had abandoned uh its drive to adhere to the 18-week referral to treatment time because it hadn't been met for so many years and uh and but certainly it's gone up from over four million to now six million and and rising so that's for sure but in terms of actually defining the problems that people have people have what you know trying to establish a diagno diagnosis what is happening in calderdale in terms of increasing diagnostic capacity you would like to uh lead on that anna yeah cool i can answer that and you may be aware that in terms of um diagnostic pathways we have performed well in terms of the six-week access provision to access to diagnostic services but we do have some challenges and addressing that we are installing currently installing a new for example mr scanners to increase our capacity we are also working with the west yorkshire ics um you've probably read around the intent to establish community-based diagnostic services so we're actively working with partners across west yorkshire to develop our proposals for that and some of the announcements earlier this week and and previously have been about the availability for investment into community-based diagnostics to improve that access so there's a raft of work being undertaken currently thank you council and megan swift thank you um a couple of questions uh in case we don't get around everybody um why yeah why the ccg taking so much longer than i don't mean ccg itself i mean ccg in the other part why is it taking so much longer we've been working on april for as long as i can remember and i doubt whether it's anything real quick but stuff you need that right to know what it is do you want them all at once just don't know just pause on that one and neil johnson sorry councillor swift what what's the question there about april do you mean the the closure of ccgs or yeah so we are guided by national legislation being passed so this isn't a local determination so this requires parliament to pass the act to dissolve and create new nhs organizations so we are guided by their timetable clearly the local structures that we're wanting to put in place in the west yorkshire structure we were we were working towards april and we'll hopefully have a shadow or arrangements in place between now and june so we are tied to the national legislative process so it's not a local delay i suddenly think it was yeah um recruitment from abroad i thought we were stuck on this because the government had said people got to work so much money and some of the nurse like things aren't the amount of money that was said now is that still the case or is it different now neil anna was i'm i'm sorry i don't i don't know the answer to that question i'm not close to the issue again i'm happy to try and find out more information thank you anna yeah thanks again i don't know i'm rather honest you're not by yourself um right couple more and then i'm done honest can i say something good um can i say to neil or whoever said it that unfortunately my family had used cancer care during the pandemic and i have to say they were brilliant we couldn't see that they slipped at all and i know it depends when you go and what you know but it was absolutely brilliant uh so i'm not picking her up and something else do you have another point as well megan yeah but i'll leave it i think oh okay right okay so in that case council uh bombs thank you chad um a couple of things uh i've got two points firstly i think there's some notable admissions in here there's no reference at all to oral health uh at all in the whole of this report and the ten points so i think as well it's great to see that we're improving mental health services for people with learning disabilities and or autistic but there's no reference to mental health services in general so i think there's a number of other missions and it would be interesting to see how these are planned to be looked at locally and the second point um these are some great goals um con fulton where's the road map what road map do we have to achieve these so where do we stand at the moment for example great to hear on cancer where are we in regard to handover delays between ambulance and hospitals or where are we in relation to eliminating waste of over 140 104 weeks as a priority by march 2022 which if i think is in two weeks time so where's the road map for this and can we have a a site of that road map and in particular can we have an rag status red amber green status against those just to see where we are and how we are progressing against them thank you chair thank you uh council of anz um i just think in in terms of the question around milestones and against those national goals and reflecting where are we now and the trajectory to reach those goals and targets that's the work that's being undertaken at this time those plans are um will be brought together at ics level but locally ahead of that um um during the period up to the end of april and they will sorry just come in you're working on them this was issued in december and one of the targets is march so some of those targets referenced in the documents that you're referring to have been updated in some of the announcements this week there is a bit of fluidity around the national goals and some refreshments of that that's actually happened this week which is why we're continuing to work on those goals so there is information available we do publish information um in our public reports that we can share but the definitive how are we going to reach the the particular goals around the national um plan um annual plan that will be published in april now do you have anything else to add to that just to sort of um carry on from what anna says so so yes so there was a big caveat in the december things around particularly elective care and hence the announcement this week um we are and we will be looking for the the plan and the monitoring of this to be done through the local subcommittee of the icb um so it's a place based response rather than just a ccg or a provider response um and we will be benchmarking where we are against all those already and they'll be part of our regular uh performance monitoring um as we transition from ccgs to place-based committees chair would it be possible to make a recommendation that we see sight of that and it's brought in front of this committee and we have the the ability to look at it and analyze it at a future date a lot more than happy to uh to put onto the uh on to the agenda the recommendation yeah absolutely thank you chad thank you sir councillor kingston please thank you very much and and thank you to to my question you asked some of the stuff that was concerning me um i did want though to ask about virtual awards um i'd like a bit more explanation about what a virtual ward looks like is a virtual ward um and by my reckoning according to this recommendation we should be setting up between 80 200 virtual wards in calderdale and so i wondered how you plan to go about doing so and then just if you could indicate to me what's the primary reason for virtual wards because i went online and googled it and the answers that i got made it look like it was more than anything a cost cutting exercise i hope that's not the case i hope it's about improving care not just cutting costs thank you anna do you want to come in on that unit so they're not not in your head so no no neil go ahead um so i think in the initial guidance there was a bit of a typo about the number of wards so where you read 80 to 100 wards that should mean to an 80 to 100 bed stroke people we currently have between 50 and 80 people that work in that way already and by virtual it's it's a service that our community seems and working with social care community service and gps have been working on for about 12 months and it's to enable people to be careful in their own home or their place of residence away from hospital so it's a multi-disciplinary team approach and it's to help reduce unnecessary hospital admissions there's been a number of reports over the years about when people do get into a hospital bed they deteriorate so this is about taking action to either discharge them or avoid them going to a hospital bed so it is not about cost cutting it's about providing the best care where possible in a multi-disciplinary approach in their place of residence thank you neil and do you want to add anything to that okay thanks no that's great that's the answer i wanted thank you very much hey good question as well thank you for that um thank you chad just have to open up my notes sorry um part of my question has been answered but in section f about improving mental health services for people with learning disability and artistic people is that including the diagnostic pathway because um it doesn't make it clear whether it is improving the diagnostic pathway for adults in that area and young people and the second one was in regarding um the management around ill health in inequalities and redesigning the pathways i just wondered if that was um in all areas around i'm considering like dental care and things like that or is it specifically around primary care um so yeah that's it thank you neil thank you neil yeah thank you so for that first one um you should read all ages um and and the access to those diagnoses is a priority for us in cold adele um we've done a lot of work particularly around children and we are doing a lot of work at the moment around adults to ensure that we have better access to that diagnostic so we do prioritize all ages here in calderdale and that second one the approach we're taking in caldera is health inequalities to all for all sort of health and social care so debs and partners leads on a number of areas where we're looking at health inequalities and how we can bridge those not just in primary care we would love to look at things like dentistry and oral care but that is unfortunately out of our remit at this moment in time that's nhs england but we continue to work with them to understand what the pressures are but there is there has been a lot of work looking at how we can bridge those health inequalities looking at what access are for different services and how we can bridge those gaps over the next 12 months to 18 months but a lot of work going across partnership working to understand the issues and to improve those and it is very much a key strategy within the health and well-being strategy that the health and well-being board monitors thanks thank you neil councillor hutchinson thank you chair um can we look at section two i um on the final page of the report um it says that there's going to be changes to the fair share allocations is called adele consuming more or less financial resources than its relative need so is the funding of calderdale going to go down or go up or stay the same and the other thing that i was surprised at where it says written contracts between commissioning and all providers will be required by the start of the financial year i thought that written contracts were the normal way of commissioning services um am i wrong neil do you want to come back yeah thank you yeah on on on the on the first thing we're still working through um what this means around allocations so allocations are moving from ccg level to the icb level so they're going to be on a west yorkshire basis um and they haven't published the sort of guidance of of whether people are over or underfunded if we work on a high are historic we weren't over funded and we weren't over funded we were just about right in our direction of travel for our main commissioning for primary care we were slightly underfunded and we were getting increased levels of investment uh to bring us up to sort of that so we've got to work all through that as an icb and that will be part of the plans that we bring back later on as to what would be the share out to calderdale we are expecting it to be fairly similar to the levels we've got now and the pre-published levels of increase there is a bit about um they are looking to sort of smooth things and ensure that um appropriate places and there is a bigger influence on deprivation and health inequalities in the new formulas that they're proposing um but we'll report that once we know more um but at this moment in time that's what we're working through and hope to have a better idea when we present our sort of final plan in in april thank you for that what was your other question yeah it was about some written contracts being required between variations and providers uh conjures up the idea of people sealing these with a handshake or an elbow no no so across the nhs and not particularly in our area we we've got um and had very good relationships with calderdale huddersfield trust with our aligned incentive contract and with our mental health providers there is always an annual requirement for contract values to be agreed before the start of the year and there are a number of areas where that doesn't always happen and we have arbitration processes i can reassure you we haven't been in those realms for a number of years because of the relationships we've got between organizations but that is a bit of a warning shot to other areas and other providers okay thanks for the clarification thank you neil councillor kingston thank you chair just the section again on mental health um i noticed it says ex it's like no specific targets about around waiting times in this section um and i just wondered and i know that there are incredible lengths of weight for people to get for example talking therapies um and i wondered do we have targets locally length of time that people should um be allowed to wait to um access talking service therapies or mental health services in general so for iapp services which is the talking therapies we do have um targets around access and recovery and we report those in our performance reporting through the ccg and we do actually have quite favorable performance in that however in more specialist areas there are longer waiting lists however there aren't any national particular targets for that but we do monitor it and work with partners to try and improve that as much as possible excellent thank you for that um oh counselor benton please thank you chair i just wanted to ask section d where it says continue to transform community and urgent and emergency care to prevent inappropriate attendance of emergency departments obviously during the pandemic a lot more people were attending because they couldn't get into the gps what exactly does that mean you're going to continue to transform community and emergency care to prevent people attending when they don't need to what are called adele going to do to prevent people attending when they don't need to neil do you want to start off on that yeah so when we've looked at the um the data um a lot of the not seeing a gp and turning up to a d is anecdotal um but we do we do take it seriously and work on it and we have been working across health and social care and shawn and ian have been involved in the urgent care response contract which is a national pilot which is coming out which requires um interventions to people in the community within so many hours i think it's two hours to try and avoid hospital admissions so these are potentially people who are frail elderly at risk where we have that multidisciplinary approach to be able to to visit them and assess them within a certain period of time to avoid them going to a e so that is a priority area of us we've received national funding this year and i think we are awarded the contract at christmas um and are in the recruitment process now to sort of mobilize and actually so it builds on that and brings in some tougher targets for us to to be able to respond um quicker the the key a bit like the elective with all of this is workforce constraints because the same same types of people that you need are the same types of people that are stretched in health and social care now but that is that is something our community uh partnership board has been working on for some time across health social care mental health community and general practice organizations thank you neil um so concert council bent inside did you want to come back no that oh excellent castlevans then wasn't my point but i'm going to follow on to what council of benton raised which is a very important point but i think the issue there is behavioral pattern of residence or of patience you can put as many processes and procedures in place if if person x wants to go to a e person x will go to a e and unless you change that behavioral culture it will never change uh will never change i think where i would like to point out and this is no way shape or form any criticism of any of the people involved here this committee or individuals on this committee have expressed concerns and nervousness about about about the change in april and councillor swift quite rightly says how will this improve the residence of caldera the question she asks regularly and it's actually an extremely important question and i and i and i still think we are now a number of months out and once again this is not a criticism of anybody here because you're working with your hands very much tied behind your back we do appreciate that but still that nervousness persists and i'm and i'm getting extremely i think that nervousness is starting to increase as the period shortens and i think it is important that we keep a very tight eye on this thank you chair and thank thank you castlevania any important part uh point there neil johnson i'd say anything to to that at the moment i'm sure i'm sure you equal i have sleepless nights about the various changes um so there are a number of changes i think there has been a letter i'm not sure how widely it's been shared within the council that confirmed some of the place-based leadership arrangements so within calderdale robin has been confirmed as the place-based lead and i've been confirmed as the chief operating officer which gives us some certainty uh around sort of responsibilities um and the committee that uh ian is and debs are heavily involved in setting up um is in its final throes of confirming its membership uh and moving into an operational um and shadow arrangement ready for when the sort of the rains are handed down into july so um it is nervous but i am confident that everything that we are we're doing builds on the colder healthcare principles and and does respond to the needs of patients in calderdale and i think one of the key points in the planning guidance which is sort of hidden a lot of people don't go on it is about using that data and we are very much wedded and cold in our views in that data to to to argue our cases for various things to address our health inequalities and to do things for the for the benefit of our residents thank you i think one one element that is concerns me is relates to effective communication um because actually whilst we are in the know and we would well we're not really we were finding these these things out i think it's really important to ensure that our residents have brought along the journey rather than suddenly actually things have changed what what what's been done to address the that communication to ensure that people are aware what's going to happen step by step really i know um within west yorkshire there is a central communication function which is looking to work with places um and build on the network relationships that we've got to ensure that the communication goes to partners um i think probably communicating with scrutiny is probably one of those things we probably need to work on i think uh a significant amount probably comes in at leadership level and it's how we work to ensure that it's disseminated out and everyone gets sight off um and is aware of what's going on um but there is a huge amount of communication i think sometimes too much but then clearly we're not hitting it in the right park all the time so i can take that back yeah thank you for that sir counselor megan swift thank you a couple of quickers really and one of those time tables uh i was told that children's time table where the child's um speech therapy was a high number of hundreds of hours which gave me a you know a bit of an issue and i can't get anybody who will tell me what the adult number waiting you know waiting lists for adults so i'm obviously not going to the wrong place or unlike everything else he hasn't got waiting lists so we should be pleased about that but please anybody who can do anything to help on that one it would be appreciated the thing about the speech therapy um yeah uh did talk about you know some of the other things he came upon oral health but you know we're not knowing what happened i didn't know that we'd gone to a private company some of the mental health stuff you know i don't know nobody else let you go thanks and neil do you want to come back on that song so i'll take that question away unfortunately i don't have the information i had about adult speech therapy but i can have conversations to understand whether there is a waiting list there um i think just on your last point we we utilize a number of private providers for a number of things and have done for years and i think we're very clear when we do use it um i think committee paulie needs to be aware that part of the elective recovery will be utilizing the private sector and we are looking at um particularly across west yorkshire and being led by nhs england what what is the opportunities out there with private companies to help improve the where possible any recovery and we've had success with with calder huddersfield using some private companies particularly around ophthalmology and reducing the backlog there during the last few months so um i know politicians will have their views on private companies but within the nhs um they do have a benefit for for patient outcomes thank you for that sir councillor hutchinson uh thank you chair i mean regarding that i mean obviously private companies or the so-called independent sector doesn't train doctors they don't employ doctors they reque so the doctors that are being used there are trained at the public expense and are usually working working in private hospitals uh where at in their spread in their spare time there are also differences in the level of supervision of patients overnight in private hospitals compared to nhs hospitals so the what they call called the resident medical offices don't have access to the intermediate tier of support from more experienced colleagues if prop problems are occurring it's all dependent on whether they can find the consultant who that patient is is under the care of to see if they can give some support and the safety guidance or the safety strategy framework that private hospitals work with work under is different from nhs hospitals so you know i would i would certainly like to see if they are going to be receiving their treatment in private hospitals that they have currently within nhs hospitals and that there should be the same level of transparency if more use is going to be made made of thank you chris hutchinson i'm looking towards possibly earning on that one um i i think um you know the comments that council hutchins since said they're around the differences between the service models um across providers is is you know an insight into that um i think there is a um definitely an important very important contribution that working with the whole rafter providers and independent sector providers to help us deliver nhs services and address our backlogs i think is it is really important yeah no thank you for that as you are and neil we want to work with you we want to go along the journey with you uh we are you your critical friends as you always know so we know we always need to go away upset upsetting her but we you know we do want to we do want to be updated on the good and the the the not so good more negative aspects of what was you know what we're going to be facing on the day-to-day level so uh so i very much appreciate the report um nobody else is indicated to speak um so uh i'm going to take the recommendations as suggested from counselor barnes so you will provide us with some that information as some stage in our work program so thank you for for attending uh we are your critical friend once again uh and we'll move on to item number five now which is the burns bridges uh so we welcome uh the independent chair of the safeguarding board i'm just looking around everyone's changed where's james direction marianne welcome mount marianne um you know you have bought the ben bridges report to us we won't we don't really want to go over all grounds but we want to focus on uh moving forward in in my view so uh marion do you want to add anything to the report that's uh this is already here we welcome roanoke as well and we'll welcome julius and what uh floster yeah hi there you're in front of it so you're welcome so it's a marion after you yeah yeah just briefly um i won't repeat it but as you know uh burnt bridges was a thematic review of the tragic um uh lives of five men who died within a short period of time who live street-based lives it's a really significant impact on the way that we think about homeless people um in calderdale but significantly has a made a real difference to how agencies are working together to support those people with multiple and complex needs who need our care and support so um today really is a short powerpoint presentation with updates from julia sean rona um to explain really where we are now so it's a bit of an update sadly neve can't be with us but rona will address those areas in the presentation so um i think it's just to hand over to julia with the presentation and then we can answer any questions once we've finished that yeah thank you very much answer are you okay with me sharing the screen yes please do yeah fingers crossed it started there we go thanks um i've lost you so you'll need to speak if uh instead of making faces or pointing if you if you need to um the um you've all had the presentation and we just wanted to give you a bit of an update um since the last time we spoke to you and saw you and gave you an update um our our desire for this was to get updates from those who are directly involved so either leaders managers or frontline practitioners who are actively involved in this piece of work and um council offense and glenn attended a burnt bridges progress event where each of those sectors presented where they were up to with regards to successes and achievements also any barriers and anything that they wanted to kind of raise and escalate to the safeguarding adult board um the other work and i won't go through line for line is is trying to get messages out there to the widest possible workforce so that has included briefings we call them seven minute briefings videos and we've had um a very very powerful video of people in recovery and friends of the men who died who have read out the lives of those gentlemen who died um which is probably the most impactful piece of work that's been produced um we held a learning event called a launch event as well again looking at that wider workforce dr warren larkin who is um a professor and research and leader in the field of trauma and adversity uh did that with us with neve um and with that showing that video of the men and we've um presented progress in various different forums and asked for their contributions and i'll come back to exactly kind of what we're asking people where we're up to now what the next steps are [Music] just hand over to sean thank you sorry about that i was just trying to find my i'm so used to using teams i i couldn't find my my soon mute yeah so uh this slide and the the next slide is really about the progress that we've made um as and this is the really important thing really as a group of operational services right across the board within the council in terms of public health adult social care neighborhoods directorate housing homelessness and also our external partners strategic partners and in terms of the kind of realization of that or how it's become more tangible um there is a specific focus particularly with this population it's a small population of people um it's about 150 in total where and they have the core um kind of core complex needs of street based lives with many kind of complications around that um but where we've made the progress is in terms of and this is a lot of work that neve and public health colleagues have been doing with with ourselves too around making sure that there is um outreach regular outreach and recovery workers um and experts by experience and those are people that have previously used services and i've been down to um certain places in in um in halifax uh with councillor uh fenton glenn as well um where we've seen that in action um uh there's assertive re-engagement and that might sound a little bit heavy but essentially that is about making sure that there's more flexibility particularly around substance and alcohol misuse support and with people who are deeply entrenched with their um with their addiction and and their lifestyles we've got much more closer working relationship now um with the policing team much more so recently and that's mainly been because there's more consistency and focus from the police um and their understanding about how to work with this group and the willingness of working with other agencies to support us with that and so that's really come on and been a very kind of positive development in the last couple of months and particularly as well which is crucial and working with landlords one landlord in particular again near to the center of halifax um where um with the police and with community safety um us and and a number of other agencies there's been some really proactive support um with this with this group of people um and again within some tendencies um within this this project near um near to the center of halifax and there will be two tenancy sustainment workers to actually work with the landlord um and the tenants to see how they can start to improve the environments that they're working in plus there are other ideas around bids to look at around the improvement and the hard targeting of kind of security um where this group is quite vulnerable and they are kind of um kind of targeted by a number of kind of outside groups so there's a whole lot of work going on there in terms of making the place safer and the quality of life better and that's going to be part of the tenants association the second the next slide just very briefly as an example really of um where we were i wouldn't say we were going wrong but where there were silos um and the the you know this was was kind of during the the period of how we were looking at the recommendations of burnt lives and actually having some really truthful and open conversations challenging conversations across all of the agencies about how we really need to kind of um break down our preciousness as agencies really about our areas of work so for instance you know instead of of saying that people needed um social care care act assessments necessarily that wasn't really the point we were missing the point it was more about what was needed for that person immediately and flexing services around them and this this slide is just one example of the the growing number of people that we're now um positively working with where um services have less less pressures across mental health housing adult social care and and understanding the person and that's particularly the case through the um the new and evolving uh multi-disciplinary team approach that we that we've we've developed we've still got a way to go with that um and it meets on a weekly basis but it's putting the resources in to make that happen um so that's certainly been progress over the last six months in terms of a positive impact on people's lives thanks sean i'll bring um ronan now can okay thank you um so i'm going to just feedback on the work that's been undertaken by um in the nhs and and i lead on the the work the recommendations from burnt bridges review um around um health actions um and i've been to school before and talked about this but there's a lot of work that's going on that sits across this work that as sean said it's about joint working so although this says nhs this is about a lot of people putting work in working together and being really passionate to move this forward um so this report this first slide shows you some of the service developments and some of the training that have happened um we've made significant progress since we were last here especially around the training within general practice and across the board of areas around trauma informed training and safeguarding training to bring people to speed with this area and and that was one of the key things that we said we needed to do um as a starter for 10 real life um there's lots of work that has happened in the service development where people who as i say are really passionate about this have actually just started some pieces of work and got involved and said this is we're going to make some changes and the really positive changes and some of that is around the the wound care clinic and the sexual health clinic at the gathering place um and the trauma inquiry pilots in gp practices that are being planned going forward so there's as i said there's lots of passion and interest there that admit that's you know helping us to move this forward um a couple of key things that we were asked to do was to review pathways um from the action plan um in the ccg and it was across um dual diagnosis and if you remember we had that conversation about have we got the buy-in from our partners to do that and we certainly have and that's moving forward now um and kovid and the omikrom did slow that down and pause that again but actually it's moving forward at pace people are really engaged with it um and we started to do some work around the the ask was around learning from um the risks um and the gaps around the pathways and we've been starting to look at those both for adults and for children young people um and mothers um as well um as was the request and we did um a piece of work yesterday with the children young people um open minds group and it's a partnership group so it's got a wide range of partners there from across calderdale and we focused on the the complex needs of children young people and it was a really good piece of work that people are so passionate and so i want to get involved in around identifying where we've got gaps and what we need to do and learning from that that whole element of the young person's experience because these five young these five men um you know a lot of the information that was gathered you could take some of that back into the the the childhood experiences and we need to learn from that and we need to address that and we've done some really good work starting with that and what's made me realize there's lots of other pieces of work that we need to connect together to bring this together to to join it up but um i wanted to just explain give you an example of that from yesterday because it was we saw a lot of people coming together that are really really passionate about this if we go to the next slide the next slide talks about the strategic leadership and the commissioning so i've i've kind of pulled out some key um areas from that the dual diagram we've got all the partners around the table and we're walking through the pathway and identifying where the risks are and identifying where the gaps are and what we need to do differently um so again it's a piece of work that's been where we've got partnership involvement um there's engagement in the means strategic group which is um making every action matter um and um there's a big piece of work around west yorkshire around trauma informed system and with a plan to have the trauma and farm system in place by 2030 and we are heavily involved in that from calderdale um at a place base so we are leading and working and linkedin to that piece of work which is really really positive um i'll stop there and allow next slide and let people thank you enough we moved back to sean thanks yeah um so uh this is um in the absence of of heidi and um and nicola who weren't able to make it today from housing and homelessness um but essentially this is just an update and it was stated at the previous scrutiny update on um on the development of initiatives for people who are off sleeping particularly the pathway so as you can see on the slide um there continues to be a flexible approach to how people are being supported and that that again exemplifies what i was just saying earlier on in terms of this multidisciplinary but not precious approach to how we really need to um support the engagement and with this group there are new homes coming online or have come online um new steps or next steps home i should say um for people to access independent housing and support the winter shelter and that has been around this year um that was upgraded as well um to accommodate people um over over the winter period which is still open um ryeburn house and crashpads as well um and then getting back to what um uh roma was talking about what we need to remind ourselves uh constantly is that we are working with young people who um will be adults who are living with trauma and it's knowing how we um can have the sets of skills really to work with these people and have some of the most kind of complex and difficult lives um who find it very difficult to express or communicate what they're feeling they usually do that through self-harm so the emphasis and it's been kind of re-emphasized through the safeguarding board and other strategic groups is to have a workforce that really understands and is trans and is trained um around trauma um and and and understanding how to work with that group um so the second second part of this slide is very much about that really and making sure that um we are putting resources into that and from a housing perspective but also all the other support agencies can you put the next answer please um and then this is just um a a a graph that's uh outlining the um the access that people had particularly obviously during the pandemic through 20 20 21 and where they accessed accommodation and as you can see um two-thirds just over two-thirds of people again who were kind of either living street-based lives or sofa surfing who didn't have kind of sustainable housing or consistent housing or accommodation have continued to access and remain in secure accommodation and uh yeah that's it to the next slide please lovely thank you and over to dabs now please debs brilliant thank you yeah so i'm just going to give you a little bit of an update of the work that we've been doing through our substance misuse services and so i mean the real the key approach that's really been taken um has been about uh it's been about joining up the support that we give to people that misuse substances in calderdale um and actually taking the services all the support to um to where people are to um the basement project to the gathering place and actually engaging with those service users hearing what matters to them what their issues are where they want to be and then taking rather than expecting um them to go to um spec different services actually taking a wide range of support to the basement project the gathering place etc and and i think that's really really been successful and so you can see i won't go through all of this slide but you can see um that we've we've we've really tried to improve and increase the capacity for uh for substance misuse for for recovery and and also for harm reduction so that people that are using substances are supported to um you know have access to um treatment that will stop them uh reduce the likelihood of them overdosing um and also us making sure that we're meeting the needs of people with really complex needs in our substance and issue services for example through our our detoxification services and and then as rona's already mentioned the work that we're doing around your diagnosis and we're really taking that multi-disciplinary team approach we've got a health and well-being nurse who's actually talking to people identifying what they need to do and then either supporting them themself or drawing in other services like wound care um and um [Music] therapeutic services that they need and and i think what's really important actually is to share the next slide which is just some of the stories some of the comments that we've had from um uh the substance mischief service users um since the burnt bridges since we put in place this new way of working so you can see there thank you for everything you've done for me and many others you're a life saver without doubt and you should be proud of yourself and the work you've you're the best key worker i've ever had um etc etc and you know and you can see somebody a parent said following the death of my son i would like to donate 100 pounds to support your clients and say thank you to the staff for the hard work and support and then another example there of a service user who attended a restart appointment and wanted to thank the staff member for the persistent in contacting keeping not giving up on people keeping trying and keeping people engaged and thanking the workers you can see there for not giving up on me and just even just really recently and just last week we took the corvid vaccination clinic to one of the areas where people that are currently using substances in in colderdale are and vaccinated 18 of the of the people there with the most complex needs and to support them from um from corvid so really that that's the key approach that we've taken taking the services to where people are to trusted locations trusted venues and i'll hand back over i don't know if it's you julia now yeah thanks thanks dave um so just to clarify what we're working on now is um what the actual procedures are exactly in terms of reference for all of those things that you've just heard about and how they will be supported through management business sport facilitation at the moment there's a lot of good will of people like flexing and doing um on top of their own rules and and that just needs clarifying and we're looking at making it easy for ourselves to share that information and following gdpr but looking at what other places are using and how they're being successful in making it simpler for people to do that and also looking at actually the governance and accountability of this and as you've just heard how it also fits with adverse childhood experiences and social behavior suicide prevention and a lot of other under other agendas um what we're expecting from calderdale organizations therefore um are these these four major things so aside from the the individual and the multi-agency work that's just been a little bit has just been described to you there's lots more going on these are the kind of overarching asks for organization statutory volunteering community is looking at making sure your staff are um awareness-raising and trained and working in a trauma-informed way and i think if we if we get anything out of this review it's a legacy of of that trauma-informed way of working supervision then to really reflect on whether the practice is is like that um and looking at you know effective safeguarding supervision for frontline practitioners and never giving up as we've just heard from from from a service user there about how important the the culture of never giving up is breaking down barriers to engagement and support and then looking at discharging disengagement procedures um and looking to see um are they fit for purpose you know in light of the learning from the bridges review i'll fly through these because you've heard already about the progressing dual diagnosis and the um the formalization of the multidisciplinary plenary team process and there needs to be a strategy and action plan behind all of this um quite importantly the next two is the challenge events that will follow so actually what difference has this made to the lives of the people who live in the community um to frontline practitioners who are actually working with these procedures so we're going to really test that actually what impacts this has had we do this for every review that we do and we usually generate more learning actually um but that's probably one of the most important elements that is one of our next stages for this um we'll be gathering evidence of the impacts and outcomes in other ways too data audits uh case studies lots of other ways and we're looking at sorting further trauma awareness training all the training that we've offered so far has been fully booked over subscribed and so we're it's more more more uh we're producing a trauma briefing so we've already done briefings on the actual report the learning from burnt bridges we're specifically looking at trauma now what that means what is it you know people who still get asked uh what can i do and looking at the differentiation of trauma briefings for different age groups so what's trauma for for parents for babies you know through childhood it means different things to different age groups and different situations um and launching a fatality review process so we won't be undertaking a huge review like this um unless we know that it meets a criteria for safeguarding adult review what we will be doing um is looking at um what what what calderdale looks like in terms of our fatalities and and see what what further learning there is through that process which brings me to the end and so i'll stop sharing and hopefully i can see you all again and open up for questions uh thank you julia it sounds like you've come an awful long way an awful lot has been learned i've got a few people four people indicating to speak now so we'll start with uh councillor uh kingston please thank you chair i've actually got a few questions and comments i hope it's all right to me for me to post them all i'll do them in one at a time shall i yes yeah no that's probably the best way yeah so we don't get too confused okay um i did again struggle with some of the terminology in the presentation that we've just been given uh so i i just wanted enlightening as to what some of these things mean um for example i don't know what i think i've worked through most of the acronyms but not all of them i don't know what the what is meant by a trauma inquiry pilot what's the a trauma inquiry julie do you want to see what happens i need to enlighten me about where that is um who side was that on it was on the nhs response to burnt bridges that's that's testing me i i don't know exactly what's involved in that um um because it's done in the nhs as i say it's not all by me and so there's different elements of being involved in people being involved in that um but i would imagine that somebody's doing some sort of inquiry into um primary care and the input into trauma but i will come back and give you a full response um tomorrow i'll find out thank you i just wondered is it something along the lines of the gps uh given guidance on how to check with their patients to see whether there's some trauma underlying things i i thought is that what it is but i didn't know so i didn't want to assume that i'm correct yes it is i'm sure um vulnerable feedback but yeah it is essentially that the gp is asking more questions rather than just treating symptoms right thank you very much okay that's number one and then dual diagnosis what is dual diagnosis absurd i can explain that so dual diagnosis um is people that have both um a substance misuse challenge and a mental health challenge and it can be quite difficult um because uh historically um it can be quite a challenge um for services to um treat just one of those two things rather than work on the mental health problem and the and the substance misuse problem at the same time so we call that dual diagnosis and and people that have both of those challenges can find it more difficult to get effective treatment unless we work differently and work much more in a much more personalized way with with the service user excellent thank you very much right a few comments um firstly just while you were doing the presentation i thought you know you prepared really well for this um i was impressed by the preparation and um group preparation how you've worked together to prepare um for tonight's meeting which i think reflects the amount of work that you've put into this whole area full stop uh so just to acknowledge that um then um again and i've commented previously i was pleased to see how much actual practical stuff has been done um to reduce roof sleeping the amount of investment that there's been in place of bed beds and places for people to stay and very impressed by that just one comment on the housing response page and the support around effective behavior management and support those with complex behavioral needs for example clients who have clients who have specific disorders with attention seeking behavior and thrive from coming into contact with emergency services and it just struck me while i was reading that that it would be easy to read that as a criticism of those people and um i just wanted to stress that those are symptoms that i'm having attention seeking behavior and thriving on contact with emergency services is a trauma symptom in and of itself and that we need to be careful that we're not passing judgments about people um in terms of the way that they're presenting to us and just as another thing was if they're thriving from coming into contact with emergency services well that's a good thing they're thriving thriving is a good word and if it's inappropriate that the contact in emergency services instead of other services then we need to look at why are they contacting emergency services instead of more appropriate services for their needs so that was it thank you very much thank you councillor kingston does anyone want to just want to the last um point is it more generalized to him julian i think le sharma obviously he had his hand that had his hand up at that point but actually that was the point that they wanted to get across from the service was actually now that that is exactly what is being seen and therefore support and for those people support for for that you know you know for those as you say presenting symptoms that's all they are it's actually finding out a lot more so yeah that was exactly the point of the example counselor kingston yeah sean john's coming back in on that as well yes thank you chair and just just to add to that really i think actually it could have been worded um better really um because because the it looks it look it comes over as subjective um and uh it wasn't meant as that i think um so i mean you're absolutely right it is about people who are engaging with and sometimes over engaging with certain services because they need to and there's a reason for doing that and i think using the word um thriving from that probably isn't the best use of that language really but there is a there is a reason for them to do that so i think we needed to probably carefully rephrase that because it is quite subjective you know that the intention okay so thank you sean for that sir council of megan swift you just on silence at the moment counselor oh it's gone now we've got it thank you very much um a couple of things again i mean i had the same problem with um and kingston about the number of initials are suspected report i mean i didn't say to somebody um when i first came on children's services going back to when i first came home i used to take hours and hours going through the person going back to the boat's trampoline i don't have to do it for a long time but this one was one i had to so i mean i don't particularly like all the initials put together but it's better not being there at all and one of them that um council kingston knew off the top of the head i haven't picked it up with that so if we're going to get the story right we need to know what those are we talk and i don't know whether it's in this one or one of the other about every man matters re-adult matters yeah sorry um we seem to have a collection of into child matters every age friendly person matters adults matter you know and we're going to start saying every one of two matters or everyone over 50 matches it's just it didn't seem as other than the important put to it because it between so much of it and i don't think there's anything else one of the things that i thought was really good was the training and the fact that the number of training was being given all to anybody who would come with them i saw the voluntary sector as well as places like the doctors and yeah thank you very much thank you council swift i think it's really the relevant point in relation to acronyms uh making sure that we we just fully understand so we don't get confused that that's that'll be my fault cancer background i to apologized to to scrutiny there um and just with it's yeah making every adult matter um and yes we're looking at what we're going to call it but actually uh he's a nationally recognized term that we've kind of used but yeah i'll take your private knowledge councillor hutchinson please thank you chair i mean there's obviously been a lot of imaginative and collaborative work been going on um over the last well we this uh we we saw scrutinized the burns bridges uh report in july last year and particularly around housing and the work that's been done centered on the basement project and and uh and uh you know it's very impressive but there are several areas that we picked up on at the last that are in the minutes of the last scrutiny meeting um elements that were missing from the action plan one was the dual diagnosis service where there were no time scales and nobody had accepted responsibility for another was service for people with intellectual disability now it sounds as if you are having at least having discussions about a dual diagnosis service but it sounds as if there is no dual diagnosis service yet what are the barriers to actually establishing that and when when might we actually expect to see a dual diagnosis service available in calderdale you look like you you're ready to answer that one so um yeah sorry if we led you down the route line that there wasn't a dual diagnosis service there is a dual diagnosis service in place uh what we're looking at is um whether that is um the service that we want to continue to commission or whether we want to increase that service and understand where the gaps are so we have the partners involved and um i think last time you asked if the mental health trust were around the table and we were saying we were in conversations with them to have that to get them um in discussions and they are they are definitely around the table they've put additional resources in to support at this point while we're working through some of the gaps so they are definitely involved there is a service in place what we want to do is what we were asked to do was to review the pathway um to look at where there are risks and to look at where there are get gaps and then to um produce a pathway that would be um you know that would be complete pathway for the uh meets the needs of that population of that cohort that's what we're in the process of doing so we're working with partners to work through that pathway and identify those gaps um it's it's a complex pathway it's not an easy pathway but that doesn't stop us doing it but it's a complex pathway i mean with all these with this particular group of individuals everything flexibility is the key um and trying to constrain things into rigid pathways doesn't work that's one of the main contributors to how these how these guys ended up in the position that they that they did [Music] so we've been talking about that and about the no wrong door approach and that people have to be flexible and agile in the way that they accept people and how do we do that in order to make it work for both services but more so for the for the people um and that's the bit that is the bit that we have to unpick um and takes a bit of time but everybody is on board of that with that and we've said it's everybody's business so we have to do it together and that's where we're working from so totally agree with that council hutchinson oh that that sounds absolutely the right way to go and go about approaching this and good good luck to you so is that what it means by the statement standard statements in contract slash service specifications so that people aren't services aren't just working within rigid contractual bound boundaries rigid um criteria for taking p taking patient accepting the care of of individuals it is and we've done i mean some things are quite small that we've achieved and um you could say this is small but it's big in the state of the changing a contract in an in the nhs we've now included wording so that it's more flexible about who people accept we used to put things in such as um it's only accessible for people who are registered with a gp in calderdale that wording has been removed and we've put some standard wording in around um this cohort so that that goes into every contract and every procurement that we undertake now within the uh nhs uh or the ccg um so that that's what that refers to is that our contracts did weren't really flexible um and we've now addressed that and had that's gone through our governance process and has been approved and it's now in everything that we do and i would hope that that attitude so pervades the other areas of contracting for the maybe not quite so complex um patients too can i just ask you across the board counselor helped the chin yeah can i just ask one more question it's about you told us uh back in july that the system is looking to introduce a multi-disciplinary recording system that has interoperability adult social care and the mental health recording system have we got that interoperability and integration of the recording systems yet and if not where are they what are the problems that that are standing in the way of that um i i can announce uh answer that uh chair yes of course yeah please do yes oh yeah yeah sure um so what we're looking at um we we're um we're working on identifying resources and looking at bids um to um to to develop this model and so that there is um a set of resources and personnel as well as infrastructure around this um and we've been looking at well specifically working with one area that has a standalone um electronic recording system that works very well for this group um which um we think potentially we could use in calderdale but we're still looking at the feasibility of that um going forward though um it is going to be a bigger challenge because we have um we have this challenge within our own bigger system within adult social care and within the health system as well about how a system like that can be interoperable with the the bigger statutory systems so that is going to be a piece of work that will take a good while really a next the next few years really to see how it can work how feasible it is in truth um but as far as a standalone system and that um that disciplines can work with um we think that um it's it's it's likely not to be too expensive and something that can fit um to uh calderdale's needs really the purposes that we would um use it for thank you yeah i'm going to bring debs in at this stage i think she's would like to comment on something oh yeah thanks thanks chair yeah it was just going back to the um the dual diagnosis um uh question that council hutchinson asked and just just to say that and i think we've got the building blocks and with the multidisciplinary team approach with the work that ron has described but just to remind you that um the big uh drug service substance misuse service review that damn carol black undertook and that's informed the the new national drug strategy and really puts all of this on a much much stronger footing moving forward so additional resources come into each local authority area and really starting to think much more about substance misuse as a as a health issue and uh rather than a criminal community you know a criminal justice issue i think will really help us better meet the needs of um of this particular community this group of people so while we're not there yet i think dual diagnosis is a good example about where by really strengthening our partnerships strengthening the local provision with some additional resources and you know we we've got the opportunity to to really move forward thanks and thanks for that uh the clarification is really helpful uh council parsons thank you chair i'm so excited i'm really really pleased to see this piece of work it's great to see that you're doing so much around person-centered care um yeah i think it's like four years ago i think that i mentioned the word trauma-informed approach and it kind of i remember it just that seemed to send everyone into spin and i'm really excited that you're training people and it's it's fantastic to see can i just ask a few questions uh one of them is um can you tell me what psychological theory is underpinning your training so are you using polyvagal theory is it attachment theory what theory is underpinning that and um so you're also looking at who is delivering the trauma-informed system uh training who is are we doing that in-house or is that something that we're we're a private sector person to deliver um it's the second question and then something around the non-verbal so the way that trauma is stored as in the amygdala is in the non-verbal part of the brain as you probably know so um one question is is so if we use verbal therapeutic intervention obviously we only get to a certain place with that so what nonverbal therapeutic intervention are we using to um to deal with trauma thank you chair oh thank you a council passing souls um right above my pay grace i work in the profession and you know i i feel as if i don't say anything here then you know i thought i'd walk into a foreign language uh there was a course of birth of your mother's julie would you want to elaborate this please yeah on some yeah and it's just so far we've used professionals from swift so south uh west yorkshire partnership foundation trust have delivered our training for us so far um we've obviously added the intervention as i've described from dr warren larkin and we i would have to find out for you what uh theories are underpinning and uh the non-verbal therapeutic intervention so i can feed that but i can get back to you on that we are as somebody mentioned earlier working with the um west yorkshire integrated care system the where their focus is on adversity trauma and resilience and they're actually developing um training raising awareness for west yorkshire we felt like we had to get on with it straight away so we actually didn't wait for them to develop this so we are hoping that they won't be too long until there is a west yorkshire approach that we all buy into um but so far um as i say we've brought in local professionals from from swift and we're looking at sourcing further right now all right that's great thank you yeah it's really i mean there's something there isn't there about using the polyvagal theory because it means that it's so for members who don't know what it is it's fights like freeze and falling so there's those four things and basically when we look at those it creates safety and we patent it and what you were saying before about the substance misused deb i'm really excited to see that we're looking at other ways so that it's not seen as criminal because i think many of us here know it's more connected to numbing those difficult traumatic feeling you know the dramatic response in the brain so yeah thank you for the great work you're doing i'm just i'm really excited to see how it's going to run for thanksgiving and thank you for raising the more technical uh issues and we do appreciate that at councillor durham's place thank you chair i'll just go back onto the notes um again in regards to some of the references around the behaviors or the symptoms that may be presented i just wondered when you've got people that are living um within these situations the the services i guess that they're engaging with what their understanding and knowledge is as as in signpost in directing because again i'll reference what a couple of the other councils have said but we know that there are well-known um information around self-medicating not necessarily to just deal with trauma but if you've you are neurodiverse you may self-medicate because of some of the symptoms which then can create dependency on drugs and without that first kind of understanding and engagement we're going to end up attempting to rehabilitate people that will naturally fall back into that system i i expect and then i've got another question if that's okay we've got 68 who have secured accommodation and then 32 who haven't because they've left before we could work with them they've returned to custody they are in hospital or are still working with us i'm not quite sure what that means and i wonder if we have a more specific percentage in that um area and whether we've been able to re-engage with some of them and attempt to get them back into um you know off the streets and um there was another question but i've lost my trail of thoughts i'm sorry chair but yeah if you want to come back on that one that's fine um uh dude i'm looking who's nobody's nobody's nodding they're not blinking yeah julie do you want to uh yeah i just i wonder if deputies want to come back in on the first question um but certainly there's a risk mitigation approach um it's not always uh abstinence or you know trying the end goal is not always um to come off drugs you know i it's there are lots and lots of individualized flexible approaches to how uh how services now are working with people debs i don't know whether you want to probably yeah yeah no thanks councillor um [Music] for that question um i think i think um there's a few things really that was as i was as i was listening to you that were going popping into my head i think the first one is apps julia's absolutely right the the the personalized outcomes for people in terms of the support that we give them if they are you know misusing substances so it's what their goal is what do they want to achieve and obviously for many they want to recover they want to become um abstinent but others um the the what our job is is around harm reduction it's around um you know preventing serious illness uh or or death um for for those that are using substances and i guess the other bit of your question made me think about the early intervention work and actually the work that we're doing through our refreshed well-being strategy actually and so that every child gets the best start in life and and that and 15 year olds um in calderdale have got hope and aspiration for the future um and both of those that sort of really using those universal services that we have in very early childhood actually um two two and a half year checks really using what we learned from those to identify people that greater risk of not being ready for school not having good outcomes later in life and actually making sure that we use that information and and then deploy it to reduce that risk moving forward and equally in the in the adolescence and we know that it's those transitions isn't it it's it's when you it's it's new families it's the transition to school and then it's a transition out of school into the big wide world isn't it and at those points was making sure that we're really looking and identifying risks as early as possible so that we can put things in place for um those are greater risk of having poor outcomes in their life more generally thank you sean do you want to come back in as well i think you were yeah it was just to answer councillor duran's um second point um the the the percentage in terms of those people 30 uh two percent of people that have have fallen into different parts of the system probation and police you know custody the justice system in one way or the other or just fallen away in terms of not engaging with any part of the system um in truth to have um such a high percentage of people in stable accommodation within this group is quite um remarkable in itself compared to other places where i've worked but that said it's never good enough if it's not 100 in in terms of people having shelter um and that is the real challenge of this work whereby we need to close that percentage gap and for people who are so disengaged you know i i meet with them fairly regularly and you know over the weekend when i pop into town and you know when i'm in town as we all do and speak to them i've got to know them personally and not personally as such but got to know their situation more you know to see how we can support and they they their ability to to try and engage and do the right thing is sometimes so limited when they want to that they they literally because of the attractions of other people substance misuse whatever it can be means that they fall fall away and come back again and that is the real challenge for this piece of work those people that are literally on the margins of what is said already a very complex and traumatized group thank you sean sorry could i just come back in there chad of course you can i again i'm i'm just wondering if it's not necessarily that they won't engage i'm wondering if it's they can't engage for whatever reason because it's about that understanding of we might not know why that is they might not know why this if they're in crisis at that point you know they are literally surviving the my third point was chair um and i don't know if this is a relative relevant question or not the comments that we often share on these groups we kind of take a snapshot of the positives and i always wonder whether we collect some of the the comments that when we haven't been able to meet needs and what we've what then we can offer what we've done because of that so you know we all tend to want to focus on when it's gone right but i wonder if we can never share comments from service users when it hasn't gone right and then what necessarily we could have put in place or we have put in place but if we only ever reflect on what's going right we kind of can't see a journey can we i just wonder if that's ever considered thank you i'm glad to bring uh marianne in at this stage that she's indicated to speak i think she might be able to help us yeah i mean i think first of all your last sort of point was this is where things did go wrong the whole point of the burnt bridges review was when things have gone wrong and as a safeguarding adult's body sadly is those cases that we tend to look at that's not to say that when you review a case where there has been a poor outcome there might be some positives in that so this piece work of work was around where things had gone wrong so how can we make things better in the future and but i think the other point just to just to reinforce really is um the report is called burnt bridges and that came out of basically professionals saying well these people have burnt their bridges with us they've not engaged they've not attended appointments they've withdrawn from services they don't want our help and what we've tried to do and what we have done really is to change that culture so actually you've heard about services now going to people we're not sign posting people we're outreaching our services to those people and we're not giving up so i suppose that's the shift that we've made we continue to make is you know away from people burning their bridges and services not washing their hands but stepping away feeling that they don't want their needs met to one where we're not going to give up we're going to keep offering that support and eventually at some time in somebody's life they might be prepared or might be able to receive that support even if they're not when it's first offered so i hope that provides some reassurance but certainly as a safeguarding adult sport our business largely with the reviews is to look at when things have gone wrong to look at them well how can we put them right in the future thank you julie do you want to come back in on that as well yeah i just um canceled around i think the the next stage of this which you just very briefly described those challenge events um or um interviews will will will will tell us that exactly that um we do do challenge events after every review and to see whether it's made any difference as i say you know we may have services of saying yes this is absolutely wonderful it's fantastic we can have case examples we can have you know but but where is where is the other stuff around apart from the positive so we are interviewing um experts by experience people in the community as i say frontline practitioners how it actually is is it working are these new procedures working has it made any difference what impacts it had on you positive that you we will do that piece of work and as i say usually every time we do that we come up with more learning yes this is great this has changed but actually we need to do more of this or or whatever it is yeah so so i was just looking you've just put your hand down council johannes and i was like you're confusing me trying to confuse confusion i understood that obviously the burnt bridges was about learning on this hall i was i think my comment was on the three comments that were shared from the basement project specifically around a kind of array of comments of why people might not have felt the service at that time was free i think sean had referenced you know with the people that he's engaged with but i guess it's just feeling that it's okay to share things that are not always glowing you know to give us a balanced review that's just my opinion but i didn't understand the whole pro the the whole uh scrutiny review at this point so thank you chair yeah no no problems don't counsel the balance thank you chad i didn't think i had to duck very uh very much when come when councillor parsons hall started mentioning the theories and by the way counselors there is a test on it at the end of the uh at the end of the session i think cancer duran sums a point in the sense that you know that those 32 and i think it was a concern that was raised when the burned bridges report came to scrutiny i think it was a concern about how do we manage how do we look at those that drop out for whatever reason they drop out and i think uh uh council duran summed it up when he said sometimes they don't they themselves aren't aware of why they drop out um and i think that's where we need to see still keep our activity high that looking at them and ensuring that those people who who do drop out that there are other mechanisms in place and and that we are continuing to look after after those individuals i think we have come a long way i think we've come a significant way um i think there's some some things probably on mental health that still probably need to be uh you know nailed down tightened down and and looked at i think it's important that we as a scrutiny committee keep asking this to come back um as a sanity check maybe just to make sure that things are are progressing it just takes it you know we don't want to be in a situation to do another one of these reviews so so regularly coming back and just having a separate pair of eyes looking at it i think i think is a is a very important thing so thank you jen thank you to everybody uh for their presentations and comments tonight uh absolutely i totally agree in terms of the presentation being excellent is a very extremely tragic circumstance but a great deal has moved forward uh you know from this um uh as as anybody well within this group uh knows how shall we equally uh have learned some lessons as well actually that is communication have regular meetings with uh marianne and julia which are extremely useful uh and will continue to to actually do so uh councillor fenton glenn yeah i just wanted to kind of add a couple of reflections obviously i came after the report had been released but kind of at the start well we'd already started implementing some other things before that's before it had um but i just thought i'd kind of share a couple of reflections just because i think it's worth underlining how much is being done and how well it's been done it's one of the things when you know if someone else says you know what are you proud about as lead member for adult service and well-being carlsdale then i would point to a lot of the work that we do and the fact that we've found the right partners and actually you know the fact that a lot of it's run out of the basement project which is a voluntary organization which we're doing things the right way and we built on that that approach and that outreach work rather than kind of coming in as a lot of kind of statutory organizations doing going this is our model and so well you know if you can fit into this then we'll commission you but we've said look here's people are doing things well and now increasingly some of the other services are looking to kind of move into that so it's more of a one-stop shop uh if you will and and that's you know that's something that's really good to see i hope it's something we continue to learn on another areas of our commissioning is finding the things that are working and working with people that are doing well and have engaged with the grassroots i think that's something that we can't underline enough um the point about people you know getting them when they access services absolutely key and just you know there's been a few cases um since i've been in this role where you know they've they they have kind of got someone and they've been able to to to to to wrap the services around that that person and it you know it's great to see them looking out for that but there is still work to do and um i mean when i when i went around with the outreach workers we um we came across someone who'd been turned away at any because they thought she was kind of um not there for the right reasons and she had quite a um a shed a wound on her leg and it was you know quite distressing to see and i think you know you you forget that you know this isn't something that you know we're going to blame people in a e for because it's a it's a stretched system it's an overworked system and you know perhaps during the triage people don't have time to go through all the causes that might get someone there luckily because because of the outreach work that was being done there were people who were able to then pick up and make sure that she got the services that she needed but there is still work to do and i think that's really important and the final thing i'd say is i'd like to just pay tribute to some of the work that sean's done kind of constantly chasing up things that are happening some of those groups um i'd like to pay tribute to neve who isn't here but is um tenacious and occasionally terrifying when she doesn't think that we're doing it right um and that's exactly the kind of challenge that we really need kind of from coming in from public public health and in this area of work and it's been really really useful to see and also it's not been discussed very much here but the work at craven mountain actually getting people people off the streets into an environment where they can be looked after where we can look at after the whole person but also the really good work that's been done to keep the streets out of craven mount when i was out with one of the outreach workers us said to them look what's the one thing you're doing they said build more build five more craving mounts now we don't immediately have the the resources to do that but it shows that where that service working in fact it is having long-term impact and you know i just say you know please you know continue to support the work we're doing but continue to ask us the difficult questions so yeah thank you and i'd like to pay tribute to everyone who's done done their bit in making this this really innovative work thank you okay thank you councillor defensively uh about just one final question from uh for me to julie is there anything you think the the cabinets are you all the councils should be doing or commissioning additional to what the volunteer we're already doing at the moment no i think um when i get the next training a lot of dates i'll send them over to you and if you want to go on that training yourselves that might be useful for yourself yeah uh thank you marion thank you julia thank you uh and thank you sean for collecting it it's a really extremely useful uh presentation and uh you're always always welcome back here as as you know so um so we go on to item number six which is safeguarding adult balls peer review when when i read this i thought there must be a bullet point coming there must be killer something killer coming and and it wasn't so so we've had the report so uh marion would you like to just expand uh is there anything this that you would like to inform us off that's not already in the report really yeah we haven't done a powerpoint presentation you'll be delighted to know and i mean the report speaks for itself so i'll just tell you a little bit about why we wanted the report doing and what's happening next really and then it happens to answer any questions i'm mindful of the time so the safeguarding adults board in calderdale was um established in 2011 and it had an independent chair at that time um the chairs changed a few times over that period of time but we've never actually had a peer review undertaken so um as an incoming chair and having discussed it with um board members and we made a formal request that the the yorkshire and humber um uh directors of adult services would come and do this challenge for us so really to come and have give us an external view on the work of the safeguarding adult sport and our ability to keep people safe in in calderdale so really it was about uh benchmarking where we were and identifying priorities for us for the future so we could get gaining our strength and we specifically asked around three things so one was around communicating and engaging with service users the second was around the effect effectiveness of the board and then the third one was about the visibility of our activity and and you know what value did we add really so that was the um the reason for the ask they came virtually for three days it talks about who the members of the pay challenge team were they used a standard methodology and they identified a number of strengths and areas for development which you'll see in the report i won't go through them all you'll see that burnt bridges and the approach taken there and obviously gets a number of notes and what we've done in terms of the areas the consideration for further development we've discussed them as a board we've had a vote uh really on the ones that we want to prioritize over the next 12 months and we've highlighted kind of four key areas and that we're going to really try and progress as a board so we're working those into some smart action plans having further more detailed discussions so that we can build that into our annual plan and work on that so um again they're just things that are already mentioned in the areas for consideration um but particularly and the ones that we're looking at really are considering the scope of the board and our relationship with other partnerships and their effectiveness in keeping people safe that's one of the areas that we're looking at and looking at how we can get the board vision right down to the front line to give them that support during the pandemic and our recovery from covid and looking at how we can better engage with the community and voluntary sector we do engage they are represented on the board about how we can do better in that area um and another one which was a seen as a strength actually um which was about gathering the lived experience of people in calderdale but not satisfied that that's the strength that's something we want to develop further so develop an approach to hear the voice of people with lived experience so how can we really hear from people where things have either gone right all gone wrong and and start to improve our services so that's uh that will be our focus in our next um business plan um but happy to um take any questions if anybody's got anything specific they wanted to ask thank you very much marianne um councillor barnes uh thank you chair i think uh for the purpose of the other committee members we met earlier on this week and had a quick chat about this and and we came up with some recommendations in relation to the the the idea of a peer review and i think um i'd leave it to the chair to to to comment on those at the end of our session i think it was just important that councillors knew that i think a couple of things one if i'm being really picky i'm i'm not sure that scrutiny welcomed the bridges uh review uh report i think um on that one but i think what i would like to say is in particular to marianne is that there's been a massive and marked improvement in in relationships and um uh between uh the board and this committee since her appointment and i know at times we come across a little bit um sometimes grumpy sometimes a little bit maybe aggressive assertive but i think i would just like it put on record as to the significant changes that we've seen uh in that relationship over the period of time i'm not going to make any specific comments on on the peer review but i just wanted that minute so thank you chair yeah nothing thank you uh councilman as it was in a fairly useful discussion in relation to the review we had to i suppose i'll kick it off and then i'm sure council barnes will will help me along the way really on this one and wait probably it raised it raised some issues in relation to uh when you actually conduct a peer review and i sort of get why you did but sometimes it's often a a trigger and something that's gone wrong to instigate the the peer review so that was probably one of our first inquiries as to you know what what made you do this because as i said at the beginning it sounded it it was very very nice reading and then pass on the back and well done which we we don't congratulate you when you do things right but it was almost missing something it's almost you know yeah i mean we did it not for a pat on the back but really for a bit of a reality check um to somebody independently against you know quite a straightforward framework it's you know other people will have the same methodology applied to them so we can benchmark but it was really you know come in and tell us um you know what we are doing well in but actually tell us the areas that we need to do better and that was really what we wanted and yeah it wasn't it'll come well there was a lot of really positive stuff in it which is nice but that's not necessarily useful in terms of moving forward so there wasn't any particular problem with the board and we have a really broad membership but it's always really well attended aboard meetings um some you know some really good work goes on in our subgroups um so there's some fantastic work that goes on but we just wanted somebody to come in and say right we've had a little bit of a poke around and actually and really think these are areas that you need to build on which is what they've done and um so that's what that's what we will do with it yeah no no seems superb so we certainly get that take that on board i think the thing there is ways raised more questions for us as as counselors is actually peer reviews in in uh as a whole and actually the involvement of members and the involvement certainly you know if a fusion one is carried out it's about uh you know who sets the parameters out uh and actually who's actually involved in the the actual peer review itself you know for instance uh um you know it would have been nice for us as councillors to be you know involved in that peer review as an outside body i think we're missing outside people sometimes you know i know the council has done a peer review in relation to the planning department and what what they fail to do is actually ask the key members and actually the the end users as well so so i think it's it's trying to learn from these moving forwards um i'm going to bring some other people in so i'm going to be in him first because he might all be able to help me out here thank you and i was trying to see if i could go through scrutiny without actually speaking but i i thought it might be useful just to talk a little bit about the whole process of peer reviews there's a national methodology around peer reviews of which there's a particular tool that's around the safeguarding um boards but there are a series of tools that are formulated through the local government association peer reviews are part of a wider approach called sector led improvement which is an attempt to try and improve services normally what you would have on a review team and it wasn't possible this time is an elected member from another authority um and they will look at this from a political member-led lens and it was just unfortunate i think that we couldn't have that um depending on the scale of the review there usually are some opportunities to talk to um elected members and usually that's the interest that where you've got a an elected member as a team member of the peer review they will particularly want to develop that and i've certainly been part of reviews when um they asked to talk to scrutiny and they'll have to talk to the lead portfolio holder um which is probably a bit of demand the domain that we were kind of lacking because we couldn't get an elected member from another authority um i know the review teams um really welcome elected members volunteering to be part of peer reviews but obviously that you the you can't peer review your own area um but i you know i would say that we would normally seek to get elected member perspectives um we just didn't do it on this occasion um we are required as a local authority in terms of adult social care the commitment we make is that we will have a peer review at least every two years to have that external view but peer reviews don't replace your strategy function and i think that's a really important bit here is i think they give you they can give scrutiny a really helpful um lens from um the peer review perspective but it gives you an opportunity to go further in your scrutiny yeah thanks for that and would we have any inputs in relation to the terms of reference for instance in future moving forward um normally what happens is the um the framework is set um and there are a set of domains by which the peer review comes in usually the um the commissioning organization which in this instance was the peer review and decide which of the domains are important to focus on um it is possible if in future um that if scrutiny had a view and we knew what that view was we could try and accommodate that cool yeah no thank you thanks for that i think he's raised a few interesting questions marion says so thank you for you know bringing it to us as well because so it's not it's not actually i i you per se but actually certainly um you know actually is made us question some of the uh uh some of the different things um uh council oh ian yes sorry apologies check there's one more thing i was going to say which is and i think it's um um kind of echoing what councilor barnes has said um people who have been on the safeguarding board will know that for a number of years i was uh requesting and and being quite challenging that i felt it was it would be timely to have a peer review i think marion has come in as independent chair has been really open to seeking views and i think an open to challenge and i think it's it's testament to her um taking up the role that it's meant that we've been able to very quickly establish the peer review very early in our tenure as well which i think really helps think then about where we want to take that ten years so i i really want to pay credit to marianthis for really picking up the mantle really quickly yeah no to totally agree but i suppose the question is in hindsight do you think this should have been carried out you know prior to your arrival i guess in some ways that's that's the biggest question i guess so i'm sort of thinking about and it's a question we can't handset's a wonderful thing and we can't go back and we've done it and and that's great but you know um i think as an independent chair you you've moved you've moved outside the organization but you you've moved it forward in a long way um i think possibly there were some issues prior to your arrival but you know equally i think okay i'll bring councillor kingston and then i'll be back in council of arms just reading this um i was impressed by it and what i appreciated was that you've subjected yourself to scrutiny by people that really know what the remit of your role is what it is that you're meant to be doing because it felt like that they've been able to go much further than i feel that i could go in a scrutiny board meeting like like this and because they know much more what it is that you're supposed to be doing and it just looked to me very thorough and a lot more detailed than what we would do in these meetings and so i was impressed by that and then my only question from it was um what are you going to do to implement the recommendations what's your action plan for doing that what's the timelines that are involved i presume that you've planned meetings that you're going to delegate tasks to specific people to identify the way that these recommendations can be implemented and that you you're going to set targets for yourselves around though that and i just want to know what what's your action plan and your timeline around doing yeah um absolutely right and and let me say it's not just me that's open myself up to scrutiny it's the board itself so you know the other people ian julia the members of the board across the board have opened themselves up to scrutiny not just me but thank you for that feedback yes we've already discussed the report at our board meeting we've identified of the areas of the consideration areas for development we've identified the top sort of four or five that we hope over the next 12 months we can really make some um headway with they've all been um an individual has offered or a group of people have offered to lead on each one of those so for example the one around community and voluntary sector i've got a meeting tomorrow with a few other people um where we're going to start to unpick that a little bit and start to develop a bit of a smart action plan if that makes sense to you it will probably look like an excel spreadsheet with a rag rating um but yeah we will build um a development plan for us aboard that we will work through over the next business year and that's not to say that other things might drop in during the course of the year as we make progress but yeah that's exactly um how we will um address this thank you marian castle of arms uh thank you first i'd like to apologize to ian baines for forcing him to speak tonight uh it's a hard life isn't it um uh secondly i think you know the point about um involving scrutiny is is important but it's also the fact that scrutiny need to know that the peer reviews are going ahead in the first place if the first thing we know about a peer review is when it's hitting our uh uh our inboxes uh with a report it's a bit late in the day for scrutiny to be able to make any form of comment and i think i think these recommendations relate across the script to peer reviews across the piece it's not relating to this one it uh i j we just think that the um the involvement of the relevant committee committee chair committee deputy chair and also potential as in let's say planning would people who have put planning uh uh appeals in would actually add to the review and improve the service and that's what we're all about here so thank you and once again apologies ian yeah and i think i think you've heard the nail on the head thank you council of barnes and that and that was the the element of marianne is actually made us think ourselves so as well what you've done is help us to to think as a as a scrutiny board as to how can we improve ourselves as well i think that so it's brilliant so so yeah fantastic reports i didn't expect anything anything less from you or from you in in charge of uh this uh adult safeguarding uh balls um because it is nice to get clarification and ratification actually you are doing that you are doing some wonderful work and i'm moving in the right direction so so very very much um thank you for attending thank you julie also for attending and taking uh uh all the questions uh i think we've been fairly okay with you hopefully you're not gonna go away upset so uh then we'll we'll catch up soon i'm sure so so thank you for that uh which takes us on to the item number seven our final item which is the work program uh it has been circulated we had a meeting earlier this week uh to make some amendments uh mike uh would you like to obey very briefly just update us very briefly chair um council blackburn council bounds met with ian baines and colleagues and we are proposing to to take the commissioning item in bite-sized chunks and focus on supporting living in extra care at the next meeting and then pick up on other issues relating to commissioning during the new next next municipal year we had a good discussion about the neurodiversity item and we are going to work myself i'm just going to work with ronaldo you met earlier and with swift to put together an item that will allow the scrutiny board to inform the future direction and commissioning of services for people affected by neurodiversity and autism in particular so that's rather than looking back on the on the item we had probably nearly two and a half years ago that's i'm sure we make reference back to it but that's looking forward on that issue um those are two fairly meaty items um and we're suggesting that the dementia item that we've had on actually for a while we'll give some more thought to and do in the summer um and i think that's all i need to say chair on that one only to remind mind you've only got a couple of meetings left for the musical year so there's not much time to build and everything we need to do as always i think it's been a i think it's been a really good year really a good day of discussions i'm actually proud of what we've done and achieved as a board as a as a whole collective board um so yeah well done bold members on that one uh continue uh the the questioning and the uh really nice real nice questions actually um so i i think that ends concludes the business of the day so thank you everyone for attending especially debs uh andy very much appreciated sean of course not for getting sean and your inputs and of course members input is extremely valuable uh i hope you enjoyed the rest of the evening and have a nice have a nice weekend as well so