►
Description
AGENDA
1. Declarations of Interest 00:01:56
2. Minutes 00:02:07
3. Public Participation 00:05:08
4. Verbal update on how GP practices are coping with the Covid emergency 00:05:17
5. 2020/21 Finance and Performance First Quarter Report Health and Adult Social Care 01:12:53
6. Winter Care Plans 02:07:48
For full agenda, attendance details and supporting documents visit:
https://democracy.york.gov.uk/ieListDocuments.aspx?CId=968&MId=12432
A
A
A
I
hope
I
haven't
missed
anyone,
and
please
do
let
me
know
if,
if
I
have
and
say,
we've
got
a
full
cam
com
complement
of
councillors
this
evening.
So
we'll
move
straight
to
the
agenda
items.
Any
members
have
any
declarations
of
interest
at
all
relevant
to
this
evening's
meeting,
not
seeing
any.
No
that's
good.
The
meetings
of
the
last
public
meeting
from
february
are
on
pages
one
to
ten
of
the
agenda.
A
I
think
we'll
probably
only
have
I
think,
three
or
four
members
this
evening
that
were
were
here
with
us,
so
there
were
some
change
of
membership
since
so
I
would
ask
the
members
that
you
know
that
were
with
us
in
february
whether
they
are
happy
with
this
or
it's
an
accurate
reflection
of
the
minutes,
as
they
recall
just
to.
Let
me
know
if
you
wouldn't
mind.
Thank
you
excellent.
Thank
you
very
much
what
I
would
just
say.
I
think,
with
regards
to
the
minutes.
A
A
So
there
are
several
several
items
we
might
want
to
pick
up
on
and
my
suggestion
would
be
there
that
would
pick.
We
perhaps
discuss
some
of
those
at
the
next
informal
session
and
try
and
formulate
some
kind
of
work
plan
going
forward
to
to
reintroduce
us
those
and
any
others
that
we
might
want
to
add.
And
likewise
there
were
a
number
of
areas
that
we
discussed
at
the
last
informal
session
that
we
wanted
to
to
raise,
and
obviously
a
couple
of
those
are
actually
the
agenda
this
evening
in
essence.
A
B
Let
me
just
I
I
think
you
were
suggesting
and
if
you
were,
I
would
agree
that
we
in
these
records
just
include
some
some
reference
to
the
informal
meetings
that
have
been
ongoing
in
more
recent
times.
They
they
have
been,
as
you
say,
informal
meetings,
but
I
think
just
a
minute.
The
fact
that
indeed
happened
rather
than
we've
we've
not
been
doing
anything
for
the
last
few.
C
A
Very
succinctly:
council.
Thank
you
right,
okay,
so
we'll
move
on
to
the
next
item.
We'd
actually
actually
have
anyone
registered
to
speak
at
all
in
public
participation
this
evening.
So
we
can
move
to
the
the
first
item,
which
is
the
verbal
updates
on
how
gp
practices
are
coping
with
a
covert
emergency
and
before
I
open
it
to
our
colleagues
from
the
ccg.
A
But
again
what
I
would
recommend
with
this,
the
ccg
provided
a
shortish
report
last
month
that
we
members
received
as
part
of
that
informal
session.
I
think
it
would
be
useful
if,
if
we
had
that
included
along
with
either
the
minutes
or
listed
with
today's
meeting,
because
there
was
some
some
of
the
questions
that
were
were
covered
in
in
that
essentially,
I
think
that
would
just
be
useful
to
tie
all
together
right,
so
I'll,
probably
pass
over
to
dr
wells
now.
A
If
you
want
to
to
give
a
bit
of
an
introduction-
and
obviously
I
would
say
at
this
point-
we
we
don't
normally
encourage
verbal
reports.
We
prefer
something
that
women
can
consider
in
advance
but
appreciate.
Obviously
we
did
have
a
report
last
time
only
last
month
from
from
dr
lee
and
and
the
it's
very
fast
moving,
shall
we
say,
and
probably
as
soon
as
you
write
something
at
moments,
it's
almost
out
of
date
straight
away.
So
I
appreciate
that
aspect.
D
Thank
you,
chair
and
you're
you're,
absolutely
right
that
things
are
fast
moving
and
happily
in
fast
moving
moving
for
many
months.
So
thank
you
very
much
for
giving
us
this
opportunity
to
come
and
talk
to
you.
I'm
delighted
to
be
joined
by
steph
porter,
our
director
of
primary
care
and
phil's
with
us
as
well
the
accountable
officer
so
between
us.
D
So
straight
away
overnight,
right
at
the
beginning,
primary
care
protected
the
patients
and
protected
its
staff
by
changing
the
way
that
it
offered
a
service
services
were
open
and
accessible,
but
they
were
in
a
different
way.
So,
straight
away,
we
went
to
remote
consultations,
total
telephone
triage,
and
in
that
way
we
were
able
to
keep
our
services
going,
but
also
to
protect
patients
and
protect
staff.
D
And
what
we've
been
able
to
do
is
bring
a
lot
of
technology
on
board
that
has
rapidly
sort
of
changed.
The
way
that
we
we
practice
so
straight
away.
What
we're!
What
we're
seeing
now
is
that
we're
maintaining
our
essential
services
by
telephoning
people
back
to
video
conferences
or
consultations,
using
text
with
the
ability
to
add
in
photographs
of
skin
lesions
and
so
and
things
like
that,
so
really
really
good.
D
The
other
thing
that
happened
was,
of
course
we
went
to
providing
hot
sites,
which
meant
that
we
would.
We
were
again
protecting
patients
and
staff
by
making
sure
that
if
we
did
need
to
see
people
that
we
saw
them
are
at
covert
secure
sites
and
all
through
this,
we
were
dealing
with
variable
variable
demand.
D
But
now
with
the
restoration
of
services
and
the
easing
of
lockdown
over
the
summer,
we
are
as
busy
as
we've
ever
been,
and
actually
we
are
busier
and
and-
and
if
I
remember
rightly
and
steph
might
be
able
to
help
me
with
the
numbers.
But
there's
more
consultations
being
done
in
these
last
few
months
than
there
were
in
the
same
period
last
year.
So
primary
care
is
open
and
it
is
incredibly
busy.
So
it's
it's
really
important
that
we
would
get
that
message
across
that
primary
care
is
open
and
it's
hoping
for
business.
D
E
So,
although
we're
doing
all
the
the
technical
work
to
support
the
technology,
the
way
in
which
we've
moved
to
a
telephone
triage
model,
there
are
there,
there
is
an
impact
on
our
staff.
That,
then,
is
translating
into
the
the
workload
of
of
our
practices,
and
it's
just
interesting
to
to
compare
how
those
numbers
would
reflect
if
you've
got
to
for
gp
practice
and
25
of
the
workforce
is
self-isolating,
the
corresponding
effect.
E
E
But
of
course
our
face-to-face
appointments
are
taking
twice
as
long
because
of
the
amount
of
personal
protective
equipment
and
safety
measures
that
are
in
practice
to
protect
patients
and
our
staff.
So,
although
the
numbers
are,
are
one
indicator,
it's
just
important
to
realize
that
the
activity
in
practice
is
taking
twice
as
long.
E
I
just
want
to
make
a
final
point
about
about
the
activity
that
our
practices
are
are
delivering.
We
have
seen
the
biggest
take-up
in
flu
vaccinations
we're
running
at
over
75
when
traditionally
we
would
be
in
that
50
to
60
percent.
So,
alongside
all
the
work
that
that
that
we
we've
discussed
this
evening,
it's
just
worth,
bearing
in
mind
that
that
general
practices
have
also
delivered
some
fantastic
activity
and
numbers
to
protect
people
with
the
flu
vaccinations.
D
F
F
And
so
what
that
has
created
is
a
level
of
a
level
of
resilience
through
these
last
nine
months
that
we've
been
able
to
sustain
that
smaller
practices
certainly
haven't
been
able
to,
and
it's
also
enabled
us
to
provide
that
hot
and
cold
service
that
that
neces,
that
hasn't
necessarily
been
available
in
other
parts
of
the
region
as
well.
So
so
I
I
I
think-
and
this
is
only
my
my
personal
view,
but
my
personal
view
is
we
should
be.
A
A
Obviously,
we've
heard
some
of
the
how
corvids
impacted,
potentially
on
the
availability
of
appointments
for
residents
and,
not
least
because
of
some
of
the
absences
that
we
have
in
in
the
system
with
staff,
which
is
understandable.
I
think
it's
reassuring
to
hear
that
in
general.
I
think
the
gps
have
responded
well
in
york
and
we
obviously
appreciate
the
the
work,
and
particularly
it's
such
a
trialling
time
for
everyone.
D
I'll
respond
and
then
steph
might
want
to
come
in
in
a
minute.
I
think
when
you
remember
when
I
said
about
protect,
you
know
keeping
services
going
and
protecting
really
by
overnight.
We
had
to
change
the
way
that
general
practice
was
run
and
was
offering
a
system,
because
this
was
all
about
protecting
staff
and
protecting
patients.
D
You
know
it's
it's
a
risk,
it's
an
infection
risk,
so
so,
yes,
things
have
changed,
and
that
was
because
we
needed
to
protect
patients
and
we
needed
to
protect
staff
now
going
forward.
I
don't
know
when
this
will
will
change
or
or
have
we
flipped
into
a
different
way
of
working,
that
we
need
to
sort
of
make
sure
that
we
are
digitally
digitally,
including
everybody,
so
they
have
a
good
online
access
as
you're
saying,
and
so
is
it.
E
Yeah,
I
think
I
would
just
echo
those
points
really.
It
depends
when,
in
the
transition
people
have
experienced
difficulties.
So
at
this
at
the
start,
in
in
march,
for
example,
we've
traditionally
supported
our
practices
to
have
fixed
computers,
and
we
were
only
some
way
along
getting
everybody
transitioned
onto
laptops
that
would
allow
them
to
work
remotely.
E
And
if
you
can
remember
back
to
march,
which
seems
like
a
age
ago,
we
had
all
sorts
of
procurement
issues
with
where
we
were
buying
laptops
from
and
long
leading
times,
because
by
and
large
they
were
coming
from
the
the
far
east
from
from
china,
the
other
complicating
factor
and
just
to
sort
of
expand.
A
little
bit
more.
E
If
patients
were
invited
to
a
face-to-face
meeting,
we
had
designated
a
much
smaller
number
of
surgeries
where
people
who
were
coming
either
with
symptoms
or
without
we
were
streaming
them
to
make
sure
that
we
were
protecting
staff
and
making
sure
that
we
were
directing
people
to
sites
that
had
plenty
of
space.
You'll.
Be
aware
that
we've
got
a
number
of
surgeries
that
are
that
are
quite
small
and
wouldn't
lend
themselves
to
having
lots
of
staff
in
the
same
site
and
maintaining
social
distances.
E
So
I
would
hope
that
the
transition
and,
as
we've
got
better
over
the
summer,
has
negated
some
of
the
the
points
that
have
have
been
shared
with
you.
But
we
are
not
without
our
our
difficulties
and
and
as
I
expressed
before,
on
a
day-to-day
basis,
if
staff
in
their
numbers
are
reporting,
ill
or
self-isolating
or
are
identified
through
track
and
trace
and
have
to
leave
the
practice,
then
we
will.
E
We
will
get
fluctuating
changes
in
the
availability
of
appointments,
but
we
hope
that
that
is
negated
by
the
fact
that
so
many
more
appointments
are
available
through
telephone
consultation
and
and
just
on
a
final
point.
Sometimes
when
we
talk
about
online
consultation,
people
do
think
about
video
consultation
and
and
we're
not
quite
there.
Yet
in
with
our
practices.
Actually
it's
more
a
telephone
triage
service
with
uploading
of
photographs.
We
don't
necessarily
have
the
bandwidth
and
the
quality
yet
in
the
digital
advancement
with
our
practices.
E
A
C
C
That's
where
I'm
coming
from
with
this,
and
is
that
something
your
comms
and
engagement.
People
can
look
at
perhaps
a
quarterly
bulletin
that
goes
out
to
every
door,
not
people's
email,
inboxes,
but
out
to
every
door
and
just
to
bust
those
myths
that
often
come
in
the
national
newspapers,
because
you
only
ever
get
the
horror
stories
there,
but
they're.
So
influential
on
on
the
country
and
so
that'd
be
the
first
thing
and
I'd
raise
I
mean
chair.
If
I
can,
let
people
respond
to
that
and
come
back
with
my
second
point
that
would
be
lovely.
D
D
D
A
F
Thank
you,
counselor
taylor,
thanks
thanks
for
for
you,
for
your
angle,
really
appreciated.
Thank
you.
There's
a
bit
there's
a
bit
of
it's
a
bit
of
a
values
issue
this
for
for
the
nhs,
as
well
as
a
a
sort
of
operating
model
issue
so
from
a
values
perspective,
nigel's
sort
of
given
his
clinical
professional
response.
F
Nhs
organizations
are
have
a
value
base
which
comes
from
it's
a
public
sector
organization
there
to
serve
so
so
so,
following
the
line
following
the
line
that
that
you
suggested
I
get
that
entirely,
but
it
it
doesn't
fit
with
our
values
of
how
we
normally
carry
out
our
ou
our
business.
So
it's
it's
not
something
that
we
would
normally
normally
do.
That's
not
to
say
that
we
shouldn't
do
it.
F
F
F
We
can
talk
with
them
about
what
we
may
be
able
to
do
or
not
to
meet
those
expectations
and
how,
on
an
ongoing
basis,
we
can
start
an
engagement
and
dialogue.
That
is,
that
is
real.
That
grows
that
is
organic,
and
that
starts
to
build
within
the
community,
because
the
way
that
we
are
trying
to
do
it,
which
is
well
intentioned
and
value
based,
isn't
landing.
C
C
I
say,
piece
of
work
not
not
to
make
it
sound
massive,
but
I
think
there's
a
gap
here
for
some
really
effective
partnership
work.
You
know,
maybe
we
can
get
on
to
the
executive
member
about
this
and
I'm
sure
councillor
unsermon
would
support
it
and
I
just
sort
of
think
if
we
don't
crack
it,
then
you
know
our
gp
practices.
C
D
Yeah,
I
I
I
I
think
it's
really
really
really
really
good
points
actually
really
really
important
and
good
points
and
you'll
know
this
better
than
I
do,
and,
and
maybe
understand
that
that
that
counting
numbers
and
seeing
numbers
is
is,
is
possibly
a
good
way
of
of
of
of
politically
seeing
your
way
through
things.
But
it's
not
a
qualitative
outcome.
Is
it
it's
not
about
people's
quality
of
life
and
how
actually
far
they
can
walk
down
the
street
street
or
how?
How
do
they
interact
with
their
communities?
D
So
I
think
we
need
to.
We
need
to
absolutely
get
out
of
out
of
this
sort
of
the
the
counting
numbers
for
counting
numbers
sake
and
move
more
into
outcomes
and
quality,
and,
in
my
mind-
and
I
would
say
this
because
I'm
a
generalist,
I'm
a
general
practitioner,
family
doctor
who
who
who's
worked
in
family
medicine,
it's
about
the
whole
person
and
the
whole
family,
and
it's
about
societies
and
communities,
because
there's
not
always
a
medical
solution
for
people's
needs
and
wants.
D
D
If
we
go
back
to
counting
numbers,
then
we'll
go
back
to
trying
to
deal
with
those
numbers
and
those
numbers
normally
are
dealt
with
in
in
hospitals
or
in
in
in
in
how
many
people
are
waiting
for
this,
that
the
other
it
doesn't
show
you
that
the
richness
of
what
actually
needs
to
happen
in
the
communities.
So
I'm
probably
rambling
a
bit
now,
but
I
hope
you
get
my
drift
a
bit
on
that.
I
don't
know
whether
steph
or
phil
want
to
come
in
maybe
clear
it
clear
up
what
I've
said.
E
Thank
you.
If,
if
I
may,
I
will
interject
on
some
numbers
because
it
it
might
help
people
sort
of
quantify.
I
mean
if
people
remember
jeremy
hunt
said
five
years
ago
that
we
needed
5
000,
more
gps,
just
to
stand
still
well
since
that
time,
we've
lost
2,
000,
whole
time
equivalents,
and
so
actually
we
probably
need
7
000
to
to
stand
still.
E
We
talked
about
the
prevention
agenda
and
where
we
place
the
control
for
the
prevention
agenda,
and
we
we
just
need
to
get
smarter
around
around
that.
On
a
positive
note,
the
kovid
crisis
did
inject
a
whole
new
way
in
which
we
could
encourage
returners
back
into
the
profession,
and
the
city
has
benefited
from
that.
So
nurses
and
gps
who'd
left
the
pro
the
profession
they
were
encouraged
to
come
back
in
so
they're,
certainly
positive
signs
and
the
the
city
are
are
well
supported
in
their
recruitment
process.
A
Thank
you.
I've
got
a
kind
of
question,
that's
linked
to
what
callum's
asked
really,
although
it's
more
of
a
short
to
term
element
to
it,
so
our
colleagues
able
to
give
us
some
kind
of
summary
as
to
how
much
extra
resource
has
gone
into
primary
care
to
help
deliver.
Specifically,
you
know,
services
around
corbett
during
during
the
current
crisis,
have
we
seen
actual
additional
money
into
the
system
locally
to
help
gp
services.
E
So
I'll
take
that
one
everybody's
looking
glazed
eyes
at
whether
I
can
quantify
how
much
money
we've
spent-
and
I
I
don't
have
an
up-to-date
picture
but
additional
resource
did
coming
into
into
wave.
One
typical
spend
was
around
extra
ppe
for
staff
to
be
able
to
deliver
services.
We
had
some
money
going
to.
A
G
G
Obviously
it
always
brings
with
it
additional
pressures
on
the
nhs
services
and
obviously
a
flu
jab
take
up
may
help
with
some
of
that,
but
I'd
be
interested
to
hear
how
you're
going
to
be
supporting
staff
with
burnout
if
they
are
already
fatigued
and
then
we
know
it's
a
yeah
going
to
be
a
tough
time
for
them
ahead
in
the
next
few
months.
If
you
can
just
talk
us
through
what
steps
you're
taking
to
deal
with
some
of
those
issues.
D
Yeah
thanks
for
that
I'll
I'll,
maybe
open
up
and
then
steph
might
want
to
come
in
with
some
other
specifics.
I
think
absolutely
right
that
that
and
I'm
sure
it's
a
national
thing,
isn't
it
we're
sick
of
this?
Aren't
we
we're
all
we've
all
had
enough
and
and
we've
all
we're
all
really
pulling
together
as
a
nation
and
as
a
region
as
a
city,
and
you
see
that
also
in
primary
care
that
the
fatigue
is
there.
D
Winter
is
always
a
a
tough
time
and
we
are
gearing
up
by
sort
of
trying
to,
if
at
all
possible,
clear,
clear
out
things
that
we
maybe
don't
need
to
do
as
much
now
to
try
and
push
back
and
and
and
try
and
offer
as
much
resource
as
we
can
as
steph
said
to
to
to
to
give
to
practices.
However,
as
I
was
just
going
to
come
in
before
we
you
can't,
you
can't
get
any
more
stuff,
we
have
a
finite
staffing
resource
and
and
it's
full,
so
we
are
where
we're
at.
D
So
it
is
absolutely
about
those
fundamentals
of
communicating
all
amongst
ourselves,
keeping
ourselves
safe,
keeping
ourselves
so
like
well.
If
we
can-
and
you
know
doing
the
minor
ailment
things
that
we
can
at
home
using
one
one
one
appropriately,
not
going
to
ed
using
the
gp
services
appropriately
as
well,
so
that
we're
all
helping
each
other,
because
every
little
bit
that
everybody
does
helps
massively.
D
You
know
our
gp
services,
like
you
say
well,
like
we've
said,
are
taking
hundreds
of
calls
a
day.
Well,
if
that
can
be
reduced
by
10
or
20,
calls
a
day
by
people
doing
self-care
and
looking
at
different
ways
of
accessing
health
on
online
through
nhs
one
one
one
online.
That
makes
a
massive
difference
in
primary
care
for
resilience
and
sustainability.
D
E
Just
to
pick
up
on
a
previous
comment:
we're
doing
a
a
media
campaign
on
on
the
back
of
some
of
the
national
stuff,
a
paraphrase,
but
a
bit
like
be
nice
to
the
receptionist
she's.
My
mummy,
you
know,
because
actually,
when
you've
waited
in
a
queue
to
ring
and
speak
to
to
the
receptionist
and
you're
anxious
you're
nervous,
actually
it's
that
person
who's
trying
to
do
the
the
their
job
at
the
end
of
the
phone,
who
isn't
a
clinician
who
probably
gets
it
in
the
neck?
E
And
you
know,
if
we're
honest,
we've
we've
had
examples
of
people
saying
just
can't
cope.
I
might
as
well
go
and
work
at
the
supermarket
and
have
have
less
stress.
So
we
are
cited
on
all
of
those
things
and
we
are.
We
are
looking
to
actively
support
practices
and
our
lmcs
have
well-being
champions
so
so
on
on
that
side,
we're
we're
providing
a
safety
net.
E
On
the
the
specific
question
of
what
are
we
doing
around
winter,
people
may
be
aware
about
the
nimbus
care
mass
vaccination
flu
site.
So
that's
in
that
mutual
aid.
What
can
we
do
across
a
number
of
practices
over
the
next
eight
weeks?
Nimbus
care
will
have
sixty
thousand
flu
vaccination
appointment
slots.
Whether
they'll
have
the
flu
vaccine
to
deliver
to
all
of
those
appointments
is,
is
another
question
and
also
as
part
of
our
winter
planning.
E
We've
got
a
whole
range
of
ways
in
which
practices
will
help
each
other
in
geographical
cluster
locations
and
we
also
are
putting
on
extra
clinical
sessions
and
traditionally
that
would
more
likely
be
required
in
in
january,
but
we
are
providing
additional
sessions
so
that,
if
I
can
describe
it
as
the
overflow
activity
into
our
extended
hours,
clinics
and
there's
there's
more
money
going
into
it.
But
it's
rare
we
say
this,
but
there
are
lots
of
different
funding
routes.
E
A
D
So
it
it
is
really
affecting
everybody,
the
mental
health
stuff
that
we're
getting
through.
So
that
is
really
an
important
part
of
working
with
our
our
partners,
with
our
mental
health
provider
tube
as
well
around
how
we
can
improve
access
to
that.
But,
of
course
they
still.
They
have
the
same
issues
around
staffing
around
protecting
staff
and
patients
when
they're
accessing
resources
as
well.
D
Maybe
phil
and
staff
can
can
add
to
this,
but
have
invested
so
much
more
in
the
last
years
than
than
previously
into
mental
health,
because
because
we
know
of
the
importance
of
that
and
as
a
as
governing
body,
it
is
one
of
our
key
messages
that
we
want
to
to
to
take
forward
into
action.
So
I'll
pause
then
and
steph
and
phil
might
want
to
come
in
on
that,
because
it's
really
important
point.
Thank
you.
E
Yeah,
so
colleagues
here
may
may
have
heard
in
various
forums
that
were
doing
a
lot
of
work
to
to
project
what
will
be
of
a
very
long
ramping
up
of
demand
around
mental
health
over
the
four
or
five
years
mark
and
what
we're
seeing
in
primary
care.
I
referred
to
additional
roles
that
are
coming
into
primary
care
and
from
april
onwards,
there
there
are
new
mental
health
workers
who
are
are
available
for
for
practices
to
employ.
E
Why
april?
Why?
Not?
Now
those
posts
are
linked
to
training
programs,
so
we
we
know
that
they
will
come
on
stream.
So
that's
the
primary
care
end
of
end
of
the
pathway
and
we
are
working
with
our
mental
health
provider
to
make
sure
that
there's
much
more
joined
up
activity
with
our
practices,
but
it
is
tough
and
we
are
anticipating
more
more
demand,
particularly
as
some
of
the
recession
starts
to
hit,
and
you
may
have
heard
in
different
forums
that
our
secondary
care.
E
E
Some
people
actually
have
responded
really
well
to
online
services,
and
and
it's
it-
it's
been
a
it's
been
very
interesting
to
see.
Some
people
really
are
responding
well
to
online
services
in
a
way
that
perhaps
they
wouldn't
have
face-to-face
engaging
with
mental
health
services.
But
again
it's
a
it's.
A
wave
of
demand
that
we,
we
know
is
coming
and
we're
working
with
our
health
providers
to
smooth
the
demand
so
that
we
can
respond
to
people
safely.
A
A
You
know
that
they
might
have
a
family
member
or
a
neighbor,
or
that
they
have
concern
concern
with
so
that
might
that
might
be
something
I
don't
know.
Sharon
could
pick
up
for
us.
A
list
of
you
know
current
services
in
the
city
that
we
can
have
handy
to
so
that
we
we
can
sign
post
people
appropriately
appropriately
counselor
call
it
next
time.
Please.
B
Thank
you
jay.
I
I
noticed
just
as
you
gave
me
the
opportunity
to
come
in
that
that
sharon
stoltz
was
making
herself
available.
I
think
you
thought
you
were
inviting
her
to
comment
at
that
point
and
given
her
enthusiasm,
I
don't
want
to
tread
on
her
toes
and
by
all
means
in
invite
the
director
of
public
health
to
comment.
I
B
Council
college.
Thank
you.
I
think
that
the
points
that
have
been
picked
up
this
evening
by
various
colleagues
have
been
have
all
been
important
ones,
and
I
just
want
to
say
initially
thank
you.
Thank
you
for
giving
us
the
time
and
and
sharing
your
experience
and
thoughts
with
us
this
evening.
I
realized
that
you
must
be
tired,
you
must
be
exhausted
and
the
the
resources
are
inevitably
limited.
B
B
In
terms
of
obesity
and
healthcare
and
well-being-
and
there
are
good
things
to
build
on
from
these
last
months-
hasn't
it
been
good
to
see
families
exercising
together
hasn't
even
been
good
to
see
people
enjoying
their
localities
and
and
maybe
exercising
in
a
way
they
never
would
have
done
before,
because
they've
just
been
reminded
how
important
it
is
and
when
there
have
been
few
other
things
to
do.
Sometimes
it's
been
great
to
get
outside.
All
of
that
is
good,
so
I
put
that
on
record.
A
I
I
I
And
some
of
those
conversations
have
already
started
with
the
lrs
and
and
they'll
be
ongoing.
Work
to
to
take
that
forward.
And
but
I
think
it's
fair
to
say,
and
I'm
sure
nigel
and
steph
might
want
to
come
in
here
and
that
the
first
cohort
will
be
very
reliant
on
gp
practices
to
deliver
that.
But
as
a
city,
we
will
support
primary
care
and
we'll
have
conversations
with
our
gp
practices
about
any
additional
resource
that
we
might
need
to
mobilize
to
support
them.
I
So
whether
our
health,
visitors
and
school
nurses
need
to
be
involved,
for
example,
in
supporting
that,
so
I
just
want
to
reassure
committee
members
that
this
is
very
much
a
partnership
approach.
As
a
city
and,
for
example,
I
had
a
telephone
conversation
with
the
chief
executive
of
york
racecourse
today,
who
was
offering
the
facilities
of
the
race
course
to
support
us
and
with
a
mass
vaccination
program.
So
this
will
very
much
be
a
city
response
and
we'll
do
whatever.
D
I'd
just
like
to
come
and
say
thank
you
to
councillor
colic
for
his
his
words.
I
really
appreciate
that
and
your
thanks
are
noted.
So
thank
you
for
that.
With
regards
the
the
the
covered
vaccination,
I
completely
agree
with
sharon.
It's
a
it's,
a
collaborative
approach
that
we're
going
to
take
and
we
will
take
you
know.
You
know
there
is
a
mass
vaccination
site
that
that
you
that
the
city
of
york
has
has
set
up.
So
that's
great.
D
E
I
don't
I
don't
normally
take
this
role,
but
I
heard
a
lovely
fact
today
from
an
lmc
colleague
in
england
and
wales.
Primary
care
normally
deliver
19
million
appointments
between
january
and
march
to
support
the
coveted
vaccination
you're
looking
at
80
million
appointments.
So
it's
just
it's
a
fast-moving
picture.
It's
our
next
challenge
to
be
to
be
managed
and
I'd
echo
sharon's
words
that
that
we
can
only
do
it
in
in
partnership
and
we've
we've.
We've.
We've
got
some
good
examples
to
to
build
on
so
we're
we're
hopeful.
B
H
H
I
obviously
appreciate
that
we're
gonna
gonna
be
waiting
a
while
for
any
sort
of
program
to
to
get
off
the
ground
and
and
for
yeah
well
for
everything
that's
been
mentioned,
but
it
does
strike
me
anecdotally
that
there
appears
to
be
more
resilience
potentially
from
the
public
to
taking
this
vaccine
than
there
might
be
something
like
the
flu,
and
it
does
perhaps
strike
me
that
it
might
be
sensible.
I
don't
know
for
work
on
starting
to
chip
down
that
resilience.
H
I
Yeah
and
certainly,
and
we're
all
aware
of
that-
and
are
already
national
conversations
happening
about
that
and
some
of
the
measures
that
nationally
and
might
be
able
to
be
put
in
place
to
address
some
of
the
misinformation
that's
being
shared
on
social
media,
for
example.
It's
very
difficult
for
us
to
do
that
as
individual
organizations.
That
would
need
to
be
done.
Central
centrally
and
some
of
those
conversations
are
already
happening.
Public
health
england
has
a
behavioral
change
specialist
units
who
are
involved
in
some
of
that
messaging.
I
There
will
be
publicity,
materials
and
health
promotion
materials
that
will
be
published
nationally.
That
will
be
available
to
local
organizations
and
and
will
certainly
be
working
collaboratively
across
the
ccg
and
the
councils
through
our
comms
leads
preparing
for
that.
So
it's
it's
a
really
good
point
and
you're
right
the
sooner.
I
We
can
start
that
work
the
better,
but
I
I
would
like
to
nuance
that
a
little
bit
with
when
we
know
the
vaccine
is
going
to
be
available,
and
so
we
don't
want
to
start
that
messaging
too
soon
and
because
people
will
just
get
tired
of
it.
So
we
need
to
be
prepared
and,
and
then,
as
we
have
more
confidence,
that
those
vaccine
stocks
are
going
to
be
available
to
us
locally,
then
we
can.
We
can
certainly
step
that
up,
but
a
really
really
good
point.
Thank
you.
Councillor,
norman.
A
A
So
thank
you
very
much
for
that.
I
appreciate
dr
wells
has
appointments
still
this
evening
so,
and
it
applies
to
any
any
of
you.
You're
all
welcome
to
to
stay
with
us,
but
please
do
if
you,
if
you,
if
you've,
got
other
work
that
you
need
to
be
doing.
Please
please
do
it
don't
feel
as
if
you
need
to
stay
on.
So
thank
you
very
much.
A
J
So
this
is
the
the
quarter
one
position.
So
what
you
have
in
front
of
you
is
an
extract
of
the
overall
council
report
that
went
to
the
executive
in
october.
So
we
take
out
the
bits
that
are
relevant
to
this
scrutiny
committee
and
bring
them
to
yourselves
for
the
discussion
here
so
on
the
finance
side
of
things,
so
the
table
on
a
table
one
on
page
11
of
the
of
the
pack
that
you've
got.
J
That
shows
a
projected
outer
variation
of
plus
2.6
million
or
about
5.4
percent
of
the
net
budget
for
the
areas
subject
to
this
scrutiny
and
that
sort
of
compares
to
a
an
overspend
of
3.8
million
in
the
last
financial
year.
2019
20
for
the
same
areas
of
budget
and
the
that
net
position
does
include
an
assumption
of
future
mitigations
between
quarter
one
and
the
end
of
the
financial
year
of
2.5
million
that
their
directorate
are
currently
working
on
to
bring
that
down
to
that
particular
level.
J
K
K
K
Number
of
adults
in
contact
with
mental
health
services
has
gone
down,
but
that's
partly
to
do
with
the
way
we
count
it
rather
than
because
it
actually
has
gone
down,
and
the
numbers
of
people
who
get
direct
payment
says
continue
to
increase
public
health
measures.
There
are
some
there's
some
information
at
the
end
of
the
report
about
public
health
measures.
We've
got
something:
we've
got
the
health
healthy
treatment
service
has
been
halted
for
safety
reasons,
substance
misuse,
we've
got
broadly
similar
figures
to
what
we
had
reported
previously
bear
in
mind.
K
Some
of
this
information
is
out
of
date
because
there's
always
a
lag
with
public
health
data
sexually
reproductive
health.
There
is
a
slight.
The
numbers
have
increased
slightly
in
terms
of
young
females
becoming
pregnant
for
the
first
time,
adult
obesity
in
physical
activity,
still
above
the
regional
and
national
averages,
and
the
numbers
of
mothers
that
who
are
pregnant,
who
smoke
has
increased
again
slightly
compared
to
where,
where
we
were
a
year
ago
and
just
working,
the
general
population
continues
to
be
less
than
the
national
average.
A
I
No
no
thank
you.
Thank
you
chair.
I
just
wanted
to
make
a
correction
really
my
apologies
to
colleagues
in
performance
that
we
didn't
get
this
corrected
before
the
report
was
submitted.
So
it's
my
fault,
not
not
terry's
and
just
correct.
The
information
around
the
healthy
child
service
and
the
service
has
continued
to
operate
during
the
pandemic,
and
it
didn't
close.
G
Thank
you
chair.
I've
actually
got
a
couple
of
questions
so
if
I
can
just
start
off
on
one
around
the
budget
overspend
areas,
so
a
lot
of
the
areas
that
seem
to
be
overspen
ism
due
to
there
being
more
demand
than
we
had
budgeted
for,
and
I'm
just
wondering
sort
of
how
the
forecasting
has
worked
for
that,
because,
obviously
it's
not
a
great
position
to
be
in
in
quarter,
one
that
we're
already
seeing
increased
demand
on
services.
J
Okay,
so
I
mean
I
can-
I
can
pick
a
little
bit
on
that
and
others
might
want
to
to
comment
in
other
aspects
of
it.
So
in
terms
of
in
terms
of
setting
the
budget,
we're
doing
the
projections
for
the
budget
setting
for
the
forming
financially
they're
sort
of
around
about
the
time
we're
speaking
now-
and
I
think,
you've,
probably
seen
in
in
last
year's
reporting-
that
there
was
a
continuing
increase
in
the
number
of
in
the
overspend
towards
the
end
of
the
year.
G
G
Thank
you
so
my
next
one's
probably
more
for
terry
about
performance,
so
obviously
delayed
transfers
of
care
have
been
halted
at
the
moment.
But
is
this
something
that
we
could
look
at
sort
of
continuing
measuring,
as
I
know
that
it's
something
that
we
have
had
quite
a
focus
on
in
previous
years,
trying
to
improve
the
waiting
times
for
people
transferring
out
of
hospital
and
into
the
normal
place
of
residence.
K
Yeah,
I
don't
know
if
pippa
wants
to
help
answer
this
one
as
well,
but
the
latest
information
we
have
is
that
the
department
of
health
and
social
care
stopped
asking
us
to
count
it
in
march,
and
they
haven't
indicated
that
there
is
a
there's,
a
desire
on
either
the
part
of
hospitals
or
local
authorities
or
themselves
to
restart
it.
How
we
go
about
measuring
delays
from
hospital,
I'm
not
quite
sure
how
we
do
that,
but
certainly
detox
isn't
going
to
restart
anytime
soon.
L
Thanks
terry
and
thanks
councillor
parrot,
it's
quite
true
that
the
government
has
suspended
the
reporting
of
delayed
transfers
of
care
as
a
performance
indicator
and,
as
terry
says,
not
only
have
they
actually
not
indicated
they
want
to
return
to
it.
We've
had
some
really
strong
indications
that
the
government
doesn't
intend
to
reintroduce
it
next
april.
L
We
were
required
to
establish
what
is
has
been
named:
a
command
center,
a
discharge
command
center,
which
in
effect
was
an
evolution
for
us
of
what
we
call
our
sort
of
discharge
arrangement
with
discharge
coordinators
and
the
discharge
hub
and
our
one
team,
and
to
make
sure
that
people
were
as
soon
as
they
were
ready
to
leave
hospital.
They
went
on
to
the
right
place
for
them,
so
for
as
many
people
as
possible.
L
That
was
expected
to
be
home
with
no
need
for
support,
or
for
some
people
it
was
home
with
quite
a
short
spell
of
support.
Perhaps
in
the
voluntary
sector.
If
family
weren't
available
or
a
little
bit
of
paid
for
service
and
then
a
much
smaller
proportion
may
need
to
go
to
a
bed
somewhere
for
a
temporary
basis,
and
the
expectation
was
that
only
one
percent
of
people
who
were
leaving
hospital
with
covert
19
would
need
to
go
to
a
permanent
placement
in
a
in
a
you
know:
a
care
bed
of
one
sort
or
another.
L
G
Thanks
pippa,
it
does
cover
it.
I
think
I
suppose
what
I
was
driving
at
is
if
it's
been
something
that's
been
really
sort
of
worth
us
focusing
on
and
measuring
in
the
past.
I
just
don't
want
us
to
sort
of
lose
sight
of
them
still
dealing
with
it
in
the
future,
so
as
much
work
as
we
can
do
to
sort
of
proactively
still
find
out
that
people
are
being
transferred
out
of
hospital
in
a
timely
manner.
That
would
still
be
appreciated.
Even
if
there's
not
the
statutory
requirement
to
report
that
information.
L
And
certainly,
I
agree:
the
focus
on
the
outcomes
for
the
individual
have
always
been
worth
monitoring
and
measuring,
but,
like
all
key
performance
indicators,
it's
a
moot
point
as
to
whether
or
not
it's
really
been
worth
measuring
in
the
way
we
were
asked
to
measure
it,
because
sometimes
the
measure
drives
the
wrong
relationships
within
the
partners
that
need
to
deal
with
it.
So
I
think,
what's
happened
around
the
changes
to
funding
and
the
financial
decision
making
and
making
sure
that
people
leave
hospital
and
are
then
fully
assessed
has
been
the
most
powerful
change.
A
It's
kind
of
a
follow-on
really
and
sorry
for
interrupting
anna.
If
you
wanted
to
I'll
come
back
to
you
in
a
moment,
if
you
want
to
add
anything
else,
but
obviously
a
lot
of
the
data
in
the
reports,
particularly
18
pages
18
to
24
is
his
activity
that,
in
some
cases
is
a
year
out
of
date
now-
and
I
think
anna
quite
rightly
questions
about
wanting
to
know
more
about
the
outcomes
and
obviously
sharon
already
already
mentioned,
we'll
continue
with
the
the
the
healthy
children's
service,
etc.
M
In
yeah,
thank
you
and
apologies
for
not
having
my
video
on
earlier.
I
have
got
an
eye
infection
which
is
making
me
feel
quite
unwell,
looking
at
it,
and
I
don't
really
want
to
impose
it
on
other
people
yeah.
I
think
one
of
the
challenges
we've
got
is
that
the
comparator
data
in
in
this
bit
of
the
world
is
not
as
readily
available
as
it
is
for
some
some
of
the
other
bits.
So
so
children's
services,
for
example,
has
a
huge
data
set
and
there
is
regional
and
national
comparative
data.
M
That's
almost
live,
and
that
isn't
isn't
the
same
in
in
adult
services
in
in
the
same
way.
So
that's
why
some
of
the
data
that
you've
got
there
may
look
like
data,
that's
slightly
out
of
date,
that
isn't
because
the
team
aren't
very
robustly
monitoring
the
data
and
I'm
working
very
hard
on
the
data,
and
I've
been
in
the
dash
position
for
a
total
of
what
three
weeks
now.
M
What
we
have
seen,
though,
as
a
consequence
of
covid,
is
that
more
people
have
had
their
community
systems
break
down
and
that's
particularly
apparent
in
the
second
wave.
So
you
know
where
you've
had
that
informal
care
which
is
really
important.
It's
crucial
that
that's
what
we
support
people
to
access
those
kind
of
neighborhood
and
locality
support
systems
because
of
the
stress
that
everybody
is
under
that
we're
starting
to
see
some
of
that
fall
away.
M
But
I'm
sure
people
will
we'll
talk
later
when
we
get
into
winter
plans
about
that
doesn't
change
our
approach.
What
we
still
wanted
to
do
is
very
much
that
kind
of
strength
based
approach.
Very
much
knitting
people
into
community
support
very
much
the
home
first
approach,
because
they're
the
right
approaches.
It's
just
that
covert
has
given
us
a
kind
of
a
glitch
in
the
system
for
want
of
a
better
phrase.
G
Thanks
chet,
I
suppose
there's
just
one
final
question
that
I
did
have
about
the
performance
figures
and
it
is
around
how
performance
has
sort
of
varied,
so
much
2017
to
18
up
until
the
latest
quarter.
So
there
are
a
few
areas
where
the
numbers
seem
to
have
decreased
quite
rapidly
over
the
years.
So,
for
example,
a
number
of
safeguarding
pieces
of
work
that
were
completed
went
from
1056
in
2017
18
to
304,
and
I'd
just
appreciate.
G
K
It's
not
that
the
numbers
have
dropped
off.
I
know
in
the
first
two
columns
you've
got
two
completed
years
and
then
the
last
two
columns
you've
got
a
comparison
of
2018
19
call
to
one
with
29,
which
sorry
28
19
20
20
19
20
quarter,
one
with
20
20
21
quarter,
one
she's
only
comparing
two.
What
two
quarters
in
the
last
two
columns
as
opposed
to
two
years.
C
C
Can
you
talk
about
why
the
delay
hasn't
yet
happened?
I
mean
I
I
understand
the
report
says
due
to
covid,
forgive
my
cynicism,
but
we
hear
that
an
awful
lot
and
I
I
like
to
sort
of
ask
people.
Well
what
do
you
mean
due
to
covet?
How
has
that
stopped
the
transfer
to
york
care
from
taking
place
because
that's
that's
a
hell
of
an
overspend.
J
I
mean
I'm
not
sure
the
full
details
of
that
one
particularly,
but
I
mean
I,
I
suspect
it's
because
the
staff
that
would
have
been
involved
in
facilitating
that
transfer
and
doing
the
work
on
it
will
have
been
diverted,
particularly
in
the
early
days
of
the
of
the
kerbid
issues
onto
all
the
work
and
a
lot
of
staff
were
moved
off
quickly
onto
other
work.
So
that's
probably
delayed
that
and
then
probably
the
inability
of
of
external
partners
as
well,
who
would
be
dealing
with
to
actually
facilitate
that
transfer.
L
Yeah,
thank
you
richard,
so
I
I
don't
want
to
give
a
definitive
answer,
because
I
I'm,
I
might
not
have
the
full
story.
I
might
might
have
mistaken
it,
but
we
can
definitely
give
a
a
note
with
the
minutes
about
precisely
what
the
concern
was,
but
I
I
think
part
of
it
is
because
it's
as
an
element
of
the
program
which
is
to
do
with
construction,
so
construction
ceased
for
a
period
during
the
early
part
of
the
pandemic,
and
I
know
that
it
has
begun
again.
L
I
think
that
that
did,
and
also
all
of
the
wider
issues
about
everything
changing
has
interrupted
the
sort
of
transfer
of
hacksby
hall,
because
I
think
the
assumption
is
that
you
know
staff
would
transfer
with
the
with
the
service
that
we've
not
taken
on
permanent
staff.
For
that
reason,
and
also
people
don't
necessarily
want
to
come
and
join
a
service,
that's
changing,
so
we've
been
obliged
to
deliver
the
service
with
short-term
staff,
which
is
sometimes
more
costly.
L
It's
a
good
service
they're
doing
great
work,
but
it
does
change
the
way
the
financial
structure
works.
So
I
think
that
it's
about
a
stage
of
of
timing,
really
where
we
are
with
timing
and
that
it
will
get
back
on
track
into
your
course,
but
you're
right,
it
is
a.
It
is
a
considerable
sum.
That's
quoted
in
the
paper.
I
suggest
that
we
ask
michael
and
the
team
just
to
round
up
a
formal
note,
just
to
provide
a
bit
more
overview
of
that.
C
Thank
you.
I
mean
what
would
also
be
helpful
is
if
it's
possible
some
sort
of
time
scale
when
the
when
the
transfer
will
be
completed,
because
this
is
a
gaping
hole
by
the
looks
of
it
and
and
if
I'm
right
in
remembering
the
the
amount
of
money
that
your
care
were
paying
the
council
to
take
on
the
125
year,
leasehold
was
450k.
C
Now,
I'm
I'm.
No,
I'm
no
whiz
kid
at
numbers,
but
my
initial
reading
of
that
is
before
we've
even
transferred
haxby
hall.
We
are,
we've
lost
more
money
than
we
were
going
to
get
from
giving
up
that
leasehold,
because
over
500k
is
greater
than
450k,
and
maybe
it's
not
that
simple,
but
yeah.
It's
a
bit
alarming,
so
any
sort
of
detailed
explanation
would
be
much
appreciated.
C
Thanks
chair,
thanks
to
you
all
for
putting
up
with
me,
I
wanted
to
look
at
the
these
health
checks
that
we
do
and
it
looks
like
in
in
this
area.
So,
commission
services
there
was
a
projected
underspend,
a
small
one,
but
still
an
underspend,
and
I
looked
at
this
area
and
it
seems
to
be
a
place
where
we
we
could
improve.
How
many
people
do
these
health
checks.
C
C
I
I
I
I
I
J
J
The
health
checks
are
funded
from
the
public
health
budget,
which
is
effectively
on
budget
as
it
stands
overall.
So
it's
actually
in
that
line
where
we're
showing
that
a
nil
variation,
so
they're
from
two
different
budget
areas.
That's
the
reason
why
sharon
was
wondering
where
that
understand
came
from.
B
B
L
Shall
I
just
comment
briefly:
I
think
obviously,
the
well-being
of
the
workforce
is,
you
know
really
important
to
us,
and
sharon
may
also
want
to
come
in.
We
have
so.
These
are
the
council
employees
rather
than
the
wider
workforce
across
health
and
social
care.
It's
just
important
to
remember
that,
so
the
actions
that
we
take
within
the
local
authority
to
support
staff
well-being,
I
would
hope,
are
having
an
impact,
both
mental
and
emotional,
as
well
as
physical
well-being,
there's
always
an
element
of
of
ill
health.
L
That
at
the
moment,
we
can't
avoid.
One
of
the
things
that's
been
interesting
to
note
is
that
for
some
people
of
of
or
for
the
workforce
as
a
whole,
I
think
sickness
absence
has
reduced
during
the
pandemic
and
there
might
be
a
number
of
factors
for
that.
So
one
is
that
if
you're
socially
distancing
anyway
and
you've
got
a
cough
or
a
cold,
but
you
feel
well
enough
to
work,
and
you
know
that
we've
got
a
really
pressing
urgent
mission.
L
I
don't
I
haven't
looked
in
detail
at
what
the
issues
are,
that
people
are
still
unwell
with,
so
I'm
that
hypothesis
that
I'm
putting
forward
could
be
rubbish,
but
certainly
I
think
some
people
have
found
the
flexibility
of
working
from
home
as
well,
has
enabled
them
to
manage
their
work.
Life
balance
better
and
to
continue
in
work.
L
I
think
we
focus
strongly
on
some
of
the
behaviors
and
the
values
and
the
cultural
attitudes
of
how
we
support
our
staff
to
feel
confident
and
positive
and
happy
in
the
workplace.
You
know
it's
one
of
those
things
that
we
should
always
be
focused
on,
so
I
think
that's
probably
enough
from
me
on
that
amanda.
B
M
I
yeah,
I
was
just
going
to
actually
say
quite
a
lot
of
what
pippa's
just
said
so
great
minds,
and
all
that
yeah
I
mean.
I
think
the
the
flexibility
of
working
from
home
is
something
that
staff
are
certainly
feeding
back
is
is
really
important
to
them,
and
and
one
of
the
things
that
we
are
looking
at
as
part
of
the
building
bet
better
as
we
come
out.
The
other
side
of
this
is
around.
M
All
of
those
things
have
been
really
really
important
and
I
think
that's
been
really
appreciated
by
staff
in
terms
of
feeling
like
there
is
a
team
approach
to
this
and
we're
all
in
this
together
and
moving
forward
together,
and
I
think
that's
that's
been
one
of
the
factors
in
in
helping
people
feel
like
they.
They
are
more
able
to
be
in
work
and
and
to
look
after
themselves
a
bit
better.
B
B
That
is,
is
so
important
and
enabling
this
I
don't
really
like
the
phrase:
work-life
balance,
it's
all
life,
but
but
life
balance.
So
please,
please
let
us
hang
on
to
that,
and
I
think
that
that
will
contribute
significantly
to
improving
these
sickness
levels
and
to
see
that
that
has
fallen
at
a
time
when
you
know
it
really
wouldn't
have
been
surprising.
If
we've
been
talking
about
25
sickness
levels,
it
is
something
that
we
have
to
say
there
are
things
to
learn
here.
Let's
make
sure
we
do.
Thank
you.
N
J
Okay,
so
on
on
the
first
one,
I
think
that
was
when
this
particular
paper
was
was
being
put
together.
That
was
the
understanding
of
what
was
going
to
happen,
so
I
think
where
we
are
now
it's
more
of
a
phase
transfer
in
terms
of
that,
so
that
will
happen
between
now
and
the
31st
of
march.
So
one
of
the
things
that
we're
developing
at
the
moment
in
terms
of
the
quarter
two
paper
that
will
we
will
come
to
this
at
this
meeting
in
in
a
couple
of
months,
is
a
mitigations
list
along
there.
J
We're
trying
to
put
in
some
assessment
about
what
that
change
might
mean.
So
I
think
that
in
financial
terms
the
picture
is
probably
moving
to
slightly
more
favorable
than
a
quarter.
One.
That's
if
that's
helpful
on
the
second
point,
which
was
around
continuing
healthcare,
I'm
not
sure
of
the
actual
issue,
for
why
why
customers
no
longer
qualify
for
hundreds,
and
maybe
that
one
that's
actually
happening.
What
I
do
know
is
the
the
director
has
been
quite
a
lot
of
effort
into
that
recently
as
well.
L
On
the
21st
of
august,
they
published
new
guidance
which
actually,
as
richard,
said
and
gave
us
a
bit
longer
to
arrange
that
and
they
created
two
phases
or
two
schemes,
so
people
who
had
been
discharged
from
hospital
with
kobe
19
or
not
with
kobe
19.
In
fact,
but
under
the
covered
arrangements
from
march
up
until
the
31st
of
august,
were
deemed
as
being
scheme
one
and
they're
what
we
call
the
deferred
assessments,
so
people
who
may
have
been
eligible
for
chc
and
are
waiting
for
their
full
assessment
to
be
completed.
L
We
have
until
the
31st
of
march
2021
with
the
ccg
to
complete
those
assessments.
The
ccg
has
to
report
fortnightly
on
their
performance
against
completing
those
deferred
assessments,
and
we
have
a
trajectory
planning
to
get
them
all
completed
in
time
so
that
nobody
gets
forgotten
and
we're
able
to
do
that
in
an
orderly
way.
At
the
same
time
now,
from
the
first
of
september,
anybody
discharged
from
hospital
is
funded
through
the
nhs
for
a
period
of
up
to
six
weeks
to
complete
all
the
necessary
assessments,
so
their
scheme
too.
L
So,
as
richard
said,
the
original
forecast,
we
assumed
that
everybody
was
going
to
come
back
to
the
council
in
a
big
chunk
in
you
know
short
order.
So
I
think
that
will
end
up
having
been
helpful
on
the
chc
cases
and
adults
with
learning
disabilities
having
been
reviewed
and
no
longer
eligible.
I
think
that
is
quite
a
it's
a
bit
of
a
bone
of
contention.
L
Really,
I
think,
for
the
local
authority
and
the
ccg,
and
certainly
one
of
the
things
the
local
authority
staff
have
been
doing
is-
is
ensuring
that
we're
fully
adequately
geared
up
to
understand
all
of
the
legislation
to
make
sure
that
people
are
getting
their
entitlements
and
that
there
are
no
cases
where
people
are
being
incorrectly
reviewed
as
no
longer
eligible.
But
it
has
had
a
big
financial
impact.
C
A
A
G
Thank
you
chair.
I
apologize
technological
difficulties,
as
is
usually
the
case
on
zoom.
It
was
just
a
quick
one
on
page
24,
paragraph
64.,
about
referrals
to
why
out.
I
know
it's
a
bit
of
a
snapshot
figure
because
it's
2019
20
quarter
two
data,
but
is
there
any
reason
why
our
referrals
are
so
much
lower
than
the
england
average?
I
think
we're
504
per
100
000
compared
to
953,
so
I
don't
know
if
anybody
can
just
talk
me
through.
Why
we're
not
referring
as
many
people.
A
I
K
I
A
C
C
A
L
L
In
the
cover
note,
I've
included
that
winter
plan
that
came
from
the
government
and
also
the
report
of
the
social
care
kobit
19
support
task
force,
which
was
set
up
by
the
government
after
the
first
phase
of
the
pandemic,
when
in
particular,
there
was
real
concern
that
social
care
had
not
had
the
attention
that
it
needed
right
at
the
beginning,
because
so
much
attention
had
gone
to.
Naturally,
the
national
health
service
and
the
concerns
that
were
raised
particularly
around
care
homes,
was
the
prompt,
I
think,
for
the
task
force.
L
And
when
you
look
across
the
two
reports,
there
are
many
areas
where
they
overlap
and
the
task
force
made
50
recommendations,
some
of
which
are
translated
directly
into
the
winter
plan.
Many
of
them
are
for
government
or
for
the
regulator
cqc,
and
also
for
providers.
So
they're,
not
all
recommendations
for
councils.
L
If
you
like
to
develop
a
care
home
support
plan,
we
were
asked
to
do
that
in
the
form
of
a
letter
to
the
care
minister,
helen
waitley.
So
to
kind
of
be
consistent,
we
chose
to
do
this
through
the
same
sort
of
format
really
covering
off
each
of
the
main
areas
that
they
wanted
to
see
addressed
in
our
winter
plan.
L
L
Supporting
people
who
receive
social
care,
the
workforce
and
carers
and
both
formal
and
informal
family
carers
supporting
the
system.
So
thinking
about
how
the
funding
works
and
care
market
sustainability
and
such
like,
and
within
that.
I've
also
attached
two
reports
which
we
sent
to
the
government,
because
quite
a
lot
of
what
we
have
talked
about
is
the
strength
of
our
community
response
and
how
the
whole
system
collaborated
together,
including
use
of
the
voluntary
sector
and
the
social
prescribing
link,
workers
and
ways
to
well
being
that
hosted
in
the
cvs.
L
So
I
thought
it
was
really
important
to
share
that,
because
there
are
lots
of
really
important
stories
about
how
the
community
responded
in
york
and
the
reason
that
we've
been
able
to
do.
That
is
because
we
already
had
a
really
firmly
established
program
around
asset-based
community
development,
social
capital
building
and
community
capacity.
A
Thanks
very
much
pippa.
I
think
it
was
really
good
in
particular
that
you
included
the
cbs
report
in
this,
because
I
think
it
just
shows
how
strong
the
links
are:
the
community
involuntary
sector
in
york
and
the
work
it's
doing
with
the
council
to
support
residents.
I
think
that
was
really
good,
that
that
was
included
just
just
one
question.
Well,
a
couple
really
now.
A
I've
just
just
said
that
about
cvs,
the
very
very
back
page
page
46,
in
the
supplement
with
the
as
a
reference
to
the
york
dementia
action
alliance,
and
when
I
read
that
my
heart
sank
and
I'm
hoping
that
last
lap
almost
like
the
last
line
in
it,
it
says
why
dear
is
coming
to
an
end
in
september.
2020.
A
L
So
the
the
program
of
work
around
supporting
people
with
dementia
and
creating
a
multi-agency
forum
where
those
with
a
concern
around
supporting
with
people,
dementia
and
their
carers,
can
meet
and
take
action.
That
program
of
work
still
exists
and
people
are
still
meeting.
I
think
the
we
had
a
small
amount
of
money
that
was
funding
a
worker
for
dementor
action
alliance,
and
that
was
time
limited.
L
Those
sorts
of
issues
where
it
can
be,
you
know
very
isolating
at
the
best
of
times.
So
when
we're
in
periods
of
lockdown
and
thinking
about
winter,
we're
really
concerned
to
make
sure
that
we
make
contact
with
those.
So
it's
more
a
story
of
evolution.
I
think-
and
this
report
at
a
point
in
time
reflected
that
the
program
as
it
had
been
operating
was
coming
to
an
end,
but
it
will
be
moving
on.
A
L
L
I
And
so
we've
been
assured
that
there
are
sufficient
vaccine
supplies
in
the
country.
But
because
of
the
high
uptake.
What
we're
finding
is
that
gp
practices
and
community
pharmacies
will
order
a
supply
of
flu
vaccine
and
then
once
they've
used
that
they
have
to
wait
for
further
stocks
to
arrive
and,
and
that
has
just
meant
that
there
have
been
delays
and
for
some
residents
and
and
I'm
certainly
aware,
because
I've
been
contacted
by
some
residents
who
have
been
concerned,
that
they've
not
been
able
to
book
an
appointment.
I
And
there
are
a
couple
of
issues,
then,
with
vaccine
supply,
and
that
means
that
it's
being
prioritized
and
to
the
the
higher
risk
groups.
So
anybody
who
is
an
eligible
but
healthy
in
the
over
50
age
group,
for
example,
and
will
have
to
wait
and
until
they're,
there
they're
invited
and
but
everyone
who
wants
a
vaccine
should
be
able
to
have
one
there.
There
are
just
some
kind
of
short-term
delays
in
the
system
at
the
moment.
L
Physical
activity,
health
champions
works
really
closely
with
the
cvs
around
a
number
of
programs,
including
social
prescribing
and
such
like.
So
those
events
did
happen
in
terms
of
the
cbs
hosting
more
than
one
gathering
through
different
platforms,
obviously
no
longer
able
to
meet
at
priory
street
but
online
gatherings
of
different
organizations
and
really
exploring
our
understanding
of
what
changed
as
a
result
of
the
pandemic.
So
I
talked
earlier
on
about
the
vast
number
of
people
that
came
forward
to
ask:
could
they
make
a
difference?
L
Was
there
something
they
could
do?
We
talked?
Don't
we
about
the
sort
of
4
000
people?
They
were
not
all
the
same
sort
of
people
that
are
normally
in
touch
with
the
voluntary
organizations
and
charitable
sector,
and
I
think
one
of
the
things
that
we've
learned
as
a
system
is
that
we
can
be
more
sophisticated
about
understanding.
We
just
talk,
oh
third
sector
or
launching
community
sector,
and
it
rolls
off
the
tongue.
But
do
we
actually
really
consider
all
the
different
types
of
organization
or
groups?
L
So
I
think
one
of
the
things
that
we've
learned
is
to
be
a
bit
more
sophisticated
about
those
voluntary
sector
organizations
that
are
part
of
our
community
infrastructure.
Some
of
them
are
big
anchor
organizations.
Some
of
them
are
very
small
community
groups,
but
they
occupy
a
certain
traditional
space
within
sector,
and
then
there
are
these
things
that
to
me
are
probably
quite
alien
really
because
they
evolve
from
social
media,
they're,
hyper
local
networks
in
neighborhoods,
even
just
street
level,
whatsapp
groups
and
such
like.
L
Where
people
came
forward
and
said:
oh
hang,
on
a
minute:
I've
got
a
neighbor,
or
actually,
I'm
always
out
about
running
and
doing
some
of
those
activities
like
collecting
prescriptions,
doing
shopping.
That
sort
of
thing-
and
we
have
some
different
types
of
groups,
so
quite
different
to
the,
if
I
say
conventional,
traditional
voluntary
sector,
I
don't
want
that
to
sound
in
any
way.
L
If
you
like,
so
I
think
that's
partly
what
that
report
is
talking
about
is
how
can
we
make
sure
that
people
who
come
forward
to
volunteer
have
a
role
that's
meaningful
for
them
and
which
they
can
manage
within
whatever
the
circumstances
are
so
some
of
the
people
came
forward
because
they
were
going
to
be
furloughed
or
because
their
normal
arrangements
around
caring
had
changed,
and
that
will
be
different
in
the
winter.
You
know
the
the
lockdown
is
slightly
different.
L
Isn't
it
this
time,
so
it's
about
being
capable
of
really
responding
as
a
whole
sector
and
a
whole
system
to
all
the
different
phenomena
that
that
we're
going
to
encounter
but
trying
to
make
sure
that
nobody
gets
left
behind
really
either
as
a
person
in
need
or
as
a
person.
Who's
got
a
massive
contribution
that
they'd
like
to
make
or
a
tiny
contribution.
They
feel
they
can
make.
C
C
If
you
like,
a
cue,
and
it
wasn't
as
simple
as
just
saying:
oh
yeah,
you,
you
can
go
and
speak
with
that
person
you
can
go
and
do
this
is,
is
what
you're
saying
here
then
basically
saying
that
there
isn't
that
lagging
anymore
or
there's
much
less
of
a
lag
and
that
we
can
better
deploy
anyone.
That
does
want
to
help
in
the
most
efficient
and
appropriate
way.
Much
more
quickly,
and
and
are
we
seeing
that
on
the
ground.
L
But
it
doesn't
surprise
me
that
we
had
4
000
people
come
forward
to
say:
can
I
volunteer?
Many
of
them
were
also
nhs
volunteers
through
the
nhs
apps,
some
of
them
were
elected
members.
I
know
from
from
what
members
have
told
me:
I
see
that
as
something
that
is
an
absolutely
fantastic
strength
that
people
really
wanted
to
make
a
difference
and
they
came
forward
to
say.
Can
I
make
a
difference?
L
If
so
tell
me,
I
don't
think
it's
particularly
to
the
detriment
of
the
city
that
not
everybody
who
offered
to
help
immediately
found
a
carved
out
role
where
they
could
go
and
do
it.
I
think
they
were
a
strength
that
that
is
here
all
the
time
and
people
have
a
calling
and
we
need
to
find
ways
of
of
drawing
on
that
in
terms
of
how
we're
martial.
L
Actually,
we
were
really
efficient,
both
as
a
council
and
as
a
sector,
so
in
very
short
space
of
time
staff,
whose
normal
roles,
weren't
going
to
continue
in
quite
the
same
way,
were
deployed
to
set
up
the
community
hubs
to
do
the
volunteer
registration
to
manage,
deploying
and
kind
of
interviewing
or
getting
in
touch
with
volunteers.
So
those
people
that
helped
the
social
prescribing
calls.
They
were
people
that
were
registered
through
the
council
we
registered.
L
L
We've
learned
a
lot
from
that
and
I
think
between
the
council
and
the
cvs,
we're
probably
better
placed
now
to
coordinate
that
and
to
know
who's
going
to
do
what
and
where
to
use
those
resources.
But
it
is
all
about
people
and
it's
all
about
relationships.
So,
every
time
we
do
these
sorts
of
things,
we
continue
to
learn
and
it
will
evolve.
G
If
any
care
providers
were
to
go
under
and
not
be
able
to
provide
care
in
the
same
way
and
we'd
have
to
then
sort
of
take
on
those
placements
as
a
provider
of
last
resort.
So
I
suppose
there's
any
kind
of
assurance
that
we
are
looking
at
those
risks
and
what
we're
doing
to
mitigate
them
and
ensure
that
this
sustainability
is
there
within
the
care
market
in
the
city.
L
Absolutely
so
just
to
talk
briefly
about
discharge,
as
we
talked
to
earlier
on
about
the
command
center
and
that
there's
a
whole
thing
in
place
which
hasn't
ever
gone
away
since
the
beginning
of
the
pandemic,
to
manage
discharges
and
to
get
people
to
the
right
place
as
quickly
as
possible.
We
established
peppermill
court
rapidly
in
may.
It
was
full
for
a
relatively
short
period
during
the
sort
of
height
of
the
the
early
stage
of
the
pandemic,
and
then
it
was
stood
down
again.
L
We
reopened
it
or
prepared
to
reopen
it
in
september,
because
we
were
looking
at
the
public
health
information
about
the
numbers
of
infections
and
also
we
were
aware,
the
numbers
of
admissions
to
hospital
with
kobe
19
were
increasing
again
against
a
backdrop
where,
of
course,
duri
through
the
phase
three
planning
that
was
issued
in
summer
services
had
been
restored,
so
other
types
of
elective
services
in
the
hospital
had
been
reopened
and
were
beginning
again.
So,
whereas
in
april
we
had
been
under
instruction
at
the
end
of
march
to
empty
the
hospital
as
far
as
possible.
L
Now
the
hospital
has
a
higher
occupancy
and
fewer
available
beds
because
of
the
social
distancing
measures.
So
back
in
september,
we
looked
at
the
numbers.
We
said:
okay,
let's
get
it
open
now,
while
we
can
so
fortunate
that
we've
got
that
resource
and
the
partnership's
willingness
to
work
together
on
that,
because
not
long
afterwards
in
mid-october,
the
government
issued
a
an
instruction
for
all
areas
to
establish
designated
alternative
accommodation
for
people
who
were
covered
positive.
L
So
actually,
it
would
be
really
draining
of
staff
resources
if,
in
the
end,
we
didn't
need
to
admit
anybody
to
them
now
the
actual
numbers
have
remained
relatively
low,
but
as
of
today,
there
are
two
people
currently
well.
I
think
three
people
currently
in
peppermill
court
a
couple
due
for
discharge
at
the
weekend
and
we've
had
seven
in
total
since
the
first
admission
in
this
phase
on
the
24th
of
october.
So
the
idea
is
that
people
would
go
there
only
for
a
brief
time,
while
they
see
out
their
isolation
period.
L
The
care
homes
have
done
exceptionally
well
and
we've
had
an
opportunity
to
do
whole
site
precautionary
testing
ever
since
may,
and
we
do
discover
that
there
are
individual
staff
members,
for
example,
who
have
tested
positives
through
that
process,
but
they've
been
asymptomatic
and
the
most
impressive
thing
is
that
in
almost
no
cases
has
that
been
then
transmitted
to
residents
so
we're
on
top
of
it.
We're
able
to
see
it.
L
So
another
return.
Thank
you.
Another
return
that
we
had
to
submit
was
a
self-assessment
on
behalf
of
the
director
about
how
sustainable
we
felt
the
care
market
was,
and
we
had
to
submit
that
back
to.
Government
and
york
is
an
interesting
situation,
because
the
proportion
of
self-funders
in
york
and
the
state
of
the
market
in
york
is
very
healthy,
really
compared
to
a
lot
of
areas
and
occupancy
in
care
homes.
Here
it
was
particularly
care.
Homes
that
we
were
being
asked
about
has
always
been
very,
very
high.
L
L
B
I
think
it
would
also
be
appropriate
for
us,
as
we
conclude
as
I
imagine,
we
will
very
shortly
as
a
committee
to
put
on
record
our
thanks
to
the
tremendous
work
that's
being
done
throughout
the
whole
of
the
adult
social
care
sector.
So
thank
you
very
much
and
we've
appreciated
your
contributions
this
evening.
C
A
You
and
I'd
just
like
to
echo
what
council,
okay
said
by
passing
a
thanks
on
to
to
everyone
really
for
all
the
hard
work
that
they've
been
doing
and
will
continue
for
some
time
to
do
in
the
most
challenging
of
times
that
probably
any
of
us
remember
in
our
lifetime
from
the
health
public
health
point
of
view.
So
thank
you
very
much.